1.Study on the Association of Dietary Habits with Cardiovascular Disease in South-Eastern Rajasthan
Hemlata Sharma, Varun Kumar Saini, Mayank Sarawag, Jitendra Ahuja
Introduction: Unhealthy Dietary patterns have an important role-playing factor in rapidly progressing cardiovascular incidences. Regional differences, nutrition accessibility, and lifestyle factors can lead to differences among the dietary intake of populations. This research focuses to establish a clear relationship between the type of nutrient & cardiovascular disease in the population of southeastern Rajasthan. Materials & Methods: 200 patients (30-80 yrs) with an established CVD or related symptoms who were admitted in the IPD were included in this study. Using  Semiquantitative food frequency Questionnaire Socio-demographic variables, cardiovascular events, and dietary information(carbohydrate and fat uptake), history of smoking tobacco & chronic alcohol use was collected. Results: A total of 189 patients (131 males and 58 females) were included in the study. Out of these 131 were males(69.%) and 58 were females (30.7%). The mean and standard deviation for the age was 58.62 ± 12.49 years. 81% of the patients had below-normal energy uptake from carbohydrates (i.e. below normal lower limit & up to 500 kCal) with a mean of 714.68 kCal/day. 80% of the patients had a higher dietary fat intake with a mean of 62.01 grams/day. 52.3% ( out of 109) hypertensives,74.2% (out of 62) of chronic tobacco smokers & 81% (out of 21)  experienced MI incidences. Conclusion: To the best of our knowledge this cross-sectional study is the first of its kind to evaluate the association between dietary habits and cardiovascular disease in South-eastern Rajasthan. The intake of fats was higher and that of carbohydrates was low-normal in maximum patients, implying that there is an association between higher fat intake and cardiovascular disease but the causal association is unknown. Strikingly, carbohydrates intake was not found to be associated with cardiovascular disease. Low carbohydrate consumption is probably related to the poor socio-demographic structure of the study population.

2.In-Vitro Cytotoxicity Assay of Crude Extract of Ethnobotanical mixtures used in Indigenous Treatment of Tuberculosis
Jyoti Tomar, Vijaylatha Rastogi, P C Garg, Tarun Patni, Mukul Chaurasia, Chhavi Vijay
Introduction: Use of ethno botanical therapies is more vigorously being explored in combating diseases. Studies published mentioned that crude essential oil (EO) extract of herbal formulary (HS) indigenously used in inhalational & oral treatment of Tuberculosis (TB), is a promising natural product with potential for new drug development in the treatment of TB. Cytotoxicity studies of HS on cell lines are not available in published literature. Materials and Methods: Extraction of essential oil (EO) from the mixture was done by hydro distillation and chemical characterization was done by Gas Chromatography and mass Spectroscopy (GCMS). Cytotoxic effect of two different ethnobotanical mixtures (HS1 and HS2) was studied by MTT assay using human monocyte THP-1 cell line. Statistical Analysis: The IC50 of HS1and HS2 was determined by constructing a dose-response curve of the effect of different concentrations of HS1 and HS2. IC50 values for cytotoxicity tests were derived from a nonlinear regression analysis (curve fit) based on sigmoid dose response curve (variable) and computed using Graph Pad Prism 6 (Graph pad, San Diego, CA, USA). Results: HS1 showed an IC50 value of 454.7µg/ml in THP-1 cells. HS2 did not show significant cytotoxicity. Conclusion: This study proves that the HS1 and HS2 with potent in-vitro anti TB effect are non-cytotoxic on THP-1 cell line, thus proving biological safety of use of these ethno botanical mixtures, traditionally used in TB treatment. This is a milestone development towards novel anti TB drug development.

3.Prevalence of Various Reasons for Donor Deferral In Blood Bank, Jhalawar Hospital and Medical College Society, Jhalawar
Manish Kumar, Brajendra Shakyawal, Ummed Singh Solanki
Introduction: Blood donation and its subsequent transfusion to recipients are considered as an important life-saving intervention in healthcare emergencies. Materials and Methods: The present retrospective study was carried out at Jhalawar Hospital and medical college society blood bank, Jhalawar district, Rajasthan, India, during the 1‑year period from January 2020 to December 2020. The data and information of deferred donors were retrieved from deferral donor register, donor selection form. This study aims to study donor deferral rate and determine the prevalence of various reasons for donor deferral at-Jhalawar hospital and medical college society, Jhalawar, Rajasthan. Result: In the present study, Out of total 11559 registered pre donation screening interviews 11223 were males (97.093 %) and 336 (2.906 %) were females. Total number of deferrals due to various reasons were 231 giving an overall incidence of 1.99 %. Out of these 231 deferrals, 185 (80.086%) were voluntary and 46 (11.913%) were replacement donors. Out of these 231 deferrals, 203 (87.88 %) were deferred due to temporary causes and 28 (12.12 %) were deferred due to permanent causes. Most common causes for deferral were underage/underweight (35.06%) and low haemoglobin (34.63%). Conclusion: Most common causes for deferral were low haemoglobin, low body weight and underage donor. Strict donor selection criteria and donor education regarding self-exclusion is the key point of safe blood supply. A large number of temporarily deferred donors can be recruited back into the donor pool if managed actively. This will also help in maintaining a healthy donor pool in the long run & improvement of efficiency of the donor programme.

