International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1.A Correlational Study of Serum Magnesium Level with Microalbuminuria in Type 2 Diabetes Mellitus Patients
Jyoti Jha, Nishikant
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
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
Abstract
Aim: The purpose of this study to determine the prevalence of dermatological lesions in patients with diabetic retinopathy. Methods: This cross sectional study was done the Department of Ophthalmology,  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 Determine the Effect of Ammonium Lactate 12% Lotion as Monotherapy and in Combination with Clobetasol Propionate (0.05%) and Calcipotriol (0.005%) in the Management of Chronic Plaque type Psoriasis
Rakesh Ranjan Kumar Rahul
Abstract
Aim: To determine the effect of various topical agents in chronic plaque type psoriasis. Methods: This was a prospective, randomized study was done in the Department of Skin & VD, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for 1 year. Total 90 patients were include and were divided in three groups comprising of 30 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. PASI scoring of each patient was done at baseline, at the end of 4 weeks and at the end of 8 weeks. Results:  No significant difference was noted between study groups (p=0.54). 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 (p=0.041), group A and group C (p=0.031) but between group B and group C (p=0.88) difference was not significant. it was found that 14(46.67%) out of 30 subjects attained PASI 50 in group A, 19(63.33%) out of 30 patients in group B and 19(63.33%) out of 30 patients in group C. Physician global assessment scale shows that in Group A, 7(23.33%) patients had excellent response, 6(20%) patients had good response, and 7(23.33%) patients had fair response whereas 10(33.33%) patients had poor response. In group B, 10(33.33%) patients had excellent response, 11(36.67%) patients had good response, and 4(13.33%) patients had fair response whereas 5(16.67%) patients had poor response. In group C, 10(33.33%) patients had excellent response, 11(36.67%) patients had good response, and 2(6.67%) patients had fair response whereas 6(20%) patients had poor response. Conclusion: We concluded that the combination therapy is effective, well tolerated with minimal side effects and better compliance was seen. Ammonium lactate 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
Abstract
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
Abstract
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
Abstract
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
Abstract
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.

40.Evaluation of Anatomical Position of Baska Mask in Different Head and Neck Positions in Anaesthetized Paralyzed Patient
Munish Kumar, Sanil Mohan, Kusum Singla
Abstract
Background: Head and neck movement can lead to the changes in shape and volume of pharyngeal space. This may result in displacement of the airway device due to alteration of the forces transmitted along the device during ventilation. This study was designed to determine the effect of different head and neck positions on the anatomical position of Baska mask in anaesthetized paralyzed patients. Methods: In this randomized prospective trial, Baska mask was inserted in 40 anesthetized paralyzed adult patients. Anatomical position of Baska mask was assessed by fibreoptic evaluation of glottis, after passing a fibreoptic scope through airway tube of the mask. Brimacombe scoring system was used for the scoring of fibreoptic view of glottis. The position of the head and neck was changed randomly from neutral to flexion, extension and lateral rotation. Brimacombe score and ventilation score were measured in all positions. Results: Brimacombe score was reduced in flexion position as compared to neutral position. 3 (7.5%) patients had score 1 in flexion position whereas none of patients had score 1 in all other positions of head & neck. Brimacombe score 4 was observed in 47.5% cases in neutral, 50% cases in extension, 37.5% cases in flexion and 42.5% cases in lateral position of head & neck. Ventilation score was comparable in all positions. Conclusion: Fibreoptic view of glottis assessing the anatomical position of Baska mask is deteriorated in flexion position without any statistical and clinical impact on ventilation. There is no correlation between fibreoptic view and performance of Baska mask in anaesthetized and paralyzed patients.

41.Alpha-Methylacyl-CoA-Racemase expression in Gastric Lesions
S.S Sabitha Rani, I.S. Vamshidhar, M. Kalpana, G. Vidya
Abstract
Background: Alpha-Methyl-CoA racemase (AMACR) is involved in the beta-oxidation of fatty acids and their derivatives. It is expressed in several neoplasms including prostate, colon cancers. The study aimed to determine the rate of expression of AMACR in various gastric lesions. Methods: This cross-sectional study was conducted in the Department of Pathology, Kamineni Institute of Medical Sciences Narketpally, Nalgonda, Telangana State. Successive tissue samples with gastric lesions and suspected gastric malignancy were taken for the study. The Samples were stained with Hematoxylin and Eosin for morphological details and immunohistochemistry (IHC) was done to check for the expression of AMACR proteins. Results: A total of n=41 cases of various gastric lesions were included. N=24 cases of gastric carcinoma cases subjected to AMACR staining. N=14 (58.33%) cases were positive and n=10(41.67%) cases were AMACR negative. Out of the n=24 cases, n=18(75%) cases were male and n=6(25%) were females. The n=9 cases of well-differentiated adenocarcinoma n=6 cases were positive and n=3 cases were negative for AMACR. In signet ring carcinoma n=1 case was positive and n=2 cases were negative for AMACR. Conclusion: The Expression of AMACR is higher in neoplastic tissue as compared to adjacent dysplastic and non-neoplastic tissue of the stomach. The expression is higher in cases of intestinal adenocarcinoma as compared to signet ring carcinoma. Higher levels of expression in poorly differentiated carcinoma were noted.

42.Treatment of Chalazion with Intralesional Triamcinolone Acetonide Injection- A Case Series Study
Mahendra Kumar Meena, Reena Meena, Sameer Jagrwal, Mamta Meena
Abstract
Background: A chalazion is a lipogranulomatous lesion of the eyelid that develops due to the retention of meibomian gland secretion. The granuloma contains various inflammatory cells, including epithelioid and giant cells, neutrophils, eosinophils, and lymphocytes. Aims & Objectives: To assess the Resolution of Chalazion after intralesional injection of Triamcinolone Acetonide at RNT Medical College Udaipur, Rajasthan. Place and Duration of study: The study was conducted at the Ophthalmology department of RNT Medical College Udaipur, Rajasthan from October 2016 to April 2017. Material and Methods: A case series was done in 62 eyes of 62 patients using intralesional injection of triamcinolone acetonide in patients of chalazion. The patients included in the case series were those who had chalazion and presented to outpatient department from October 2020 to April 2021. The patients were included using non-probability purposive sampling technique. The size of the chalazion was measured by using measurement rings of different sizes. Resolution of chalazion after intralesional injection of triamcinolone acetonide at 2 weeks was noted. Data analysis was done using SPSS version 13.0. Results: Fifty (80.6%) patients showed complete resolution of the lesion with single injection of triamcinolone acetonide. Complete resolution of chalazion after treatment was directly associated with the duration of chalazion. With longer duration of the lesion complete resolution of the lesion decreased. Conclusion: Intralesional triamcinolone acetonide injection is very useful in resolving chalazion of different sizes, so this treatment can be used as a convenient treatment option for chalazion.

43.Obstetric and Neonatal Outcomes of The Pregnancies Complicated with Thrombocytopenia
Ponnam Chandramathi, Ponnam Vaishnavi, Puppala Vinayaka Vishnu Vardhan
Abstract
Background: After anemia, the second most common abnormality in pregnancy is thrombocytopenia. Aim: This study aimed to evaluate the factors associated with newborns prognosis with gravidas having thrombocytopenia during pregnancy and compare the infants with and without thrombocytopenia in terms of maternal and neonatal outcomes. Materials and Methods: This study is prospective study which was conducted in department of Obstetrics and gynaecology a total number of deliveries in our institute were 10,000-13000. Sample size was 90. Results: Most common cause of thrombocytopenia was 20 (22%) of patients were diagnosed with gestational thrombocytopenia,16 (18%) of patients were diagnosed with pre-eclampsia. 82 (91%) of patients of thrombocytopenia in pregnancy were diagnosed in antepartum period. Majority of patients 50 (55%) were diagnosed with moderate thrombocytopenia. Most common complication in mothers was 8 (9%) had oozing at caesarean site followed by 3 (3%) had placental abruption. The thrombocytopenia degree and need for blood and blood product transfusion showed no statistical significance (0.55). In a total of 90 patients, 21 (23%) of new born babies of mothers having thrombocytopenia were admitted in NICU. Conclusion: Pregnancy is complicated by thrombocytopenia. Approximately 10% is the overall incidence of thrombocytopenia in pregnancy. The complications in mothers delivering new borns were oozing at caesarean site, placental abruption, postpartum haemorrhage and hemo-peritoneum. By antenatal follow up, vigilant monitoring and appropriate treatment can prevent the most of the complications.

44.Detection of Biofilm Formation and Virulence Markers Amongst the Cons Isolates in a Tertiary Care Center in Bihar
Priyanka Paul Biswas, Kahkashan Akhter, Farhaan Fidai, Anamika Singh, Aninda Sen, Sangeeta Dey Akoijam
Abstract
Background: The aim of the study was to speciate Coagulase negative staphylococci [CoNS] from blood samples, ascertain the antibiogram and to determine the expressions of these virulence markers and biofilm production in the CONS isolates. Materials and Methods: A total of 350 blood samples were collected from clinically suspected cases of BSI [during the fever spikes] for routine blood culture. A panel of standard biochemical tests was used to identify the CoNS upto species level. Phenotypic detection of virulence markers was done by standard test. Biofilm production was screened by tissue culture plate [TCP], Tube method [TM] & Congo red agar [CRA] and brain heart infusion agar [BHIA] with 6% sucrose method. Antibiogram was detected by modified Kirby Bauer method as per CLLSI guidelines. Results: 32.3% [45/139] isolates produced biofilm by standard tissue culture plate [TCP] assay. 5.7% [8/139] strains by tube method [TM] method followed by 2.1% [3/139] each by and Congo red agar [CRA] method & brain heart infusion agar [BHI] 6% suc method were strong biofilm producers in comparison to TCP method 15.1% [21/139]. The sensitivity & specificity of TA method was [53.3% & 81.9%]. However, sensitivity of CRA & BHIsuc6% method were much lower being, 28.8% & 20.0% whereas the specificity was 93.6% & 89.3%.. Production of DNase, lipase, caesinase and gelatinase was common to all the seven species, DNase being more common in of Staphylococcus epidermidis 42.8% [15/35]. Conclusions: The TCP method was found to be most sensitive, accurate and reproducible screening method for detection of biofilm formation. Biofilm forming capacity and elaboration of various virulence determinants followed by multi-drug resistance by CONS will facilitate its colonizing ability. Hence importance should be laid for routine identification of CONS and determining its antimicrobial susceptibility pattern.

45.Measurement of Intraocular Pressure between Goldmann Applanation Tonometer and Non-Contact Air Puff Tonometer- A Comparative Observational Study
Mamta Meena, Sameer Jagrwal, Reena Meena, Mahendra Kumar Meena
Abstract
Background-Increase in intraocular pressure is one of the risk factors in the development and progression of glaucoma1-2. Control and reduction in IOP is the main goal in treatment of glaucoma. Aims & Objectives: To compare measurement of intraocular pressure between Goldmann Applanation Tonometer and Non-Contact Air Puff Tonometer. Study Design: Clinical Observational Study. Place and Duration of Study: This study was carried out at outpatient Department of Ophthalmology, RNT Medical College Udaipur, Rajasthan from January 2017 to March 2017. Material and Methods: In this study intra ocular pressures of 400 eyes of 200 patients, Male 125 (250 eyes) and Female 75 (150 eyes) with age ranging from 20 to 70 years, were measured by Goldmann Applanation Tonometer (GAT) and Non-Contact Air Puff Tonometer (APT), results and differences were noted. Results: The mean IOP was 16 mm Hg (SD = 6 mm Hg) measured by APT and 13 mm Hg (SD = 3 mm Hg) measured by GAT. The calculated difference between APT and GAT was 3 ± 2.5 mm Hg. Pressure taken by APT was slight high (i.e. around 3 mm Hg). Conclusion: Air Puff tonometry gives slightly higher results (about 3 mm Hg) but is safe and easy than Goldmann Applanation tonometer. There is no fear of spread of infection and can be used easily in mass screening programs.

46.Study of Lipid Profile and Lipoprotein (A) in Type 2 Diabetic CKD Patients with or without Dialysis
Subhash Chand Meena, Abdul Rehman Pathan, Ravi Kumar Verma, Abdul Wahid
Abstract
Introduction: This study was conducted to evaluate the lipid profile and lipoprotein (a) level in type 2 diabetic CKD patients with or without dialysis. Methodology: A comparative study conducted on 150 chronic kidney patients of age group 30 to 80 years. Group A were healthy control patients (n=50), group B were CKD patients without hemodialysis (n=50) and group C were CKD patients on hemodialysis (n=50). Results: The mean age of patients were 52.2±15.4 years, 49.2±14.1 years and 54.8±5.9 years in group- A, B, C, respectively. There was statistically significant difference in lipid profile of patients having CKD with healthy controls, but we do not find any statistically significant difference in lipid profile of CKD patients with and without dialysis. Conclusion: Lipid profile was not significantly affected by dialysis or presence of diabetes among CKD patients.

47.Ocular Anomalies in Patients of Cleft Lip and Palate in North Indian Population: An Observational Study
Sumit Malhotra, Pooja Kanodia, Rubie Malhotra, Ausaf Ahmad, Anirudh Sharma
Abstract
Introduction and objective: All types of cleft-associated anomalies do not occur with equal frequency. It has not been well-known if specific types of anomalies are commonly related with clefts, or which organ is most commonly affected. Cleft lip and palate (CL and P) could be associated with many other structural abnormalities of the adjacent vital structures of the face. This study aimed to identify the ocular anomalies in patients with CL and P in north Indian population. Methods: Three hundred seventy consecutive syndromic and non-syndromic children with CL and P patients at medical colleges of Lucknow Uttar Pradesh India, from January 2019- December 2019 were studied. Data were analysed using Statistical Package for Social Sciences (SPSS) version 16. Results: A total of 370 cleft lip and palate patients were managed. More than fifty-five percent were male and 44.3% were female. 9.7% patients had ocular anomalies. Out of 36 CL and P patients, 41.7% patients had bilateral cleft lip and palate, 22.2% patients had unilateral cleft lip and palate. Overall, 63 ocular defects were identified in 36 patients. Lid abnormalities were the common most followed by Orbital and squint. Conclusion: Individual approach and long-term follow-up of multidisciplinary specialists for each syndromic cleft lip and palate. Patient is required to classify early forthcoming complications.

48.Comparative Evaluation of PFNA2/PFNA in Trochanteric Fractures: A Prospective Study
K. Manav, Abhinav, Rajesh Kumar Ranjan
Abstract
Purpose: Trochanteric fractures commonly occurring in elderly and notorious for their morbidity and complication. With the aim of early mobilization and minimization of complications we did this prospective comparative study of PFNA2 and PFNA. Methods: We had 38 cases in each group. All the cases were operated by same set of surgeon/assistant. Our mean follow up was 30.6 weeks. Results: The results were evaluated in respect of operating time, blood loss, and mobilization of patients and union time.  We had less blood loss, lesser operating time, better functional outcome and minimal complications with PFNA2. Mean HHS in PFNA2 group was 87.32 ± 11.67 and 83.23 ± 11.45 in PFNA group. Conclusion: We found PFNA2 a better implant compared with PFNA in management of Trochanteric fractures.

49.Pearls & Pitfalls of VBAC- An Observational Study
Neelam Kumari, Alka Pandey, Manisha
Abstract
Purpose: The high incidence of LSCS is a matter of great concern. The fear of Scar dehiscence in subsequent pregnancy is far from the reality. The present prospective study has been done to evaluate the feasibility and safety of vaginal delivery in patients having one previous LSCS. Material & Methods: This prospective study was done at PMCH between January 2018 and December 2018. 100 cases of previous caesarean section were selected and given trial of labor under supervision of a senior consultant. Observation & Conclusion: 72 % patients with one previous LSCS- done for non-recurrent indications had successful vaginal delivery i.e., VBAC. The success rate was better in women with at least one normal delivery in addition to previous LSCS. There were only two cases of Scar dehiscence- delivered safely with LSCS. We conclude that VBAC is a safe alternative to repeat elective CS in properly selected cases at proper places.

50.The Relationship Between Haematological Parameters and Thyroid Hormone Levels in Non-pregnant Women of Reproductive Age
Amrish Kumar, Anima Prasad
Abstract
Aim: Study of hematological parameters and their correlation with thyroid hormone status in non-pregnant women of childbearing age. Methods: This comparative study was conducted  in a tertiary care centre, Shahjahanpur, Uttar Pardesh, India.  In total, 120 non pregnant female patients, aged 18 to 50 years, with thyroid diseases, were taken up. Patients were classified, as having hyperthyroidism (n=60) or hypothyroidism (n=60). Only patients who had all T3, T4 and TSH serum levels  tested were taken up for categorization as hypothyriod  or hyperthyroid. Results: Among the parameters assessed the highest significant P value was found for Haemoglobin, MCHC and RBC count and Total Leucocyte Count ( TLC) between the groups. Haemoglobin was significantly lower with a mean of 11.5 g % indicating the prevalence of anaemia in hypothyroid females. However the cells in both hypothyroid and euthyroid categories were normocytic as evident by the MCV. Although the Total Leucocyte count was significantly lower in the hypothyroid group, it did not go below the normal reference ranges to be categorized as leucopenia. MCH did not show any significant variation in between the two groups. The RDW and AEC were found to be significantly more in hypothyroid subjects. AEC though increased was still within the normal range. There was no significant relationship between the above mentioned haematological parameters and the hyperthyroid and the euthyroid groups. Conclusion: Thyroid hormones, in more than one way play a crucial role in regulating the various haematological parameters. Though concurrent medical conditions may also contribute to the same but it is important not to ignore the evaluation of thyroid hormones in cases of unexplained anaemia in the female reproductive age group.

51.To Examine the Efficiency of Butorphanol and Clonidine in Controlling Shivering During spinal Anaesthesia
Nagina Choudhary, Niranjan Kumar
Abstract
Aim: To examine the efficiency of Butorphanol and Clonidine in controlling shivering during spinal anaesthesia. Methods: 100 Patients aged between 18-65 years, of either sex, had American Society of Anaesthesiologists (ASA) physical status I/II, scheduled for elective lower abdominal surgeries under subarachnoid block were included in this study. Group B (n= 50) received intravenous bolus butorphanol 1 mg while group C (n= 50) received an intravenous bolus of 150 μg (1 mL) clonidine. The prophylaxis for shivering was regarded as ineffective if the patient exhibits grade-3 shivering any time during the study. Patients, who developed grade 3 or more of shivering were treated with tramadol (50 mg intravenously) with ondansetron 4 mg. The subarachnoid block characteristics, hemodynamic parameters, shivering with its onset time and grade, time of disappearance, level of sedation and any other intraoperative adverse events were recorded for statistical analysis. Results: 100 patients were randomly allocated into group B (n= 50, received butorphanol) and group C (n= 50, received clonidine). We compared age (years), weight (Kg), BMI(Kg/m2), Gender (Male/Female) and ASA grade between both groups and no statistically significant difference was noted among them. We noted earlier onset of sensory as well as motor block and prolonged duration of sensory as well as motor block in butorphanol group as compared to clonidine group and difference was statistically significant. Incidence of shivering was more in clonidine group as compared to butorphanol group and difference was statistically significant. Also hypotension was more in clonidine group as compared to butorphanol group and difference was statistically significant. Similar incidence of bradycardia was noted in both groups. Conclusion: The butorphanol is more effective than clonidine in the treatment of shivering because of its faster onset, lesser recurrence rate, and fewer complications reported. Intravenous administration of butorphanol is a safe and effective for prevention of shivering.

52.A Study to Evaluate the Yolk Size as Prognostic Factor of first Trimester Pregnancy Outcome: Prospective Observational Study
Priyanka Singh, Reena Yadav, Manisha Kumar, Abha Singh
Abstract
Aim: to evaluate the yolk size 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. On sonography gestational sac diameter, mean yolk sac diameter, yolk sac size and shape, crown ramp length was measured. 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. Out of 230 women small yolk sac (<3.5mm) was observed in 17(7.39%) women. Out of these 17 women with small yolk sac size, 13(76.47%) women had abortion and remaining 4 (23.52%) women had continued the pregnancy. Conclusion: Suggested that pregnant women with large yolk sac had normal fetal outcome while patients with small yolk sac had more incidence of missed or spontaneous abortion. So, it showed that small and irregular shape yolk sac has poorer prognosis.

53.Prospective Observational Assessment of Ectopic Pregnancy Incidence, Risk Factors, Clinical Characteristics, Diagnosis, Management and Outcome
Priyanka Singh, Anuja Pritam, Muntaha Khan
Abstract
Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Lady Harding Medical College, Delhi, India, for 15 months . Total 100 cases were diagnosed with ectopic pregnancy. Results: During the study period, 39000 deliveries and 100 ectopic pregnancies. Therefore, the incidence of ectopic pregnancy (0.024%) or 2.4 per 1000 deliveries. The most common site of ectopic pregnancy was fallopian tube 88(88%). Ampulla was the commonest site 67(67%) 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(3%)  cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 44(44%) followed by H/o previous abortion 20(20%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 23(23%). Although any form of contraception decreases the overall risk of pregnancy including ectopic Pregnancy, when contraceptive failure occurs in women using an IUCD or following tubal sterilization, risk of Ectopic Pregnancy is elevated. In our study, 13(13 %) patients were using copper IUCD. H/o infertility due to tubal block or other causes, treatment associated with infertility, endometriosis and H/o previous ectopic pregnancy were other identified risk factors. Conclusion: The incidence of ectopic pregnancy is on the rise. The incidence of ruptured ectopic pregnancy is high in developing countries due to late diagnosis and delayed referral. In developing countries, PID and postabortal sepsis continue to be the most important risk factor for ectopic pregnancy.

