International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

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1.Assessment of Epithelial Changes of Gall Bladder in the Gallstone Disease
Hemlata Sharma, Manogya Agarwal, Mayank Sarawag, Varun Saini
Background: Gallstone disease is a common health problem worldwide forming about 95% of the biliary tract disorders. The estimated prevalence of gallstone disease in India has been reported between 2- 29%. In India, this disease is seven times more common in north (stone belt) than is south India. It is appeared to be increasing in incidence over past couple of decades in India. Material & Methods: This prospective study was conducted in the Departments of Anatomy and Pathology of R.N.T. Medical College and Attached Hospital (M.B. Govt. Hospital), Udaipur. The study was done in hundred patients of cholelithiasis which were admitted and operated in our hospital either open or laparoscopically, irrespective of age, sex, physique or parity. Results:  In the present study it was observed that maximum (46%) cases had mixed type gallstones. (30%) cases had pigmented type gallstones and (24%) cases had pure cholesterol type gallstones. In the present study it was observed that multiple gallstones present in 58% cases which is followed by single gallstones present in 30% cases. In the present study it was observed that maximum 32% cases had faceted gallstones which is followed by irregular gallstones present in 29% cases which is followed by round gallstones present in 22% cases. Ovoid gallstones present in 15% cases. Only 5% cases had normal mucosa. Rest of cases showed different types of epithelial alterations as above mentioned. The most common epithelial alterations observed was focally ulcerated which is followed by hyperplastic changes. Atrophic changes were observed in 9% cases. However, this difference was statistically non- significant. Conclusion: The type and number of gallstones were not significantly correlated with the various epithelial lesions of gallbladder. Histopathological examination is thus important in every case of cholecystectomy for identifying hyperplasia, metaplasia, dysplasia and carcinoma.

2.Bioactive Secondary Metabolites from Marine Streptomyces Isolated from Mangrove Forest Soil of Can Gio, HoChiMinh City, Vietnam
Nguyen Tuan Hai, Cao Ngoc Diep
The objective of this research was studying the bioactive secondary metabolites composition of marine Streptomycesalbogriseolus and to evaluate the isolates for possible in vitro antifungal and antibacterial activities. The compound obtained were screened by GC-MS method. While agar-well diffusion method was employed to measure antimicrobial activity against four human pathogenic bacteria. Twenty-five bioactive secondary metabolites compounds were identified in the ethyl-acetate – hexane extract of Streptomycesalbogriseolus. The identification of bioactive secondary metabolites compounds is based on the peak area, retention time, molecular weight, molecular formula, and antimicrobial actions. GC-MS analysis of Streptomycesalbogriseolus revealed the existence of the Cyclohexasiloxane, dodecamethyl, Cyclohexasiloxane, tetradecamethyl, 2, 6 dihydroxybenzoic acid 3TMS, Heptasiloxane, hexadecamethyl, Octasiloxane, 1,1,3,3,5,5,7,7,9,9,1 1,11,13,13,15,15- Hexadec and Tetracosamethyl, cyclododecasiloxane. Thus, it could be inferred that the therapeutic potential of marine Streptomycesalbogriseolus is because of different compounds present in the extract prepared.

3.Ayurved Management of Diabetes Melitus: A Case Report
Kajaria Divya, Behera Satyajita
Introduction: Diabetes mellitus is a metabolic disorder involving carbohydrate, protein, and fat metabolism resulting from absolute or relative insulin deficiency and resulting in chronic hyperglycaemia with micro and macro vascular complications. Type 2 diabetes is a chronic illness that has major long-term implications for individuals suffering from the disease as well as the health-care system as a whole. Modifications in diet, exercise, and lifestyle are all important factors in successful treatment of type 2 diabetes and are incorporated into the ancient Indian medicinal practice of Ayurveda. Diagnosis & Outcome: This article includes a case study from All India Institute of Ayurveda, New Delhi, from the kayachikitsa department that details the specific traditional intervention used in a patient, bringing her HbA1c from a level of 11.10 to 8.2 over the course of 3 months along with significant reduction in lipid profile with marked improvement in general weakness and controlled weight loss after treatment. Conclusion: Patients with type 2 diabetes mellitus must go through the treatment modalities available in complementary and alternative therapies.  Awareness of such modalities is necessary for effective patient counselling and care. From this case it can be concluded that traditional therapeutic intervention helps in possible reduction of HbA1c in the management of Type 2 Diabetes mellitus & can be helpful for the successful management of similar cases.

4.Drug Utilization and Evaluation Study of Statins: Tertiary Health Care Centre
Vijay S. Bayaskar, V. Hemanth Kumar, Jeetendra M Singh
Background: Drug Utilization Studies (DUS) aim to evaluate factors related to the prescribing, dispensing, administering and its associated events, either beneficial or adverse. Statins are very commonly prescribed drugs for hyperlipidemia and diseases pertaining to cardiovascular system. Hence, statin utility study has been planned. Hyperlipidemia is responsible factor for the atherosclerosis which leads to many diseases including cardiovascular diseases (CVD). Variations among prescriptions in terms of dose and duration is routinely observed. Drug utilization studies are therefore essential for evaluating and analyzing the statin therapy. Material and Methods: This were a prospective cross sectional observational single centred study. After obtaining approval from ethics committee, study was conducted on patients visiting medicine and cardiovascular clinics. Data was collected on Microsoft excel and appropriate statistics used for analysis. Results: Analysis of 600 prescriptions was done and results showed that men (56.7%) received more statins than females (44.3%). Among CVDs, hypertensive (49.16%) patients are more commonly prescribed with statins. Among the statins atorvastatin (63.3%) was commonly prescribed than other statins and dose is 10mg. Drugs prescribed by brand name were 80.77% and percentage of fixed drug combinations were 76.67%. Conclusion: Prescription pattern shows the widespread use of statins in CVDs. Such studies are needed to educate physicians on good prescribing patterns of hypolipidemic agents.

5.Stroke in COVID-19 Patients: An Observational Clinical Study
Nitin B. Agarwal, Basavaraj P. G., J. S. Jain, R. Y. Biradar, P. S. Sheelavantmath
Background: The novel coronavirus is not exclusively a respiratory disease but have a neurological manifestation that is associated with high rates of mortality and morbidity. The aim of study was to examine stroke in COVID-19 patient in a tertiary care hospital. Method: This was a single center retrospective, observational study of total 960 confirmed COVID-19 patients admitted in Ayush Hospital between July 1, 2020, and March 30, 2021. The medical history, demographic characteristics, laboratory and chest CT scan findings were extracted from electronic medical records. All neurological symptoms of stroke patients were reviewed and confirmed. The data were collected, segregated and analyzed. Results: The study shows that 0.7% COVID-19 patients had stroke during hospitalization. Further, the older patients, co morbidity (hypertensive) and severity of infection were found to be associated risk factors. Conclusion: The present study concludes that patients with older age group, co morbidity especially hypertensive and severe COVID-19 infection had possible risk factor for cerebrovascular disease like stroke.

6.A Prospective, Comparative, Observational Analytical Study to Determine the Clinical Profile of Patients with Benign Gynecological Disease Subjected for Hysterectomy
Anupam, Mamta Singh
Aim: A prospective, comparative, observational, analytical study to determine the clinical profile of patients with benign gynecological disease subjected for hysterectomy (TAH vs TLH). Materials and methods: A prospective observational analytical study was conducted in the Department of Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar, India and private set-up for 1 year from January 2021 December 2021 after taking the approval of the protocol review committee and institutional ethics committee. Total sample size was 50 cases in each group. Women with benign gynecological disease opting for hysterectomy, perimenopausal age group between 40-49 years and uterus size </= 16 weeks of pregnant size were included in the study. Results: Among 100 study subjects, 50 underwent Total Abdominal Hysterectomy (TAH) and other 50 underwent Total Laparoscopy Hysterectomy (TLH). In TAH group, highest proportion of patients were aged 40 years (18%) followed by 42 years (10%) and 46 years (10%). In TLH group, highest proportion of patients were aged 46 years (20%) followed by 47 years (12%) and 48 years (12%). It was observed that the distribution of age between the two groups was different, but this difference was not statistically significant. In TAH group, maximum number of patients had BMI in the range 25 – 29 (62%) followed by 19 – 24 (24%) and 30 and above (14%). In TLH group, maximum of patients had BMI in the range 25 – 29 (62%) followed by 19 – 24 (26%) and 30 and above (12%). There was not much difference in the BMI distribution between the two groups and was also not statistically significant. The most common presenting feature in both the groups was Abnormal Bleeding (46%) followed by fibroid (26%), Endometriosis (12%) Chronic pelvic pain (7%) and PID (4%) the difference between the groups was not statistically significant. In TAH group, patients with para1 were 28%, patients with para2 were 62%, patients with para3 were4% and nulliparous women were 6%. In TLH group, patients with para1 were 34%, patients with para2 were 52%, patients with para3 were4% and nulliparous women were 10%. There was no statistically significant difference between the two groups. Conclusion: In TAH group, highest proportion of patients were aged 40 years (18%) followed by 42 years (10%) and 46 years (10%). In TLH group, highest proportion of patients were aged 46 years (20%) followed by 47 years (12%) and 48 years (12%). In TAH group, highest proportion of patients had BMI range 25 – 29 (62%) followed by 19 – 24 (24%) and 30 and above (14%). In TLH group, highest proportion of patients had BMI range 25 – 29 (62%) followed by 19 – 24 (26%) and 30 and above (12%).