4.LASER Lipolysis at 1060 nm: A Promising Tool for Non Surgical and Non-Invasive Fat Reduction
Arvinder Singh
Obesity is state of excess of adipose tissue mass. Obesity is global cause of concern. Lots of medical conditions are linked with Obesity, like insulin resistance, glucose intolerance, diabetes mellitus, hypertension, dyslipidaemia, sleep apnoea, arthritis, hyperuricemia, gall bladder disease, PCOD, coronary artery disease and certain types of cancer. Non-invasive and nonsurgical methods are gaining lot of reputation and interest for fat loss and to combat obesity. The study was conducted at Arth Skin and Fitness Centre, Udaipur and machines of Woxmen Company were used. CALYSTA – Woxmen for LASER lipolysis was used, while for tightening, help of Unipolar and Bipolar Radiofrequency technology was taken. 30 patients were selected between age of 24 to 64 years having Body Mass Index of 27 or above. 20 patients were Male, and 10 patients were Female. All the patients showed good response in terms of reduction of abdominal girth. The average reduction in abdominal girth was 9.9 cms which is approximately 4 inches in single session within 6 weeks of therapy. The highest decrease was 16.5 cms and lowest was 4 cms. Male and female patients responded almost equally to the LASER and Radiofrequency technology. LASER lipolysis at 1060 nm coupled with radiofrequency tightening is promising nonsurgical tool for fat reduction around abdominal areas.

5.Evaluation of Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) Spectroscopy for Characterization of Trichosporon Species Isolated from Clinical Samples
Rastogi V, Parashar A, Bhatnagar M, Sharma M, Rudramurthy SM
Background: Trichosporon is a medically important genus that includes causative agents of deep-seated, mucosa associated and superficial infections. Rapid and accurate identification is very important in institution of appropriate therapy, thereby reducing morbidity and mortality related to Trichosporonosis. The genotypic methods commonly used to discriminate these species are laborious and very expensive. Being cost effective, Fourier-transform infrared spectroscopy with attenuated total reflectance (ATR-FTIR) was evaluated in this study to discriminate between Trichosporon species. Methods: A collection of 75 clinical isolates pre-characterized by phenotypic and PCR-based sequencing techniques and belonging to 5 different Trichosporon and related species [T. asahii (n=62), T. inkin (8), C. dermatis (3), T. asteroids (1), A. loubieri (1)] of Trichosporon were subjected to ATR-FTIR. Standard strains from different genera were used as outliers. Spectral data acquired in the ATR mode under controlled microbiological and physical parameters for all measurements were compared. Infrared spectra were analyzed with Hierarchical cluster analysis (HCA) and Principal component analysis (PCA). A new mathematical operation, Reference & Threshold calculation (R&T) was proposed here for rapid & reliable identification of Trichosporon to species level. Results: The current study using ATR-FTIR method has sharply demonstrated 100% genus level discrimination with protein specific spectral window (1800-900 cm-1). All the 5 different Trichosporon species could be successfully discriminated using second derivative spectra. Clustering data using statistical tools showed that the polysaccharide specific signatures (1200–900 cm-1) were critical markers for species discrimination. The results have been further correlated using PCA. R&T operation applied on the genus and species level resulted in 100% identification concordant with PCR sequencing results. Conclusions: This study has confirmed that ATR-FTIR spectroscopy along with reference and threshold calculation is a promising diagnostic tool for rapid, reliable and cost-effective characterization of clinical Trichosporon species, compared to conventional/molecular techniques.

6.A Comparative Study of Efficacy and Safety of Conventional Versus Newer Antidepressants in Patients with Depressive Episode in A Tertiary Care Hospital
Satyendra Kumar Pathak, Dinesh Sah, Shankar Dayal Singh
Background: Depression is a clinical syndrome that is characterised by a cluster of emotional, behavioural, and cognitive features. Depression also poses a significant economic burden to society as it leads to reduced productivity, treatment costs and loss of human life by suicide. Aims and Objectives: To compare the efficacy and safety of newer antidepressants like Escitalopram and Desvenlafaxine versus conventional antidepressant like Imipramine in patients with Depressive episode. Material and Methods: An open label, prospective, comparative study was conducted in the Department of Pharmacology, Sri Krishna Medical College (SKMC), Muzaffarpur, Bihar associated with psychiatry outpatient department (OPD), Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar during last 3 months. Results: 72 newly diagnosed patients of depressive episode according to ICD-10 criteria were divided into three groups of 24 each receiving Imipramine (Group A), Escitalopram (Group B) and Desvenlafaxine (Group C) and followed up for 6 weeks. Efficacy measurement was reduction in MADRS, CGI-S and CGI-I scores. Safety assessment was by number, severity and dropouts due to adverse drug reactions and laboratory investigations. Data was analyzed using ANOVA and Chi square test. Response rate was 51% in Group B, 43% in Group A and 40% in Group C, but this difference was not statistically significant. Initial response was seen as early as 2 weeks in 51% in group B and 40% in group C but none in group A and showed statistical significance. No statistically significant difference was seen in CGI-S and CGI-I scores at the end of 6 weeks. Conclusion: Newer antidepressants like escitalopram and desvenlafaxine were equally efficacious in treating moderate to severe depressive episode compared to conventional drugs like imipramine however they had an advantage of faster onset of action, better safety and tolerability.

7.Drug Utilization Pattern of Anti-Epileptic Drugs in Tertiary Care Hospital
Shankar Dayal Singh, Satyendra Kumar Pathak, Dinesh Sah
Background: Epilepsy is a chronic neurological disorder that requires therapy over prolonged period of time to keep patient seizure free. Although patients respond with monotherapy, refractory epileptic patients require polytherapy. Drug utilization studies provide insight to rational drug prescribing. Aim and Objective: This study was designed to analyze and to study prescription pattern of antiepileptic drugs in patients with epilepsy in tertiary care hospital. Materials and Methods: The present study was conducted in Department of Pharmacology, SKMC, Muzaffarpur, Bihar by collecting data from medical record department. Detailed data of patients diagnosed with epilepsy including demographic details, comorbidities, and allergies admitted during last 3 months in study pro forma were collected. Results: A total of 150 patient’s data were analyzed and it was found that male patients were most affected with epilepsy compared to females. Generalized tonic-clonic seizure (GTCS) was the most commonly diagnosed in majority of the patients. Levetiracetam (42.0%) was the most commonly prescribed drug as monotherapy, followed by phenytoin (12.66%), sodium valproate (8.66%), and carbamazepine (5.33%). The most common combination of drugs in polytherapy were levetiracetam and carbamazepine (13.33%), phenytoin with carbamazepine (7.33%), phenytoin with sodium valproate (6.66%), and phenytoin with lamotrigine (4.0%). Conclusion: The higher incidence of epilepsy is noted in males of all ages. GTCS was the most common type of epilepsy diagnosed and majority of the patients were prescribed with monotherapy. As it is a retrospective study, there were several limitations in the study such as quality of life of patients, compliance to the drugs, adverse reactions to the drugs were not assessed. Hence, further prospective studies with more sample size should be conducted to assess various factors on drug utilization in epilepsy.