54.Menstrual Features and Ovarian Cancer Risk in Relation to main Tumour Histologic Subtypes: A Prospective Randomized Study
Anuja Pritam, Priyanka Singh, Muntaha Khan
Abstract
Aims: To evaluate the menstrual characteristics in relation to ovarian cancer risk overall, and in relation to the major tumour histologic subtypes. Methods: A prospective, randomized study was conducted in the Department of Obstetrics and Gynecology, lady Harding medical college , New Delhi, India, for 1 year. In all about 100 patients with palpable abdominal and pelvic adnexal mass with ovarian pathology were included for this study. Results: Out of 100 patients 40% was 20-30 years age group and followed by 30-40 yearsIt is evident from the above table that 92 patients were married giving the incidence of 92% while 8% of cases were unmarried. It is evident that 68% had regular menstrual cycle, 7% had surgical menopause, 3% had lactational amenorrhoea, 8% had amenorrhoea of pregnancy and 10% had physiological menopause, Secondary amenorrhea 2% and Bleeding P/V after amenorrhea was 2%. Conclusion: We conclude that there was no significant relation between menstrual history and occurrence of ovarian tumour.

55.Comparative Evaluation of the Effectiveness of Dexmedetomidine and Levobupivacaine in the Treatment of Brachial Plexus Block
Md Imran Mehdi, Mohd Sameer Ahmad, Fahad Manzoor Zunga, Surendra Singh
Abstract
Aim: A comparative study to assess the efficacy of addition of dexmedetomidine to levobupivacaine in brachial plexus block. Methods: This comparative study conducted in the, Department of  Anaesthesiology and critical care, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pardesh, India, for 14 months. 100 Patients posted electively for upper limb orthopedic and soft tissue lesion, between the age of 18 and 60 years of any gender, weighing above 60 kilograms with ASA Grade I and II and those who fulfilled the selection criteria and those who gave consent to participate in the study were included in the study. Patients with chronic kidney disease, hypertension, pregnant women, uncontrolled diabetes mellitus, cerebrovascular accident, COPD, coronary artery disease on anticoagulants, those with history of bleeding disorders, and those who were allergic to amide local anesthetics /alpha 2 agonist were excluded from the study. Results: In the LD group males and females were 64% and 36% respectively. In LS group, it was 56% and 44% respectively. There was no statistical significance between the two groups. The average age of study participants was 33.1 vs 31.3 in LD and LS group respectively. The mean weight of study participants in study and control group was 65.4 vs 64.2 respectively. Both the results were statistically significant. All the study participants in LD group did not require post-operative analgesia while all in LS group were given Postoperative analgesia. 26% in LD group were slightly drowsy compared to 100% in LS group. Both the results are statistically significant. The mean duration of onset of sensory and motor block was nearly 4 min earlier in LD group compared to LS group. (5.52 vs 9.37 min) Onset of motor blockade was also 4 minutes earlier in LD group compared to LS (8.55 vs 12.48 min). The mean duration of sensory block (551 vs 941 min) and motor block (573 vs 963 min) were 395 minutes lesser respectively between both the groups. The duration post-operative analgesia was 407 min lesser between both the groups (580 vs 982 min). All the results are statistically significant. Conclusion: We conclude from the study dexmedetomidine can be an ideal adjuvant for levobupivacaine for upper limb surgeries applying brachial plexus block.

56.To Determine the Prevalence of Post-dated Pregnancies, as well as the Related Maternal Difficulties, Perinatal Morbidity, and Death. A Clinicopathological Study
Anupam Kumar Chaurasia, Lata Shukala Dwedi
Abstract
Aim: To find out incidence of post-dated pregnancies, associated maternal complications and perinatal morbidity and mortality. Methods: This was a retrospective observational study conducted in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India from August 2019 to August 2020. Total 220 patients in the antenatal ward and labour room were selected for the study and they were divided into two groups, Control group with  Gestational age 37-40 weeks and Study group with Gestational age >40 weeks. The maternal outcome was noted in terms of need for cesarean section, postpartum haemorrhage and sepsis. Foetal outcome was noted in terms of intrapartam asphyxia, intrauterine foetal death, admission to neonatal intensive care unit etc. Results: Patients in the study group (72.73%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. The percentage of LSCS was 28.18% which was higher than in the control group where it was 11.82%. Incidence of instrumental delivery was also higher in the study group as compared to control group (10.91% as compared to 3.64%). The indictions for LSCS, the most common indication among the study group was acute foetal distress which includes meconium stained liquor (10.91%) followed by cephalopelvic disproportion (6.36%). The maternal complications like LSCS, PPH and sepsis all were higher in the study group as compared to the control group. Among the foetal outcomes, 13.64% of infants in the study group had asphyxia as compared to only 6.36% in the control group. 15.45% infants of the study group had to be admitted to the NICU as compared to 11.82% in the control group. 1.82% was the percentage of intrauterine deaths in the study group as compared to none in the control group. Conclusion: Post-dated pregnancy is associated with both, maternal and foetal complications. Timing of induction has to be decided carefully, as early induction leads to failure and increased rates of LSCS, while late induction leads to increased foetal complications.

57.Assessment of the Intraocular Pressure (IOP) in Diabetes Mellitus and Non-Diabetics Individuals
Umesh Kumar, Nawin Kumar
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 case control study was done in the Department of Ophthalmology, DMCH, Laheriasarai, Darbhanga, Bihar, India for 1 year, all the Patients having diabetes mellitus on treatment and Nondiabetic individuals was included in this study. Two groups were formed which includes Group A constituting diabetes mellitus patients and Group B constitutes Nondiabetic 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: 130 patients were included in our study. 55 patients had Type 2 diabetes mellitus (all were non-insulin dependent) and 10 patients had Type 1 diabetes mellitus (all were insulin dependent), and 65 patients were non-diabetics subjects. Mean age of non-diabetics was 46.66±10.73 years and that of diabetics 48.25±10.78 years (p valve 0.22) statistically not significant. In those 65diabetic patients 48 were male and 17 were female. Mean age of male subjects was 50.45±10.36 years and that of female was 50.98±10.69 years in diabetic group which was not statistically significant (p value 0.31). Mean intra-ocular pressure higher (19.02±5.63 mmHg) in diabetic patients as compared with (16.35±4.26 mmHg) in non-diabetic, p value < 0.0001 which is statistically significant. Mean intra ocular pressure was (18.91±3.86mmHg) in diabetic patients with duration greater than 10 years as compared with (18.22±4.69mmHg) in diabetic patients with duration less than 10 years, p value <0.31which is not significant. Mean intra-ocular pressure (19.69±3.63 mmHg) higher in diabetic patients with HbA1c value >6.5% as compared (18.36±3.12 mmHg) with diabetic patients with HbA1c value <6.5%, p value < 0.0005 which is statistically significant. Conclusion: We concluded that 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.

58.An Observational Study on the Outcomes of Minimally Invasive Nephrectomy for Inflammatory Renal Disease
Manoj Kumar Singh, Vishrut Bharti, Sanjay Gupta, Ahsan Ahmad
Abstract
Aim: The aim of the present study to determine the minimally invasive nephrectomy for inflammatory renal disease. Methods: This was a prospective observational study conducted in the Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, for 1 year. 100 patients who underwent a LN for IRD were included in this study. Interstitial nephritis, chronic pyelonephritis, renal tuberculosis and xanthogranulomatous pyelonephritis. The demographics, pre- operative diagnosis based on images (computed tomography [CT], magnetic resonance imaging [MRI], ultrasound and/or renal scintigraphy), and intraoperative variables such as operative time, blood loss, need for open conversion, length of hospital stay, intra and postoperative complications following the Clavien-Dindo classification were analyzed. Results: Left side nephrectomy was performed in 67% of the cases. A positive history of urolithiasis was present in 52% of the cases, followed by urinary tract infections (UTI) (42%), high blood pressure (HBP) (30%) and Type II diabetes mellitus (DM II) (9%). We identified 5 cases of nephron-intestinal fistulas (pyeloduodenal and pyelocolonic) at the moment of surgical dissection, 5 cases (5%) as misdiagnosed neoplasia, 9(9%) cases of pyonephrosis and 5 case (5%) of emphysematous pyelonephritis. Most of the cases had severe pyonephrosis (60%). According to pathology results, there were 10 cases (10%) of xanthogranulomatous pyelonephritis (XGP), 86 cases (86%) of chronic nephritis, 2 case of renal abscess and 2 case of renal tuberculosis. The mean operative time for patients who did not required conversion to open surgery was 203±88 min, for the conversion ones was 388±174min and for all the 100 patients was 218±111min, ranging between 85min and 647 min. The mean estimated blood loss for patients who did not required conversion to open surgery was 213±221mL, for the conversion ones was 1477±748mL and for all the patients was 258±423mL, with a range of 55-3275 mL. The mean length of hospital stay after surgery was 2.9± 2.2 days, being longer for the converted ones compared to the no converted ones (5.6± 2.2 days vs. 3.2 ±2.2 days), ranged between 1 and 14 days. Conclusion: Laparoscopic nephrectomy for IRD is a reproducible technique with low risks and complication rates despite the surgical challenge it represents.

59.Study of Gestational Trophoblastic Diseases at a Tertiary Care Hospital in Chhotanagpur Area
Anubha Singh, Vandana Kumari
Abstract
Aim: Study of gestational trophoblastic diseases at a tertiary care hospital in India. Methods: This observational study conducted in the Department of Obstetrics and Gynecology, RIMS, Ranchi, Jharkhand, India, the study population consisted of all the pregnant women registered at the study centre. Due to low incidence of gestational trophoblastic disease, all the diagnosed cases of GTD reporting to the tertiary care hospital were included. The data for total number of GTD cases, total number of pregnancies and live births in the hospital were taken from hospital registries. Following selection criteria were adopted for the present study. All the cases diagnosed as GTD either histologically or sonographically which included complete mole, partial mole, invasive mole, choriocarcinoma, PSTT and ETT. Results: There were total 21000 deliveries at the study centre during study period. A total of 53 cases out of these were diagnosed to have GTD. These 53 patients were considered as participants for final analysis. Regarding symptoms of the participants, amenorrhea was seen in all 53 (100%) patients. The commonest symptom was bleeding per-vaginum which was seen in 40 (75.5%) of patients. The classic symptom of passage of grape like vesicles was seen in 5 (9.4%) of patients only. On evaluation of cases with ß-hCG, majority (70%) had pre-evacuation ß-hCG values between 1,00,000- 10,00,000 IU/L, with remaining 30% having ß-hCG values between 10,000-1,00,000 IU/L (mean pre- evacuation ß-hCG- 1.89±1.70 lakhs IU/L). The values changed post-evacuation (24 hours) to a mean of 0.62±0.54 lakh IU/L. Total 18 (90%) patients were followed till they attained first normal value of β hCG and the mean time taken for the same was observed to be 9.2±2.31 weeks. With respect to thyroid status, 15% of CHM were hyperthyroid whereas 45% of PHM patients were hyperthyroid. The need for blood transfusion was more in cases of CHM (80%) with average 1.6 units required per person compared to PHM where 80% required blood transfusion with an average of 2 units per person. Conclusion: In conclusion, it can be said that early diagnosis and treatment is the key in GTD. Regular follow up of the patients is critically important for ensuring complete remission.

60.Evaluating Serum C-Reactive Protein Level in Patients with Chronic Obstructive Pulmonary Disease and its Correlation with Disease Severity
Barun Kumar Kundu, Rajnish Kumar, Shashi Kant Kumar
Abstract
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, Madhubani Medical College and Hospital, Madhubani, Bihar, India, from October 2019 to September 2020. 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: In the COPD group, 30 subjects (60%) noted cigarette smoking during the study, 11 subjects (22%) reported cigarette smoking in the past, and 19 subjects (38%) mentioned a history of baking. In the control group, 10subjects (20%) noted cigarette smoking during the study; 4 subjects (8%) mentioned cigarette smoking in the past, and five subjects (10%) reported a history of baking. The mean hsCRP was 7739±427ng/mL in the COPD group and 2994±483 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). Regarding smoking and its relationship with the severity of COPD, 30 patients reported as current smokers, where nine subjects had moderate COPD, 16 subjects had severe COPD, and two subjects had very severe COPD. In this category, there was a significant relationship between the severity of COPD and current smoking (P=0.027). Furthermore, 10 subjects reported as past smokers. In this group, there was a significant correlation between the severity of COPD and a history of smoking (P<0.001). The correlation between the severity of COPD and hsCRP equaled r=0.342 (P=0.039). Therefore, there is a significant correlation between the severity of COPD and hsCRP. There is also a significant correlation between hsCRP and the severity of COPD. 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.

61.An Enlarged Mesenteric Lymph Node Seen on USG was Linked to Recurrent Abdominal Discomfort and the Fate of These Individuals
Manoj Kumar Singh, Anuradha Singh, Hemant Kumar
Abstract
Background: Mesenteric lymphadenitis is an inflammation of lymph nodes. The lymph nodes that become inflamed are in a membrane that attaches the intestine to the lower right region of the abdominal wall. These lymph nodes are among the hundreds that help your body fight disease. They trap and destroy microscopic “invaders” like viruses or bacteria. Mesenteric lymphadenitis causes abdominal pain. Mesenteric lymphadenitis is commonly reported in children with acute, chronic or recurrent abdominal pain and no evidence of other pathologies. Aim: The purpose of this study was to find out the association of USG finding of enlarged mesenteric lymph nodes with causation of recurrent abdominal pain and outcome of these patients on follow up. Methods: A prospective, single centre study was conducted in the Upgraded Department of Pediatrics, Patna Medical college and Hospital, Patna, Bihar, India. Cases included children of age group 5–15 years with CAP who were subjected to abdominal ultrasonography during the study period. Controls included children in whom abdominal sonography was performed for reasons other than abdominal pain. Descriptive statistics were used for the analysis of baseline characteristics of the study group. For the variables following normal distribution curve, mean and standard deviation were computed. The presence of enlarged nodes, their location, size and other significant findings were recorded. Detailed history, physical examination, relevant investigations and USG abdomen was done in all patients. Results: In the present study there were 41 (56.16%) children aged from 5 to 10 years and 32 (43.84%) children aged from 10-15 years in the case group. There were 47 (61.04%) children aged from 5 to 10 years and 30 (38.96%) children aged from 10-15 years in the control group. Higher frequency of CAP was observed in the younger age group. Most common symptom was Vomiting (27.40%), followed by pallor (23.29%), Abdominal tenderness (16.44%), constipation (12.33%), fever (10.96%) and hepatomegaly (9.59%). Conclusions: Mesenteric lymphadenopathy, with lymph nodes more than 5mm on their short axis, is a significant finding in children presenting with chronic abdominal pain.

62.A Prospective Comparative Clinical Study to Evaluate Urinary Tract Infections in Diabetics and Non-Diabetics Patients
Navneet, Nistha Kishore
Abstract
Aim: The aim of the present study to evaluate the urinary tract infections in diabetics and non-diabetics patients. Methods: This prospective comparative study was conducted in the Department of General Medicine, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for 1 year. All patients were screened for UTI through a midstream 5-ml urinary sample. Urinary culture analysis, for identification of the pathogen, was performed only for patients who were found to be infective on urine microscopy. During the study period, 100 diabetic patients were recruited. For every diabetic patient, a non-diabetic patient was included. Results: Among 100 patients in the diabetic group, there were 45 (45%) males and 55(55%) females. Their mean age was 58 ± 9 years. Non-diabetic patients were relatively younger with a mean age of 48 ± 10 years. There were more women (= 65; 65%) than men (= 35; 35%) in the non-diabetic group. In diabetes group, 20 (20%) patients were identified with culture positive UTI as compared to 10 (10%) participants in non-diabetic group. In both groups, UTI was more common in female gender. Diabetic group had an overall twice risk of UTI (p = 0.01; OR: 2.34; CI: 1.23, 3.91) and female gender in diabetic group had a risk of almost five times (p = 0.01; OR: 6.11; CI: 1.32, 20.16) that of the non-diabetic group of developing urinary tract infection. Almost 30% patients in the diabetic group with culture proven UTI were asymptomatic as compared to only 10% in the non-diabetic group (p = 0.05; OR: 6.89; CI: 0.72, 63.18). E. coli was the most commonly identified microorganism in both diabetic and non-diabetic groups. P. aeruginosa was identified in 20% of diabetic cases. Other organisms included Klebsiella species and Enterobacter species. Conclusions:The frequency of UTIs is higher in the diabetic population as compared to their non-diabetic counterparts. UTIs are more common among females in both groups. Clinical presentation in the two groups is also similar. Asymptomatic bacteriuria is a more common entity in diabetic patients and does not require any treatment.

63.Oral Symptoms of Diabetes Mellitus in Complete Denture Wearers Patients: A Case Control Study
Nikita Raman, Samir Jain
Abstract
Aim: To study of oral manifestations of diabetes mellitus in complete denture wearers. Methods: This prospective case-control study conducted in the Department of Dentistry, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. The sample consisted of 60 adult subjects using complete maxillary or maxillary and mandibular dentures. Thirty subjects diagnosed with type-2 diabetes were matched with 30 controls on the basis of gender, race, and age. Results: Comparison of the 2 groups revealed no significant difference in mean (SD) salivary flow between the control group (1.14 (0.87) mL/min) and the diabetic group (0.95 (0.61) mL/min) (t=0.98; df=51; P=.331). A significant difference in mean (SD) buffering capacity was observed between the control (5.80 (0.85)) and diabetic groups (5.26 (0.83))   (t=2.478;   df=57;   P=.017).Regarding blood glucose levels, the Mann-Whitney test for distribution values indicated a significant difference between the 2 groups (control: 111 mg/dL versus diabetic: 182 mg/dL; P=.001). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) showed the same behavior in the 2 groups, with a mean SBP close to 140 mm/Hg and a mean DBP of 90 mm/Hg. Denture retention was observed in 66.7% (20/30) of the control group and in 50% (15/30) of the diabetic group. Comparison of proportions demonstrated no significant differences (2=1.714; df=1; P=.190). Comparison of proportions was statistically significant (2   = 18.261; df =1; P=.001). Low salivary buffering capacity and reduced salivary flow require special care and greater attention on the part of the dentist (2 = 18.261; df=1; P=.001). Reported alcohol consumption did not differ significantly between the control (3/30, 10%) and diabetic groups (1/30, 3.33%) (2=1.071; df=1; P=.301).  Conclusion: Within the limitations of this study, no significant differences were observed in salivary flow, self-reported denture retention, or oral mucosal lesions when comparing diabetic and nondiabetic subjects.

64.Diclofenac vs Different Paracetamol Preparations for Post-Operative Analgesia After Laparoscopic Cholecystectomy
Ram Nath Das, Deepak Kumar, Pramod Kumar Sinha
Abstract
Aim: A comparative study Diclofenac vs Different Paracetamol Preparations for Post-Operative Analgesia after Laparoscopic Cholecystectomy. Methods: This comparative study conducted in the Department of Anaesthesiology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 1 year. 100 patients were included in the study. They were divided into two groups with 50 patients in each group. Group DP: Patients received Diclofenac with Paracetamol P (100 ml infusion) and Group DF: Patients received Diclofenac with Paracetamol PL (2 ml stat). Selected patients were from either sex, age group between 18-to-55-year, average weight, belonging to ASA grade Ι and ΙΙ posted for laparoscopic cholecystectomy. Patients with history of drug allergy, bleeding disorders, asthma, gastrointestinal system bleeding, renal insufficiency, etc. were excluded from the study. Results: The demographic data showed that the mean age group was 36.5 years, weight was 59.10 kg, height was 161 cm and a sex ratio of female: male=57:43 in either group. The mean duration of operation was 31 ± 8.5 minutes, and the mean duration of analgesia was 110 ± 20 minutes. VAS taken for post-operative pain assessment was same in both the age groups over equal time interval without significant difference. The requirements of rescue analgesia were also same in both the groups. The patient satisfaction at 6 hour was assessed by taking verbal rating scale, which was same in both the age groups. There was no significant difference in incidence of side effect among both the groups. Conclusion: Both the group of patients have almost equal analgesic effect and patient satisfaction, when drugs were given as combination therapy in same dose.