7.Ocular Trauma Score (OTS): A Method to Predict the Visual Outcome of Patients after Ocular Trauma
Sudhanshu Kumar, Jawed Iqbal, Bishnu Deo Goel
Aim: A prospective study to evaluate the predictive value of ocular trauma score in cases of mechanical eye injuries in a tertiary care hospital. Methods: This prospective observational study was carried out in the Department of Ophthalmology, Anugrah Narayan Magadh Medical College Hospital (ANMMCH), Gaya, Bihar, India for 1 year. 100 patients who presented to our tertiary care centre with mechanical eye injuries. Results: Out of 100 patients mean age was 29.46 years, with majority between 21 to 50 years of age. Males were 76% and 24% were females. Most injuries (90%) were unintentional while only 10% were due to assault. The inflicting agents in 52% were metallic object, in 31% wood. In 11% road traffic accident was the aetiology while broken glass was responsible in 2%. 13 eyes (13%) presented with lid laceration and in 67(67%) eyes hyphema was present. Traumatic cataracts developed in 21 eyes (21%). Vitreous loss was noted in 25 (25%) eyes. Intra-ocular foreign body was detected in 3 (3%) eyes. Out of 100 eyes 84 eyes affected with globe rupture (84%), 7 with retinal detachment (7%), RAPD noted in (7%) and 2 patient showed signs of endophthalmitis (2%). The initial visual acuity was no perception of light in 25% (25 cases), hand movement or perception of light in 64% patients and 2 patient (2%) had vision between 1/200 to 19/200. Conclusion: Ocular trauma in any age creates agony in patient and family. Just after trauma the question treating team faces is how much visual damage is and how it will evolve in future. This question is more haunting in era of consumer protection act. OTS helps to row the boat of prognosis amidst the storm.

8.Vacuum Assisted Grafting and Closure of Problem Wounds
Vivek, Satish Kumar
Introduction: Vacuum dressing has established it’s role in the treatment of problem wounds and may be regarded as an important tool for approaching such difficult wounds. We go a step further to state, that, vacuum assisted wound closure and skin grafting improves both the short term and long-term outcome of these grafts by significantly reducing the complications and improving graft uptake. Aims and Objectives: The aim of this short series of cases was to explore, whether vacuum dressings over grafted problem wounds, or for that matter, approximation of even non grafted problem wounds, had any significant advantage over conventional grafting and dressings methods for closure of problem wounds and whether it should be included on a more regular basis for this part of the treatment of problem surgical wounds. Materials and methods: Although, it is a short series of four cases, an attempt was made to include a range of challenging conditions which generally adversely affects the outcome in such problem wounds, faced in Plastic Surgery practice. Conclusion: Concurrent use of vacuum dressings with skin grafting promises to improve both short term and long-term outcome of wounds in such problem cases. The benefits are both in terms of reduced hospital stay and reduced treatment cost.

9.The Intravenous Dexmedetomidine Infusion on Subarachnoid Block with Bupivacaine in Inguinal Herniorrhaphies: A Prospective, Randomised Clinical Study
Alok Ranjan, Deepak Kumar Maurya, Pramod Kumar Sinha
Aim: The Effect of Intravenous Dexmedetomidine Infusion on Subarachnoid Block with Bupivacaine in Inguinal Herniorrhaphies. Material and methods: This prospective, randomized study was carried out in the Department of Anaesthesia and Critical Care, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year. all the patients were dived in two groups. Group A: received Spinal Bupivacaine 0.5% (Heavy) and intravenous Dexmedetomidine 1µg/kg bolus infusion in 20 mL (syringe) over a period of 10 minutes followed by 0.5µg/kg over a period of one hour in 50 mL (syringe). Group B: Received Spinal Bupivacaine 0.5% (Heavy) and normal saline Infusion. The volume of intravenous bolus dose for groups A and B was made same (20 mL). For loading dose in group A, Dexmedetomidine 1µg/kg taken, made to 20 ml with distilled water & for group B 20ml of normal saline was taken. The volume of intravenous maintenance dose for group A and B was made the same (50 mL). Results: Mean pain score at 60mt, 2hr, 3hr, 4hr, 5hr in group A is 3.4, 17.4, 26.6, 32.19, 39.11 and for group B is 10.11, 38.6, 48.68, 50.11. At 60 minutes the mean pain score for group A was 3.4 and for group B was 10.11 which was again showed significant difference between two groups. All the patients in group B showed a pain score of >50 before 4hr and received rescue analgesia. At 4hr the mean pain score in group A was only 32.19. At 60mt, 2hr, 3hr, 4hr, 5hr, 6hr, 7hr, 8hr mean pain score in group A is increased from 3.4, 17.4, 26.6, 32.19, 39.30, 45.21, 48.78, 50.21 is observed difference among the groups were statistically significant and that of group A continues to be a superior drug when mean pain scores were compared, then the other group. Conclusion: Intravenous infusion of dexmedetomidine added to subarachnoid block with bupivacaine shows prolonged analgesia in adult patients, without increasing the incidence of unwanted effects.

10.Quantitative Evaluation of the Blood–Brain Barrier Integrity in Tuberculous Meningitis: An Observational Study
Baidya Nath Singh, Ishan Tiwari
Objective: The aim of the study was to quantitatively evaluate blood–brain barrier (BBB) perfusion changes in TBM patients using dynamic contrast-enhanced (DCE) MR perfusion. Methods and Material: Fifty untreated patients of TBM and 10 healthy controls were prospectively evaluated by conventional imaging and DCE MR perfusion. Mean permeability indices— K trans and Ve—were calculated from multiple regions of interest (ROIs) placed in basal cisterns and comparison was done between the patients and controls. Results: The basal cisterns showed variable enhancing exudates in 21 patients. Tuberculomas were seen in 24 patients. Hydrocephalus was seen in 20 patients. Cerebral infarction was seen in 17 patients. There was also statistically significant difference in the permeability indices (p < 0.001) between “enhancing cases” versus “non-enhancing cases,” and no statistically significant difference as observed in any of the permeability indices between “non-enhancing” cases versus the controls. Statistically significant positive correlation was seen between clinical staging and Ve mean (where p < 0.05). No significant correlation was seen between clinical staging and Ktrans mean in our study. Conclusion: DCE MR perfusion is useful in the quantitative measurement of disruption of BBB and perfusion alterations in patients of TB meningitis.

11.An Assessment of the Discarded Placentae to Study the Morphogenesis of the Prostate Gland in Human Foetuses
Barun Kumar
Aim: To study the morphogenesis of the prostate gland in human foetuses. Methods: The present study was the conducted among 80 discarded foetuses were collected at random from deliveries (both vaginal and caesarian) conducted at Department of Anatomy, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India, for 1 year. Total 80 foetuses of different gestational ages ranging from 14 weeks (80 mm) to 40 weeks (450 mm), products of terminated pregnancies under MTP Act of India, 1971 and stillbirths were collected from the Department of anatomy. Only those foetuses which were free from any gross anatomical abnormality were selected for the present study. The age of the foetuses was assessed from the obstetrical history, crown rump length (CRL) and gross features before fixation. The foetuses were preserved in 10% formalin for 12 to 15 days. The specimen was categorised into different age groups for study. Results: The first time of appearance of the prostate gland to the naked eye till its definitive adult shape (at term) is studied in detail. GROUP I: 14 Weeks: In the earliest specimen of this series (14weeks; CRL-7.7 cm), the developing prostate is seen as jelly like, slight fusiform bulge along the upper half of the developing urethra i.e., in the lower part of the urogenital sinus. GROUP II: 14 -18 Weeks: Prostate is more prominent and better defined than the previous age group and has gained in size, but still its length is more than its transverse measurement. GROUP III: 18 -22 Weeks: At subsequent age groups i.e., at 20 weeks it increases in size. Posterolaterally, the prostate is more prominent, and the posterior surface looks flat. GROUP IV: 22-26 Weeks: At this stage, there is overall increase in size in all dimensions, thus gain in anteroposterior and transverse measurements resulting as lateral convexities. the transverse dimension is more than the vertical and anteroposterior dimensions. GROUP V: 26-30 Weeks: The prostate shows more increase in its transverse dimension. The posterior aspect seems to support the lower part of the urinary bladder in a funnel shaped way. Thus, at around 30 weeks, it has a stunted pear shape appearance whose anterior portion has developed into a firm mass. GROUP VI: 30-34 weeks: With further increase in size in all dimensions, the shape of the prostate assumes as that of an adult. GROUP VII: 34-40 weeks: With further growth in this age group, there is overall increase in all dimensions. The posterior surface is flattened, and the upper and lateral surface is occupied by the two lateral lobes. Conclusion: Increase in vertical and transverse dimensions, assumption of adult shape was noted as the age changes and at term, it has all the three components of the adult tissues although it is not as mature as in adult. This signifies that the growth of the prostate continues postnatal.

12.Study of Outcome of Extra Pulmonary Drug Resistant Tuberculosis Patient at Nodal Drug Resistance Tuberculosis Centre, Nahsik
Ravindra J Shinde, Kappagantu Surya Chaitanya Neeladrirao Subbarao, Komal Bhavik Shah, Sushama Dugad, Jeetendra Singh
Background:  India leads in highest share of global burden followed by China and the Russian Federation. In 2019, MDR/RR TB was found in 3.3% new TB cases and 18% in previously treated cases. There is limited information on the prevalence and the drug-resistant patterns of MTB in patients with extra-pulmonary tuberculosis (EPTB). Thus, this study was aimed to determine the drug resistance patterns of M. TB in patients with EPTB and outcome of those affected. Materials and Methods: Retrolective study was conducted during period of December 2020 to March 2021 on patients diagnosed as extra pulmonary multidrug resistant tuberculosis. Study was done study the clinical profile and treatment outcome.Results: Our study found 54 patients to have extra pulmonary drug resistant tuberculosis, 66.6% were females while males were 33.3% and mostly affected were age group of 21-29 age (26.4%). Lymph node involvement most common in our study group. 74% patients were resistant to rifampicin. Treatment showed favorable outcome in majority of cases. Conclusion: We found 8.85% of EP DR TB cases at our centre and with good treatment outcome and stressing the fact concomitant history of pulmonary TB in 14.81%.