8.Case Control Study to Assess the Association Between Glycated Haemoglobin, Total Protein and Albumin Levels in Patients with Type 2 Diabetes Mellitus
Akhalesh Kumar, Rituraj, Pradeep Kumar Singh
Aim: The aim of the study to assessment of glycated haemoglobin, total protein and albumin levels in patients with type 2 diabetes mellitus. Methods: This case control study was done in the Department of Pathology, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India, for 10 months. A total of 120 subjects comprising of 60 diabetic subjects and 60 controls aged between 35 and 70 years were recruited for the study. 5mls of blood sample was collected from each patient and 1ml was dispensed into EDTA for the estimation of glycated haemoglobin, and 4ml was dispensed into plain containers for estimation of serum albumin and total protein levels. Determination of glycated haemoglobin level, estimation of serum albumin level and estimation of total protein done by standard methods. Results: The mean level of HbA1c was significantly higher in the diabetic subjects when compared with control group (11.56±1.79Vs 7.21±0.98; p=0.001). There were no significant differences observed between the age, the serum levels of Albumin and Total protein in the test and control subjects (p>0.05). Conclusion: We concluded that the present study showed significantly higher mean levels of HbA1c in the diabetic patients compared with the control subjects.

9.An Investigation of the Functional and Anatomical Outcomes of Displaced Intraarticular Calcaneal Fractures Treated with Locking Plate Fixation: A Prospective Research
Baidyanath Kumar, Swati Sinha, Satyendra Kumar Sinha
Aim: The aim of the present study determines the Functional and anatomical outcome of displaced intraarticular fractures of calcaneum treated using locking plate fixation. Methods: This Prospective study was done the Department of Orthopedics, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. A total of 50 patients aged 18 years, displaced intra articular fractures of calcaneum were included in this study. Post-operative management involved, immobilization using a below the knee slab for a duration of 2-3 weeks to ensure wound healing. Subsequently on the second post operative day non weight bearing mobilization was advised followed by ankle movements on removal of the slab. Complete weight bearing was recommended only after ensuring fracture union on x-ray. Follow up- Patients were followed up at an interval of 6 weeks, 3 months and 6 months post-surgery and imaging via x-ray, at each visit was done to assess the fracture healing.  Results: In our study we included 50 patients, amongst them 7 were female and the rest 43 were male. The mechanism of injury was noted to be road traffic accident in 9 patients and fracture sustained as a result of fall from a height in the rest.  According to this scale, 35 patients (70%) had good outcome, 11 patients had fair outcome (22%) while 4 patient (8%) had poor outcome. 4 out of the 50 patients, was noted to have wound dehiscence where suture removal was delayed until 3 weeks and the wound healing was ensured at the end of 8 weeks. Regular dressings were done, and the wound healed with secondary intention without any further intervention. For this patient regular cultures were taken, and the antibiotics were changed accordingly. 4 patient developed superficial wound infection, for which regular dressings were done and antibiotics changed according to culture reports. Conclusion: we concluded that the anatomic locking plate can be used effectively in the treatment of displaced intraarticular calcaneal fractures using simple reduction techniques with a potentially shortened operating time.

10.A Prospective Cross-Sectional Study to Evaluate the Balance of Serum Calcium and Phosphorus in Diabetic Nephropathy and Its Correlation with Glycated Hemoglobin (HbA1c)
U.C. Jha, Maadhav Gopal Bansal, Md. Belal Ashraf
Aim: To evaluate the balance of serum calcium and phosphorus in diabetic nephropathy and its correlation with glycated hemoglobin (HbA1c). Materials and methodology:  Across-sectional study conducted in 40 patients with diabetic nephropathy admitted in DMCH, Laheriasarai, Darbhanga, Bihar, India during the period for 1 year. The subjects were sub-grouped into 2 groups on the basis of HbA1c levels i.e. Poor glycemic control (HbA1c > 7%) and good glycemic control (HbA1c < 7%). Fasting blood sugar, serum creatinine, calcium and phosphorus levels were measured and analyzed at daily level. Results: Out of 40 patients, 21 (52.5%) were males and 19 (47.5%) were females. 42.5 % of the patients distributed in stage 3, 25 % in stage 4 and 32.5% in stage 5 of diabetic nephropathy. With decline in eGFR values, increased phosphorus, increased creatinine and decreased calcium levels were seen. A significant increase in phosphorus levels were observed with decline in eGFR values. A highly significant increase in creatinine levels were also seen at stage 5 of diabetic nephropathy. Conclusion: This study showed a highly significant negative correlation with creatinine, phosphorous, HbA1c and a highly significant positive correlation with serum calcium level. Correlation between eGFR and other parameters in all the stages of diabetic nephropathy showed a highly significant decrease in serum calcium.