65.A Prospective Research to Assess Postoperative Mastoid Cavity Complications Following Modified Radical Mastoidectomy
Ratnesh Kumar, Preeti Sharma, Vineet Sinha
Abstract
Aim: The aim of the present study to evaluate postoperative factors involved in the causation of cavity problems. Methods: This prospective observational study conducted in the Department of ENT, Patna medical college & hospital Patna, Bihar, India, for 1 year. Total 250 patients who came for open cavity mastoidectomy were included in this study and all those patients had undergone open cavity mastoidectomy. Results: The incidence of postoperative cavity problems in our set up is 40%. Of the 250 cases, 155 (62%) had sclerotic mastoid and 35 (14%) had cellular mastoid and 60 (24%) had diploeic mastoid. Of the 155 sclerotic mastoids, 65(41.94%) had post mastoidectomy cavity problems. Of the 60 diploeic mastoid, 29(48.33%) had postoperative cavity problems and of the 35 cellular mastoids, 6 (17.14%) had postoperative cavity problems. i.e., Of the 100 patients with cavity problems, 65% were of sclerotic mastoid and 6% were of cellular mastoid and 29% were of diploeic mastoid. Of the 100 problem cavities, 90 had prolonged discharge from mastoid cavity as the main problem (90%). Accumulation of wax in the cavity was present in 37 cases (37%). Vertigo persisting beyond the immediate postoperative period was present in 21 cases (21%). Perichondritis of pinna was found in 7 case (7%). Persistence or/development of facial palsy in post- operative period was found in 15 cases (25%) and recurrent cholesteatoma was seen only in 15 cases (15%). 7 Cases had postoperative wound infection (7%). Conclusion: The incidence of post mastoidectomy cavity problems in this study was found to be 40%. Increased incidence of cavity problems was found predominantly in 30-40 age groups. There was no significant difference in the incidence of cavity problems according to the type of anaesthesia Cavity problems were seen slightly more in sclerotic mastoids.

66.Comparative Assessment of Alcaftadine 0.25%, Olopatadine Hydrochloride 0.2% and Bepotastine Besilate 1.5% as Anti-Allergic Conjunctivitis Agents
Renuka, Alok Ranjan, Ajay Kumar Sinha
Abstract
Aim: The aim of the present study to compare the safety and efficacy of Alcaftadine 0.25%, Olopatadine hydrochloride 0.2% and Bepotastine besilate 1.5% in allergic conjunctivitis. Methods: A total of 90 patients with mild or moderate allergic conjunctivitis were randomized into three groups with an allocation ratio of 1:1:1 using computer‑generated random number sequence to receive topical anti-allergic medication for 14 days as Group 1: Topical 0.25% Alcaftadine eye drops OD, Group 2: Topical 0.2% Olopatadine eye drops OD and Group 3: Topical 1.5% Bepotastine besilate eye drops BID. Patients were examined and their baseline symptoms and signs (TOSS) were recorded. Results: The 4 major complaints recorded by patients were itching (30 patients, 100℅), redness (22 patients, 73.33%), tearing (25 patients, 83.33%), and swelling (13 patients, 43.33%). The total ocular symptom score (TOSS) showed a consistent decrease in subsequent visit in all the Groups, and it was statistically significant, when compared from baseline to 14th day in all the groups (p=0.0006). The difference in mean TOSS between (Group A) Alcaftadine and (Group C) bepotastine treatment groups was observed at the third day of follow‑up. This showed early relief of allergic conjunctivitis symptoms by bepotastine (5.57 ± 1.26) compared to Alcaftadine (mean (6.31 ± 1.47) and olopatadine (6.31 ± 1.47) but this was not statistically significant. Total ocular symptom score at 14th‑day visit with post hoc Tukey HSD test showed mean of Alcaftadine group vs mean of olopatadine group – p < 0.05, mean of olopatadine group vs mean of bepotastine group – p<0.01, which were statistically significant whereas mean of Alcaftadine group vs mean of bepotastine group showed no significant difference. Alcaftadine was found to be better than olopatadine in reducing the Allergic Conjunctivitis symptoms using TOSS score at 14th‑day visit (p < 0.5). Although there is no significant difference between bepotastine and Alcaftadine groups, bepotastine showed a better reduction of symptoms compared to Olopatadine group using TOSS score at 14th‑day visit (p<0.1). Conjunctival hyperaemia had reduced in all the treatment groups but there was a significant reduction in Alcaftadine and Bepotastine treatment groups at 14th day compared to olopatadine group (p = 0.0021). Conclusion: we concluded that all three topical ophthalmic medications used in the study are safe and effective in the treatment of allergic conjunctivitis. However, Bepotastine and Alcaftadine appear to outweigh Olopatadine in resolving the symptoms of allergic conjunctivitis.

67.A Cross-Sectional Investigation of Diarrheal Illnesses and ORS Knowledge and Practises Among Young Mothers
Tulika
Abstract
Background: According to World Health Organization (WHO), Diarrheal disease is the second leading cause of death in children under five years old. It is both preventable and treatable. Objective: To find out the knowledge and practices of mothers regarding the causes, prevention and management of diarrhoeal disease in children under 5 years old. Materials and Method: This cross-sectional study was conducted in the Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, India, over a period of last 6 months using simple random sampling method including 337 mothers with at least one child under less than five years of age. All the mothers were interviewed using preformed questionnaire including open, semi-open and closed end questions. Results: Most of the mothers knew the common signs and symptoms of diarrhea while few of mothers knew the danger signs of diarrhea. Approximately 72.11% of mothers knew the common causes of diarrhea while very rare mothers knew about the treatment of diarrhea. Approximately 91.03 % of mothers have heard about the ORS, out of these mothers, 87.83 % of mothers knew how to prepare ORS but only 45.40 % mothers have used it in their life in diarrhea regularly. Conclusion: Association between knowledge and practices is not satisfactory. Therefore, health education, implementation of policies, sanitation, implementing preventive interventions, training anganwadi workers and other health workers is important to create a positive attitude and practice towards the prevention and better management of diarrheal diseases in children under 5 years old.

68.The Role of Magnetic Resonance Imaging in the Assessment of Patellar Instability in the Indian Population
Manish Nair Mohanan Nair
Abstract
Purpose: The purpose of this study was to determine the role of MRI in the assessment of anatomical abnormalities in case of patellar instability and to determine the sensitivity, specificity, and accuracy of each variable in detecting the concerning pathology. Methodology: This study included a total of 115 keens in 65 patients who attended the OPD of Amrita institute of medical science hospital, Kochi, Kerala, India. MR examinations were carried on 15 knees in 15 patients suffering patellar instability and 100 knees in 50  volunteers with healthy knees. Out of 15 patients with patellar instability, 4 patients were males and 11 were females. The mean age of these patients was 16 years. The age range was between 10 years to 42 years. Out of 50 patients who volunteer with healthy knees, 40 patients were males and 10 were females. The mean age of these patients was 26.5 years. The age range was between 20 years to 42 years. The MR imaging studies of the 115 selected knees were performed in a 1.5-T imager (General Electric Medical Systems, Milwaukee, WI, USA). A dedicated knee coil was used. The knees were positioned in a minimal flexion (30 °). Axial and sagittal proton density fat-saturated spin-echo and coronal T1 fast spin-echo sequences were performed.  The participant’s data were collected over 3 years from 2009 to 2012. Results: This study included a total of 65 patients who attended the OPD of Amrita institute of medical science hospital, Kochi, Kerala, India. MR examinations were carried on 15 knees in 15 patients suffering patellar instability and 100 knees in 50 patients volunteer with healthy knees. In this study, Patella Alta and trochlear depth showed the highest sensitivity (87%) followed by lateral trochlear inclination (80%). Lateral patellar tilt had the highest specificity (100%) followed by patellar lateralization (95%). Conclusion:Patellar dislocation is characterized by the complete loss of contact between the patella from the trochlear groove of the femur. The most common predisposing factors for patellar instability include trochlear dysplasia, patella Alta, and lateralization of the tibial tuberosity. Important secondary factors contributing to patellar instability are trauma-related tear of the medial patellofemoral ligament (MPFL) and ligamentous laxity (Ehlers-Danlos and Marfan syndromes). Characterization and quantification of these anatomic anomalies will reveal the individual mechanism of patellar instability and help the orthopedic surgeon choose the optimal treatment. These anomalies can be diagnosed and characterized with MR imaging. This study demonstrated that Individual characterization of medial patellar stabilizers (MPFL and medial retinaculum), trochlear depth, and the assessment of patella Alta with any lateral displacement of its attachment in tibial tuberosity would help physicians in accurate planning of the concerned anatomical abnormality to get better treatment and surgical outcome in cases of Patellar instability.

69.Knowledge, Attitude and Practice Regarding Organ Donation among a selected Adult Population of Kannur District, Kerala
Nisanth Prabhakaran, Nishitha. P, Shakhy Vati
Abstract
Background: To study a selected adult population of Kannur, Kerala with regard to their knowledge, attitudes and practices towards different aspects of organ donation. Methods: A Cross-sectional study was done in a population of 225 patients attending the out-patient department of a primary health center in Kannur district of North Kerala to study their knowledge, attitudes and practices towards organ donation. Participants selected by simple random sampling were assessed using a semi-structured interview schedule with a pre-tested questionnaire containing socio—demographic variables and questions directed at different aspects of their knowledge, attitudes and practices towards organ donation. Statistical analysis was done using SPSS v21. Results: Amid 225 participants 218 had heard of organ donation. Our study found that 69.3 % had positive attitude towards organ donation , amongst which 16.1% had expressed strong motivation to donate irrespective of the circumstances. Most important factors influencing their decision to donate organs were health status and relationship to the recipient. 61% considered abuse and misappropriation of their donated organs to be a possibility. Most respondents 94% would authorize consent of donation of a deceased person’s organ to either his/her family or spouse. Regarding mentally unsound people, majority wanted parents or guardian to give consent for organ donation. 92% were in favor for promotion of organ donation. Majority preferred organ recipients to be a family member 52%, younger 57% and physically and mentally sound. Respondents were largely unwilling to donate to an alcoholic or a smoker. Legislations governing donations were considered a must by most 94%. Conclusion: Though largely aware, the willingness to donate organs among public is low. Socio-demographic characteristics, emotional factors and laws to ensure appropriate use of donated organs influence the public willingness to donate. Educational and behavioral change campaigning is the need of the hour.

70.Diverse Manifestation of Hypothyroidism: A Case Series Study
Makwana Kiran Maheshkumar, P Krishnamoorthi
Abstract
Hypothyroidism is a condition in which thyroid gland does not produce enough thyroid hormones. Thyroid irregularities adversely affect the overall health of the affected person. Even though physical examination helps to suspect hypothyroidism clinically, only advanced laboratory technique can accurately confirm it. In this case series we report three hypothyroidism cases which give a broad view of manifestation of hypothyroidism and its clinical associations. Early diagnosis and prompt treatment can prevent, detect, or treat hypothyroidism and it will improve the quality of life.

71.A Prospective Observational Evaluation of Fungal Diseases of Nose and Paranasal Sinuses
Chandan Kumar, Vandana, Satyendra Sharma
Abstract
Aim: Evaluation of Fungal Diseases of nose and paranasal sinuses in a Rural Tertiary Care Hospital. Methods: The prospective observational study was conducted in the Department of ENT, Nalanda Medical College and Hospital, Patna, Bihar, India total 100 patients who had clinical features suggestive of fungal infections of nose and paranasal sinuses were evaluated with standard pro forma-hematological investigations, radiological procedures, immunological procedures, and pathological diagnostics formed part of the armamentarium. Surgical management and follow-up were done. Results: Out of 100 patients’ study, 34% were male and 66 % were female. The majority of cases were in age group between 20 – 40 years. All patients, in our study, have nasal symptoms 100 (100%). They are nasal obstruction, nasal discharge, postnasal discharge, frequent sneezing, reduced sense of smell (hyposmia) or complete loss of smell (anosmia), and nasal bleeding. Ocular symptoms such as proptosis, epiphora, diplopia blurring of vision in our study were 21%. Fungal culture, in our study, showed out of 100 patients,35% are Aspergillus flavus, 15 %Aspergillus fumigates, 11 % are Aspergillus niger, 4 %are Aspergillus terreus and 35 were negative. Bilateral disease and involvement of ethmoidal sinus were noted in the majority of cases. Recurrence was observed in 14 % of the cases. Conclusion: About 100% of our series of 100 cases were histopathologically proven to be allergic Aspergillus sinusitis. CT was found to be highly effective for pre-operative evaluation and intraoperative guidance. Nasal polyposis was a concomitant feature in fungal sinusitis.

72.Analyzed the Influence of Maternal Vitamin D Deficiency on Hyperbilirubinemia risk in Term Newborns: Observational Study
Sanjay Kumar, Sujatha Guttala
Abstract
Aim: To study the effect of Maternal Vitamin D Deficiency on Increased Risk for Hyperbilirubinemia in Term Newborns. Methods: This prospective observational study was carried out in the Department of Paediatrics, Visakha Steel General Hospital Visakhapatnam, Andhra Pradesh, India for 1 year. Serum 25-hydroxyvitamin D was measured from 100 included pregnant women during birth time. The level of bilirubin was measured in their newborns at 3rd to 5th days of life. Results: Vitamin D deficiency with range <10 ng/mL was detected in 16(16%), insufficient level of 10-30 ng/mL in 78(78%), and sufficient level in 6(6%) pregnant women. Serum calcium was sufficient in 58(58%); while 42(42%) of them had hypocalcaemia below 8.5 mg/dL. There was a correlation between the level of maternal vitamin D with calcium, phosphorus and alkaline phosphatase of mothers (P< 0.001 each). They reported the use of vitamin D during pregnancy in 84 (84%) mothers. hundred (50 girls and 50 boys) newborns who were delivered by the pregnant women were included in this study. The level of bilirubin more than 15 was detected in 15(15%) newborns at the 3rd to 5th days of life as hyperbilirubinemia. Conclusion: The presence of maternal vitamin D deficiency could effectively predict the increased risk for neonatal Hyperbilirubinemia.

73.A Prospective Investigation Evaluating the Relationship between Body Mass index and Menstrual Irregularities in Women Aged 20-40 Years
Swati Priya
Abstract
Aim: To study of association of body mass index and menstrual disturbances in women aged 20-40 years. Methods: A prospective study was conducted in the Department of Obstetrics and gynaecology, AIIMS, Deoghar, Jharkhand, India for 10 months. Total 100 patients age ranging from 20-40 yrs presenting with history of menstrual irregularities were included. Results: Majority of patients belong to the age group of 30-40yrs- 70 % and the rest belong to the age group 20-30yrs. In our study majority of our patients were multiparous patients 75% and 25% patients were nulliparous. Our study had no patients who were morbidly obese. Menstrual disturbances and pain abdomen was the two symptoms as presenting complaints. In menstrual disturbances, increased frequency of cycles was the highest with 9 patients. Next was heavy menstrual bleed with 7 patients. Decreased frequency with menorrhagia, intermenstural bleed and continuous bleed had the same number of patient distribution of 4. Abdominal pain was observed by 32 patients with back ache also being the most common symptom. Other uncommon symptoms were nervousness, depression and anxiety. Majority of patients had menarche after 12yrs. 30 patients had recent history of onset of symptoms from 3mths. Out of 100 cases anaemia was present in 40 patients. Conclusion: BMI plays a very important role in menstrual cycle regulation. Lifestyle modifications and nutritional counseling could decrease the incidence of menstrual irregularities. Healthy eating habits and maintaining optimal BMI improves menstrual health.

74.Treatment of Open-Angle Glaucoma with Moderate Intraocular Pressure using Timolol Maleate and Timolol – Brimonidine Combination: A Comparative Study
Swetabh Verma, Amit Kumar Ambasta, Asha Kumari, V. K. Mishra
Abstract
Aim: Comparative study between timolol maleate and timolol-brimonidine combination in treatment of open-angle glaucoma of moderate intraocular pressure in a tertiary care hospital. Methods: This observational comparative study was carried out in the Department of Pharmacology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India, for 12 months (1 Nov 2020- 31 Oct 2021). The total number of cases comprises of 200, with 100 in each group. In some patients both their eyes were involved hence I.O.P was measured separately. The concentration of the monotherapy was 0.5% w/v Timolol Maleate. The concentration of the combination therapy was 0.2% w/v Brimonidine Tartrate and 0.5% w/v Timolol Maleate. Both drugs were instilled in the affected eye, twice daily (once in morning and once at night), for a period of four weeks. Results: Study was conducted on a total of 200 patients of POAG, with 100 patients undergoing monotherapy of Timolol Maleate and the remaining 100 undergoing the combination therapy of Timolol-Brimonidine combination. There was no direct correlation to the presence of comorbidities in the patients. Around 43% was present with both DM (Type 1) and Hypertension in case of monotherapy of timolol. In the case of Timolol-Brimonidine combination, 55% of the patients presented with DM (type 1) and 53% of the patients with Hypertension. This slight increase may be due to the increase in the age of the patients undergoing combination therapy when compared to monotherapy. While 50% of the patients in both the groups had POAG in both their eyes, the remaining patients developed POAG in either the right eye or the left eye. The other eye was only suspected to have glaucoma and the IOP was less than 20mmHg. Hence the sample size to test the efficacy of the drug therapy is a total of 300 eyes, with 150 under each group. Monotherapy of Timolol is seen to lower the IOP at 26.67% in 3 days, whereas the Timolol-Brimonidine combination therapy lowers the IOP at twice the rate that is 44.67% in 3 days. After reaching a I.O.P of 12mmHg, which is the normal IOP, both the drugs are used for maintenance therapy. Dryness of eyes was seen in 4.67% of the patients in both cases. With the Timolol-Brimonidine combination therapy, an additional redness of eyes was seen in 4.67% of patients, which was not reported in case of monotherapy of Timolol. Conclusion: Timolol monotherapy provides the same result as the Timolol-Brimonidine combination therapy and is also comparatively cheaper. Therefore, Timolol monotherapy is better suited for the treatment of POAG in a tertiary care hospital.

75.A Prospective Research to Evaluate the Functional Outcomes of Complex Extra Articular Tibial Pilon Fractures Treated with A Hybrid External Fixator System
Ramashish Yadav, Nand Kumar
Abstract
Aim: Functional results of compound extra articular tibial pilon fractures managed with hybrid external fixator. Methods: This prospective study conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 15 months. 50 patients were included in this study. The age of patients above 20 years, compound type 2 or 3 (a or b) and isolated extra articular displaced fractures of tibial pilon (AO 43-A1, A2, A3). Results:  There were 20 (40%) patients with right distal tibia fractures and 30 (60%) patients with left distal tibial fractures. In our study, 40 (80%) of patients sustained injury following road traffic accident, 5 (10%) patient sustained injury following fall and 5 (10%) had history of trauma due to falling of heavy object on leg. All the open fractures were classified based on Gustillo Anderson classification of open fractures, 20 (40%) were type 2 compound while 30 patients were type 3 compound, out of which 20 (40%) were type 3a and 10 (20%) were type 3b. The fracture pattern was classified based on AO/OTA classification for fractures of distal tibia of the 50 cases studied, 10 (20%) cases were A1, 18 (36%) were A2, 22 (44%) were A3. Average time taken for union in our study was of 14.5 weeks. At the end of 6 months, out of 50 patients treated, 20 (40%) patients had excellent outcome, 22 (44%) had good results, 5 (10%) had fair outcome and 3 (6%) patients had a poor result as per objective examination. On subjective evaluation, out of 50 patients treated, 22(44%) patients had excellent outcome, 22(44%) had good results, 4 (8%) had fair outcome and 2(4%) patients had a poor outcome. Conclusion: The study shows that it is possible to achieve a satisfactory outcome in compound extra articular tibial pilon fractures with the hybrid fixator technique. It provided adequate stability and allowed early motion and ambulation. The fractures were treated immediately after the injury, regardless of soft-tissue damage.

76.Questionnaire-based Research to Determine the Level of Knowledge of Diabetic Retinopathy among People with type 2 Diabetics
Ganesh Kumar
Abstract
Aim: 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, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar, India, for 15 months, Participants were asked to answer questions from a structured questionnaire developed in English and Hindi, which included questions about awareness of DR due to DM and compliance with DM and DR management. All interviewed patients were with Type 2 DM and were randomly selected using multistage random cluster sampling from the general population in and around Bihar. 200 study subjects having Type 2 diabetes mellitus were selected. 200 Patients with Type 2 diabetes mellitus who had normal cognitive ability and could speak Hindi and resided in and around Bihar was selected. Result: Of 200 randomly selected Type 2 diabetes mellitus patients, 78% of these people had awareness about diabetes mellitus causing a condition called diabetic retinopathy. But only 36% knew that Diabetic Retinopathy can cause blindness. 86% of them are aware that Diabetic retinopathy can be prevented. Only 15% are aware that laser treatment for DR does not improve vision but reduces further deterioration in vision. 78% feel regular eye check-ups are required in DM patients and nearly 78% patients are fairly frequent with their eye check-up. 80% of people are aware that maintenance of blood sugar levels can reduce the risk of diabetic retinopathy and 72% check their blood sugar levels regularly while 28% are irregular with blood glucose checking. 94% of the patients have a source of information about diabetes mellitus and diabetic retinopathy with only 6% answered they do not receive any information. Only 33% of people are aware that a diabetic patient should first see an eye doctor at the time of diagnosis. Conclusion: There is a need to implement strategies to increase the awareness of DR and the importance of early retinal screening among affected patients, in order to reduce the risk of visual complications.