13.A Comparative Study to Evaluate the Outcomes in Endoscopic Assisted Vs Conventional Middle Ear and Mastoid Surgery
Manoj Kumar, Vikram Satyarthy, Rana Pratap Thakur
Aim: A comparative study of endoscopic assisted versus conventional middle ear and mastoid surgery at a tertiary care teaching hospital. Methods: This comparative study was carried out in the Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India Cases of chronic otitis media, inactive mucosal disease for tympanoplasty, cases of chronic otitis media, active or inactive squamosal disease for mastoidectomy and patients with the age between 10 to 60 years were included. Total 60 patients; among them 30 cases were of endoscope assisted middle ear surgery and 30 cases with conventional microscopic middle ear surgery. Results: Out of 30 cases; tympanoplasty was performed in 16 patients and mastoidectomy (canal wall up/canal wall down) performed in 14 patients both groups.  In patient of endoscopic assisted tympanoplasty mean preoperative A-B gap was 30.61±9.19 dB while post operative mean A-B gap was 17.85±7.28 dB. In patient of non-endoscopic assisted tympanoplasty mean preoperative A-B gap was 26.76±8.82 dB while post operative mean A-B gap was 18.38±9.56 dB. In present study mean preoperative A-B gap was 41.11±2.13 dB and 36.76±3.42 dB for endoscopic assisted mastoidectomy and non-endoscopic assisted mastoidectomy respectively. While post operative mean A-B gap was 33.18±4.71 dB and 28.92±5.14 dB for endoscopic assisted mastoidectomy and non-endoscopic assisted mastoidectomy respectively. In present study mean A-B gap closure for endoscopic assisted tympanoplasty was 13.76±5.00 dB, while 9.38±4.78 dB for non-endoscopic assisted tympanoplasty. Mean A-B gap closure for endoscopic assisted Mastoidectomy was 8.93±3.16 dB, while 8.84±2.27 dB for non-endoscopic assisted mastoidectomy. Conclusion: This study concluded that the endoscope can be successfully applied to ear surgery for most of the ear procedures with a reasonable success rate both in terms of perforation closure and hearing improvement and with minimal exposure.

14.A Randomized Double Blind Controlled Study to Assess the Efficacy of Levobupivacaine Alone Versus Levobupivacaine with Ketamine in Subcutaneous Infiltration for Postoperative Analgesia in Lower Segment Cesarean Section
Rajesh Verma
Aim: The aim of the present study to comparison of levobupivacaine alone versus levobupivacaine with ketamine in subcutaneous infiltration for postoperative analgesia in lower segment cesarean section. Material and Methods: A randomized double blind controlled study conducted in the Department of Anaesthesiology, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. A total of 30 parturients were randomly assigned to two groups (each with 15) based on computer-generated random numbers kept in sealed and numbered envelopes. Parturients in Group A received a subcutaneous surgical wound infiltration with a 0.5 percent levobupivacaine solution diluted with normal saline to a total of 32 ml at 2 mg/kg body weight to a maximum of 150 mg. Parturients in Group B received a subcutaneous surgical wound infiltration with a solution of 0.5 percent levobupivacaine 2 mg/kg body weight diluted with normal saline to a total volume of 32 ml, plus ketamine 1 mg/kg body weight diluted with normal saline to a total volume of 150 mg. The VAS scale and total analgesic use throughout the 24-hour postoperative period were used to assess the primary outcome, postoperative pain alleviation. Results: The mean heart rates at zero hour (baseline) were comparable in groups A and B (P=0.871). Except at the 4th and 6th hour post-operative, the mean heart rate of group A was greater than that of group B, which was statistically insignificant at the majority of time periods. Conclusion: In terms of greater pain relief, reduced need for rescue opioid analgesia, and no serious side effects, the study concluded that ketamine is a viable adjunct modality to levobupivacaine for local wound infiltration.

15.A Study of Mesh-Related Infections After Hernia Repair Surgery: A Retrospective Analysis
Sanjeet Kumar, Alok Kumar Niranjan
Aim: The aim of this study to analysis of mesh related infections in a tertiary care centre. Methods: The A retrospective observational study was conducted in the Department of General Surgery, Jannayak Karpoori Thakur Medical College and Hospital Madhepura, Bihar, India for 1 year. All cases that underwent ventral and groin hernia surgeries and reported with mesh infections in the Department of General Surgery were included in the study. Demographics like age, sex and factors associated with mesh infection like BMI, comorbidities, time of presentation, tobacco consumption, ASA grade, type of hernia, type of hernia repair done were taken from medical records of the patients and their association with mesh infections were analyzed. Results: Total 20 cases of mesh infection were recorded out of 600 open repair hernia surgeries. The incidence was 0.033%. 70% of patients with mesh infection had a history of tobacco consumption, i.e., out of the 20 patients, 15 patients consumed tobacco, and 5 patients had no history of tobacco consumption. 65% patients had co morbidities. HbA1c of all diabetic patients was >16 is noteworthy, emphasizing the fact that tight control of blood sugars is vital to prevent mesh infection. Out of 20 cases, 7 cases took less than 100minutes to be performed, and 13 cases took more than 100mins to be performed. The time duration of open surgery was 94+/-21.17mins and in patients who eventually had mesh infection were118.0+/- 20mins. Duration of surgery in patients who underwent laparoscopic surgery was 111.50+/-13mins, and in patients with mesh infection post, the laparoscopic repair was 133.45+/-30mins. 11 patients were of ASA grade 3 who developed mesh infection, and 9 patients were ASA grade 2 i.e 55% patients were ok ASA grade 3. Conclusion: In our study the incidence of mesh infection after the open procedure was 0.033%. As ours is a teaching hospital, surgeries are performed by surgeons in the early phase of the learning curve, so it takes much longer to perform surgery than an experienced surgeon would take.

16.An Additional (Accessory) Lobe of Liver and its Clinical Significance: Cadaveric Study
Swami Nand Prasad, Nimisha Madhu, Rajendra Prasad
Aim: Cadaveric study of an accessory lobe of liver and its clinical significance. Methods: This observational study was carried out in the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for 1 year. 60 adult human livers were obtained from donated embalmed cadavers (50 male & 10 female) in the Department of Anatomy. All of them were found between 64 to 74 years of age. Only cadavers, whose clinical history excluded liver diseases, were used for the study. Results: We observed an accessory lobe in 6 livers. They were situated in the posterior part of the fissure for ligamentum teres, close to the porta hepatis. The lobes were triangular in shape and about one inch in width. They were attached to the left anatomical lobe of the liver through a vascular pedicle which contained the branches of hepatic artery, portal vein and hepatic duct. Microscopic structure of the accessory lobe showed normal liver architecture. Conclusion: Knowledge of the presence of a small accessory lobe of the liver near the porta hepatis is useful for surgeons and radiologists in diagnosing, surgical planning and avoiding iatrogenic injuries of the accessory lobe.

17.A Prospective Assessment of the Psychological Distress and Caregiver Burden Among Care Givers of Schizophrenia Patients
Upendra Paswan
Aim: The study was conducted with the aim of assessing the psychological distress and caregiver burden among care givers of schizophrenia patients. Material & Methods: The study sample consisted of 60 patients with schizophrenia and their caregivers who were randomly selected from the Darbhanga Medical College & Hospital’s OPD, Laheriasarai, Darbhanga, Bihar, India. The study relied on the Burden Assessment Schedule and the General Health Questionnaire-12. Results: Our research also found that 45.76 percent of caregivers were under a lot of stress. Caregivers of patients with low education levels reported a higher level of stress. Parents and spouses had a moderately greater amount of stress, whereas siblings had the highest level of stress. Parents had more psychological distress than spouses and siblings. Caregivers with a higher level of psychological stress were found to have a greater burden of caregiving. Conclusion: The most important predictive factor of psychological distress in caregivers was the severity caregiving burden.

18.Retrospective Hospital-Based Assessment of Maternal Mortality in Chota Nagpur Region
Vandana Kumari, Nitish Kumar Ranjan, Priti Bala Sahay
Aim: A study on maternal mortality in a tertiary care center in Chota Nagpur region, Jharkhand. Materials and methods: This were a retrospective study of 100 cases of maternal deaths over a period of 12 months from June 2012 to May 2013.  All booked or unbooked maternal deaths admitted at the time of pregnancy, delivery or during puerperium were included in study. The data was collected from hospital records. The medical records sheets of all identified women were reviewed regarding age, parity, residence, antenatal booking status and cause of maternal death. Results: Maximum maternal deaths were reported in the age group 20-24 years (49%). Death among teenage pregnancies was seen in 6% of cases. Regarding parity majority of deaths were seen in multiparous women (55%) as compared to primiparous women (45%). 59% of cases were unbooked. More maternal deaths were reported in women from rural areas (84%). The classic triad of haemorrhage, hypertensive disorders and sepsis were the major causes of maternal death. In our study haemorrhage was the leading cause of maternal death followed by hypertensive disorders seen in 29% of cases. Sepsis was seen in 12% of cases. Rupture uterus and pulmonary embolism were other direct causes of maternal death. Anemia was the major indirect cause and significant comorbid factor of maternal death. Conclusions: Majority of maternal deaths were preventable by proper antenatal care, early detection of high-risk pregnancies and their timely referral to tertiary care centre.

19.A Study of the Prevalence of Metabolic Abnormalities in Urolithiasis in A Tertiary Care Centre in Bihar
Md. Umar Abdullah, Shashi Prakash, Rajesh Kumar Tiwari, Arshad Hasan
Aim: Study of the prevalence of metabolic abnormalities in a tertiary care centre in Bihar region. Methods: This was a prospective observational study conducted in the Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for 10 months. Total 50 patients over 18 years old were included in this study. Results: Metabolic abnormalities were found in 94% patients (Confidence Interval   95%:   87.2–99.8%).   Almost a quarter (26% [CI95%: 16.0–36.8%]) only had one   metabolic   abnormality, and   68%   patients CI95%: 56.9–79.4%) had multiple metabolic abnormalities. Hypercalciuria was the most commonly observed metabolic abnormality and was found in 54% (CI95%: 43.5–67.6%) of patients. Other significant metabolic abnormalities were hyperoxaluria (34% [CI95%: 22.4–49.8%]), hyperuricosuria (32% [CI95%: 21.9–44.7%]) and hypomagnesuria (30% [CI95%: 21.3–44.2%]). several sociodemographic and clinical variables with the most frequent metabolic abnormalities found in our study (hypercalciuria, hyperoxaluria, hyperuricosuria and hypomagnesuria). Patients with hypercalciuria were older (55.8 ±12.9 years vs. 48.8 ±6.8 years, p = 0.022), family history of stone disease was significantly more frequent among patients with hyperoxaluria (70% vs. 30%, p = 0.011) and there was a higher prevalence of present and former smokers among patients with hyperoxaluria (p = 0.012). Conclusion: Immediate metabolic evaluation is the key for a better and individualized management, guiding the selection of proper pharmacological and dietary measures to prevent recurrent stone formation and to relieve all clinical and economic burdens behind this condition.