11.Prospective, Observational Study Looking at How Much Pain (VAS) Endometriosis Patients Experience, As Well As the Types and Degrees of Adhesions
Priyanka Rani, Sanjeev Kumar, Sweta Singh, Sadhana Singh
Aim: Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, NSMCH, Amhara, Bihta, Patna, India for 10 months.  Total 80 women; aged 20-50 years, diagnosed as having endometriosis by clinical history, abdominal and pelvic examination, trans vaginal sonography and colour Doppler were included in the study. Pain intensity was assessed by visual analogue scale (VAS). Pain intensity was scored from 0 to 10, in which score 0 means no pain and 10 means worst pain. A score of 1-3, 4-6 and ≥7 was classified as mild, moderate and severe pelvic pain respectively by looking at the facial expression of the patients. Results: Out of 80 women with endometriosis, 20 women (25%) had mild pain, 50 women (62.5%) had moderate pain and 10 women (12.5%) had severe pain. Forniceal thickening was present in 65 women (81.25%), cyst was felt in 44 women (55%), uterine mobility was restricted in 32women (40%) and pouch of Douglas (POD) thickening was present in 27 women (33.75%). Out of 80 women with endometriotic cysts, 64(80%) had unilateral cysts while the remaining 16(20%) had bilateral cysts. Unilateral tubal adhesions were present in 64(80%) women and bilateral adhesions were present in 16(20%) women. Among the types of adhesions, flimsy adhesions were most common, being present in 64(80%) women, isolated dense adhesions were present in only 2(2.5%) women, while combination of flimsy and deep adhesions were present in 14 (17.5%) women. Less than 1/3rd tubal adhesions were present in 10(12.5%) women, 1/3rd-2/3rd tubal adhesions were present in 41(51.25%) while more than 2/3rd tubal adhesions were present in 29(36.25%) women. All the ovarian adhesions were flimsy. Out of 80 women with endometriosis, ovarian adhesions were present in 15(18.75%) women while absent in 65(81.25%) women. Less than 1/3rd ovarian adhesions were present in only 4(5%) women, 1/3rd-2/3rd ovarian adhesions were present in 7(8.75%) women and more than 2/3rd ovarian adhesions were present in 4(5%) women. Conclusion: The severity of pain correlated with type of adhesions being more commonly associated with dense adhesions as compared to flimsy adhesions.

12.An Observational Study to Evaluate the Clinical, Demographic Profile and Admission Blood Pressure as Prognostic Marker in Acute Nontraumatic Intracerebral Hemorrhage Patients
Sanjeev Kumar, Janardan, Priyanka Rani
Aim: To evaluate the clinical, demographic profile and admission blood pressure as prognostic marker in acute nontraumatic intracerebral hemorrhage patients. Methodology: The present study was mainly centered on stroke patients (only hemorrhagic). The stroke was defined by criteria in WHO1. Stroke types were defined based on the criteria of the Oxford Community Stroke project. The detailed history and thorough clinical examination were done in each patient to assess the neurological deficit, to know the risk factors, and coincident diseases according to the proforma. Every patient underwent brain CT scan within 24 hours of onset of symptom. Then all the patient was assigned to subtypes (Hemorrhagic, Ischemic stroke) based on neuroimaging finding (CT-Scan) and those having nontraumatic hemorrhagic stroke were taken in our study. Blood pressure was measured in each patient in the supine position on arrival at the S.R.N. hospital, Allahabad. Patients in whom the cause of death was directly related to the hemorrhage were classified as patients with fatal outcome. Results: Mean age of presentation was 61.549±12.38 years. The commonest anatomic location was thalamus 40.45 % (n=53) followed by basal ganglia 39.70% (n=52). The hematoma was visible on COMPUTED TOMOGRAPHY (CT) scan in 100% (n=131) of the patients with acute intra cerebral haemorrhage. The mean systolic blood pressure of all patients was 176.93±33.84 mm of mercury (n=131). The mean diastolic blood pressure of all patients was 100.09±17.47 mm of mercury (n=131). The mean arterial pressure in fatal group is higher in all groups except in pontine group where mean arterial pressure in nonfatal group is higher 140.00 (n=1)>115.53±43.39. Mean arterial blood pressure in fatal group was significantly higher 132.91±24.26 mm of mercury than in nonfatal group 119.36±16.59 mm of mercury (p<.05). Conclusion: The mean systolic blood pressure and diastolic blood pressure at the time of admission was high. The commonest anatomic location was thalamus followed by basal ganglia. The Mean arterial blood pressure in fatal group was found significantly higher than in nonfatal group. Control of mean arterial blood pressure can reduce the fatal outcome.

13.A Prospective Clinical Study on Catheter Associated Urinary Tract Infections (CAUTI) and Antibiotic Sensitivity Pattern
Shamim Ahmad, H.L. Mahto
Aim: A study on catheter associated urinary tract infections (CAUTI) and antibiotic sensitivity pattern of uropathogens causing CAUTI from a tertiary care hospital. Methods: This prospective study was done the Department of Microbiology, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. Total 400 catheterized patients were included. Infection control nurse collected all the details like name of the patient, age, sex, date of catheterization, laboratory reports during her daily rounds. The diagnosis of CAUTI was done as per the CDC guidelines published in 2009. The selection criterion for the inclusion in the study was above 18 years and patients of both genders and who were put on Foley’s catheter for at least 48 hours were included in the study. Results: Out of 400 catheterized patients, 20 developed CAUTI. The overall incidence was 5%. Male patients were more than the female patients for catheterization. The most common uropathogens were E. coli (30%) and Klebsiella pneumoniae (30%) followed by Pseudomonas aeruginosa (20%) and Acinetobacter species (20%) from the cases of CAUTI. Bacterial uropathogens isolated from patients with CAUTI revealed the presence of multidrug resistant pathogens. Imipenem was the single best antibiotic for all pathogens except Pseudomonas aeruginosa where Amikacin was the drug of choice. The Acinetobacter species also showed very high resistance to all antibiotics except Imipenem. Conclusion:CAUTI remained a great burden to patient safety and a challenge to the infection control team. Implementation of proper care bundles and continuous education to health care workers plays a key role in reducing the CAUTI rates, thereby decreasing the morbidity and hospital stay to the patients.