77.Anatomical Variations of Origin of the Coronary Arteries: A Cadaveric Study
Amrendra Prasad Sinha, P.K.Verma, Rajendra Prasad
Abstract
Aim: The present study was aimed to explore the morphometric examination of placenta in birth weight of full-term newborn babies. Methods: The present study was the conducted in Department of Anatomy. Total 120 discarded placentae were collected at random from deliveries (both vaginal and caesarian) conducted Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for 8 months. 60 out of the 120 placentae were from controls (birth weight > 2500gms) and 60 from low birth weight deliveries (birth weight <2500gms). In the collected placenta, the weight, volume, diameter and thickness of placenta were measured. Results: The 70% of  placenta had birth weight 400-500 gms and followed by 30% >500 gms in group A, and 60 %  of placenta had birth weight <400 gms in group B. 45% of placenta had  volume 401-499 ml  and followed by 28.33% of  placenta had volume ≤ 400 ml in group A and 78.33%  of placenta had ≤ 400 ml volume in group B. the mean placental weight was 466.88±30.67gms in normal birth weight group and 393.71±57.21 gms in the low birth weight group. The mean placental diameter was 19.13±0.78cm in normal birth weight group and 16.84±2.16cm in the low birth weight group. The mean placental thickness was 1.80±0.17cm in normal birth weight group and 1.72±0.17cm in the low birth weight group. The mean placental volume in the normal birth weight group was 440.26± 39.83ml and in the low birth weight group it was 377.25±45.88 ml .The mean feto-placental ratio in normal birth weight group was 6.25 whereas in low birth weight group, it was 5.23. All the parameter was found to be statistically significant. In the present study the placental  coefficient in normal birth weight group was 0.159 ± 0.014 and in low birth weight group was 0.189± 0.031. Conclusion: we conclude that the morphometric observation of placenta is associated with foetal weight. So an early examination of not only the fetus, but also the placenta by non-invasive techniques like ultrasonography will be helpful to predict and to avoid low birth weight babies with better preventive measures.

78.Prospective Observational Study to Assess the Association between Glycemic Control, Lipid Profile and C-reactive Protein in Adults with Type 2 Diabetes Mellitus
Nilashish Dey
Abstract
Aim: The aim of this study to determine the Correlation between glycemic control, lipid profile and C-reactive protein in adults with type 2 diabetes mellitus done tertiary care hospital of Jharkhand region, India. Methods: This prospective observational study was carried out in the Department of General medicine, Seikh Bhikhari Medical College, Hazaribgah, Jharkhand, India for 1 year. The patients above 28 years with fasting venous blood glucose value equal or more than 100 mg/dl and postprandial glucose >140 mg/dl were include in this study. FBS and PPBS, CRP (immunoturbidimetric method), and HbA1C (ion exchange chromatography using HPLC) lipid profile samples were drawn at entry and at subsequent follow-up with a minimum gap of 3-6 months. Results: total cholesterol was compared to CRP. Number of patients with total cholesterol   <100 was 5, 100-200 were 35, 200-300 were 22 with mean CRP of 1.79, 0.82, 2.88. There was a significant positive correlation between CRP and total cholesterol (p<0.05). LDL cholesterol was compared with CRP. Patients with LDL cholesterol <60 were 12, between 60-80 were 26, between 80-100 were 15, between 100-120 were 24, between 120-140 was 1,  >140 were 12 with mean CRP levels of 1.86, 0.85, 1.83, 0.76, 1.35, 2.28. There was no significant correlation between CRP and LDL cholesterol (p>0.05). HDL cholesterol was compared with CRP. Patients with HDL cholesterol between  0-20 were 3,  between  20-40  were  43, between 40-60  were  41  and  HDL  cholesterol  >60  were  3 with mean CRP levels of 2.15, 1.42, 1.23, 1.17, respectively. There was a negative correlation between HDL cholesterol and CRP triglyceride levels were compared with CRP. Patients with triglyceride levels between 100-200 were 45, between 200-300 were 30, between 300-400 were 8, between 400-500 was 3 and with levels >500 were 4 with mean CRP levels of 0.72, 0.85, 1.85, 2.46, 2.46, respectively. There was significant positive correlation between CRP and triglyceride levels (p<0.05). patients with HbA1C <7 were 15 between 7-9 were 22, between 9-10 were 20, HbA1C >10 were 33 with mean CRP of 0.48, 0.66, 1.55, 2.29, respectively. There was significant correlation between CRP and HbA1C (p<0.05). Conclusion: We concluded that the CRP is an additional marker of better glycaemic control and also correlates with the dyslipidaemia profile seen in type 2 diabetes mellitus.

79.Estimation of Anti Mullerian Hormone in Reproductive Age Group of Women of Bihar, and its Clinical Utility
Rita Kumari
Abstract
Introduction: The measurement of circulating AMH levels has been applied to a wide array of clinical applications mainly based on its ability to reflect the number of antral and preantral follicles present in the ovary, which is seen to investigate & basis of this investigation for taking earlier fertility treatment to maximize the likelihood of a surgical pregnancy. Material & Methods: A prospective randomized study was carried out on fifty women in the Gynaecological Department of Nalanda Medical College & Hospital, Patna Chemiluminescent Immunoenzymatic Assay Method is used. Result: S. AMH level peaked before 25 years of age falling to a quarter of this peak by 40 years of age. Discussion: AMH level is one measure of reproductive performance an international standard to AMH & improved assay validity are urgently needed to maximize the clinical utility of this very promising biomarker of ovarian function in large assay of clinical situation both in childhood & adulthood.

80.A Comprehensive Study with Regards to Quantity of Blood Loss and Post Operative Mortality and Morbidity
Salil Kumar Sharma, Ashok Kumar
Abstract
Purpose: Maxillectomy is removal of all or part of maxillary bone (Upper jaw).  This surgery is needed for both benign and malignant tumour of hard palate, nose, maxillary sinus or any tumour that has involve maxilla. Maxillectomy is a challenging surgery because it affects cosmesis and quality of life.
Maxilla is the most important bone of skull and face. It houses the upper teeth and forms portion of upper jaw. Removal of maxilla is a devastating procedure and affects the quality of life. Maxillary bone is supplied by maxillary artery which is terminal branch of external carotid artery. Hemorrhage is most important intra-operative complication of maxillectomy.
Purpose of this study was to know how ligatation of external carotid artery affects intra-operative hemorrhage during surgery and evaluate the amount of blood loss in preligated maxillectomy and compare it with those cases where ligation was not done.

81.Prediction of Stature from Hand Dimensions in Undergraduate Medical Students
Shweta Jha, Ruchira Sethi
Abstract
Background: Stature estimation from different body segments is a very important tool for identification purposes. This has very important implications in modern world to identify bodies in natural disasters, terrorist attacks and accidents. Literature proves that the regression formula and multiplication factor to calculate stature from hand dimensions differs for every region. Objectives: To measure stature and hand dimensions of undergraduate medical students. To calculate standard equation derived from hand length and hand breadth to calculate stature in North Indian population. Material And Methods: Height (in cms), Right hand length (RHL), Left hand length (LHL), Right hand breadth(RHB ) and Left Hand breadth(LHB) were measured for undergraduate medical students in North India. Descriptive statistics was used to expressed quantitative variable as mean±S.D. Independent t test was used to compare hand dimensions and stature in male and female. Pearson correlation coefficient was used to find correlation between the variables. Regression equation to calculate stature from hand dimensions was derived. Results And Conclusions: Mean value for stature for all subjects was 163±8.92 cms. For males, it was 173.88 ± 7.599 cms whereas for females it was 159.47 ± 5.874 cms. Mean value for RHL for all subjects was 18.76±1.17 cms, for males it was 19.792 ± 1.28 cms and females it was 18.413 ± 0.90 cms. Difference between all values was statistically significant. Right hand breadth (RHB) for all subjects was 7.5±0.6 cms, for males it was 8.307 ± 0.56 cms and females it was 7.234 ± 0.492 cms difference between two genders was statistically significant. (p<0.001). Left hand breadth (LHB) for all subjects was 7.48± 0.66 cms for males it was 8.19 ± 0.523 cms and for females it was 7.244 ± 0.522cms. Correlation coefficient of RHL, LHL, RHB and LHB with height was 0.75,0.73,0.72 and 0.46 respectively. Regression equation for stature estimation from hand dimensions was calculated. Hand length was found to be a better predictor of stature as compared to handbreadth.

82.In Laparoscopic Surgery, a Comparative Study of the Open vs Closed Approach of Pneumoperitoneum Generation
Prem Prakash, Sanjay Kumar Rao, Rajesh Narayan
Abstract
Aim: A comparative study of the open versus closed method of pneumoperitoneum creation in laparoscopic surgery. Methods: This comparative study conducted in multiple institutes of Bihar, India, for 12 months. 100 patients of either sex were selected who undergone operative procedure for laparoscopy surgery were included in this study. The patients were diagnosed on the basis of clinical symptoms, physical examination and haematological as well as radiological investigations. All patients undergoing elective laparoscopic surgery and hemodynamically stable patients. Results: Technical difficulties like multiple attempts, gas leak at port site and port site bleeding are more in open method than in closed method, which is attributed to larger size of incision in open method, Furthermore, a significant higher incidence of such minor complications is found in case of BMI >25 p=-5.44 (p<0.05) at confidence level of 95%). Duration for pneumoperitoneum creation in open method group is shorter as compared to closed method group for pneumoperitoneum creation in laparoscopic surgery; p-value is 0 (p<0.05) at confidence level of 95%). Minor technical difficulties like multiple attempts (p=0.041), gas leak at port site (p=0.047), and minor complications like port site bleeding are more with open method. While one case pre peritoneal insufflation is noted in case of closed method. Herep<0.05 in most of the cases. Hence, it is statistically significant. Conclusion: In our study, we can conclude that both methods i.e. open and closed methods of creating pneumoperitoneum in laparoscopic surgery are safe to perform. The open technique has slightly more incidence of minor complications due to large incision size but has advantage of lesser duration needed for procedure.

83.An Observational Study to Evaluate Fungal Elements by Potassium Hydroxide Mounts in Chronic Otitis Media
Chandan Kumar, Vandana, Satyendra Sharma
Abstract
Aim: Study of fungal elements by potassium hydroxide mount in chronic otitis media. Methods: This retrospective study conducted in the Department of ENT, Nalanda Medical College and Hospital, Patna, Bihar, India . Total 100  Patients chronic otitis media were included with no history using ear drops for last one week and using two sterile swab without touching the external auditory canal, ear discharge was taken from middle ear and placed in sterile container and sent for microbiology laboratory for culture and potassium hydroxide (KOH) mount respectively. Results: We found that 16% KOH rate positive with 9.5-22.5% probable range for KOH positivity 95% CI which will impact in modification of treatment in chronic otitis media and were effectively treated with antibiotic and antifungal ear drops and 7 patients were required oral antibiotics as well. Pseudomonas was found to be common bacteria among 100 samples and 50 samples were  showing no growth and 8 out of 50 samples were showing positive for KOH mount. In our study, 10/16(62.5%) was found to be aspergillus, 4/16(25%)  was found to be candida and 2/16 (12.5%) was found to be other saprophytic species. Conclusions: We conclude that in patients with COM, send ear discharge for both culture and sensitivity and KOH mount and it should be routine and always consider combined therapy i.e., antibiotic and antifungal drugs.

84.To Investigate Glaucoma Patient’s Socio-Demographics and Medication Compliance Issues: Cross-Sectional Study
MD. Jabir Hussain, Sheel Mani, Ram Kumar Satyapal, Uma Shankar Singh
Abstract
Aim: To study the Socio demographic profile of glaucoma patients and barriers to treatment compliance. Methods: This cross-sectional study was carried out in the Department of ophthalmology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, for 15 months, after taking the approval of the protocol review committee and institutional ethics committee. 100 consecutive patients on medical therapy were included in this study. The patients had been diagnosed as glaucoma, following slit-lamp biomicroscopy, fundus examination using +90 D lens, applanation tonometry, gonioscopy, and perimetry (Humphrey Field Analyzer). Results: A total of 54 patients were compliant to glaucoma medication. Out of 45 males 20 (44.44%) were compliant and out of 55 females 34 (61.18%) were compliant. (p= 0.185). On the basis of type of glaucoma, 27 (56.25%) of 48 open angle glaucoma patients, 18  48.65%) of 37 narrow angle glaucoma patients, 5 (62.5%) of 8 neovascular glaucoma patients and 4 (57.14%) of 7 secondary glaucoma patients were found to be compliant. (p=0.659).   Among the 100 patients 66 patients were of rural background and 36 (54.55%) of them were compliant to glaucoma medication, while the rest 32 patients resided in urban areas and 18 (56.25%) of them were compliant. (p=0.949). On the basis of religion among these 100 patients there were 26 Hindu patients and 74 Muslim patients, among the Hindu patients only 19 were compliant (73%) and 36 were compliant (48.6%) among the 74 Muslim patients. (p=0.021). In socio-economic status, 100% compliance was observed with subjects of the upper socio-economic status, 84.62% compliance was observed in the upper middle class, 61.90% compliance in lower middle socio-economic group, 36.36% in upper lower class and 36.36% with the lower socio- economic group. (p=0.014). Conclusion: Compliance to glaucoma treatment is a global problem that needs cooperation of physicians, media, and social care providers. More effort needs to be done by health care providers to educate our patients about the nature of glaucoma, glaucoma susceptibility, and importance of treatment, follow-up visits, and effect of treatment on prognosis.

85.Assessment of the Outcome of Type 1 Tympanoplasty with and without Anterior Tucking: Comparative Study
Manoj Kumar, Vikram Satyarthy, Rana Pratap Thakur
Abstract
Aim: Comparative study of outcomes of type 1 tympanoplasty with and without anterior tucking. Methods: This prospective comparative study was carried out in the Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 12 months. Patients with only tympanic membrane perforation due to COM were included. Patients with cholesteatoma with atticoantral disease, hearing impairment more than 50 dB which indicates ossicular chain discontinuity, already undergone tympanoplasty or any other otologic surgery, sensorineural hearing loss were excluded. For all patients; age, sex, presence of contralateral perforation or otitis media with effusion, type and location of perforation, preoperative and postoperative hearing levels were recorded. 100 Patients were divided into 2 groups and group 1 underwent type 1 tympanoplasty with anterior tucking and group 2 underwent type-1 tympanoplasty without anterior tucking. Results: In this study 100 patients were included, 50 patients under type 1 tympanoplasty with tucking and 50 patients underwent without tucking. The age group of this study patients ranged from 10 to 50 years, more patients was noted in 20 to 30 years 45%, followed by 30 to 40 years 30%. Out of 100 patients, 54% were male and 46% were female patients. In our study when we compare pre and post-operative audiometry in type-1 tympanoplasty with and without anterior tucking, the p-value was 0.57 in both the groups which were statistically not significant. The hearing improvement was almost the same in both the groups. Graft uptake was good in type 1 tympanoplasty with tucking (94%) when compared to without tucking tympanoplasty (90%). Complications like residual perforation were seen in both groups equally, anterior marginal blunting was noted (10%) in type 1 tympanoplasty with tucking. Conclusion: The hearing improvement following type-1 tympanoplasty with anterior tucking and without anterior tucking was comparable. No statistical difference was found in either of the groups. Type-1 tympanoplasty with anterior tucking has a better graft acceptance. The only disadvantage of type-1 tympanoplasty with anterior tucking is anterior marginal blunting.

86.A Prospective Study to Evaluate the Clinico-demographic Profile of Falciparum, Vivax and Mixed Infections of Malaria
Nilashish Dey
Abstract
Aim: evaluate the clinical profile of falciparum, vivax and mixed infections of malaria, from a tertiary care hospital. Methods: A prospective study was conducted in the department of General medicine, Seikh Bhikhari Medical College, Hazaribagh, Jharkhand, India for 15 months 100 patients were included in this study. A detailed history was taken followed by a detailed clinical examination to assess clinical severity and all the patients in this study were proved to be case of malaria either by Peripheral smear examination (both thick and thin smear) or MPQBC or by Malarial antigen Assay. Results: In the present study, out of 100 patients more number of males (62 patients) were affected when compared to females (36 patients). Male to female ratio was 1.62:1. The predominant age group affected was 20-30 years, which constitutes to about 33%, followed by 30-40 years (31%). Up to 64% of patients affected were in the age group of 20-40, who were young and working outdoors. The mean age of in this study was 37.52 years. Fever is the most common presentation in all 100 patients both falciparum and vivax infected patients. This is followed by chills and rigors was present in 75% (75) patients, 81.4% (44) of patients with falciparum and 70.4% (31) of the patients infected with vivax. Nausea and vomiting were the another common complaint was observed in 59% (59) of total patients, more in falciparum 64.8% (35) than vivax 54.5% (24) .Other less common symptom were, easy fatiguability observed in 28% patients, abdominal pain was in 17% patients and cough was present in 14% patients.  Pallor was the most common clinical sign, was observed in 72.2% (39) patients of falciparum and 65.9% (29) with vivax species. Splenomegaly was second common clinical sign, found in 46% (46) of all patients. It was observed in 57.4% % (31) with falciparum and 29% (13) of patients infected with vivax. These were followed by icterus, detected in 23% (23) of patients, more in falciparum 27.7% (15) and 13.6% (6) with vivax species. Hepatomegaly was in 14 patients, out of which 16.6% (9) of falciparum, 5.5% (3) of vivax patients. Conclusion:  Malaria is very common disease in our country especially in South India, which is one of the endemic areas. Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity.

87.To Determine the Relationship Between Blood Bilirubin Levels and Coronary Artery Disease: A Case Control Study
Amrendra Prasad Singh
Abstract
Aims: To assess the association between serum bilirubin levels and coronary artery disease in comparison with controls without coronary artery disease. Methods: A cross-sectional study was conducted in the Department of Geriatrics, Patna Medical College and Hospital, Bihar, India for 1 year. Total of 200 subjects were included in the study with 100 cases and 100 controls. General and systemic examination was conducted on all study subjects including laboratory investigations like complete blood count, renal function test, lipid profile, viral markers such as HBsAg, HCVIgM and liver function test which includes total bilirubin, direct and indirect, liver enzymes, albumin and globulin levels. Results: The mean age among the cases male and female respectively was 66.76±8.2 and 67.85±8.3 and controls group were 65.85±8.4 and 66.38±8.5 years male and female respectively. 58%  were male and 42% female in case group and 62% patients were male and 38% patients were female in control group  and So, it shows that the cases and controls did not show any significant difference with respect to age and gender which implies that the controls were age and sex matched. The most common risk factors for CVD like diabetes, hypertension, smoking, obesity and family history of CVD was found to be slightly higher among the cases than the control groups but it was not found to be statistically significant and it proves that the controls were matched for almost all the risk factors for CVD except for dyslipidemia which was found to be significantly higher among the CVD patients than the controls. The various liver function test parameters were compared between the cases and controls it was found that the serum bilirubin levels which includes total bilirubin, direct bilirubin and indirect bilirubin was found to be lower among the case group compared to the control group and this difference was found to be statistically significant. Conclusion: we conclude that   relationship between the decreased serum bilirubin levels and the event of CAD; in this manner, bilirubin level can fill in as a prognostic factor, together with other significant factors for recognizing an individual who is in the peril of coronary artery disease.

88.A Cross-sectional Research Conducted at a Tertiary Care Centre Examined the Clinical Characteristics of Individuals with Pelvic Inflammatory Disease
Vandana Kumari, Anubha Singh
Abstract
Aim: To study clinical profile of patients with pelvic inflammatory disease. Methods: The prospective cross-sectional study which was carried in the Department of Obstetrics and Gynecology, RIMS, Ranchi, Jharkhand, India. 200 patients in reproductive age group having PID were selected randomly. Result: Most common group presenting with PID were between 25to 29 years of age (35%) followed by 22 to 24 years of age (25%). It was less common in age less than 20years (1%) and more than 40 years of age (4%). Maximum women with PID were having parity of 2 to 5(64%). It was less common in nullipara (5%). PID was commonest in illiterate women (54%) and less common in women who were graduate (2%). PID was more common in women having low socioeconomic status. Maximum number of women presenting with PID did not used contraceptive. (60%). 15% used barrier method but were irregular and 12% used IUCD. Most of the women presented with discharge per vaginum (75 %) followed by pain lower abdomen (85%) and back ache (41%). 75% women had discharge per vaginum on speculum examination. 91% had cervical motion tenderness and only 5% presented with adenexal mass. Conclusion: Incidence of PID is increasing especially in developing countries due to lack of awareness and unsafe sexual practices. It is seen to be more in younger age group with morbidity like tubal factor infertility, ectopic pregnancy and chronic pelvic pain.