20.An Analytical Assessment of Serum Uric Acid Level in A Subject of Essential Hypertension with Specific Reference to Age and Body Mass Index
Bahis NP, A. K. Mehta, U.C. Jha
Aim: The aim of this study to evaluate the serum uric acid levels in subjects of essential hypertension with special reference to age and body mass index. Methods: This analytical study was conducted during the period from December 2020 to November 2021 in the Department of medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. 100 patients with hypertension and 100 normotensive age and sex-matched otherwise healthy subjects were included in this study. The serum uric acid level was measured by the uricase method, serum creatinine by Jaffe method, triglyceride, total cholesterol, and HDL cholesterol by enzymatic method. LDL- cholesterol was calculated using the Friedewald equation. Glucose was measured by the glucose oxidase method in the venous blood samples collected in EDTA tubes. The estimated glomerular filtration rate (eGFR) was calculated using the Cockroft-Gault formula. Hyperuricemia was defined if SUA levels above 7.0 mg/dL in males and above 6.0 mg/dL in females. Results: The frequency of hyperuricemia was higher in the hypertensive group in comparison to the normotensive control group (30% vs. 5%, p<0.001). Serum uric acid level was higher in the hypertensive subjects than the controls (6.20±0.78 vs. 5.48±0.44 mg/dL, mean±SD, p<0.001). In the hypertensive group, subjects with stage II HTN had higher serum uric acid than those with stage I HTN (6.56±0.73 vs. 5.82±0.68 mg/dL, mean±SD, p<0.001). In the hypertensive group, uric acid level showed significant positive correlations with both systolic and diastolic blood pressure though in the control group, uric acid showed such correlation with systolic BP only. Conclusion: Patients with essential hypertension had higher serum uric acid compared to normotensive controls; patients with stage II HTN had higher uric acid than those with stage I HTN in this study. Serum uric acid level showed positive correlations with systolic and diastolic BP in the hypertensive subjects.

21.Prospective Open Label Observational Assessment of the Association Between Hyperuricemia and Albuminuria in Patients with Type 2 Diabetes Mellitus
Alok Kumar, A.K. Mehta, U.C. Jha
Aim: Study on the association between hyperuricemia and albuminuria in patients with type 2 diabetes mellitus. Methods: This Prospective open label observational study was done the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, the study group comprised of 50 patients of type 2 diabetes mellitus of age between 35 to 75 years. Age, body weight, height, body mass index (BMI), serum uric acid, urinary albumin to creatinine ratio (ACR), fasting blood glucose (FBG), glycated haemoglobin (HbA1c), lipid profile, serum creatinine was studied. Results: Mean serum creatinine levels in the study population and mean GFR of the same were recorded as 0.990±0.19 mg/dl and 78.66±13.95 ml/min/1.73 m2 respectively. The mean urinary ACR observed in study population of our study came to be 147.4±170.46(µg/mg). In the present study on basis of urinary ACR, albuminuria was divided into 3 groups of normoalbuminuria (ACR <30 ug/mg), microalbuminuria (ACR between 30 ug/mg & 299 ug/mg) & macro albuminuria (ACR ≥ 300ug/mg). The mean urinary ACR values in these three study groups came to be 23.3±3.53, 145.6±70.11 and 422.3±149.33 respectively. In patients with normouricemia 61.11% (n=22) had normoalbuminuria, 22.22% (n=8) had microalbuminuria; and 11% (n=4) had macro albuminuria. In patients with hyperuricemia 43.75% (n=7) had microalbuminuria; 37.5 % (n=6) had macro albuminuria& 18.75% (n=3) had normoalbuminuria. Thus, albuminuria was significantly associated with hyperuricemia. The concentration of serum uric was 4.79±1.23 mg/dl, 7.99±0.97 mg/dl and 6.81±1.48 mg/dl in patients with normoalbuminuria, microalbuminuria and macro albuminuria, respectively. On comparison, the results were found to be statistically significant. Conclusion: As hyperuricemia is a common finding in this group of patients, and its treatment is easy and available, early diagnosis and treatment may be helpful to prevent or decrease the rate of development of overt kidney disease in this population of patients.

21.A Prospective Observational Assessment of the Role of Dyslipidemia and Other Unidentified Risk Factors in Ischaemic Stroke
Bhavana, A.K. Mehta, U.C. Jha
Aim: Evaluate the role of Dyslipidemia and other unidentified risk factors in Ischaemic stroke in our population. Methods: It was a prospective observational study in 80 angiographically proven CAD patients at Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Anthropometry and cardiovascular risk variables were assessed in all patients, and blood samples were taken to test biochemical and inflammatory markers. This study included a total of 80 individuals who were admitted to the Medicine Department for examination of chest discomfort and confirmed to be angiography positive. Results: A total of 80 individuals with known CVD (Male: 50; Female: 30, age: 58.22 ±4.21 years, range: 27-77 years). indicates the individuals’ baseline characteristics. Males and females were not separated by age (Male: 60.45±12.21; Female: 54.21±11.11; P = 0.7 4). Males had higher levels of dyslipidemia than females. Males had a larger percentage of T2DM, Dyslipidemia and HTN than females. Total cholesterol level (169.41±18.26 vs. 199.24±11.45, P = 0.88) and LDL cholesterol (104.21±8.21 vs. 99.41±9.45, P = 0.64) were comparable in patients with and without atherogenic dyslipidemia. There was no statistically significant difference in percentage of patients with hypercholesterolemia among patients with or without atherogenic dyslipidemia. Cardiovascular risk factors found significantly higher in patients with atherogenic dyslipidemia present in cases and there was statistically significant difference in both groups. Conclusion: In individuals with CAD, hypertriglyceridemia and low HDL cholesterol are more prevalent than hypercholesterolemia. This shows that among Indian individuals with CAD, a new preventative approach is necessary.

23.Comparative Assessment of the Vascular Perspective Between Normal Tension Glaucoma and Primary Open-Angle Glaucoma Patients
Jawed Iqbal, Sudhanshu Kumar, Bishnu Deo Goel
Aim: Comparative study between normal tension glaucoma and primary open-angle glaucoma. Materials and methods: Total 100 patients attended the eye OPD in 12 months having primary open angle glaucoma patient and normal tension glaucoma was recruited in the research. Group A: Patient with or without primary hypertension having primary open angle glaucoma. Group B: Patient with or without primary hypertension having normotensive glaucoma Group C: Patient age-matched controls without hypertension. Results: A total number of study populations were 100 patients. The average age of the study population was 55.38 ±8.92 years and ranging from 40 to 77 years. There was strong correlation between MAP (mean arterial pressure) and MOPP (mean ocular perfusion pressure) amongst NTG group. There was strong correlation between MAP (mean arterial pressure) and MOPP amongst NTG with hypertension group. In POAG with hypertensive group with medication, the correlation between MAP (mean arterial pressure) and MOPP (mean ocular perfusion pressure) was strong, while MOPP was inversely correlated with IOP showing strong association. The MAP was weakly correlated with IOP. In POAG with hypertensive group without medication, MAP (mean arterial pressure) was also strongly correlated with MOPP, while MOPP was inversely correlated with IOP showing strong association and MAP showed inverse correlation with IOP showing strong correlation. In NTG with hypertensive group with medication, MAP was strongly correlated with MOPP. Conclusion: This study demonstrates that in all groups a moderately strong correlation existed between MAP and MOPP and IOP and MOPP were inversely correlated.

24.A Double Blinded Randomized Controlled Study to Evaluate the Outcome of IV Tranexamic Acid Versus Topical Tranexamic Acid Application in Prevention of Postpartum Hemorrhage in Women with Placenta Previa
Kiran Bharati, Bhuvneshwar Kumar, Sudha Bharati
Aim: Adjunctive IV tranexamic acid versus Topical tranexamic acid application on the placental bed for prevention of postpartum hemorrhage in women with placenta previa. Methods: A double blinded randomized controlled study was conducted in the Department of Obstetrics & Gynaecology, Government Medical College Bettiah, West Champaran, Bihar, India for 1 year. Study inclusion criteria were Women undergoing cesarean delivery for placenta previa (PP). Diagnosis of PP based on ultrasound in which the placenta covered the internal os of the cervix. Informed consents were obtained from them. After that participant were randomized into 3 groups: Group 1: 50 patients received 10 IU oxytocin (syntocinon Novartis company) IV after placental delivery. Group 2: 50 patients received 1 gm tranexamic acid (2 ampoules of kapron 500 mg 5 ml.) IV just before skin incision plus 10 IU oxytocin IV after placental delivery. Group 3: 50 patients received 10 IU oxytocin IV after placental delivery plus 2 gm topical tranexamic acid (4 ampoules of kapron 500 mg 5 ml) applied on placental bed. Results: 150 women were enrolled (n = 50 in each group). Both groups of women received IV tranexamic acid (Group II) and topical tranexamic acid (Group III) showed great reduction in intraoperative and 4 hours post- operative blood loss compared with (Group I) which received 10 IU oxytocin only (P = 0.0001, 0.0001, 0.0001, 0.0001), so the overall estimated blood loss in group II and III showed highly reduction compared with group I (P = 0.0001, 0.0001). Conclusions: Prophylactic adjunctive Tranexamic Acid (TA) topical application on the placental bed or iv administration reduces blood loss during and after caesarean delivery in women with a placenta previa. Novel application of topical tranexamic acid on the placental bed is effective in reducing intraoperative and postoperative bleeding in comparison with IV route with elimination of theoretical risk of thrombic embolism complication with IV rout.