14.A Retrospective Histopathological Analysis of Soft Tissue Tumours in A Tertiary Care Center
Vivek Kumar Pandey, Rituraj, Vimal  Kumar Gupta, Awadhesh Singh
Aim: Histopathological analysis of soft tissue tumours in a tertiary care hospital in bihar region. Methods: This retrospective study was carried out in the Department of Pathology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. Total 100 patients of all the soft tissue tumors, both benign and malignant were included in this study. Results: Benign soft tissue tumours formed 85% of all soft tissue tumours while malignant soft tissue tumours constituted 15%. The commonest benign tumour was lipoma (50%) of all benign tumours of soft tissue followed by vascular tumours (20%) peripheral nerve sheath tumours (17%), fibrous tumours (3%), fibrohistiocytic tumours (4%) smooth muscle tumours (2%) and tumours of uncertain differentiation (1%) in the decreasing order to frequency. The benign adipocytic tumours accounted for the majority of benign soft tissue tumours (47%) followed by vascular tumours (16%). Benign tumours of smooth muscle (1%) and tumours of uncertain differentiation are nil encountered. 38% benign soft tissue tumours were seen in extremities followed by head and neck 30% 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.

15.A Case Control Study to Assess the Role of Platelet Count in the Early Identification of Preeclampsia and Eclampsia
Rituraj, Akhalesh Kumar, Pradeep Kumar Singh
Aim: The study aimed to evaluate the platelet count in the pregnant Women. Methods: This cross-sectional study was carried out in the Department of Pathology, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India, for 8 months. Total 100 patients were divided in two groups as Cases and Control. Cases study group includes 50 females with the thrombocytopenia and Control includes 50 females without thrombocytopenia. Results: The data from the 100 pregnant females were collected and presented as below. The study population was divided in two groups as Cases and Control. Cases study group includes 50 females with the thrombocytopenia and Control includes 50 females without thrombocytopenia. The Most effective age group in which thrombocytopenia seen was between 20 to 25 years. Out of 100 patients with thrombocytopenia, mild preeclampsia was present in 22 cases (44%) and while the rest 28 (56%) had Severe Pre-eclampsia with thrombocytopenia. In women with Mild Pre-eclampsia Platelet Count (x 109/L) was 65-277, Severe Pre-eclampsia Platelet Count (x109/L) was 27-249 and women without thrombocytopenia had normal Platelet Count. Conclusion:The clinically platelet indices can be a useful screening test for early identification of preeclampsia and eclampsia. Also, platelet indices can assess the prognosis of this disease in pregnant women and can be used as an effective prognostic marker because it correlates with severity of the disease.

16.Efficacy and Tolerability Comparison of Olopatadine, Ketotifen, and Epinastine in Seasonal Allergic Conjunctivitis: A Prospective Open-Label Comparative Study
Dinesh Sah, Satyendra Kumar Pathak, Shankar Dayal Singh
Background: Seasonal allergic conjunctivitis (SAC) is the most common allergic disease affecting the eye, with an estimated prevalence of 15–20%. Although sequelae affecting patients’ vision are rare, the symptoms are distressing and may have a significant socioeconomic impact, affecting the quality of life, daily activities, productivity, school performance, etc. The latest generation multiple action topical antiallergic agents such as olopatadine, ketotifen, and epinastine possess antihistaminic, mast cell stabilizing, and anti-inflammatory actions and has now been recommended as the first-line agents in the treatment of SAC. Aims and Objectives: This study aims to compare the efficacy and tolerability of olopatadine, ketotifen, and epinastine in SAC. Materials and Methods: A prospective, comparative study was conducted at Department of Pharmacology, SKMC, Muzaffarpur, Bihar associated with Department of Eye, SKMCH, Muzaffarpur, Bihar during last 3 months. Patients enrolled 90 subjects with SAC. They were randomized into three groups of 30 each, to receive olopatadine, ketotifen, or epinastine. The study medications were instilled into the affected eyes (one/both) twice daily for 4 weeks. The primary outcome measure was changed in clinical parameters of SAC, which was assessed by grading on a 4-point scale (none to severe). The treatment response was monitored during the follow-up visits at 1, 2, 3, and 4 weeks. The tolerability was assessed by monitoring the adverse events (AEs). Results: All the study drugs showed comparable efficacy in reducing conjunctival hyperemia, papillary reaction, and itching. Among them, olopatadine was distinctly more effective than other two drugs at all the visits. Ketotifen and epinastine were equally effective in relieving conjunctival hyperemia, and epinastine was more effective in relieving papillary reaction and ocular itching compared to ketotifen. The study medications showed good tolerability with less severe AEs. Conclusion: In the present study, olopatadine was more effective in relieving symptoms and signs of SAC compared to epinastine and ketotifen.

17.Study of the Placenta in Relation to the Birth Weight of Full Term Neonates Using Morphometric Analysis
Amrendra Prasad Sinha, P.K. Verma, Rajendra Prasad
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.