89.Evaluation of Diagnostic Accuracy of Transabdominal Ultrasound in Respect to Transvaginal Ultrasound in Diagnosing Ectopic Pregnancy Taking Histopathology as The Gold Standard at Tertiary Care Hospital
Chandan Kumar Agarwal, Bharat Gupta, Abhilasha Garg, Manisha Singhal
Abstract
Background: An ectopic pregnancy is defined as implantation of the fertilized ovum that occurs outside the normal uterine cavity. Ectopic pregnancy is an outcome of a flaw in the reproductive physiology during the implantation process which ultimately results in the loss of the fetus. The worldwide prevalence of ectopic pregnancy is approximate 0.25-2.0% of all pregnancies. It is reported among the most common cause of maternal mortality and morbidity in the first trimester. Material & Methods: The present prospective study was conducted at the department of radiodiagnosis and pathology and the department of obstetrics and gynecology of our tertiary care hospital. Patients with clinically suspected ectopic pregnancy and patients having lower abdominal or pelvic pain, vaginal bleeding with a positive pregnancy test, and raised serum beta HCG level were enrolled in the present study. Results: Based on the sonographic analysis and histopathological analysis, in all 30 cases we got positive results found on the pregnancy test and no intrauterine G sac was demonstrated in any modes of ultrasonography. Transabdominal ultrasound detected 21 cases to be ectopic whereas transvaginal ultrasound detected 24 cases to be ectopic. On the histopathological analysis, 27 cases were confirmed to be ectopic and 3 cases were not confirmed by histopathology respectively. Diagnostic parameters of Transabdominal ultrasound in respect to histopathological examination the sensitivity was 75%, specificity was 80 % positive predictive value was 97% and negative predictive value was 26 %. Diagnostic parameters of transvaginal ultrasound in respect to histopathological examination the sensitivity was 86%, specificity was 82% positive predictive value was 97.5% and negative predictive value was 30%. Conclusion:  We concluded from the present study that Transabdominal ultrasound is a good method to diagnose ectopic pregnancy however Transvaginal ultrasound is better in terms of diagnostic accuracy to diagnose ectopic pregnancy.

90.Burden of Hepatitis A Virus (HAV) and Hepatitis E Virus (HEV) Infection in the Patients Presenting with Acute Viral Hepatitis Attending A Tertiary Care Hospital, Jaipur, Rajasthan
Manju Yadav, Ashok Kumar Yadav, Rameshwari Bithu, R.K. Maheshwari, Bharti Malhotra
Abstract
Introduction: Hepatitis A virus (HAV) and Hepatitis E virus (HEV) are enterically transmitted infections resulting from fecal contamination of drinking water and are of great public health importance in developing countries like India. Exposure rates over a period of time are different in different parts of the country and in different socio-economic groups. Aim of the study: (1). This study was aimed to estimate burden of HAV and HEV infections at a tertiary care hospital, Jaipur, Rajasthan. (2). To determine the age specific prevalence rates of HAV and HEV. (3). To estimate change in the epidemiological pattern of these infections. Material and Methods: This study was conducted on blood samples of 4525 suspected acute viral hepatitis patients in the clinical microbiology section of central laboratory of S. M. S. Hospital, Jaipur over a period of 2 years from January 2018 to December 2019. All the serum samples were screened for IgM Antibody to HAV and HEV using IgM capture ELISA Kits (RecombiLISA HAV IgM ELISA test, CTK Biotech and RecombiLISA HEV IgM ELISA test, CTKBiotech). Descriptive data were analysed with Microsoft Excel version 2016. Results:In this 2 year retrospective study a total 2290 & 2235(4525) serum samples were analyzed for IgM antibodies HAV and HEV respectively. 461 patients of jaundice were diagnosed with HAV and HEV infection by demonstrating the IgM antibodies by capture ELISA. HAV and HEV IgM antibody were positive in 299 (13.05%) & 162(7.25%) serum samples respectively. HAV and HEV were more common in males than in females. Infection was more commonly seen between age group 11 -20 years with HAV and 21 -30 years with HEV. All liver enzymes were raised in both infection. No significant seasonal trend was seen. Conclusion: Prevalence of HAV is much higher than that of HEV, screening for early diagnosis of HEV is of immense importance in pregnant women. These data will be essential for planning of future vaccination strategies and for better sanitation programme to improve general health of community.

91.A Study of Conventional Risk Factors of Metabolic Syndrome in Hypertensive Subjects and their Probable Correlation with Blood C-Reactive Protein and Fibrinogen Level
Mohd. Shakeel, Surendra Jinger, Jamil Mohammad, Nirali Salgiya, Dileep Singh Nirwan
Abstract
Background: Hypertension is one of the most important risk factors for cardiovascular disease and has become an increasingly important contributor to the global health burden. Mostly hypertension is idiopathic. Recently, chronic low-grade inflammation has been identified as an integral part in the pathogenesis of vascular disease. Present study was planned to investigate the level of acute phase reactants in hypertension & their correlation with conventional risk factors of metabolic syndrome. Materials & Methods: It was a case-control observational study. All subjects were divided in two groups 100 hypertensive and 100 healthy controls, between 30-60 years of age, of either gender. Standard protocol had been followed to analyze biochemical parameters on Biochemistry Fully auto-analyzer EM-360 by TRANSASIA. Data were collected and subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS trial version 16.0). Results: Statistical analysis showed that the hypertension significantly affects blood sugar and lipid levels. Hypertensive subjects had significantly elevated level of blood sugar, triglycerides, total cholesterol and LDL cholesterol and significantly lower HDL cholesterol level as compare with Non-hypertensive subjects. The mean serum CRP levels were significantly higher in subjects with hypertension compared with control group of healthy subjects (17.27±12.24mg/l versus 8.28±5.78mg/l, p<0.05). Similarly mean plasma fibrinogen levels were also significantly higher in hypertensive compared with control group (470.6±150.9mg/dl versus298.54±113.6mg/dl, p<0.05). Conclusion: The elevated concentration of inflammatory markers observed in present study indicates major role of inflammation in development of hypertension.

92.Assessment of Liver Function Tests among Patients with Scrub Typhus Fever
Abdul Rehman Pathan, Subhash Chand Meena, Ravi Kumar Verma¸ C.P. Meena, Abdul Wahid
Abstract
Background: Scrub typhus fever, a rickettsiosis caused by Orientia tsutsugamushi, usually seen in mountainous and forest areas, is now being normally characterized among patients in urban areas presenting with symptom of febrile illness in monsoon and post monsoon season. It has a varied presentation of signs and symptoms associated with morbidity and mortality today. Hence all cases with symptom of febrile illness ought to be investigated and high suspicion of rickettsiosis mainly scrub typhus. Material & Methods: The present cross-sectional study includes 200 Patients who had scrub typhus IgM antibody positive were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results:  Among the total study participants 42 (21%) had normal serum ALT levels, 52 (26%) patients had serum ALT levels raised less than Two-folds, 48 (24%) patients had serum ALT levels raised more than Two-folds, 42 (21%) patients had serum ALT levels raised more than four-folds and 16 (8%) patients had serum ALT levels raised more than ten folds. Among the total study participants 30 (15%) had normal serum AST levels, 52 (26%) patients had serum AST levels raised less than Two-folds, 56 (28%) patients had serum AST levels raised more than Two-folds, 50 (25%) patients had serum AST levels raised more than four-folds and 12 (6%) patients had serum AST levels raised more than ten folds. Conclusion: We concluded from the present study that liver function test deterioration among scrub typhus fever was varied from normal range of biochemical markers to raised liver function markers. AST elevation was observed more statistically significant than ALT elevation. Hyperbilirubinemia and raised alkaline phosphatase levels were also observed. Low serum albumin levels were associated with the critical phase of the liver disease.

93.Chlamydia Infection as a Risk Factor in Ectopic Pregnancy: A Case Control Study
Ponnam Chandramathi, Ponnam Vaishnavi, Madhavi Ramkiran, Puppala Vinayaka Vishnu Vardhan
Abstract
Background: Due to irreparable tissue damage, Chlamydia trachomatis has been associated to 30-50 percent of all ectopic pregnancies. As a result, it’s important to look at the risk factors for Chlamydia infection and ectopic pregnancies. Aim: The goal is to see if Chlamydia infection is a risk factor for ectopic pregnancy in comparison to early intrauterine pregnancy, as well as look at other ectopic pregnancy risk factors. Methods and Materials: This was a case-control study that compared patients with ectopic pregnancy to patients with early intrauterine pregnancy as controls in a tertiary care center in Hyderabad. This study was conducted between June to November 2018. Results: A total of 100 patients, 50 cases and 50 controls were studied. Females over the age of 25 were more likely to have an ectopic pregnancy, with an odds ratio of 2.18, indicating a two-fold increased risk in women over the age of 25. 70% of cases were from upper class socioeconomic status. Thus, it can be confirmed that patients from upper class socioeconomic status were more to develop ectopic pregnancy when compared to subjects from lower socioeconomic status. Total of 40 patients have shown a history of pelvic inflammatory disease. 28 (56%) of them had an ectopic pregnancy, while 12 (24%) of those in the control group had history of pelvic inflammatory disease . A history of pelvic inflammatory illness was shown to have an odd of 3.87 (p value = 0.005). 6 patients had used oral contraceptive pills out of 100 patients in the study group. P value was 0.057. Patients positive for serum chlamydia IgG antibodies were 33 patients in study group and 28 patients in control groups. P value was 0.199. Conclusion: With the rising prevalence of Chlamydia infection and the possibility of developing irreversible consequences such as ectopic pregnancy, it’s more important than ever to detect, treat, and prevent vaginal infection and pelvic inflammatory disease.

94.A Birth in a Scar: A Case Report on Caesarean Scar Pregnancy and its Surgical Management
Vaishnavi Ponnam, Chandramathi Ponnam, Ramadevi E, Puppala Vinayaka Vishnu Vardhan
Abstract
Caesarean scar pregnancy is a rare complication. There is a increase in its incidence parallel to the increase in the incidence of primary caesarean section rate. Symptoms include pelvic pain, vaginal bleeding and many are asymptomatic. Early diagnosis is the main stay. Choice of investigation is Ultrasound. MRI will confirm the diagnosis. Treatment depends on the case presentation. Caesarean scar pregnancy may result in serious life-threatening complications, unless managed promptly.

95.Comparative Functional Outcome of Modified Blair’s Arthrodesis for Injuries of Talus
Baidyanath Kumar, Swati Sinha, Satyendra Kumar Sinha
Abstract
Aim: The aim of this study to evaluate the functional outcome of modified Blair’s arthrodesis for injuries of Talus. Methods: This Prospective study was done the Department of Orthopedics, Nalanda Medical College and Hospital, Patna, Bihar, India for 15 months. Total 20cases who were treated with modified blair’s arthrodesis for non-union and osteonecrosis were included in this study. The median interval between injury and index surgery was 6 weeks to 18 weeks. Among 20 patients, 13 (65%) were males and 7(35%) were females. Preoperatively roentgenogram was performed to all patients for confirmation of fracture and was managed with modified blair’s arthrodesis using sliding graft from anterior tibia. Results: In the present study four patients (45%) showed tibia pedal motion of 10°-15° and five patients (55%) showed tibia pedal motion of 15°-20°, resulting in good to excellent gait. In this study the ankles were fused in 0-degree dorsiflexion with which patient is able to walk more physiologically without any difficulty. With this technique, AOFAS was significantly increased, and VAS was reduced. Conclusion: We concluded that the arthrodesis with preservation of talus provided greater intraoperative stability and almost normal looking foot with no limb length discrepancy. This technique has high reliability in pain relief and remained tibia pedal movement helps the patient to walk more physiologically without any difficulty.

96.A Retrospective Histopathological Investigation of Neoplastic Lesions of Thyroid in A Tertiary Care Centre
Vivek Kumar Pandey, Rituraj, Vimal Kumar Gupta, Awadhesh Singh
Abstract
Aim: Histopathological study of neoplastic lesions of thyroid in a tertiary care centre in Bihar region. Methods: This retrospective study was carried out in the Department of Pathology, Sri krishna medical college and Hospital, Muzaffarpur, Bihar, India, for 15 months. The material for this study consisted of thyroidectomy specimens including lobectomy, partial thyroidectomy, subtotal thyroidectomy and total thyroidectomy. Every patient was preoperatively assessed by FNAC. Detailed information regarding age, gender, clinical details (hypothyroid, hyperthyroid and euthyroid), relevant investigations like Fine Needle Aspiration Cytology, USG reports, thyroid scan and operative findings were obtained from histopathological report forms. Results: 80% cases were found to be females and 20% cases were males with a female: male ratio of 4:1. Among total of 100 neoplastic lesions, 27 cases were adenomas 21 cases of follicular adenoma and 6 cases of Hurthle cell adenoma were diagnosed accounting for 21% and 6% respectively of all neoplastic thyroid lesions. The age of the studied benign thyroid neoplastic lesions ranged from 11 years to 67 years with a mean age of 37.95 years and the relative peak age of incidence was seen in 20-30 years age group (28%). The young age group (≤20 years) and the elderly age group above 60 years constituted 9% and 5% of cases respectively. Malignant thyroid lesions accounted for 73% (n=73) of all neoplastic lesions. Papillary carcinoma was the commonest malignant tumor in this study seen in 60(82.19%) of all malignant lesions. Of these cases, 10(16.67%) were males and 50 (83.33%) were females with a female: male ratio 5:1. Most of the patients (n=18; 30%) were between 20-30 years of age. 8 cases of follicular carcinoma and 4 cases of medullary carcinoma were encountered in this study, comprising of 8% and 4% of all malignant neoplasms respectively. No case of anaplastic carcinoma was seen in our study. Conclusion: Thus, in conclusion, females accounted for 80% of patients with neoplastic thyroid lesions and the incidence peaked at a younger age. Papillary carcinoma was the most frequent thyroid cancer accounting for 60% of thyroid cancers and follicular adenoma was the common benign tumor.

97.Analysis of the Clinical Profile of Diabetes Mellitus and its Association with Autonomic Dysfunction
Govind Sharan Sharma, Priya Charan, Radha Chonsariya, Prahlad Dhakar
Abstract
Aim: Histopathological study of neoplastic lesions of thyroid in a tertiary care centre in Bihar region. Methods: This retrospective study was carried out in the Department of Pathology, Sri krishna medical college and Hospital, Muzaffarpur, Bihar, India, for 15 months. The material for this study consisted of thyroidectomy specimens including lobectomy, partial thyroidectomy, subtotal thyroidectomy and total thyroidectomy. Every patient was preoperatively assessed by FNAC. Detailed information regarding age, gender, clinical details (hypothyroid, hyperthyroid and euthyroid), relevant investigations like Fine Needle Aspiration Cytology, USG reports, thyroid scan and operative findings were obtained from histopathological report forms. Results: 80% cases were found to be females and 20% cases were males with a female: male ratio of 4:1. Among total of 100 neoplastic lesions, 27 cases were adenomas 21 cases of follicular adenoma and 6 cases of Hurthle cell adenoma were diagnosed accounting for 21% and 6% respectively of all neoplastic thyroid lesions. The age of the studied benign thyroid neoplastic lesions ranged from 11 years to 67 years with a mean age of 37.95 years and the relative peak age of incidence was seen in 20-30 years age group (28%). The young age group (≤20 years) and the elderly age group above 60 years constituted 9% and 5% of cases respectively. Malignant thyroid lesions accounted for 73% (n=73) of all neoplastic lesions. Papillary carcinoma was the commonest malignant tumor in this study seen in 60(82.19%) of all malignant lesions. Of these cases, 10(16.67%) were males and 50 (83.33%) were females with a female: male ratio 5:1. Most of the patients (n=18; 30%) were between 20-30 years of age. 8 cases of follicular carcinoma and 4 cases of medullary carcinoma were encountered in this study, comprising of 8% and 4% of all malignant neoplasms respectively. No case of anaplastic carcinoma was seen in our study. Conclusion: Thus, in conclusion, females accounted for 80% of patients with neoplastic thyroid lesions and the incidence peaked at a younger age. Papillary carcinoma was the most frequent thyroid cancer accounting for 60% of thyroid cancers and follicular adenoma was the common benign tumor.

98.A Cross Sectional Point Prevalence Survey of Antimicrobial Consumption in a Tertiary Care Facility
Archana Kumari, Rohit Kumar Singh
Abstract
Aim: A point prevalence survey study (PPS) of antimicrobial consumption in a tertiary care super-speciality hospital. Methods: This cross-sectional observational study was carried out in the Department of pharmacology, A. N. Magadh Medical College and Hospital, Gaya, Bihar, India, from November 2019 to August 2020, after taking the approval of the protocol review committee and institutional ethics committee. The study followed the standard guidelines of point prevalence survey (PPS) methodology as described by Global PPS of Antimicrobial Consumption and Resistance (version January 2019). Results: A total of 100 patient related data was collected in the designated survey form. Total beds covered were 200 and the number of patients on antimicrobials was found to be low at 20 %. The patients surveyed were predominantly female (80 %). The mean number of antimicrobials per patient was found to be 1.72 (range of 1.5 to 2.3) relatively low numbers of patients were found to be on 2 or more antimicrobials. Double gram negative and double anaerobic coverage of AM used varied across departments covered. Conclusion: The study was not only able to demonstrate the feasibility of conducting point prevalence survey in high patient volume and paper based medical record system but also generated the baseline intervention for evaluating the impact of future interventions.

99.Prospective Observational Study Evaluating Paediatricians’ Treatment Practices in the Symptomatic Management of Fever
Hemant Kumar Thakur, Nishant
Abstract
Aim: A study of treatment patterns in symptomatic management of fever in children (antipyresis) among Pediatricians. Methods: This cross-sectional study conducted in the Department of Paediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 13 months. A sample was not selected, but there were attempts to contact the whole population. A questionnaire was administered to convenient samples of pediatricians and family physicians eliciting information about fever definition, methods of temperature measurement, and antipyretic use.  Differences in responses between the doctors were evaluated. Results: Most of the doctors (84%) recommended an axillary measurement of fever to the parents of the febrile child and 40% of them indicated that a body temperature of above 37.5°C, according to an axillary measurement, was treated as fever. The body temperature treated as fever by doctors according to an axillary measurement varied between 36.5°C and 39°C. About two third of doctors (74%) reported that they recommended an antipyretic agent to every child under the age of 5 with fever. Only 26% of doctors took into consideration signs and symptoms other than fever (malaise, irritability, prolonged crying, signs of infection) to prescribe the antipyretic. A few doctors (31%) indicated that febrile convulsions can cause brain damage. About 34% of the doctors said that fever is harmful for the child and 78% of them reported that a body temperature of above 38°C must definitely be treated, whatever the underlying pathology. Conclusion: There were significant misconceptions about the management and complications of fever. There is a perceived need to improve the recognition, assessment, and management of fever with regards to underlying illnesses in children and a national consensus statement on fever and antipyresis in children.

100.Descriptive Observational Research to Assess the Severity of Malnutrition among Children with Pneumonia and Diarrhoea: Moderate Acute Malnutrition
Nishant, Hemant Kumar Thakur
Abstract
Aim: The severity of malnutrition among children with pneumonia and diarrhoea: moderate acute malnutrition. Methods: This Descriptive observational study conducted in the Department of Paediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 10 months. Total 100 Children between 1 month and 5 years of age with community-acquired pneumonia or diarrhoea. Diagnosis of ‘Pneumonia’ (fast breathing and/or chest in drawing) and ‘severe pneumonia’ (pneumonia with any danger sign).  Diagnosis of diarrhoea: the passage of >3 loose stools/ day (or more frequent passage than is normal for the individual). Results: More number of females were malnourished, and a greater number of males were well-nourished which was statistically significant (p = 0.021). There was no statistically significant association between age and severity of malnutrition. (p=0.061). There was no statistically significant association between the severity of diarrhoea and malnutrition. (p=0.52). Therefore, the prevalence of diarrhoea was the same among both MAM and SAM children. There was no significant association between the severity of pneumonia and malnutrition. Therefore, the prevalence of pneumonia was the same among both MAM and SAM children. There is a statistically significant association between complications and severity of malnutrition [more complications are noted in the SAM group and MAM group (p-value 0.029). More children with MAM had anaemia (15%) than SAM and normal groups. Fewer children with normal anthropometry had comorbidities. These data were statistically significant (p = 0.022). In the present study, there was no mortality and 65% of SAM children had pneumonia, 20% had diarrhoea, while in the MAM group, 73.33% had pneumonia and 26.67% had diarrhoea. Conclusion: The prevalence of diarrhoea and pneumonia, which are the leading causes of under-five mortalities, were found to be same in both children with Moderate Acute Malnutrition and Severe Acute Malnutrition.

101.A Hospital Based Prospective Observational Evaluation of Adolescent Abnormal Uterine Bleeding (AUB) and its Outcome
Priti Singh, Priyanka Kumari, Anupama Sinha
Abstract
Aim: Study of adolescent abnormal uterine bleeding (AUB) and its outcome. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for 12 months.  after taking the approval of the protocol review committee and institutional ethics committee. All OPD patients attending gynae clinics present with AUB. Age group 10-19 years were included in this study. Results: 86% patients were inn AU-O class followed by 7% in AUB-N, 3% in AUB-C,0% in AUB-I, 1% in AUB-L and AUB-P class. According to PALM 1% and COEIN 99%. Conclusion: The study concluded that Menorrhagia in adolescents can be caused by a number of conditions, the most common being the immature hypothalamic-pituitary-ovarian axis. Assessment of each case with thorough history, physical examination, and laboratory investigation is crucial in reaching the diagnosis. We see that we can successfully apply palm coein approach to adolescent AUB. Anatomical abnormalities like fibroid or polyp are also to be ruled out.