25.A Retrospective outcome assessment of Phacoemulsification versus Manual-Small Incision Cataract Surgery for Cataracts
Sudhir Kumar, Vineeta Laxmi, Vijay Shekhar Kumar
Aim: Phacoemulsification versus Manual-Small Incision Cataract Surgery for Cataracts. Methods: A retrospective study was conducted in the Department of Ophthalmology, Government Medical College, Bettiah W. Champaran, Bihar, for 1 year. Electronic medical records of the patients were reviewed, and demographic, preoperative, and postoperative data collected included age, gender, preoperative uncorrected visual acuity (UCVA), presence of preoperative comorbidities, intraoperative and postoperative complications, and postoperative UCVA on postoperative day (POD) 1 and 30. The surgeons were classified into three groups based on years of experience after completion of residency training into < 5,5–10, and >10 years. The intraoperative and postoperative data were analyzed to note any differences among the three groups and between the two procedures. Results: Among the 150 cases with brunescent cataract reviewed, 100 underwent MSICS and 50 underwent PE. 71 cases (47.33%) were male, and 79 cases (52.67%) were female. Mean age was 67.73 (±7.16) years in the PE group and 69.52 (±7.43) years in the MSICS group, which was found to be statistically significant (P = 0.002), suggesting that more older patients underwent MSICS. Preoperative documentation showed that 50 cases had PXF, 14 cases with shallow AC, 8 cases with associated posterior polar cataract, and three cases with phacodonesis. A total of 30 intraoperative complications were encountered in both groups. PE group had 10 (33.33%) intraoperative complications with the most common being polymerase chain reaction (PCR) in 6 (60%) cases followed by ZD in 3 (30%). In the SICS group, 20 complications (66.66%) were noted with PCR in 10 (50%) followed by ZD in 6 (30%). The only complication that was not encountered in the PE group was iridodialysis, which occurred in 4 (20) cases of MSICS. The mean postoperative UCVA on POD 1 and POD 30 was 0.44 and 0.33, respectively, for the PE group and 0.44 and 0.31 for the MSICS group, with significant difference seen at POD 30 (P < 0.002). Conclusions: For developing nations where cost and training are the rate limiting factors, where patients tend to present late with harder and complicated cataracts, MSICS is the procedure that serves the need for low-cost, high-volume, high-quality cataract surgery for all.

26.A Prospective Cross-Sectional Assessment of the Clinico Microbiological Profile of Patients with Fungal Corneal Ulcer
Vikash Vaibhav, Nandani Priyadarshini, Uday Narayan Singh
Aim: To evaluate the clinical features, laboratory diagnosis and microbiological profile of fungal keratitis. Method: A prospective cross-sectional study was conducted on 50 patients with features of corneal ulcer presenting to the Department of Ophthalmology Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. from March 2018 to February 2019. Corneal ulcer with or without intact epithelium were included in the study. Clinical diagnosis of fungal keratitis was made on the basis of following features: dry raised slough, stromal infiltrate with feathery edges, satellite lesions and thick endothelial exudate. A standardized proforma was filled up for each patient documenting socio-demographic features duration of symptoms, history of trauma, associated ocular and systemic conditions, prior therapy received, and all other clinical findings including visual activity. Results: Out of the 50 patients of corneal ulcers included, mycotic etiology was established in 27 cases [54%]. Out of 30 fungal corneal ulcer cases males (19, 70.4%) were affected more than females (8, 29.6%). Majority of the patients were more than 40 years of age (11, 40.7%) followed by 31-40 years of age group (7, 25.9%). Most patients were from rural areas (17, 62.9%). Corneal trauma (22, 81.5%) was the most common predisposing factor. 4 patients (14.8%) had co-existing ocular diseases responsible for development of fungal keratitis. Use of topical steroids predisposing to fungal keratitis accounted for 3 cases (11.1%) and associated systemic diseases were seen in 7 cases (25.9%). Conclusion:A good clinical evaluation aided by microbiological support will help in better diagnosis and treating the corneal ulcer. In cases of fungal corneal ulcer, Fusariumspp is the most common organism responsible followed by Aspergillus spp.

27.Prospective, Randomized Clinical Assessment of the Effect of Single Dose Dexmedetomidine Given Prior to Extubation Following General Anaesthesia
Deepak Kumar Maurya, Alok Ranjan, Pramod Kumar Sinha
Aim: Effect of single dose dexmedetomidine given prior to extubation-on-extubation conditions in adult patients following general anaesthesia. Material and methods: This prospective, randomized, study was carried out in the Department of Anaesthesia and Critical Care, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 15 months. After obtaining informed written consent for participation in the study, 50 adult patients aged 18-70 years belonging to American Society of Anaesthesiologists physical status (ASA PS) class I-II of both genders undergoing elective surgeries were enrolled. Results: Incidence of cough at extubation was comparable in both groups (68% vs. 66%, p 1.11). Baseline mean arterial pressure was comparable in both groups, but at 3min after extubation it was significantly lower in Group A. Heart rate, postoperative nausea, vomiting, shivering and sedation scores did not show any significant difference between the two groups (p>0.05). Conclusion: An infusion of dexmedetomidine at 0.75mcg/kg prior to extubation did not affect the severity of cough but resulted in improved hemodynamics at predefined time points after extubation.

28.A Prospective Study on Laryngotracheal Injuries Following Endotracheal Intubation
Vikram Satyarthy, Manoj Kumar, Rana Pratap Thakur
Aim: The aim of the present study to evaluate the laryngotracheal injuries following endotracheal intubation. Methods: A prospective study was conducted in the Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 10 months. 50 Patients intubated for more than 48 hours and admitted in medical ICU and aged more than 15 years were included in this study. To find the incidence, types of injury and to study the factors influencing LTI following intubation. Results: Endotracheal tube of size 7.5 and 8 were used in 84% of patients. Majority of the patients (52%) were cases of organophosphorus (OP) poisoning followed by metabolic disorders like diabetic ketoacidosis and chronic kidney disease with encephalopathy. 36% of the patients were intubated for more than 10 days. The x-ray was normal in 36 patients (72%) while the abnormality was picked up in 14 (28%) patients. On 70-degree endoscopy, 4 patients (8%) had granulation tissue in the posterior commissure and one patient had bilateral vocal cord fixation. All the patients who had LTI were aged less than 45 years and 16 of 20 cases affected were males. Among the cases of LTI, 16(80%) out of 20 cases were intubated with endotracheal tubes of size more than 7. 12 (60%) of the total cases of LTI had intubation for more than 10 days. OP poisoning was the etiology for LTI in 16 cases (80%). Conclusion: A high incidence of LTI especially in cases of OP poisoning warrants one to be cautious in managing these intubated patients. Those patients requiring prolonged intubation should be considered for other alternative airway managements like tracheostomy in addition to using low pressure, high volume cuffed tubes.

29.Clinical Assessment of the Diagnostic Utility of Leukocyte Parameters in the Patients with Acute Myocardial Infarction
Deepak Kumar Jha
Aim: To evaluate the diagnostic potential of leukocyte parameters in the patients with acute myocardial infection. Methodology: 200 patients were enrolled in this study which were sub-grouped into group A and B. In group A, 100 were healthy individuals diagnosed with hypertension and in group B, 100 patients were included who were admitted to Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India Blood sampling was performed from the ulnar vein in the first hour and on the 7th day after hospitalization. CBC was performed as well as erythrocyte sedimentation rate (ESR) was performed. Leukocytic parameters and their ratios, in particular the levels of leukocytes, lymphocytes, neutrophils, ESR, as well as the ratios of N/L and PLT/L were studied. Results: Comparing the parameters of the CBC between the two groups, it was established that the level of leukocytes was significantly higher in the group of patients with AMI than in the group A. There was significant difference in the absolute number of lymphocytes and granulocytes between the groups A and B: in the AMI group, there was a significantly lower lymphocyte count and higher granulocytes. The N/L ratio and PLT/L ratio differed between both the groups and were highest in the patients with AMI. Conclusion: A significant relation between leukocytic parameters such as lymphocytes, granulocytes, N/L ratio and PLT/L ratio in patients having acute myocardial infarction was found.

30.Hospital Based Cross-Sectional Assessment of Lipid Profile in Non-Diabetics with Stroke
Nehal Hyder, Sudhir Chandra Jha, Syed Yousuf Faisal
Aim: To evaluate the diagnostic potential of leukocyte parameters in the patients with acute myocardial infection. Methodology: 200 patients were enrolled in this study which were sub-grouped into group A and B. In group A, 100 were healthy individuals diagnosed with hypertension and in group B, 100 patients were included who were admitted to Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India Blood sampling was performed from the ulnar vein in the first hour and on the 7th day after hospitalization. CBC was performed as well as erythrocyte sedimentation rate (ESR) was performed. Leukocytic parameters and their ratios, in particular the levels of leukocytes, lymphocytes, neutrophils, ESR, as well as the ratios of N/L and PLT/L were studied. Results: Comparing the parameters of the CBC between the two groups, it was established that the level of leukocytes was significantly higher in the group of patients with AMI than in the group A. There was significant difference in the absolute number of lymphocytes and granulocytes between the groups A and B: in the AMI group, there was a significantly lower lymphocyte count and higher granulocytes. The N/L ratio and PLT/L ratio differed between both the groups and were highest in the patients with AMI. Conclusion: A significant relation between leukocytic parameters such as lymphocytes, granulocytes, N/L ratio and PLT/L ratio in patients having acute myocardial infarction was found.

31.A Study of Knowledge, Attitude and Practice of Family Planning Methods in Mothers Visiting in Urban Health Centre in Patna, Bihar
Manish Kumar Singh, Shikha
Objectives: This study was to evaluate the knowledge, attitude and practice of family planning methods in mothers visiting in urban health centre. Methods: A total of 200 married women of reproductive age group (18-45 years) attending the outpatient department (OPD) were enrolled in this study. Data was collected by using a predesigned questionnaire, to elicit information regarding their age, educational status, knowledge and attitude towards different contraceptive methods. Results: Majorities of women were in age group of 18-25 years. Most of the women 180(90%) had the knowledge oral contraceptive pills. 113(56.5%) had the knowledge of condom. Least number of women 22(11%) had the knowledge of PPIUCD and vasectomy. Conclusions: Oral contraceptive pills is the most common choice of contraceptive methods. Asha workers are the great role for awareness about contraception in rural women. Fear of side effects, educational status is the major barrier for taking contraceptive methods in women. Hence, health worker should be organised free camp in urban and rural area for awareness of contraceptive methods and importance of family planning for women health and societies.