18.A Comparative Assessment of Norepinephrine and Terlipressin in the Management of Hepatorenal Syndrome
U.C. Jha, Natwar Lal Das, Brajesh Kumar
Aim: Assessment of norepinephrine and terlipressin in the management of Hepatorenal Syndrome. Materials and methods: A total of 40 patients with HRS type 1, presenting at the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, were prospectively evaluated. Patients were randomized to either terlipressin or noradrenaline group i.e. half for terlipressin (group A) and half for noradrenaline (group B). Patients in either group received treatment with terlipressin or noradrenaline with 20 g albumin/day. Patients in group A received terlipressin as an intravenous bolus of 0.5 mg every 6 h. Patients in group B received a continuous infusion of noradrenaline at an initial dose of 0.5 mg/h, designed to achieve an increase in MAP of at least 10 mmHg or an increase in 4-h urine output of more than 200 ml. All patients were admitted for 15 days in hospital and followed-up to 30 days. Clinical and biochemical parameters were assessed at baseline, and day 15. An arterial blood sample was collected after overnight fast and bed rest for at least 8 h in supine position for plasma renin activity and aldosterone concentration. Results: 8 (40%) patients in group A and 10 (50%) in group B responded to therapy. 22 (group A-12; group B-10) patients did not respond to treatment. There was a significant decrease in serum creatinine from baseline in both groups. Mean arterial pressure and urine output increased significantly in both groups at day 15. Plasma renin activity and aldosterone concentrations   decreased significantly in both groups at day 15. Conclusion: In conclusion, norepinephrine and terlipressin had similar response rates or equally effective in cases of hepatorenal syndrome. But this study was based on a small population size. More studies are needed on a large scale to establish this as an alternate drug.

19.A Prospective Understanding of the Prognostic Markers of Multiple Myeloma Disease
Krishna Kumar Jha, Md. Belal Ashraf, Maadhav Gopal Bansal
Aim: Understanding the prognostic markers of multiple myeloma disease hoping to incorporate the new therapeutic modalities to convert the disease into curable one. Materials and methods: A total of 100 patients diagnosed as MM according to the criteria of the Chronic Leukemia-Myeloma Task Force (Committee of Chronic Leukemia-Myeloma Task Force, 1973) admitted to DMCH, Darbhanga, Laheriasarai, Bihar, India were evaluated. In each patient, factors like anemia, urea, serum calcium, percentage of plasma cells, renal insufficiency, infections, performance status, Bence-Jones proteinuria, and para-protein index are evaluated for their prognostic significance. Results: Out of 100 enrolled patients, 56 were males and 44 were females. Four variables that had the highest correlation with the first component were creatinine, haemoglobin, performance status and paraprotein index. Conclusion: We found that the combination of clinical performance status, serum creatinine, haemoglobin and paraprotein index allowed us to discriminate three groups of patients with different survivals. It can be a useful complementary tool for classifying patients according to prognostic factors.

20.To Study the Hematological Indices and CRP in the Screening of Neonatal Sepsis
Nilesh Ahire, Suhas Vasantrao Patil, Dipak Marakwad, Rajendra Gaikwad, Jeetendra Singh
Introduction: To study the haematological indices and serum CRP levels for the early diagnosis of neonatal septicaemia. Purpose of study: Establishment of a modified sepsis screen score which is easy, cost effective and less time consuming for the early diagnosis of neonatal septicaemia. Results: Total 80 newborns were studied; consecutive 3 days sepsis screen score is established considering blood culture as a gold standard. Overall sensitivity and specificity of septic screen was 94.5% and 80% respectively while PPV and NPV was 91.2% and 87%. Overall diagnostic accuracy of septic screen was 90%.  Conclusion: Sepsis screening methods using CRP and haematological indices are easily available, rapid, cost-effective screening method and effect rapid diagnosis of neonatal sepsis and save lives due to timely detection and interventions.

21.Safety Profile of Intravenous Colistimethate Sodium among Critically Ill Neonates with Sepsis in Terms of Serum Creatinine Clearance, Serum Electrolyte Levels and Apnea Incidence
Nilesh Ahire, Suhas Vasantrao Patil, Urmila Murtadak, Rajendra Gaikwad, Jeetendra Singh
Introduction: There has been increased neonatal mortality and morbidity due to emergence of gram-negative bacteria which is multi-drug resistant (MDR). Neonatal sepsis is the one of the leading causes of neonatal mortality and morbidity in developing and developed countries. Colistin (colistimethate sodium), potent antimicrobial, a cyclopeptide antibiotic of the polymyxin class, has been re-evaluated over the last few decades against certain gram-negative bacteria causing multi drug resistant sepsis. The most common adverse effect of colistin treatment is renal toxicity along with electrolyte imbalance. Objectives: Study was performed to analyze an effect of use of intravenous colistimethate sodium on serum creatinine clearance, serum electrolyte levels and apnea incidence in critically ill neonates with sepsis. Methods: Total 62 neonates (28 days) admitted in the hospital with evidence of blood culture positive sepsis and who have received intravenous colistimethate sodium for more than 7 days were included in the study. Serum creatinine levels and serum electrolytes levels were documented before starting colistin, on 7th day of colistin and on discharge. Apnea count was done daily during administration of colistin therapy for 7 days. Results: Most of the study population were of 1 to 7 days (61.3%) followed by 8 to 14 days (16.1%), 15 to 21 days (14.5%) and more than 21 days (8.1%). There was male predominance (59.7%) amongst study population. Most of the babies were preterm (56.5%) followed by term (40.3%) and post-term (3.2%). Pseudomonas (33.9%) was one of the commonest organisms isolated on blood culture followed by Acinetobacter (21%), Candida (19.4%) and Klebsiella (16.1%). There was significant change in potassium and chloride level on 7th day after colistin as compared to pretreatment and discharge level but both values lie in the normal range. No significant difference was observed in serum creatinine and sodium level. Incidence of apnea was observed significantly in preterm babies (100%) as compared to term (0%) and post term babies (0%). Incidence of apnea was not increased after administering Colistin. Interpretation And Conclusions: Intravenous Use of Colistimethate sodium in neonates who are critically ill was not associated with drug related adverse effects like electrolyte imbalance, raised serum creatinine level and increased incidence of apnea episode.