102.A Prospective Case Control Study to Evaluate Perinatal Outcome in Oligohydramnios in term Pregnancies
Priyanka Kumari, Priti Singh, Anupama Sinha
Abstract
Aim: The aim of the study to evaluate Perinatal Outcome in Oligohydramnios in term Pregnancies. Materials and methods: A prospective case control study was conducted in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for 18 months. 100 Perinatal cases with >34 weeks of gestation with AFI ≤5 cm by sonographic estimation were included as study group and 100 women with normal AFI (8-24 cm) were included as control group. Induction of labour was done for women with high risk factors like PIH, by PGE 2 gel and accelerated with oxytocin. Labour outcome of the women were recorded includes, spontaneous /induced, nature of A F, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery. Perinatal findings such as APGAR score <7 at 1 mt and 5 mt, birth weight, admission to NICU, perinatal morbidity and mortality were noted. Results: Study group consists of 48 % Gr 1, 52 % Gr 2 and above and control group 52% Gr 1, 48% Gr 2 and above (Chi square=21.59, p<0.0001). Antenatal complications were not seen in 70% in the study group and 58% in control group. The AFI in study and control groups. In the study group 70% of women had AFI below 4. The nature of the amniotic fluid was clear in 30% in study and 80% in control group. Amniotic fluid was thin meconium stained in 31% in study, 15% in control group and was thick meconium stained in 40% in study and 10% in control group (Chi square=21.57, p<0.0001). Incidence of LSCS in the study group was 55% and 19% in control group. Percentage of birth weight of babies in study and control group is shown in Table 5. Birth weight <2.5 kg was found in 60% in study group and 18% in control group with mean of 2.3 and 2.9 in study and control group respectively (p <0.001) statistically significant. 11% of babies required NICU admission in study group in view of meconium aspiration, birth asphyxia and seizures. Neonatal death was 3% in study group. None of the babies admitted to NICU and no perinatal mortality in Control group. The p value showed strong significance <0.001. Conclusion: To conclude in presence of oligohydramnios a thorough evaluation for hypertension, PIH, diabetes PROM etc. should be done. An AFI ≤5 cm detected after 28 weeks was associated with adverse pregnancy outcome and poor perinatal outcome. Determination of AFI should be used as an adjunct to other fetal surveillance methods and is a valuable test for predicting fetal distress in labour requiring cesarean delivery.

103.A Web-based Cross-sectional Survey to Assess the Effect of Pandemic on Medical Education of Surgery Residents in a Tertiary Care Hospital
Raj Kishor Roshan, U.S. Singh
Abstract
Aim: Effect of pandemic on medical education of surgical residents in a tertiary care hospital in Bihar. Methods: A web-based survey was conducted to assess the effect of COVID-19 on the residents in various surgical specialties in our institute. The “open epi” software was used to calculate the sample size. The interview questions were generated through focus group discussions with five surgery residents from various specialties. Maslach burnout index (MBI) was used to assess burnout experienced by surgical residents. It was modified such that each of the individual components was asked as a yes or no question. Yes, was considered as 1 point and not as 0 points. The score of 22 questions was simply added. Results: A total of 100 surgical residents completed the survey out of 130 residents who received it (response rate 76.9%). Of the 100 respondents, 58(58%) were male, and 86 (86%) residents were less than 30 years of age. 24 percent of respondents were in the first year of their residency, 43% in their second year, and the remaining in the final year. Residents from 8 surgical specialties participated in the survey 85(85%) surgical residents felt the reduction in bed strength, and 83(83%) felt reduction in the number of patients seen by a resident in the outpatient clinic had impacted their learning. The amount of time spent on research work, however, increased by 66(66%). The 76(76%) residents efficiently utilized telemedicine for outpatient care, and 69(69%) residents felt telemedicine had improved patient care. There was a significant (paired t test; p<0.05) reduction in working hours since the pandemic began (8.45±2.15 hours) when compared to pre-pandemic time (13.55±2.03 hours). Hands-on surgical training was significantly affected.  MBI was modified for the sake of simplicity. The average score before pandemic was 13.78±2.56, and after the pandemic, it was reduced to 7.63±2.35, showing a statistically significant reduction in burnout among residents (p<0.001). Conclusion: Surgical trainees played a significant role in taking care of many COVID-19 patients at the cost of their training. The decrease in working hours due to the pandemic has provided more time for research work and reduction in burnout.

104.A Comparative Study of Bupivacaine Heavy and 2-chloroprocaine for Saddle Block in Perianal Day Care Surgeries: A Prospective Randomized Double Blind Clinical Trial
Ravi Ranjan Kumar, Sukesh Kumar, Jitesh Kumar, B.K. Kashyap
Abstract
Aim: To compare the bupivacaine heavy and 2-chloroprocaine for saddle block in perianal day care surgeries. Methods: This observational study conducted in the Department of Anesthesiology & Critical Care Patna Medical College & Hospital, Patna, Bihar, India, for 12 months. 80 patients were divided randomly into two groups, Group A and Group B by computer generated random numbers at 1:1 ratio. Group A received 2ml of 1% 2- Chloroprocaine, group B received 2ml of 0.5% Bupivacaine heavy. Double blinding was done where neither the patient nor the investigator knew about the drug. The patients of ASA physical status grade I and II aged between 18 to 58 years undergoing elective perianal day care surgeries < 60 mins duration were included in the study. Results: The mean time for eligibility to discharge from hospital between groups were statistically significant with p value <0.001. Group A had less mean time (238.42± 18.86 min) compared to group B (341.75±16.66 min). The mean time for length of stay in PACU was less in group A (62.25±6.88 min) as compared to group B (75.26±8.66 min) with p value of <0.001. Mean time taken to ambulate was statistically significant with group A having less mean time (182.52±20.36 min) compared to group B (266.78±19.69 min) with p value of < 0.001. The time taken to void was statistically significant with group A having less mean time (216.89±29.66 min) compared to group B (308.25±20.45 min), with p value of <0.001. Conclusion: In conclusion saddle block with 2-Chloroprocaine provides satisfactory surgical anesthesia for perianal surgeries when compared to low dose hyperbaric Bupivacaine with earlier hospital discharge and shorter PACU stay and time to ambulation and micturition.

105.Pre-procedural MRI Findings in Different Grades of Achilles Tendinitis and Correlated with Clinical Outcomes after Ultrasound-guided Retrocalcaneal Bursa Injections of Steroid
Vikas Kumar
Abstract
Aim: The aim of the study to evaluate the correlation between Clinical Outcome Following Ultrasound guided Steroid Injection in Retrocalcaneal Bursa and Preprocedural MRI Findings in Different Grades of Achilles Tendinitis. Methods: This prospective randomized control study conducted in the Department of Physical Medicine and Rehabilitation, Patna Medical College, Patna, Bihar, India, for 3 months. A total of 50 patients participated in this study. Ankle MRI was done with a 1.5-T MRI system. In each case, apart from the usual sagittal and axial plane images, coronal oblique T2-weighted, coronal oblique short-TI inversion recovery (STIR), axial gradient-echo images were also acquired at similar repetition and echo times as per the recommendation. Results: 8 patients (16%) reported no change in symptoms. 10 patients (20%) reported partial relief of symptoms at 6 months post-intervention follow-up with a reduction in pain or improvement in activities of daily living. Initially, 5 out of these 10 reported complete resolution lasting 2 weeks while 3, 2, and 4 patients reported the period of complete resolution as 4 weeks, 6 weeks, and 8 weeks, respectively, followed by a gradual return of symptoms but never touching the baseline severity till the endpoint of our study. Resolution of symptoms was always partial in one of these patients. 32 patients (64%) achieved complete resolution of symptoms after 6-month follow-up. Interestingly, three of them initially reported only partial resolution of symptoms in the first week after the intervention. No significant complications were reported. Patients with low-grade lesions reported much more complete resolution than patients with higher-grade lesions. Around 84% of patients having low-grade pathology (MRI grade I and II) reported complete resolution, while the percentage of complete resolution among the patients suffering from mid-grade MRI findings (grade III) dropped to just a little above 68.18% mark. In our study, we were comparing the clinical outcome between complete resolution (n = 32) and partial resolution or no change (10+ 8 = 18) in respect of preprocedural MRI grading, patients’ age, gender, and duration of the symptom. The proportion of patients with complete relief of symptoms decreased significantly with increasing MRI grading (p = 0.0003). Our study also comparing the patients with clinical improvement between complete resolution (n = 32) and partial resolution (10) in respect of preprocedural MRI grading, patients’ age, gender, and duration of the symptom. Complete resolution decreased as MRI grading increased in a significant linear trend (p = 0.0008). Complete resolution increased significantly in younger patients than the older age group (mean age 47.6 vs 59 years). The proportion of patients with some resolution showed a shorter mean symptom duration, but the difference was not significant (9.4 vs 34.3 weeks, p = 0.07). Conclusion: MRI of the Achilles tendon and the retrocalcaneal area may be of benefit to patients with clinically suspected Achilles’ tendinopathy because it allows confirmation of the diagnosis and also helps the operator to predict the likelihood of different patients to respond to ultrasound-guided retrocalcaneal bursal steroid and bupivacaine injection.

106.A Retrospective Evaluation of Soft Tissue Tumors in Tertiary Care Centre: A Clinic-Pathological Investigation
Kannu Priya, Vandana, N.K. Bariar
Abstract
Aim: A clinico pathological evaluation of soft tissue tumors in tertiary care centre. Methods: This retrospective study was carried out in the Department of Pathology, Patna Medical College and Hospital, Patna, Bihar, India for 15 months. Total 200 patients of all the soft tissue tumors, both benign and malignant were included in this study. Results: Benign soft tissue tumours formed 87.5% of all soft tissue tumours while malignant soft tissue tumours constituted 12.5% .the male to female ratio among the  benign soft tissue tumours was 1.33:1 and among the malignant soft tissue tumours was 1.27:1. The commonest benign tumour was lipoma (52%) of all benign tumours of soft tissue followed by vascular tumours (19.5%) peripheral nerve sheath tumours (18%), fibrous tumours (2.5%), fibrohistiocytic tumours (3.5%) smooth muscle tumours (1.5%) 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 (48.5%) followed by vascular tumours (17.5%). Benign tumours of smooth muscle (0.5%) and tumours of uncertain differentiation are nil encountered. The malignant tumours of adipose tissue accounted for majority of malignant soft tissue tumours (3.5) followed by tumours of skeletal muscle, blood vessels and peripheral nerve.31.5% benign soft tissue tumours were seen in extremities followed by head and neck 29% 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.

107.Puerperal Complications: It’s Association with Anemia
Diksha Ambedkar, Charu Mishra, Rina Sharma, Vijay Kumar, Yogesh Kumar Yadav
Abstract
Background: Anemia in pregnancy is associated with a large number of complications not just in the antepartum, intrapartum but also the puerperal phase, being responsible for both feto-maternal morbidity and mortality. Material and Methods: This was an observational study conducted in our hospital on 476 patients out of which 276 patients were anemic and 200 were non-anemic. All anemic women in puerperal phase were included in the study while puerpera with complications other than anemia were excluded. Comparison was done with regards to puerperal complications in anemic and non-anemic women. An association of complications with severity of anemia was studied. Results: Risk of puerperal complications were higher in anemic women in comparison to non-anemic women and a direct relationship could be drawn with the severity of anemia. Most common complication was respiratory tract infection affecting all subgroups of anemic women 161(58.33%) as compared to non-anemic women 75(37.5%). Conclusion: Severity of anemia is a major determining factor in puerperal complications and its outcome. An emphasis on anemia prevention, early diagnosis and prompt correction of anemia play an important role in reducing morbidity and mortality related with associated complications.

108.Assessment of the Effectiveness of the Novel Technique of Collagen Application Over Meshed Split Thickness Graft for Wound Coverage: A Prospective Study
Diwakar Yadav, A. K. Choudhary, Utkrist Kant
Abstract
Aim: To study the advantages of a novel technique of using collagen sheet over meshed split thickness graft for wound coverage. Methodology: A prospective study was conducted at Department of general surgery at Sheikh Bhikhari Medical College and Hospital, Hazaribagh, Jharkhand, India. A total of 25 patients were part of this study intending to follow each patient at least for a minimum of 6 months postoperatively. All patients underwent relevant routine investigations. Patients were regularly evaluated for postoperative complications and outcomes. Patients were asked to provide their objective pain assessments on a Pain scale from ‘0-10’ at regular intervals. For scar assessment, Vancouver Scar Scale (VSS) was used. Patient’s overall satisfaction was also accounted. Results: Out of 25 patients, 15 (60%) were males and 10 (40%) were females. The majority of patients in the study were in 3rd, 4th and 5th decades. 11 (44%), 8 (32%), and 6 (24%) patients belonged to 3rd, 4th and 5th decade of life respectively.  The lower extremity (11, 44%) was the most common area requiring skin grafting, followed by the trunk (9, 36%) and upper extremity (5, 20%) area. The mean VSS score of 25 patients at the end of 1, 2, 4 and 6 months was 0.30, 0.48, 1.04 and 2.17. Out of 25 patients, 1 patient had score more than 4 at the end of 6 months indicating hypertonic scar. Conclusion:With satisfying results obtained in this study, we acknowledge collagen for its ease of use and cost-effectiveness. Furthermore, we consider it effective because of the promotion of epithelialization, reduction of pain and limited complications.

109.Interventional Comparative Study to Evaluate the Prognostic Value of Some Serum Protein Fractions as Early Index of Clinical Recovery in Pulmonary Tuberculosis Subjects
Pawan Kumar Agrawal, Surendra Kumar
Abstract
Aim: The aim of this study to evaluate the prognostic value of some serum protein fractions as early index of Clinical recovery in pulmonary tuberculosis subjects. Methods: This Interventional comparative study was done the Department of Tb and chest, Patna Medical College and Hospital, Patna, Bihar, India for 15 months. A total of 100 subjects aged between 20 and 50 years were conveniently recruited for this study. 50 were clinically confirmed PTB subject with no HIV nor malaria co-infections. They were further sub-divided into TB subjects on ATT 25 and drug naive TB subjects 25. The remaining were 50 (25 females and 25 males) aged matched apparently healthy controls. Results: The results showed that BMI (kg/m2) in drug naive TB subjects (19.35 ± 2.75) and in the TB subjects on ATT (20.40 ± 2.90) was significantly lower when compared to control   subjects (24.68 ± 3.15) (p=0.001). Similarly, waist and hip circumferences (cm) of the drug naive TB subjects (50.22 ± 1.44,70.68 ± 2.10) and the TB subjects on ATT (51.14 ± 2.98, 70.56 ± 2.75) were significantly lower when compared to control subjects (52.34 ± 4.56, 72.33 ± 3.54) (p=0.03 and 0.02). However, the mean value of WHR in drug naive TB subjects (0.72 ± 0.04) and in TB subjects on ATT (0.74 ± 0.05) were not statistically significant when compared to control subjects (0.73 ± 0.06) (p ¼ 0.27). In TB subjects on ATT, the mean (±SD) serum albumin (g/ dl) was (3.51 ± 1.57) and control subjects (3.83 ± 1.15) (p=0.108). In contrast, the drug naive TB subjects had a significantly lower mean serum albumin (2.88 ± 0.87) when compared with the control (3.83 ± 1.15) (p=0.001). Conclusion: We concluded that the BMI was found to be significantly lower in both drug naive PTB subjects and in PTB subjects on ATT when compared with the control subjects.

110.Prospective Randomized Study to Determine the Role of Abdominal Ultrasound and Alvarado Score in Diagnosing and Preventing Negative Laparotomies in Acute Appendicitis
Prabhakar Krishna, Anisha Kishore
Abstract
Aim: Role of abdominal ultrasound and alvarado score in diagnosing and preventing negative laparotomies in acute appendicitis. Methods: The prospective randomized study was conducted in the Department of General Surgery, MGM Medical College Kishanganj, Bihar, India from July 2019 to January 2020. The study constituted of 100 consecutive patients who were above the age of 15 and underwent surgery and gave consent for the study. The patients were assessed by clinical examination, Alvarado score and an ultrasound abdomen. The results of histopathology were compared with the Alvarado score and ultrasound abdomen, and their accuracy were assessed. Results: In our study of 100 patients, 65(65%) were male, and 35(35%) were female. The number of patients, 50(50%), were between 20-29 years of age. 100(100%) of patients were admitted with pain in the abdomen. 60(60%) of patients had a duration of hospital stay of 3-5 days. The mean hospital stay was 5.3 ± 1.5. 52(52%) of patients in our study had conclusive evidence of appendicitis on ultrasound. Alvarado score calculated for the 100 patients showed that 91 had a score >=7. Of the 100 patients, 74(74%) were inflamed, 8(8%) were gangrenous, 9(9%) perforated, and 9(9%) were normal per operatively. Histopathology revealed that 94(94%) patients had appendicitis. All the 100(100%) patients had primary closure after surgery. Surgical site infection was seen in 9(9%) patients postoperatively. Post-operative fever was seen in 45(45%). Taking histopathology as standard gold ultrasound proved conclusive in predicting appendicitis 46(50%) of patients with a sensitivity of 51, specificity of 17.7 and an accuracy of 48.5. Taking histopathology as the gold standard and comparing it with the Alvarado score, the Alvarado score was >=7 in predicting appendicitis 90(95.7%) of patients with a sensitivity of 95.6, specificity of 84.3 and an accuracy of 94.8. Conclusion: Clinical assessment is the mainstay of diagnosis with ALVARADO score and ultrasound significantly contributing to the more efficient diagnosis and reduction in negative laparotomies.

111.A Cross-Sectional Study to Determine the Prevalence of Nutritional Anaemia in Children of Age Between 6 Months to 18 Years
Umendra Kumar, Avinash Kumar
Abstract
Aim: To study the prevalence of nutritional anaemia in children of 6 months to 18 years of age. Methodology: A cross-sectional study was conducted in the Department of Paediatrics, SNMMCH, Dhanbad, Jharkhand, India for a period of 6 months.  Children of age between 6 months to 18 years were included in this study. Systematic random sampling technique was used to select the study participants. Every second children under 18 years of age in the department during study period was selected for assessment. Total approximately 420 patients visited the department during study period. With 5% non-response rate, 200 children were selected for the study. Based on WHO cut-off values, Children with Hb level <110 g/L were considered anemic. Anemic children were further categorized as children with mild anemia, moderate anemia and severe anemia which corresponds to Hb value 100–109 g/l, 70–99 g/l, and lower than 70 g/l respectively. Values were recorded on the questionnaire Performa and later analyzed. Results: Out of the 200 children studied, majority were females and accounted for 106 (53%) of the subjects with males accounting for 94 (47%). 71 (35.5%) children belong to 6 months to 6 years of age group, 92 (46%) children belonged to the age group of 7 years to 14 years, and 37 (18.5%) children belongs to 15 years to 18 years of age group.  Majority (73 cases, 36.5%) belonged to class IV (upper lower), with 61 cases (30.5%) belonging to class III (lower middle) socio-economic status according to Modified Kuppuswamy classification 2021. Majority were vegetarians constituting 134 cases (67%) and the rest 66 cases (33%) belong to non-vegetarians. 67.5% patients reported with pallor, 34% platonychia, 18.5% bald tongue, and 7% patients reported with murmur. 95 (47.5%) patients had normal range of Hb values, 56 (28%) had moderate anaemia followed by 28 (14%) patients with severe anaemia, while only 21 (10.5%) patients had mild type of anaemia. Conclusion: This study has revealed that the prevalence of anemia in children is high and a matter of concern in the study area. Age, socio-economic status, and nutritional status are the factors significantly associated with anemia.

112.Qualitative Assessment of the Awareness of Dissection Skills and Tools Session in Preparing First MBBS Learners for Cadaveric Dissection
Vineeta Laxmi, Vijay Shekhar Kumar, Bhavesh Kumar
Abstract
Aim: Awareness of dissection skills and tools session in preparing first MBBS learners for cadaveric dissection in medical College a qualitative analysis. Material and methods: This prospective cross-sectional study was carried out in the Department of Anatomy, Government Medical College, Bettiah (W.Champaran), Bihar.Total 150 I MBBS learners in Anatomy department, of which only 100 participated in answering the questionnaire. The study tools used were General lecture, demonstration with audio-visual aids, validated questionnaires. Results: The results of pre and post analysis tests of 100 students are tabulated in Table 1 overall knowledge of dissection skills and tools improved after interventional session by 60%. Significant improvement evident by P value <0.0000001 was seen after the interventional session on “Awareness of Dissection skills and tools in preparing I MBBS learners for cadaveric dissection”. Most (78%) of learners felt that the session was very useful to them in stimulating interest, in-depth knowledge of the subject, acquiring dissection skills, performing qualitative dissections and a worthful session to be taken for every batch. Conclusion: It becomes evident from the present study that such interventional sessions at the initial phase of learning would improve, stimulate, and increase the learners’ participation in dissections with perfection and ease. This would also help the learner to acquire better independent surgical skills and understanding in clinical phases of learning and therefore would recommend it in early phase of I MBBS Anatomy.