32.Clinical Profile of Mucormycosis in Covid 19 in A Tertiary Care Centre: A Retrolective Study
Madhuri M Kirloskar, Jenny Koshy, Jeetendra Singh
Mucormycosis is a fungal infection which is caused by a rare type of opportunistic fungal pathogen called mucormycetes. It is a serious and potentially fatal fungal infection. A wide range of bacterial and fungal co-infections have been associated with COVID 19. The second wave of COVID 19 showed a sudden surge in mucormycosis. The most commonly observed form was rhino cerebral mucormycosis. Most of the patients had diabetes as a pre-disposing factor and had received steroids, oxygen therapy, biologicals and antibiotics as a part of treatment of COVID 19. COVID 19 in itself favours the growth of mucormycosis owing to the weakened immune system. While the diagnosis of mucormycosis still remains challenging the treatment mainly aims at managing co-morbid condition in high-risk group, anti-fungal therapy using Amphotericin B and azoles and surgical debridement. In this article, we analysed, 71, histopathologically confirmed cases of mucormycosis associated with COVID 19 admitted and studied their clinical profile and risk factors associated with it.

33.Pattern of admission and clinical outcome of scrub typhus patients admitted in PICU in Southern Rajasthan
Vivek Parasher, Sachin Shaha, Rahul Khatri, Sayan Das, Samarth Yadav, Ujjwal Mittal
Introduction: Scrub typhus is a potentially fatal disease in pediatric age group. Caused by Orientia tsutsugamushi, it is a major cause of acute febrile illness in children in the rural tropical area of south East Asia. Methods: Information retrieved included age, sex, period of stay in ICU, clinical features, laboratory test results, complications observed and morbidity and mortality profile of patients admitted in PICU in the last five years. Results: In last five years, a total of 147 patients who were diagnosed as cases of scrub typhus were admitted into PICU. There were 39 (26.5%) male and 108 (73.4%) female patients giving an F: M ratio of 2.76:1. (4) 2.7% were of 1 month to 3 years of age, and (29) 19.7% were patients aged 3-10 years, and (114) 77.5% were of 10 years to 18 years of age. The most common presenting complaint at the time of admission was high grade fever147 (100.0%). The overall mortality rate among scrub typhus patients was 12.9%. Conclusion: In our PICU, mortality rate of scrub typhus patients is high (12.9%). The presentation of scrub typhus is often variable, usually non-specific, however with doubtless severe multi-organ pathology. Eschar was noted in significantly less no. of patients in our PICU as compared to other similar studies. Early detection is essential for specific treatment and better outcomes. Further study of strains of scrub typhus should be done to create a vaccine for this disease and sensitive and accurate testing.

34.Quality of Life in Patients with Tension-type Headache, Migraine without Aura and Mixed type Headache
Meena Ritu, Meena Deepa, Hussain Samar
Introduction: In India there are lack of studies on the impact of Tension-type Headache, Migraine without Aura and Mixed type Headache on quality of life (HRQoL). Objective: The objectives of the study were to measure the quality of life in patients with migraine without aura, tension type headache and mixed type headache and to compare them with matched healthy controls. Materials and Methods: 25 patients each with tension-type Headache, Migraine without Aura and Mixed type diagnosed using Headache international headache society (IHS) diagnostic criteria were interviewed in a tertiary level hospital. 25 healthy subjects (n = 71) were used as controls. WHO-Quality of life BREF was applied to measure the quality of life in these subjects. Results: Patients suffering from headache have poorer quality of life in all the four domains (physical, psychological, social and environmental domain) of WHO-QOL compared to healthy controls. Conclusion: Quality of life is significantly reduced in Indian patients with Tension-type headache, Migraine without Aura and Mixed type headache compared to healthy controls.

35.Competency-Based Medical Education: An Overview and Application in Biochemistry
Anita Verma, Dileep Singh Nirwan, Mohd Shakeel
Competency-based medical education (CBME) is an approach to ensure that the graduates attain the competencies required to discharge their professional duties as health-care personnel. It de-emphasizes time-based training and promises greater accountability, flexibility, and learner-centeredness. Biochemistry is one of the basic subjects in medical curriculum. The comprehension of medical biochemistry is often considered to be slurred by medical students, may be due to complex chemical structures and complicated metabolic cycles. Competency-based medical education’s competencies are so designed to bridge the gap between theoretical aspects with practical clinical skills of medical biochemistry. At the same time, it is applicable to consider the challenges shadowing its implementation.

36.Perception of Medical Undergraduate Students towards Online Education during COVID- 19 Pandemic
Satish Waghmare, Rakesh Narayan Patil, Jeetendra Singh
Background: COVID 19 pandemic has almost curtailed the traditional classroom teaching of the medical students. In order to fulfill the educational needs of the medical students and to complete their prescribed syllabi, most of the Medical institutions have adopted online teaching using various online teaching platforms. In this study we intended to know the perception of students regarding online education and various attributes which could make the online learning more effective and successful. Aim: The study aimed to determine the attitude and perception of medical undergraduate students towards online learning and to study the advantages and disadvantages of online learning. Settings and design: A cross sectional study was conducted in a private medical institute among the undergraduate medical students. Methods and material: After taking Ethical Approval from the Institutional Ethical Committee, the study was carried out among the undergraduate MBBS students of tertiary care institute.  Study was conducted by distributing the online questionnaire to the students. The questionnaire was circulated amongst the medical students through Google forms and the students were asked to answer them with a single most appropriate response. Statistical Analysis: Data was analysed using SPSS software version 18.0.Chi-square tests was used to find association of gender and year of MBBS with perception of students towards online learning. Results: A total of 239 medical students participated in the questionnaire survey of all the phases of MBBS. The students underwent their regular academic sessions through online teaching. Out of 239, 125 were female students and 114 students were male. Most of the students are comfortable with  smart phone(n=185), 52 were using laptops and 29 use tabs for online teaching.95 students  from phase 1,79  students from phase 2 and  65 students from phase 3 participated in the study. Conclusion: The study showed   that e-learning is the effective method in teaching medical students. Majority of the students has positive perception towards e-learning. However there are also some limitations of e-learning and effective strategies should be made to overcome the limitations.

37.A Cross Sectional Study of Psychological Impact of Covid-19 Pandemic Among Healthcare Workers
Rupali Shinde, Anup S. Bharati, Nishant Manka, Kinnari N Doshi
Introduction: January 31, 2020, WHO declared the COVID-19 crisis as a “Public Health Emergency of International Concern.” Continuous surge in the number of confirmed cases throughout the world led to a sharp decline in the global health, economic development, and also affected social stability because of requirement of strict quarantine measures. As the cases increased around the globe and also in the country it started creating a psychological impact on healthcare workers. Material and Methods: This was a cross sectional study with sample size 222,which was conducted for the duration of 1 year among healthcare workers (consultant doctors, PG resident doctors, intern doctors, nursing staff, technicians) across Maharashtra through Google Forms and manually through direct contacts. Forms were circulated through digital medium and various social media platforms. Forms consisted of general demographic data along with semi-structured proforma to assess the psychological impact of COVID-19 outbreak on Healthcare workers using Depression-Anxiety-Stress Scale (DASS-21). Results: Total 222 participants which comprised of 54% Consultant Doctors, 30% Resident doctors, 8% interns, 6% nursing staff and 2% technicians were included in the study. The mean age of the participants was 30.59 years. Out of 122 participants 32% Consultant Doctors were found to have signs and symptoms related to stress, 33% had symptoms suggesting depression and 37% had symptoms related to anxiety, 31% of Resident Doctors, were found to have signs and symptoms related to stress , 40 % had symptoms suggesting depression and 31% of the participants were having symptoms related to anxiety. 56% Interns were found to have signs and symptoms related to stress, 88% had symptoms suggesting depression and 56% of the participants were having symptoms related to anxiety. 16% of Nursing Staff were found to have signs and symptoms related to stress, 41% had symptoms suggesting depression and 50% of participants were found to have symptoms related to anxiety. Conclusion: There were symptoms found which was pointing towards presence of various levels of Depression, Stress and Anxiety amongst the COVID-19 Pandemic Healthcare workers. Further it is the need of the hour to address these psychological impacts at the earliest to ensure a smooth & efficient functioning of the healthcare system.

38.To Evaluate the Functional Outcome of Intertrochanteric Fracture Treated by PFNA2 in COVID-19-Positive Patients: A Retrospective Study
Sijo Joseph Pakalomattom, Mohammad Salil N K, A M Georgekutty, Faizal Ali A A, Venatius Varghese
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – also known as 2019 novel coronavirus or COVID-19 – first emerged on December 31, 2019 in China, and has since rapidly spread to become a world-wide pandemic. Orthopaedic trauma services, have maintained a significant portion of their previous volume throughout the pandemic, specifically, hip fractures in the elderly population  .Intertrochanteric fracture is one of the most common injuries among the elderly and is associated with a high mortality rate within 30 days after the injury event .Treatment of Intertrochanteric fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19-infected patients and the maintenance of standards of care. PFNA2 provide stability, compression as well as rotational control of the fracture and allows early post operative mobilization, weight bearing and thereby early fracture union. This study aims to assess the functional outcome of intertrochanteric fracture treated by PFNA2 in COVID-19-positive patients. Objectives: To evaluate the functional outcome of intertrochanteric fracture treated by PFNA2 in COVID-19-positive patients: a retrospective study. Methodology: This was a retrospective study of 30 patients,18 females and 12 males ≥55 years of age with intertrochanteric fracture and COVID-19 who underwent operative management with PFNA2. Clinical characteristics and early postoperative outcomes were reported. Results: A total of 30 patients, 21 patients (70%) had fever, cough, and fatigue at the time of presentation. 9 patients (30%) had sore throat and dyspnea, headache and dizziness (23%) (7 patients), abdominal pain and vomiting (16%) (5 patient), chest pain and nasal congestion (10%) (3 patient).18 patients (60%) had comorbidities. Postoperatively all 30 patients (100%) required non-invasive mechanical ventilation. All patients (100%) were given antibiotic therapy,18 patients underwent anti thromboembolic prophylaxis. 20 patients were treated with corticosteroids. Blood transfusion was done in 14 patients. Average HARRIS HIP SCORE was 83.6 at the end of six months graded as good outcome. The length of hospital stay in our study was 10 days (7- 14 days). The complications in our study included bed sores, superficial and (which settled subsequently with Intravenous antibiotics and debridement respectively). Conclusions:Our study shows that intertrochanteric fracture patients who present with a mild to moderate COVID-19 symptoms who underwent Intertrochanteric fracture surgeries with PFNA2 had a good functional outcome with few post op complications.