22.A Cross Sectional Study of Serum Uric acid with Urine Albumin and Serum Creatinine in type 2 Diabetes Mellitus Patients at SMS Medical College and Attached Hospital, Jaipur
Karamveer Singh, Alpana Goyal, Ajay Saxena, Vipul Garg, Balveer Singh Gurjar
Background: Diabetes is a major worldwide health problem, leading to markedly increased mortality and serious morbidity. Type 2 DM is the most common form of DM characterized by hyperglycemia, insulin resistance, and relative insulin deficiency. This study was done to evaluate the level of serum uric acid in type 2 Diabetes mellitus patients and to correlate the parameters of diabetic nephropathy like albuminuria and serum creatinine levels with uric acid. Aims & Objectives: The aim of the study was to compare Serum Uric acid with Serum Creatinine and Urine Albumin levels in Diabetes Mellitus patients and find association between them. Methods: This study was a cross sectional study in which clinically diagnosed cases of Diabetes mellitus from OPD of department of Endocrinology, S.M.S. Medical College and Hospital, Jaipur were taken as cases. Results: 100 cases of Type 2 Diabetes mellitus above the age of 18 were analyzed in this study. The Mean Uric Acid levels in cases with Urine Albumin < 30 mg/24h, Urine Albumin 30-300 mg/24h and Urine Albumin > 300 mg/24h was 5.27 ± 1.25 mg/dl, 8.27 ± 1.63 mg/dl, and 12.76 ± 1.76 mg/dl respectively. These values were statistically significant after applying ANOVA test (p value <0.00001 and f ratio = 62.45). There was statistically significant Positive correlation Serum Uric acid & Urine albumin (r = 0.8126 and p < 0.0001). Mean Uric Acid levels in cases with Serum Creatinine < 1.2 mg/dl was 7.47 ± 1.95 mg/dl and with Serum Creatinine > 1.2 mg/dl was 9.32 ± 2.46 mg/dl. These values were statistically significant after applying Student T test (p value 0.000045) and also statistically significant Positive correlation Serum Uric acid & Serum Creatinine was seen (r = 0.3172 and p value = 0.001302). Conclusion: The levels of serum uric acid and microalbuminuria are significantly correlated in nephropathy in Type-2 diabetic patients. There was also significant correlation between Serum Uric acid and Serum Creatinine. Hence Serum uric acid level can not only be used as early diagnostic marker but also for the prognostic monitoring of diabetic nephropathy.

23.Study of Serum Electrolyte Levels in Thyroid Disorder Patients
Ummed Singh Solanki, Pradhuman Upadhyay, Manish Kumar, Neeraj Singh Songara
Background: Thyroid disorders are frequent, potentially serious clinical entities resulting from deficiency or excess of thyroid hormones or due to their impaired activity which may affect electrolyte levels as well as lipids in circulation. There is relationship between thyroid hormones and metabolic rate through the influence of these hormones on the metabolism of carbohydrates, fats and proteins and thus, energy produced from the hydrolysis of these compounds. The objective of this study was to find out the effect of thyroid disorders on certain electrolytes. Material & Methods: In the present study a total of 60 subjects were included, 30 were confirmed hypothyroidism and 30 were confirmed hyperthyroidism patients in the age group 18-55 yrs. Serum electrolyte levels (Na+, K+, Cl) were measured in both groups. Results: Analysis of serum electrolytes showed that the sodium was significantly higher in hyperthyroidism patients (P value = 0.014). Chloride levels were also found to be significantly elevated in hyperthyroidism patients in comparison to hypothyroidism patients (P value = 0.049). Conclusion: The study concluded that electrolyte derangements are common in thyroid disorders as shown in results by the correlation of thyroid hormones with serum electrolytes but they are not of severe grade and the patients of hypothyroidism and hyperthyroidism should be screened for electrolytes disturbances.

24.Study of the Association of Lipid Profile with Chronic Kidney Disease SMS Medical College and Attached Hospital, Jaipur
Paridhi Gupta, Vipul Garg, Balveer Singh Gurjar, Mahesh Bairwa, S K Vardey
Background: Chronic kidney disease (CKD) is a pathophysiological process with multiple etiologies resulting in the inexorable attrition of functional nephrons and frequently leading to End Stage Renal Disease (ESRD) necessitating hemodialysis as a mandatory therapeutic measure. Dyslipidemia has been hypothesized to cause kidney damage and to play an important role in the progression of renal failure. Hence, the aim of the present study was to evaluate the pattern of different lipoprotein changes in the CKD patients. Aims & Objectives: The aim of this study was to evaluate and compare the serum Lipid Profile  (TG, Cholesterol, HDL, LDL, VLDL) in CKD patients both hemodialyzed and conservatively treated and comparable control group. Methods: This study was a cross sectional study in which clinically diagnosed cases of Chronic renal failure from OPD of department of Nephrology, S.M.S. Medical College and Hospital, Jaipur were taken as cases. Results: 30 cases of chronic renal disease and matched controls between age group of 30-70 years were analyzed in this study. The mean age of cases was 46.63 years and controls were 44.45 years. TG was found to be higher in case group (179.77±69.53) as compared to control group (100.43±35.69). Similarly, Cholesterol was high in case group (182.77±37.07) as compared to control group (159.87±25.66), the mean of LDL-Cholesterol was high in case group (118.52±32.15) as compared to control group (100.60±20.44) and the mean level of VLDL was high in case group (35.94±13.86) as compared to control group (20.05±7.18). However, the mean level of HDL-Cholesterol was found to be low in case group(28.57±5.68) as compared to control group(39.23±4.60). All These values were statistically significant. However, TG and Cholesterol were significantly lower in patients on hemodialysis as compared to patients treated by conservative line. Conclusion: In this study, we concluded that there is significant dyslipidemia, raised in chronic renal failure patients as compared to healthy controls. We conclude that, the importance of this study lies in the early detection and treatment of lipid abnormalities in CRF, which in turn can decelerate / arrest the progression of the renal failure and predisposition to atherosclerosis.