113.Functional Outcome Assessment Using Quick Disability of the Shoulder, Arm and Hand (Quick DASH) Score in Children treated with ORIF for Clavicle Fractures
Kumar Satyam, Shashi Kant Kr Singh, Shankar Niwas
Abstract
Aim: Functional Outcomes of Clavicular Fractures Fixation in Adolescent Children. Methods: A retrospective study was conducted in the Department of Orthopaedics, SB Medical College & Hospital, Hazaribagh, Jharkhand, India. 50 patients treated with ORIF for closed, isolated and neurovascularly intact clavicular fractures were identified. Case notes were reviewed, and radiographic evidence analysed, paying special attention to the rate of healing, radiographic union, functional outcomes and complications. Results: 50 children treated with ORIF for clavicle fractures were identified.  Mean age was 14.2 years (range 13.5-15.8), and all 45 cases were males.  45 children had mid-shaft fractures and 5 had a lateral-end fracture. The mean shortening at time of injury was 15.5mm on the AP film (range 12-22mm) with mean vertical displacement 18.5mm (range 16-24mm). Out of 50 patients, 44 were able to return to unrestrained sport at 12 months. The 3 patients with lateral-end fractures had to have the hook plate removed at six months, 3 patients had plate removal nine months due to plate prominence. The mean Quick DASH score at 12 months follow-up was 3.34 (range: 0 – 15.8). The worst Quick DASH score was seen in the patient with the lateral-end fracture, who suffered with mild to moderate pain post-operatively and had limited ability to return to unrestrained sporting activity. Conclusion: Good functional and radiographic outcomes can be obtained with internal fixation of clavicle fractures in children. Subjective satisfaction rates post-operatively tend to be high.

114.Prospective Observational Assessment of the Clinic-Demographic and Outcome Profile of Diabetic Ketoacidosis in Children with Type 1 Diabetes Mellitus
Satish Kumar, Rakesh Kumar, Mithilesh Kumar
Abstract
Aim: A clinical, demographic, biochemical and outcome profile of diabetic ketoacidosis in children with type 1 diabetes mellitus. Material and methods: This Prospective observational study was carried out in the Department of Paediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 15 months, 50 DKA patients admitted during the study period. All those patients aged from 6 months to 14 years with Type 1 D.M. with DKA. Results: In the present study incidence of DKA in children with type 1 Diabetes Mellitus was 2.4%. The mean age of presentation was 10.76 ±3.88 years; the preadolescent age group was most affected, constituting approximately 50% of the total cases. Significant presenting signs were dehydration in 41 (82%), Kussmaul’s Breathing in 35 (70%), altered sensorium in 28 (56%), tachy penia in 9 (18%), shock in 7 (14%), while abdominal distension and guarding was present in 6 (12%) and 3 (6%) cases were comatose. In the present study, infection in 28 cases (56%) was the most common precipitating factor of DKA, URTI being the commonest in 16 (32%), followed by acute gastroenteritis in 8(16%), pneumonia in 5 (10%), U.T.I. in 4 (8%) and severe sepsis in 3 (6%). Mean R.B.S. was 395.72±91.2 mg/dl, and mean HbA1c on admission was 9.8 ±1.81%. The mean duration of insulin infusion required for resolution of ketoacidosis and changing over subcutaneous insulin was 39.98±17.61hrs. The mean duration of hospital stay was 9.19 ±2.65 days. The most common complication observed was shocking in 7 (14%) followed by hyponatremia and hypokalaemia in 4 (8%), A.K.I. in 5 (10%), cerebral edema in 6 (12%) and 2 (4%) cases had hypernatremia. The mortality rate was 6.4%. The severity of DKA was significantly associated with gender, B.M.I. of the patient, socioeconomic status, area of residence and precipitating factors (p-value < 0.05 for each). Conclusion: Diabetic ketoacidosis is a life-threatening complication of Type 1 Diabetes Mellitus in children and adolescents. Preadolescent and adolescent age groups are facing more risk of developing DKA with female predominance.

115.Retrospective Assessment of the Clinic-etiologic Profile of Neonatal Seizures in Level III NICU
Ashish Kumar Basant, Ankur Gautam
Abstract
Aim: Study of Clinical Profile of Neonatal Seizures in Level III NICU in Bihar region. Methods: This retrospective study was carried out in the Department of Pediatrics, Saraswathi Institute of Medical Sciences, Hapur, India from September 2019 to March 2020 . A comprehensive history was collected for the antenatal, natal, postnatal and family history. Age of initiation, form, duration and amount of seizures, consciousness before and after the seizures were taken. Comprehensive neonate examination was performed after detailed history. Relevant investigations were carried out depending upon clinical presentation. Results: In our analysis of 100 neonatal seizures, 97 had one of the four classically identified neonatal seizures. Multifocal clonic seizures were among the most common type of seizures 36% (36 cases) followed by subtle 27% (27 cases), GTS 26% (26 cases), Myoclonic 7% (7 cases), mixed type of seizures 3% (3 cases) and focal clonic seizures 1% (1 cases). Conclusion:Neonatal seizures are most frequently due to birth asphyxia, better antenatal and perinatal care reduces birth asphyxia and if mothers are identified as high-risk.

116.Prospective Observational Assessment of the Role of Serum CA125 Levels in Predicting the Outcome of Threatened Abortion
Anjana, Rupesh Kumar, Binod Kumar
Abstract
Aim: To evaluate the role of serum CA125 levels in predicting the outcome of threatened abortion. Material and Methods: This prospective observational study was carried out in the Department of Pathology, Sheikh Bhikhari Medical College, Hazaribagh, Jharkhand, India for 6 months. Total 70 patients having complained of vaginal bleeding with gestation age between 7 to 14 weeks were included in this study. Their blood samples were taken and sent for Complete blood count, liver function test, renal function test, ABO Rh, viral markers, serum CA 125 levels. All participants were subjected to sonographic examination to confirm gestational age, fetal viability, and intrauterine single gestation. Results: The ROC graphs gives us the cut off level of 60 IU/ ml in predicting the risk of abortion, with the sensitivity of 85%, specificity of 90%, PPV of 82.5%, NPV of 92 and accuracy of 88. Thus making CA 125 clinically important in predicting the outcome of patients with threatened abortion at an early stage of gestation.  71.43% of patients of threatened abortion with maternal serum CA 125 level of more than 60 IU/ml aborted while 28.57% of patients of threatened abortion with maternal serum CA125 level of more than 60 IU/ml continued to the period of viability. Among patients of threatened abortion with serum CA 125 level lesser than or equal to 60 IU/ml, 16% of patients aborted while 84% of patients continued to the period of viability. Statistically the difference was significant with p value of <0.001. Conclusion: Measurement of serum CA-125 may be an inexpensive, easily available, sensitive and specific predictor of outcome in threatened abortion, which results the loss of pregnancy.

117.A Study on Drug Utilization in Geriatric Patients
Braj Nandan Kumar Sah, Sara Sultana, Jeetendra Kumar
Abstract
Objectives: This present was to evaluate the drug utilization and clinical conditions in geriatric patients. Methods: A total of 100 geriatric patients with age group 65 to ≥ 80 years were enrolled in this study. Rationality of prescriptions was analysed using WHO prescribing indicators. This includes five indicators which are – average number of drugs per prescription, drugs prescribed by generic name, number of antibiotics prescribed, number of injections prescribed, and drugs prescribed from essential medicines list. Results: Majorities of patients 63(63%) were in age group of 65-70 years. 67(67%) patients were males, and 33(33%) patients were females. The most common condition for admission in medical ward were cardiovascular disorders 33(33%) followed by respiratory distress 21(21%), genitourinary disorders 18(18%) and gastrointestinal conditions 7(7%). A total 834 drugs were prescribed. Average drug prescription was 8.34. Conclusions: Preponderance of geriatric patients are more in male. Most common conditions are cardiovascular disorders followed by respiratory disorders and genitourinary disorders in geriatric patients. Hence, geriatric patients are more prone to multiple disorders and more dependent on multiple drugs. So that, health care concerns should always monitor the drugs utilization to minimise the risk for adverse effect.  Safer drug utilization may help in improving the quality of life in geriatric patients.

118.A Study on The Assessment of Utilization of the Antenatal Services and Associated Barriers Among Mothers in Northern Area of Bihar
Sara Sultana, Braj Nandan Kumar Sah, Jeetendra Kumar
Abstract
Objectives: This present study was to evaluate the utilization of the antenatal services and associated barriers and sociodemographic profile of pregnant women in northern area of Bihar. Methods: Socio-demographic details and data related to antenatal check-ups and associated barriers for not availing the services were asked from all the pregnant women and records were prepared in a prescribed Performa. Subjects were also asked for the health facility records if available and the information gathered by the interview was cross checked and supported by these records. Results: A total of 200 pregnant women were enrolled in this study. Most of the pregnant women 90(45%) and 49(24.5%) were in age group of 24-29 years and 18-23 years respectively. Most of the women 96(48%) and 92(46%) were belonged from lower middle and upper lower socioeconomical status respectively.  Majorities of pregnant women 58(29%) were illiterate and 194(97%) were housewives. Conclusions: Poor literacy, lower socioeconomic vulnerabilities, lack of knowledge and cost of services are the main barrier for non- utilization or partial utilization of antenatal care services. So that, the health care providers should be organised free health check -up camp time to time in rural as well as urban area of northern Bihar for awareness and services of the maternal health and antenatal care.

119.A Study on Snake Bite Victim Treatment Outcome in Tertiary Care Hospital in Bihar, India
Braj Nandan Kumar Sah, Sara Sultana, Jeetendra Kumar
Abstract
Objectives:  This present study was to evaluate the treatment outcome of snake bite victim in tertiary care hospital, in northern Bihar, India. Methods: A total of 50 snake bite victim who were reported in emergency unit were enrolled in this study. The information was recorded in a structured Performa from patient bed –head ticket (BHT). All the information were categorized into type and site of snake bite, time lapsed from the time of bite till the time of hospital admission, clinical characteristics of snake bite, severity, time and quantity of antisnake venom used and treatment outcome. Results: Most of the cases 32(64%) were males. Preponderance 20(40%) was more in age 21-30 years. Clinical characteristics of snake bite victim was in range from mild cellulitis 27(54%) to severe respiratory difficulty 13(26%). Maximum patient arrival in hospital after the bite was 2-7 hours. Majority 34(68%) of cases were administered 10 vials ASV. Only 6(12%) patients were administered 20 vials ASV. Conclusions: The preponderance of snake bite victims is more in younger age male populations. Hence, early hospitalisation with recognition of poisonous nature of the snakebite with prompt ASV administration results in reduced complications and improved treatment outcomes.

120.A Study on the Evaluation of Adverse Drug Reactions Associated with Antiretroviral Therapy in Tertiary Care Hospital
Sara Sultana, Braj Nandan Kumar Sah, Nadeem Arshad
Abstract
Objectives: This present study was to evaluate the sociodemographic profile and adverse drug reaction in HIV patients with antiretroviral therapy in tertiary care hospital in Bihar. Methods: A total of 200 diagnosed cases of HIV infection based on various clinical features and laboratory investigations were enrolled in this study. Socioeconomic status (SES) of the patients were assessed by Modified Kuppuswamy score. Causality assessment of the reactions was done by WHO causality assessment scale and modified Hartwig and Siegel’s scale was used for severity assessment. Once the ART drug causing the drug reaction was identified, the offending agent was stopped, and the regimen was changed. Results:  Out of 200 HIV cases, most of the cases 100(50%) were in age group of 34-49 years. And 128(64%) cases were males. According to the modified Kuppuswamy scale, most of the patients 129(64.5%) were belonged in lower middle class and had 11-15 score. Out of 200 cases, 90 (45%) cases had shown adverse drug reaction with ATR. Among them cases had 41(45.55%) anaemia, 23(25.55%) nephrotoxicity, 15(16.67%) skin rashes, 7(7.78%) giddiness, 3(3.33%) peripheral neuropathy and 1(1.11%) lipodystrophy. Conclusions: Preponderance of HIV infection was more common in lower middle class socioeconomic and middle-aged male population.  Anaemia was the most common side effects with ART associated with ziduvudin based regimens.

121.A Study on the Evaluation of Elevated Serum Triglyceride the Strongest Single Indicator for the Presence of Metabolic Syndrome in Type 2 Diabetes Mellitus Patients
Braj Nandan Kumar Sah, Sara Sultana, Jeetendra Kumar
Abstract
Objectives: This study was to evaluate the elevated serum triglyceride the strongest single indicator for the presence of metabolic syndrome in type 2 diabetes mellitus patients. Methods: All the enrolled patients were divided into two groups (group A & group B). Group A included metabolic syndrome and group B included non-metabolic syndrome patients. A complete assessment like as detailed medical history, demography and physical examination. Anthropometric parameters such as BP by sphygmomanometer, waist circumference by measurement tape in cms or inches were performed. Blood samples were obtained for testing of blood sugar, lipid profile, liver and renal function. Metabolic syndrome was diagnosed using modified National educational program adult treatment panel-III NCEPATP-III criteria. Results: A total of 200 type 2 diabetes patients with age group 40 to >70 years were included. Majorities of patients were in age group of 50 to 60 years. 130(65%) patients were males and 70(35%) were females. Prevalence of metabolic syndrome was 110(55%). When compared mean ± S.D of WC and triglyceride levels between metabolic syndrome and non-metabolic syndrome patients respectively. P-value was found to be 0.0001. which is highly significant differences. Conclusions: Preponderance of metabolic syndrome was higher in type 2 mellitus patients. Elevated triglyceride levels and increased waist circumference were the most common predictors of metabolic syndrome in type 2 diabetes mellitus patients.

122.Alteration of Liver Function Tests in COVID-19: A Correlation with Clinical Severity
Swarnim Swarn, Indu Prasad, Satish Kumar, Binod Shankar Singh
Abstract
Introduction: Coronavirus disease-19 (COVID-19) can cause a spectrum of clinical features ranging from being asymptomatic to flu-like syndrome, pneumonia, multi-organ failure and death. Liver damage in COVID-19 has been attributed to the direct attack by SARS-CoV-2, drug toxicity in COVID-19 therapy, acute inflammatory damage and hypoxia caused by pneumonia. Aim: The present study was aimed to understand whether COVID-19 causes significant alterations of liver function tests and what is the correlation between liver function tests and clinical severity. Material and methods: A cross-sectional study was conducted at Vardhaman Institute of Medical Sciences, Pawapuri, Bihar, India from July 2020 to May 2021 after receiving approval from the Institutional Ethics Committee. Two hundred COVID-19 patients, 18 years and above were selected and categorized into asymptomatic cases, mild cases, moderate cases and severe cases on the basis of clinical and radiological criteria. Venous blood sample was tested for Serum Bilirubin, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Alkaline phosphatase (ALP) and Prothrombin time (PT). Obtained data was statistically analyzed using SPSS. Results: Out of two hundred cases, 19% of cases were classified in the asymptomatic group, 41% in the mild group, 29% in the moderate group and only 11% in the severe group. Mean serum bilirubin in the severe group was 4.4±2.7mg/dl. The mean ALT in the moderate and severe group was 197±44 U/L, 964±243U/L and mean AST 293±87U/L, 1172±301U/L respectively. PT was found 17.77±2.78 seconds and 23±3.45 seconds in the moderate and severe groups respectively. These alterations in Liver function test parameters were found statistically significant when compared among different severity groups. Conclusion: COVID-19 is associated with hepatic injury and alteration in liver functions. Liver enzymes can be used as markers of severity of COVID-19.

123.An Observational Assessment of the Prevalence of Postnatal Depression and to Study the Associated Risk Factors of Postnatal Depression
Upendra Paswan, K. Manju
Abstract
Background: Postnatal depression (PND) is a serious mental illness that can strike women at any time during or after birth. Its danger rises over the first 90 days and can last up to almost two years, putting a strain on society as a whole. Although the cause of PN is uncertain, there are risk factors that can lead to the disease. The purpose of this study is to determine the prevalence of PND and its risk factors among women in Bihar. Material & Methods: A total of 170 women after delivery were included in the study. Data were collected through a self-administered questionnaire with Edinburgh Postnatal Depression Scale (EPDS) from mothers up to four months postpartum. Results: Prevalence of post-natal depression (PND) was 34%. PND showed significant association with primiparous women, husband’s occupation and unplanned pregnancy. Conclusion: A fairly high prevalence of postpartum depression was revealed among the females after delivery. Therefore, were commend screening of mothers after delivery to help early intervention and management along with psychosocial support.

124.An Observational Cross-Sectional Determination of the Epidemiology and Type of Ocular Injuries that Resulted from Motorcycle Accidents
Nandani Priyadarshini, Vikash Vaibhav, Uday Narayan Singh
Abstract
Aim: This study was aimed at finding out epidemiology and type of ocular injuries that resulted from motorcycle accidents. Methodology: This is a type of cross sectional study including 240 patients. All the cases referred to the Department of Ophthalmology, NMCH, Patna, Bihar, India from November 2017 to October 2018.  a result of motorcycle accidents and cases of eye injuries occurring in patients seen at the Accident and Emergency Unit of the Hospital were included. Visual acuity was measured with Snellen’s chart in those who were conscious. Eye examination was done with the aid of a pen torch, slit lamp biomicroscope and direct Ophthalmoscope. The age, sex and presenting complaints were noted. Results: Out of 240 patients, there were 197 (82.1%) male and 43 (17.9%) female cases. The commonest affected age group was 21-30 years with 74 (30.8%) cases followed by 31-40 years age group of 57 (23.7%) cases and least affected age group was less than 10 years and more than 80 years with 03 (1.3%) and 08 (33.3%) patients respectively. Most common presenting complaint was pain in 132 (55.0%) cases. Most common injured persons were the motorcycle drivers 157(65.4%). Out of 284 eyes, 156 (54.9%) eyes had visual acuity 6/6 to 6/18, 90 (31.7%) eyes had visual acuity 6/24-6/60 and 7 (2.5%) eyes had visual acuity of <3/60- PL+ / No PL (Perception of light) at presentation. Involvement of the conjunctiva either in form of traumatic conjunctivitis, sub conjunctival haemorrhage or conjunctival laceration was the commonest condition seen in 66 eyes (23.2%). This is followed by corneal lesions either in form of laceration, abrasion or ulceration, contributing 20.1% (57 eyes) and lid laceration in 54 eyes (19.1%). Conclusion: Ocular injuries secondary to motorcycle accidents are becoming very common. Public enlightenment campaigns through electronic media and other means to educate people on the need to seek early and appropriate treatment in cases of ocular injury and road safety programs should also be embarked upon.

125.A Prospective Study to Assess the Association Between Clinical and Radiological Outcomes of Microscopic Discectomy in Patients with Lumbar Disc Herniation
Amit Kumar, Neha Kumari, Alok kumar
Abstract
Aim: To correlate clinical and radiological outcomes of microscopic discectomy in patients with lumbar disc herniation. Methodology: This was a prospective study conducted in the Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India during a period of 18 months. 30 patients scheduled for micro lumbar discectomy for lumbar disc herniation. All patients first underwent conservative for the minimum period of three weeks, after which they were counseled for operative option. Those patients were included who had an unremitting sciatica, with or without back pain, and/or a neurological deficit that correlated with appropriate level and side of neural compression revealed on CT or MR imaging. We did not exclude patients who presented with other spinal degenerative conditions such as stenosis or arthritis with herniated disc because their symptoms were suggestive of the herniated disc. Patients with associated bony canal stenosis and spondylolisthesis were excluded. As with all surgical procedures, informed consent, demographic details, and clinical history were obtained and an explanation of risks, alternatives, and benefits was given. Results: Out of 30 patients, majority of the patients were males (66.7%) and 33.3% were females. Average age of the patients was 43.75 years (21-68 years). All surgeries were single level micro discectomy including L3-L4 (10%), L4-L5 (60%), and L5-S1 (30%). All the cases of L4-L5 and L3-L4 discectomy required fenestration of L4 and L3 lamina respectively while only 2 cases of L5-S1 required fenestration of the L5 lamina for the proper exposure of the disc space. Operative time on the average was 79 minutes (range 50 to 150 minutes). 80% of the patients had a stay of less than 5 days in the hospital, while 20% of patients had a stay of more than 5 days in the hospital. Disc sequestration (30%) and disc exclusion (26.7%) were the most commonly seen types of prolapse followed by central disc bulge (20%), disc protrusion (13.3%), and lateral disc bulge (10%). On assessing the outcome in patients in terms of returning to activities of daily living and satisfaction with surgery, 86.7% and 76.7% had score less than 2 respectively, while only 13.3% and 23.3% patients had a score more than two respectively. Conclusion: Lumbar discectomy with microscopes is very safe and effective means of treating disc herniation related sciatic pain. But conservative management should be done first. If there is no improvement, lumber micro discectomy can act as a gold standard option.

126.A Hospital Based Assessment of Clinical Profile of Falciparum, Vivax and Mixed Infections of Malaria
Chandra Shekhar Das, Rajeshwer Kumar Ranjan, Chirag Agrawal
Abstract
Aim: The aim of our study was to find out the spectrum of clinical manifestations, infecting species, age distribution and mortality in admitted patients of malaria in our hospital and to compare the clinical profile with severity of P.vivax and P. falciparum malaria in pediatrics age group in a tertiary care hospital. Methods: Malaria confirmed by Peripheral thick and thin smear or Antigen Assay underwent detailed clinical history and physical examination. Statistical analysis was done using chi square test for comparing proportions. P value < 0.05 was considered significant. Results: In the present study, out of 120 patients a greater number of males (77 patients) were affected when compared to females (43 patients). The predominant age group affected was 20-30 years, which constitutes to about 64%, followed by 31-40 years (34%). Fever is the most common presentation in all 120 patients both falciparum and vivax infected patients. Pallor was the most common clinical sign, was observed in 68 patients of falciparum and 52 with vivax species. Conclusion: Malaria is very common disease in our country. Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity.