39.Comparison of Different RNA Extraction Methods for Detection of SARS-Cov-2by RT-PCR
Dinesh Kumar Jain, Manish Kumar, Shivra Batra, Parul Sinha, Sandeep Gupta, Nitya Vyas
Background: Corona virus disease 2019 is a highly infectious disease which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2. SARS-CoV-2 is transmitted from person to person mainly by respiratory droplets and aerosols as well as by direct or indirect contact. Aims and objective: To compare different RNA extraction methods for detection of SARS-Cov-2 RNA from nasopharyngeal and oropharyngeal swabs using three different methods which are based on different techniques. Material and methods: This analytical observational study was conducted in the department of Microbiology, Sawai Man Singh Medical College Jaipur, Rajasthan from December 2020 to January 2021. We selected 200 confirmed positive (extracted by Easy Mag automated system) (remnant) samples showing a wide range of different Ct values and 20 confirmed negative samples stored in Viral Transport Media VTM for this study. In order to compare quality of three extractions methods, all samples were aliquoted separately for each extraction technique. (1) Extraction by manual method (spin column base): was done by as per manufacturer’s instructions. (2) Extraction by QIA cube HT (vaccum column base): was done by as per manufacturer’s instructions. (3) Extraction by Perkins Elmer chemagic 360: (magnetic beads based). Result: A panel consisting of 200 Covid-19 positive and 20 Covid-19 negative samples were extracted by three methods (i.e. Manual column based, automated column-based and automated magnetic beads-based method). The extracted material/elutes were put for real-time RT-PCR assay for the detection of SARS CoV-2 RNA. There was no major difference seen in individual samples’ ct values between three extraction system.  CONCLUSION: In conclusion, we recommended all three RNA extraction methods (i.e. magnetic beads & silica column-based) are interchangeable in a diagnostic workflow for the SARS CoV-2 by RT-PCR and can be taken into account for SARS CoV-2 detection in possible future shortage of one kit or times of crisis in such pandemic time.

40.Role of Ultrasound Guided Fine Needle Aspiration Cytology in the Diagnosis of Space Occupying Lesions of Liver
Deepika Mishra, Sunil Choudhary, Neeraj Verma, Anita Meena, Sonu Dhayal
Introduction: The liver is one of the most common sites for both neoplastic and non-neoplastic lesions. A diagnostic modality such as FNA, which offers accuracy without significant complications and which requires minimal intervention at low cost, warrants consideration early in the investigative sequence. Aims and Objectives: To evaluate various space-occupying lesions encountered in the liver and to correlate radiology findings with the USG FNA diagnosis in liver lesions. Materials and Methods: this was an observational study comprising of 130 cases of hepatic lesions diagnosed clinically or radiologically. FNAC was performed under ultrasound guidance. Smears were stained by May-Graunwald-Giemsa, hematoxylin and eosin (H&E) stains. Results: The mean age of the patient was 53.8 years with M: F ratio of 1.1:1. Out of 130 cases, 10 cases of liver abscess, 1 case each of diffuse parenchymal disease and regenerative nodule and 118 cases were neoplastic. Of these 118 cases, primary malignant lesions form 7 cases which were hepatocellular carcinoma. Secondaries found in 111 cases, majority (44.9%) of cases were metastatic adenocarcinoma. Discrepancies were found in 3cases of liver lesions between radiological and cytological diagnosis [Cohen kappa = 0.788 (95% CI – 0.618 – 0.958) indicates a significant correlation between radiological and cytological diagnosis]. Conclusion: USG- guided FNAC is a quick, safe, simple, cost-effective and accurate method for diagnosing hepatic lesions. Early diagnosis by guided aspiration minimizes further ancillary investigations and decreases the length of hospital stay.

41.A Study to Assess Awarness About Pentavalent Vaccine Among Mothers Attending Immunization Clinic in Bharatpur
Kawale SK, Yadav H, Kaur S, Kumar A
Background: Government of India has introduced Hib as liquid pentavalent vaccine (LPV) combined with DPT and HepB in 10-dose presentation which is effective against five killer diseases – diphtheria, pertussis, tetanus, hepatitis B and Hemophilus influenza type B (Hib). Objectives: The present study was conducted to assess awareness in terms of knowledge, attitude and practice about pentavalent vaccine among mothers attending immunization clinic in Bharatpur. Methods: The present study was a hospital based cross sectional study carried out at immunization centre. Sample size calculated as 396 and selected by systematic random sampling method. We include mothers of under 2 years of children, coming to immunization clinic and who are willing to participate in study. Data collection was done in November and December 2019 by using predesigned and pretested questionnaire after taking written informed consent. Results: Only 16.9% were having knowledge of pentavalent vaccine and 27% participants aware about its schedule. 71% participants were aware about adverse events fallowing immunization (AEFI). 97.9% participants were willing to give pentavalent vaccine to their child, 90.9% were willing to advice to their relatives and 96.9% will follow the schedule for giving pentavalent vaccine to their child. 87.8% study participants vaccinate their child with pentavalent vaccine. Conclusion: They are having poor knowledge about pentavalent vaccine, but they are having strong positive attitude and practices for pentavalent vaccine. Government needs to give more focus on IEC activity by proper utilization of mass media.

42.Prospective Outcome Evaluation of Fractures of Lateral end of Clavicle using different Modalities of Management
Amit Kumar, Alok kumar, Neha Kumari
Aim: To evaluate outcomes of fractures of lateral end of clavicle using different modalities of management. Methodology: This is a type of prospective study including patients having fracture of lateral end of clavicle treated either conservatively or operatively in Department of Orthopedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Data was based on medical records of patients in the form of case sheets, discharge cards, X-rays, etc. Medical records of patients were assessed with respect to site of fracture, distribution according to age, occupation, mode of injury, closed/open, degree of comminution, treatment modalities, fixation techniques, etc. The type of fracture was determined by Neer’s classification. Then according to the nature of the fracture, patient was either treated conservatively or surgically. Patients were given information sheet informing the procedure and informed written consent was obtained prior to surgical intervention. Patients were assessed at admission, 12 days, 1 month, 3 months and 6 months post admission. Results: Out of the 50 patients having fracture of lateral end of clavicle, majority of the patients in our study were males (62%) and 38% were females. 42% of patients were below the age of 35, 34% of the patients were between 35-50 yrs old, and 24% of the patients were more than 50 years old. Mode of injury of 56% patients in our study was fall from height and 44% patients had road traffic accident. Right side was affected in 70% of cases and left side was affected in 30% of cases. In our study, 22% patients were Neer’s type I fracture pattern, 12% patients were Neer’s type III, and the remaining 66% patients had Neer’s type II fractures. 22 patients were managed non-operatively and 28 were operated using different modalities. In operative modalities, 13 (46.4%) cases were operated in the form of tension band wiring, 9 (32.1%) patients using plates and screws, 6 (21.5%) using coraco-clavicular screw fixation. Conclusion: Non-surgical treatment should be considered as the first line of treatment in Neer’s type I and III and few stable cases of type II fractures of lateral end of clavicle. But operative treatment is preferred over conservative management for unstable, displaced type II fractures in terms of functional outcome. If surgical treatment of a distal clavicle fracture is indicated, then the fixation method with the least complication rate and the maximum union rate should be selected.

43.Hospital-based Prospective Study to Assess the Correlation between Glycemic Control, Lipid Profile and C-reactive Protein in Adults with type 2 Diabetes Mellitus
Chandra Shekhar Das, Chirag Agrawal, Rajeshwer Kumar Ranjan
Introduction: Onset of type 2 diabetes mellitus (T2DM) at early age heralds many years of disease and an increased risk that the full range of both microvascular and macrovascular complications will occur when affected individuals are still relatively young. Thus, further generations may be burdened with morbidity and mortality at the height of their productivity, potentially affecting workface, and healthcare systems of countries across the world. Methods: Sixty patients with T2DM reporting to Nalanda Medical College & Hospital, Patna were included in the study, in whom CRP levels were estimated by using commercially available kits and correlated with HbA1C and other risk factors of coronary artery disease. Follow-up was done on 25 patients who were not on statin therapy with repeat HbA1C and CRP. Results: This study showed that both HbA1C and CRP levels had reduced significantly in follow-up patients after putting them on treatment (p<0.05). It was also found that lowers the HbA1C, lower was the CRP. A positive correlation was found between HbA1C and CRP (p<0.05). Conclusion: A positive correlation was found between serum CRP and HbA1C in the initial group and in the follow-up patients, showing that CRP levels lowers with better glycemic control and correlates with dyslipidemia profile.