25. Diphallia: A Rare congenital anomaly
Prem Prakash
Diphallia is a hereditary disorder in which a baby is born with two penises. This uncommon congenital anomaly was originally documented in a report filed by Swiss doctor Johannes Jacob Wecker in 1609 when he came upon a cadaver with the condition. Diphallia affects roughly one in every five to six million infant boys. Only approximately 100 cases have been documented in the 400 years since it was first recognised medically.

26. A Rare Congenit Lower Back Pain due to Lumbar PIVD Evaluation by MRI: A Cross- Sectional Study
Khumanthem Shailendra Singh, Okram Pusparani Devi, Ruma Sarkar, Pheiroijam Robindro
Background: Lower back pain due to lumber PIVD is prevalent most commonly among the age group over 50 years. The main symptom of disc degeneration after low back pain is sciatica. There are many risk factors associated with lumbar degenerative disc disease like advancing age, smoking, obesity, trauma, heavy weightlifting, height and genetic factors. Methodology: A cross sectional study was conducted among 210 patients of lower back pain referred from Department of Orthopedics, JNIMS. They were then evaluated by MRI (3 Tesla Phillips) in the Radiology and Imaging Department, JNIMS. Multiple level disc involvement is common as compared to single level disc involvement in this study. Results:  L4-L5 and L5-S1 Disc degeneration changes was seen mostly at L4-L5 and L5-S1. X Ray LS spine with AP and Lateral views reveal gross anatomic changes in the intervertebral discs. Conclusions:  MRI Lumbo-sacral spine is the standard imaging modality for detecting Lumber PIVD due to lower backache.

27. Detection of Cognitive Impairment in Type 2 Diabetes Mellitus by Choice Auditory and Visual Reaction Times During Acute Mental Stress: A Case–Control Study
Mahendra Kumar, Benazir Bano, Ashok Kumar Deo
Aim: Detection of cognitive impairment in Type 2 diabetes mellitus by choice auditory and visual reaction times during acute mental stress. Methods: This prospective observational study was carried out in the Department of Physiology, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India for 6 months. 80 subjects within the age group of 33–53 years were included in the study. Informed consent was taken by each subject. They were cleaved into two groups. Group 1 comprised of randomly chosen 40 diagnosed cases of Type 2 DM at least 2 years of duration. Group 2 comprised of 40 age and gender-matched controls. MMSE was performed to assess the global cognitive function in these groups. Simple and choice auditory and VRTs were measured at rest and acute mental stress in these groups to assess cognitive function. The reliability of the reaction timer was tested by standard deviation obtained during the pilot study. Results: The mean age of Type 2 DM group was 45.7 years, and the control group was 43.6 years. There was a significant statistical difference between weight and BMI. Tables 2 and 3 show a significant difference in ART and VRT, both simple and choice in Type 2 DM and controls. These RTs further increased during mental stress in diabetes. Table 4 shows that there was significant difference ART and VRT, both simple and choice during resting and during mental stress and these RTs were more prolonged in Type 2 DM when compared to controls. Conclusion: we can conclude that mental stress in Type 2 DM does affect cognition, where grades of deterioration may be related to the difficulty of the given task (mental stress) and prevalence of central nerve deficits and peripheral nerve deficits seen as side-manifestation of Type 2 DM.

28. Staging of Plasma Cell Myeloma and its Correlation with Clinico Pathological Profile in a Tertiary Hospital (JNIMS)- A 3 Year Study
Khuraijam Asha Devi, Rajkumari Jayshree Devi, Urmila Thiyam, Rajkumari Banashree Devi, Irom Anil Singh, Kshetrimayum Achouba Singh
Background: Plasma cell myeloma (PCM) is a neoplastic proliferation of plasma cells, confined in bone marrow usually associated with an M protein in serum and/or urine and evidence of organ damage related to the disease. Various staging systems and risk stratification are being proposed to prognosticate the cases. Aims and objectives: To categorize the newly diagnosed or treatment naïve PCM cases attending JNIMS into stages and to correlate the different stages with the clinicopathological features. Method: This is a retrospective cross-sectional study. All the information were obtained from bone marrow registers maintained in the Pathology Department and Hematology unit, Medicine Department, JNIMS Imphal. Newly diagnosed and untreated patients of PCM coming to JNIMS over a period of 3 years from July 2018 to July 2021 were included. Results: 20 PCM patients were included in the study. Majority of the cases were in the age group of 5th to 6th decades (range: 38 to 79 years) and a mean age of 58 years. 9(47%) patients were male, and 11(53%) patients were female with male-to-female ratio of 1:1.2. 11(55%) were presented with backache and other bone pains, 8(40%) had generalized weakness and easy fatigability,1(5%) had symptoms of spinal cord compression. 8 patients (40%) were in stage I,10 patients (50%) were in stage II and 2 patients (10%) were in stage III. Stage I patients had equal proportion of IgA and IgG PCM. Regarding distribution of light chain restriction 3(37.5%) cases had kappa and 5(62.5%) had lambda light chain restriction. Stage II patients had predominantly IgG PCM (60%) and lambda light chain restriction. One case of plasma cell leukemia presenting in stage III with intermediate risk molecular profile (t 4;14) was also included. All the different stages had significantly variable beta-2 microglobulin level. Conclusion: We concluded that though most patients were in 6th decade, however we got significant involvement in young age group. Bone pain mostly low backache was the most common presenting symptom along with weakness and fatigue. The majority of the patient had IgG PCM.  As staging of the disease has prognostic implication, this finding needs to be explored further.