127.Hospital Based Assessment of the Morphology and Etiology of Granulomatous Lesions on Histopathologically Evaluated Biopsies of the Skin and Subcutaneous Tissue
Rachna Kumari, N. K. Briar
Abstract
Background: Granulomatous dermatoses are common skin pathology, often need histopathological confirmation for diagnosis. Histologically six sub-types of granulomas found in granulomatous skin diseases- tuberculoid, sarcoidal, necrobiotic, suppurative, foreign body & histoid type. Objective: The aim was to study the morphology and find the etiologyof all the granulomatous lesions on histopathologically evaluated biopsies of the skin and subcutaneous tissue. Materials and methods: A prospective study was done in Patna Medical College & Hospital, Patna, Bihar, India from August 2019 to August 2020. The biopsies of the cases diagnosed as granuloma on H & E-stained sections were selected. Special stains like Ziehl-Neelsen stain, Gomori’s Methenamine silver were done wherever required. Results: Total of 78 granulomatous lesions were studied. Granulomas with different morphology and etiology were seen. Out of a total 78 cases, 39 cases (50.0%) showed tuberculoid granulomas,12 cases (15.3%) showed histiocytic granulomas,15 cases (19.2%) showed foreign body granuloma, 8 (10.2%) showed suppurative, 4(5.1%) showed necrobiotic granuloma. Conclusion: Granulomatous lesion of skin was most common lesion in males. Commonest type of granuloma was tuberculoid and the most common etiological subtype was borderline tuberculoid leprosy.

128.Bipolar Affective Disorder: A Gender-Based Comparison of Ways of Coping and Problem Solving
Shravan Kumar, Suhail Ahmed Azmi, Rakesh Kumar Gaur, Deoshree Akhouri, Hamza
Abstract
Aim: Ways of coping and problem solving in individuals with bipolar affective disorder. Materials and Methods: This cross-sectional study was carried out in the Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India. Total 100 respondents from in-patient and out-patient department of a psychiatric hospital were included. Socio-demographic data sheet, ways of Coping Skills and Problem- Solving Questionnaire was administered to collect data. Descriptive statistics and t-test was used to assess the aim of the study. Result: It was found that Mean±SD for male respondents was 10.72±3.71 and 10.82±2.70 for female respondent with t-value .122 (p >.06) for confrontive coping, Mean±SD for male respondents was 9.88±2.45 and 9.75±2.15 for female respondents with t-value .268 (p > .06) for distancing, Mean±SD for male respondents was 12.35±2.70 and 12.82±2.59 for female respondents with t-value .689 (p > .06) for self-control, Mean±SD for male respondents was 10.22±2.25 and 10.55±2.43 for female respondents with t- value .557 (p > .06) for seeking social support, t-value was .451 (p > .06) for accepting responsibility, t-value was .830 (p > .06) for escape avoidance, t-value was 1.66 (p > .06) for painful problem solving and t-value was .579 (p > .06) for positive reappraisal. The results from table 1 show no statistical difference between male and female respondents on ways of coping questionnaire. There exists no statistical difference between the scores of male and female respondents on problem solving inventory. The Mean±SD of male respondents was 35.55±6.02 and 34.52±6.06 for females with t-value 1.266 (p > .06) on the domain problem solving confidence. On approach avoidance scale Mean±SD was 58.25±5.68 and 57.18±6.10 for male and female respondents with t-value .653 (p > .06). Mean±SD for male respondents was 20.55±4.92 and 19.75±3.07 for females with t-value .192 (p > .06) on personal control domain. Conclusion: The study concludes that gender difference does not exists when applying ways of coping and problem-solving skills in day-to-day life of the respondents with BPAD. The results of the study also concluded that coping skills and problem-solving skills are poor in the people suffering with BPAD.

129.A Clinical Study on Management of Complications of Chronic Suppurative Otitis Media
A. Naga Raju, T. Maheshwari Rani, K. Ramesh, A. S. Aruna Kumari
Abstract
Background: The incidence of complications of CSOM is high in tropical countries like India. various factors like low living conditions, over-crowding, low personal hygiene, and importantly low economy play an important role. The aim of the study is mainly to find out the incidence of various complications of CSOM. Methods: This cross-sectional study was conducted in the Department of ENT and Head & Neck Surgery, Government General Hospital, Kurnool Medical College, Kurnool. The ear was examined for the presence of scanty discharge, flakes or crusts adjacent to the tympanic membrane, presence of polypi, granulations, Cholesteatomas. Mastoid tenderness was elicited over the Macewans triangle, mastoid tip, and posterior border of the mastoid process. Results: Total number of patients with COSM attending ENT OP was n=18,100 and the total number of patients admitted in the ENT Department during the study period with intra and extracranial complications was n=40 which is 0.22 percent. The common pathology of the middle ear was granulations and cholesteatoma in n=18(45%) cases both were found in n=10(25%) and polyp were found in n=4(10%) of cases. Conclusion: With the advent of newer diagnostic modalities which include CRT/MRI, culture and sensitivity, and use of proper antibiotics and early interventions the incidence of complications can be still reduced. However, the only limitations are ignorance, poverty, and illiteracy which results in the delayed seeking of medical care contribute to the incidence of complications.

130.Study on Prevalence of Thyroid Dysfunction and Associated Risk Factors Among Type 1 Diabetes Mellitus Patients from South India
Boyapati Anand Kumar, Mungara Ranjith Kumar
Abstract
Background: Type 1 Diabetes Mellitus is a chronic endocrine disorder of children and early adults of autoimmune origin. Diabetes mellitus is being one of the greatest health threats for the 21st century. Because of high prevalence, lack of clinical features and the impact on morbidity, most investigators recommend screening children and adolescents with type 1diabetes for autoimmune thyroid disease. Thus, the aim of the study is to find the prevalence of thyroid disorder status in type 1 diabetes mellitus. Method: Data were collected from 50 type 1 Diabetic patients. Thyroid dysfunction was said to occur if patients thyroid hormones fall outside the reference range (free T3 (4.0– 8.3 pmol/L), free T4 (9.0–20.0 pmol/L), and TSH level (0.25 – 5mIU/L). Collected data was entered in Microsoft excel 2016 for further analysis, statistical analysis was done by using SPSS version 25. Results: The prevalence of thyroid disorder was found to be 20% in type 1 DM. Population comprised 50% males and 50 % females with mean age of 44.2±19.2 years. The mean age of males and females was 48.23 ± 12.3 years and 44.3 ± 13.4 years, respectively. It was observed that smoking hobbit and hypertension, family history of thyroid disease and female were the risk factor for thyroid dysfunction. Conclusion: The present study identifies thyroid dysfunction, as well as prominently subclinical hypothyroidism, and also some risk factors were associated in type 1 diabetes mellitus. Thus, regular screening of thyroid disorder, specially in family history of thyroid is recommended in this study.

131.A Retrospective Study to Establish the Incidence of PPCs in a Cohort of Patients Undergoing Emergency Laparotomy and the Consequences on Patient Outcomes
Ajay Kumar, Ashutosh Kumar Singh, Anupama Kumari
Abstract
Aim: This study aimed to establish the incidence of PPCs in a cohort of patients undergoing emergency laparotomy and the consequences on patient outcomes. Methods: A retrospective analysis was conducted of patient that underwent emergency laparotomy over a period of three years at the Department of General Surgery Nalanda Medical College and Hospital, Patna, Bihar, India.  A total of 400 patients coming to the hospital were selected randomly for this study. Individual patient data was collected using proforma which included demographics, date of operation, risk stratification using ASA score, P-POSSUM, serum lactate and serum creatinine, operative details, critical care service utilization post-operatively and in-hospital outcomes. Results: The table demonstrates high risk patients ended up having significantly worse outcomes than low risk patients. High-risk patients were older (67 years {IQR 51–77} vs. 48 {IQR 38–66}; p < 0.001) and had higher PPOSSUM predicted mortality scores (p < 0.001). The incidence of PPCs within the entire cohort was 37%. The burden of PPCs was almost entirely in the high-risk patients with an incidence of 35%, with only 5%of the low-risk patients developing a PPC. Conclusion: This study demonstrates that the sub-group of patients deemed ‘high-risk’ are at greatest risk of developing a PPC and consequently has an increased length of stay and an increased 90-, 180- and 360-day mortality. This allowed us to identify a group of patients at high risk of PPC who we can target with potential novel therapies such as high-flow nasal cannula oxygen in clinical trials to reduce mortality and morbidity.

132.A Case-Control Study to Evaluate Electrocardiogram (ECG) Changes in A Group of Newly Diagnosed Subclinical Hypothyroid Females
Anant Kumar, Rajiva Kumar Singh, Priyanka
Abstract
Objectives: The objectives of this study were to study the electrocardiogram (ECG) changes in a group of newly diagnosed subclinical hypothyroid females and to compare the ECG changes in subclinical hypothyroid females with normal healthy euthyroid individuals. Materials and Methods: This study was conducted in the Department of Physiology, Department of Physiology, Patna Medical College & Hospital, Patna, Bihar for 1 year. We studied 50 patients with newly diagnosed and untreated primary SCH who presented to KIMS, outpatient department with non-specific complaints such as fatigue, mild weight gain, dry skin, and depressive feelings but without overt symptoms and signs of thyroid hormone deficiency. Clinical and biochemical parameters and ECG were studied. Statistical software, “GraphPad QuickCalcs,” was used for the statistical analysis. Results: A total of 100 subjects (50 in the study group and 50 in the control group) were included in the study. Both groups were well matched with regard to age and BMI. Heart rate and blood pressure were comparable in both the groups. TSH levels were significantly higher in SCH patients than controls, but fT4 and fT3 were comparable. Conclusion:The present study concludes with the following important finding that patients of SCH have prolonged QTc interval, which predisposes to the potentially life-threatening ventricular arrhythmias. Therefore, it may present as a useful tool in monitoring the cardiovascular risk.

133.Prospective, Randomized, Three-Arm, Open- Label Study to Compare the Efficacy and Tolerability of Oral Desloratadine, Rupatadine and Ketotifen in Seasonal Allergic Rhinitis
Anshu Kumar1, Pramod Kumar, Rana Pratap Thakur
Abstract
Aim: To compared efficacy and tolerability of desloratadine, rupatadine and ketotifen in SAR. Patients and Methods: This was a prospective, randomized, three-arm, open- label comparative study of desloratadine, rupatadine and ketotifen in SAR. The study was conducted at Department of ENT, ANMMCH, Gaya, Bihar, India. The duration was one year. The severity of SAR symptoms was assessed by the Total Nasal Symptom Score (TNSS), which is a subjective graded scoring system based on the severity of nasal symptoms. Quality of life (QoL) was measured using a 12-item short form of the Medical Outcomes Study questionnaire (SF-12). SF-12 was administered at the start of the study and then at the end of the study. Results: Total 180 patients were recruited for this study, divided into 3 groups. DES and RUP were equally effective but significantly better than KET in improving rhinorrhea, nasal congestion, TNSS and AEC. (p=0.05). All three study groups showed a gradual and progressive improvement in rhinorrhea. RUP was slightly faster than DES in improving rhinorrhea in the first 2 weeks (p>0.05). Conclusion:DES and RUP are comparatively more effective and faster acting than KET. All the study medications were well tolerated with few mild, self-limiting, transient adverse events requiring no intervention.

134.Prospective Comparative Assessment Between Laparotomy and Laparoscopy for the Management of Ruptured Ectopic Pregnancy
Anumeha Anand
Abstract
Aim: The aim of this study to compare between laparotomy and laparoscopy for the management of ruptured ectopic pregnancy. Material and methods: This prospective comparative study was carried out in the Department of Obstetrics and Gynecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. Total sampling methods, there are 50 samples. Data analysis for this study uses Statistical Product and Service Solutions (SPSS). Univariate analysis is done for the prevalence of every variable. Multivariate analysis is done to determine the statistical correlation between maternal age, parity, pregnancy weeks, hemoglobin level, transfusion and postoperative hospital stay with the type of surgery. Results: Every sample underwent surgery, where 25 (50%) samples undergo laparotomy. The most common clinical signs and symptoms is abdominal pain which is 38 (76%) samples and 25 of them underwent laparotomy. Almost every sample, which is 45(90%) samples are not in shock. 20 of them underwent laparotomy. The most common site of ectopic pregnancy located in tubal; where 25 of them underwent laparotomy. The most common type of surgery is a salpingectomy laparotomy with a total of 13 samples. In this study, there is a statistical correlation between transfusion and methods of surgery with a p-value of 0.008. Meanwhile, there is no statistical correlation between maternal age, parity, pregnancy weeks, hemoglobin level and duration of postoperative hospital stay with methods of surgery. Conclusion: we conclude that laparotomy is still the preferred method of surgery for managing ruptured ectopic pregnancy in Indonesia. This might be caused by a lack of equipment or operator skills in managing ruptured ectopic pregnancy with laparoscopy. Laparoscopy has a smaller incision, therefore minimal bleeding and transfusion are needed compared to laparotomy. Patients undergoing laparoscopy are hemodynamically stable, so transfusion can be minimized.

135.An Analytical Cross Sectional Study to Assess the Correlation Between Various Levels of Cord Blood Albumin & Serum Bilirubin at 48 Hours of Age in Term Healthy Newborns
Binit Singh, Ved Prakash Gupta, Rizwan Haider
Abstract
Introduction: Neonatal hyperbilirubinemia is the most prevalent abnormal physical finding in newborns and the leading cause of neonatal morbidity. Early detection of at-risk infants may aid in the provision of preventative therapy and follow-up. We aimed to see if the level of albumin in the umbilical cord at delivery predicts the development of neonatal hyperbilirubinemia in term neonates 48 hours later. Methods: The level of cord blood albumin was measured at birth, followed by the level of serum bilirubin on the third postnatal day (48 hrs of age). The neonates were separated into three groups based on cord blood albumin levels of 2.8 g/dl (group I), 2.8-3.4 g/dl (group II), and >3.4 g/dl (group III), with 68, 179, and 93 neonates in each group.At 48 hours of age, 39 newborns (59.4%) in group I, 16 in group II, and 6 newborns (10.3%) in group III had serum bilirubin levels above an intermediate high-risk zone in the Bhutani nomogram. At 48 hours of age, newborns with low cord albumin (2.8g/dl) had significantly higher bilirubin levels. Conclusion: At 48 hours of life, neonates with cord blood albumin 2.8 gm/dl had a significant connection with the development of hyperbilirubinemia in the intermediate high-risk zone or higher, according to the Bhutani nomogram.

136.Prospective Observational Study of Clinical Spectrum and Management of Acute Intestinal Obstruction
Ashutosh Kumar Singh, Ajay Kumar, Anupama Kumari
Abstract
Aim: Study of clinical spectrum and management of acute intestinal obstruction. Methods: This prospective study conducted in the Department of surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 15 months.  A total of 100 patients of acute intestinal obstruction were studied. Patients coming to the hospital with features suggestive of acute intestinal obstruction, Patients included were in age group of 20 years to 78 years and Patients were informed about the study prior to inclusion and were included after written consent. Results: Maximum that is out of total 100 cases, 50 (50%) cases reported after 72 hours of onset of complaints and 39(39%) cases reported within 48-72 hours. 10 cases (10%) reported within 24-48 hours. The present study of acute intestinal obstruction showed that abdominal pain (91%), constipation (86%) and abdominal distension (74%) were the most common symptoms with which patients presented to us in emergency department. X-ray abdomen erect was done in all cases. The most common finding observed was distended small bowel loops with air fluid levels with absent colonic gas in 32 (32%) patients. Thus, X-ray abdomen erect was found useful in total 81(81%) cases. In our present study adhesiolysis procedure was carried out in 14(28%) cases. Single loop/band adhesions were separated easily followed by adhesiolysis of dense adhesion upto the level which relieves obstruction was done. In 4 patients of Koch’s abdomen, adhesiolysis was done. Resection and anastomosis was carried out in 48 (35.56%) cases most commonly in large bowel obstruction. Conclusion: Present study concluded that small bowel obstruction is more common than large bowel obstruction.

137.An Observational Study to Assess the Obstetric Outcome After Emergency Cervical Cerclage
Varsha Sinha, Swetabh Verma
Abstract
Aim: To study Emergency cervical cerclage and pregnancy outcomes. Materials and Methods: This observational study was carried out in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. The first author was the operating surgeon for all the cases. All the women who presented between 10 to 25 weeks of gestational age diagnosed with cervical dilatation ranging between 2 to 4 cms were proposed for cervical encerclage after ruling out after ruling out labour, placental abruption and infection. Results: Three patients had spontaneous abortion after cervical cerclage, two had PROM and one had severe contractions not responding to tocolytics and hence cerclage had to be removed. In around 88 percent of the patients pregnancy was prolonged beyond 28 weeks and around 54 percent. In our study group majority of the cases, pregnancy was prolonged up to 15weeks 1 day to 20 weeks (36%) followed by 10 to 15 weeks (28%). In four patients who presented at early gestation with incompetence pregnancy was prolonged beyond 20 weeks. Out of the 25 patients for whom emergency cervical encerclage was performed 21 fetus were live born after the period of viability. The mean birth weight of the neonate was 2.01 kg with equal number of them weighing more and less than 2 kg. The birth weight ranged between 1.1-3.9 kg. Conclusion: The precise incidence of cervical incompetence is unknown. Studies have also shown that where there is mere cervical shortening or funneling of the cervix as compared to cervical dilatation, the outcome in terms of prolongation of pregnancy and live births and neonatal survival is better.

138.A Hospital Based Study to Evaluate the Pattern of Lower Respiratory Tract Infections in Children Below 12 Years of Age: An Observational Study
Varsha Sinha, Swetabh Verma
Abstract
Aim: This study was conducted to know the incidence of different types of LRTIs and the common causative organisms. Methods: Routine investigations were carried out on 305 hospitalized children over 12 months and with special investigations like X-ray chest, USG chest, blood culture, pleural fluid analysis, tuberculin skin test, and CBNAAT for tuberculosis. Results: A total of 198 cases were selected for this study. The minimum hospital stay was 3 days, and the maximum was 21 days. The incidence of LRTI in children was maximum (51.0%) in 1 – 4 years age and Protein-energy malnutrition (PEM) was detected in 75.5% children. Mantoux test was positive in 20.7%. Conclusion: Maximum incidence of LRTIs were detected between the age group of 1 – 4 years, malnutrition was an associated factor.

139.Assessment of Ear, Nose and Throat Manifestations in Head Injury Cases: A Prospective Study
Pramod Kumar, Anshu Kumar, Rana Pratap Thakur
Abstract
Aim: A prospective study was done by us at tertiary care center to assess the ear, nose and throat manifestations in head injury cases. Materials & Methods: The study was carried over a period of two years and 150 patients were included. Number of male patients were more than females and young age group was affected more. This study has been done to evaluate various ear, nose and throat manifestations and investigations which help in earlier diagnosis. Results: Among 150 patients 120 (80%) were males and 30 (20%) were females, out of which three patients were in the age group of 0-15 yrs. Maximum i.e. 36 patients were in the age group of 31-45 yrs. 64 patients were having ear manifestations like bleeding from the ear (20), external ear laceration (10), fracture temporal bone (6), facial palsy (4), CSF otorrhoea (4), traumatic perforation (4), tinnitus (7) and vertigo (4). Conclusion: Screening of all the patients with head and neck injuries for the presence of trauma in the ENT region should be introduced to enable early detection and therefore prevention of complications.

140.An Observational Assessment of the Incidence of Premature Rupture of Membranes and its Effect on Prenatal & Maternal Morbidity and Mortality
Rashmi Raginee
Abstract
Objective: To assess the maternal morbidity and perinatal outcome in pre-term/ pre-mature rupture of membranes between 24 to 37 weeks gestation. Methods: This observational study was carried out in Department of Obstetrics and Gynecology, Mahila Chikitsalaya, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. over a period of 14 months. Results: This study was conducted on 175 patients. Of this most patients 98 belonged to poor class, 32 belonged to middle class and upper class accounted for 14 patients. Fetal outcome in 31 cases of preterm premature rupture of membrane revealed prematurity in 7 cases, fetal distress in 6 cases, cord compression in 3 cases, necrotizing enterocolitis in 1 cases, hypoxia in 13 cases and pulmonary hypoplasia in 3 cases. Conclusion: Low socioeconomic status is associated with increased neonatal morbidity due to fetal distress, cord compression, necrotizing enterocolitis, hypoxia and pulmonary hypoplasia at the time of delivery. An appropriate and accurate diagnosis of PROM is critical to optimize pregnancy outcome. It is suggested that the timely diagnosis and management of preterm PROM will allow obstetric care providers to optimize perinatal outcome and minimize neonatal morbidity.

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