44.Measurement of Fetal Kidney Length as a Parameter for Gestational Age in Singleton Pregnancy and its Comparative Evaluation with other Fetal Biometric Indices
Hitnarayan Prasad , Deepak Kumar, Swati Sinha, Umakant  Prasad
Aim: Measurement of fetal kidney length as a parameter for gestational age in singleton pregnancy and its comparative evaluation with other fetal biometric indices. Methods: This prospective observational study was carried out in the Department of Radio diagnosis, IGIMS, Patna, India. 100 women aged between 18 to 35 years with normal singleton pregnancies whose gestational age were confirmed by early ultrasound, were included in this study. Ultrasound was performed on Samsung HS 50 using curvilinear transducer. Ultrasound was conducted by two radiologists with ample experience and under defined scanning parameters. All cases were scanned twice by ultrasound. Radiologist one determined the average gestational age using Hadlock’s formula from foetal biometric indices viz, abdominal circumference, head circumference, femur length, bi parietal diameter, as well as carried out foetal anomaly scan of all cases. Results: There was a positive correlation between mean kidney length and gestational age as predicted by BPD, FL, AC and HC (P< 0.001). The correlation between gestational age and mean fetal kidney length is highly significant with Pearson’s correlation coefficient value of 0.98 and significance being P< 0.001 as shown in Table 1 also illustrates an extremely strong correlation with other variables as well like with AC (r = 0.911), HC (r = 0.985), BPD (r = 0.980) and FL (r = 0.988). Scatter plots were drawn between gestational age (independent variable) and with all the dependent fetal biometric indices, to depict the best fit line, linear regression equation, its slope and intercept. Regression coefficient or slope of kidney length is 1.1, abdominal circumference 1.05, head circumference 0.88, femur length 0.23, and bi parietal diameter 0.25 with respect to fetal gestational age. Conclusion: Fetal kidney length shows a strong correlation with fetal gestational age, with a steady growth rate throughout pregnancy irrespective of underlying medical condition like intrauterine growth retardation.

45.Levobupivacaine Alone versus Levobupivacaine with Ketamine in Subcutaneous Infiltration for Postoperative Analgesia
Kishore, Prabhanjan Kumar Choudhary, Ashok Kumar
Aim: Comparison of levobupivacaine alone versus levobupivacaine with ketamine in subcutaneous infiltration for postoperative analgesia in lower segment cesarean section. Methods:  A total of 100 adult parturients of Physical status II or III as per the American society of anesthesiologists (ASA) without any medical or obstetrical problems and scheduled for cesarean section under spinal anesthesia were included in this study. Parturients were randomized to one of the two groups (50 each) according to computer-generated random numbers kept in separate, sealed, and   numbered   envelopes. Group A parturients received subcutaneous surgical wound infiltration with a solution of 0.5% levobupivacaine at 2 mg/kg body weight (rounded to nearest multiple of 10) to a maximum of 150 mg (maximum safe dose) diluted with normal saline to a total of 32 ml. Group B parturients received subcutaneous surgical wound infiltration with a solution of 0.5% levobupivacaine 2 mg/kg body weight (rounded to nearest multiple of 10) to a maximum of 150 mg plus ketamine 1 mg/kg body weight diluted with normal saline to a total volume of 32 ml. The primary outcome, postoperative pain relief was measured using the VAS scale and the total analgesic consumption during the 24 hours postoperative period. Results: We observed that both the groups were comparable with respect to demographic data. The zero hour (baseline) mean heart rates were comparable between groups A and B (P = 0.947). The mean heart rate of group A was higher than that of group B which was statistically insignificant at majority   of   the   time   points   except at 4th and 6th hour post operative. The intra group comparison of mean heart rate showed a gradual decrease in values across time in both the groups but was more prominent in group B. Correspondingly, parturients in group A had higher mean VAS scores than those in group B at all time intervals and statistically significant difference were observed at 1, 4, 6, and 12 hours. The mean time to FRA of group A was at 3.35 ± 2.21 hours (194 mins) while that of group B was at 4.97 ± 2.36 hours (286 mins). This difference was statistically significant (P=0.043). Thus, parturients in Group B complained of pain 1.6 hours later than the parturients in group A. In group B with ketamine as an adjuvant to levobupivacaine, only 45% of the parturients demanded rescue   analgesia, whereas nearly 95% of the parturients needed rescue analgesia in group A which received levobupivacaine alone. Parturients   in   group   A   consumed a mean total opioid dose of 97.63 ± 38.26 mg in 24 hours compared to 62.12 ± 23.67 mg in group B. Thus, statistically significant higher opioid consumption was observed in group A than in group B (P = 0.002). There were 7% parturient in Group A compared to 24% in Group B in whom the PSS was of excellent quality and 25% in Group A and 45% in Group B graded the PSS with good quality. Thus, the difference in patient satisfaction score was statistically   significant   between the two groups (P = 0.007). Conclusion: ketamine is an effective adjunct modality to levobupivacaine for local wound infiltration in terms of superior pain relief, lesser need for rescue opioid analgesia, and no major side effects.

46.Comparative Assessment of the Efficacy and Aspiration risk of Proseal LMA and LMA Supreme with LMA Classic in Adult Anaesthetized Paralyzed Patients
Om Prakash, Anil Kumar Sinha, Ajay Chaudhri, Moti Lal Das
Objective: In the present study we compared the efficacy and aspiration risk of proseal LMA and LMA supreme with LMA classic in adult anaesthetized paralyzed patients. Methods: A randomized prospective study in Department of Anesthesia, Nalanda Medical College and Hospital,Patna, Bihar, India for 1 year.105 adult anaesthetized paralyzed patients. The proseal LMA and LMA supreme were compared with LMA classic in terms of ease of insertion, number of attempts, insertion time & hemodynamic parameters as primary outcome. Results: Ease of insertion was although more in PLMA and SLMA than CLMA but statistically comparable in all three groups. Insertion time i.e., time from jaw relaxation to connection to an aesthetic circuit and checking of adequate ventilation in all the groups was comparable (21.2±3.5 sec, 20.2±3.6 sec, 19.1±4.8 sec in group 1, 2 and 3 respectively). There was no statistically significant difference between LMA tip and gastric pH among all the three groups. Incidences of intraoperative & postoperative complications were similar in all the three groups. Conclusion: Clinically PLMA and SLMA are easier to insert than CLMA, but overall, the three groups were comparable with respect to insertion characteristics, airway manipulation required, hemodynamics, risk of aspiration and perioperative complications but cost effectiveness along with clinical benefit was seen more with PLMA.

47.An Observational Assessment of the Emerging Cases of Mucormycosis in Post Covid-19 Disease Patients
Pratulya Nandan, Swati Sharan
Aim: The aim of the present study to determine the emerging cases of mucormycosis in post Covid-19 disease patients. Materials and Methods: This observational study was carried out in the Department of Microbiology, Patna Medical College, Patna, Bihar, India for 1 year. Basic microbiological methods such as gram stain and KOH smear were used for the detection of MC in the received clinical specimen and morphology was seen in the microscope. Results: During study period our microbiology lab received n=30 suspected clinical specimens from N= 20 post covid-19 patients for MC diagnosis over one month period. Out of n=30 specimens, n=5 was positive for MC by gram and KOH smear method, and we saw filamentous fungi by conventional microscopic method. Conclusions: The present study concluded that the cases of life-threatening MC increase day by day in central India as post complication of covid-19 disease.

48.Association Between Prolonged Sexual Exposure and Cervical Cytological Changes: an Observational Study
Rachna Kumari, N.K. Briar
Background: Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. Material & Methods: The study cases were derived from the camp screening which is in progress in the Patna Medical College and Hospital, Patna, Bihar, India. Of the 1185 study cases, 97 were adolescents, 338 young adult girls and remaining 750 were adult women. A total of 1350 women who have undergone Pap smear examination at the camps, 102 were adolescents, 333 were young adult’s girls and 915 were adult women. Results: The SIL was present in 4 cases of erosion cervix (28.9%) while the only case of hypertrophied cervix also showed SIL. In the young adult girls and adult women, all the 3 types of clinical lesions were seen, the erosion cervix being more common, (10.2% and 6.7%, respectively).The SIL rate associated with three gynecological symptoms was higher in the adolescents than in young adult girls and adult women but the difference was found to be statistically insignificant (vaginal discharge- χ2=0.80: p=0.321, pain in lower abdomen- χ2=6.23: p=0.026, menstrual disorders-χ2=0.89: p=0.986). Conclusion:Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence.

49.Management of Chronic Lower Back Pain: an Observational Study
Rajeev Kumar Rajak, Barun Kumar Golwara
Background: Low backache with lumbosacral radiculopathy remains the most challenging musculoskeletal problem for its therapeutic management. Caudal epidural steroid administration is an effective treatment for chronic low back pain (LBP). Materials and Methods: 150 patients were treated with caudal epidural steroid injection for chronic low backache of more than three months at our institute. 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: A total of 150 patients were followed for one year. Out of 150, 65 were males and 85 females with chronic LBP. Lumbar disc herniation was seen in 52, lumbar canal stenosis in 23 and degenerative disc disease in 30 cases while 45 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). Conclusion: Epidural steroids are slowly proving to be a reliable alternative for all aviating pain and radiculopathy for a short term.

50.Cross Sectional Study to Evaluate the Clinical Correlation Between Migraine and Mood Disorders
Shravan Kumar, Suhail Ahmed Azmi, Rakesh Kumar Gaur, Deoshree Akhouri, Hamza
Aim: The aim of this study to evaluate the clinical correlation between migraine and mood disorders. Material and Methods: This cross-sectional study was carried out in the Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India. Each patient was evaluated in detail with a questionnaire with details regarding the duration of headache, frequency and duration of each episode, site, quality and severity of pain, auras, migraine accompaniments such as photo or phonophobia, nausea, vomiting as well as triggers. To assess disability, Migraine Disability Assessment Questionnaire (MIDAS) was applied to all patients. A score of 6 or more is taken as positive with cut offs for mild, moderate, and severe disability. The presence of concurrent anxiety and mood disorders was assessed by the Hospital Anxiety and Depression Scale (HADS). Results: A total of 200 patients were studied during the study. The sample consisted mostly of (n = 160, 80%) of middle age (20-50 years) Individuals with mean (standard deviation [SD]) of age of 35.12 (8.58) years. It was a female predominant sample (n = 138, 69%). As per HADS score, among the 22 patients (11%) suffering from depressive symptoms, 50% had borderline abnormal score and 16% (n = 32) had abnormal score whereas among the 27 persons (54%) suffering from anxiety 18% had borderline score and 50% had abnormal score. Mean HADS score (SD) of depression was 11.24 (3.04) while that of anxiety was 13.81 (2.71). Median of duration of headache was 6 years with SD of 6.5 years. Here, duration of disease was not normally distributed, so nonparametric statistics were applied. Though female individuals had more duration of illness (mean rank: 69.87), it was not significantly different (P = 0.04) from males (mean rank: 58.47). Middle-aged individuals suffered more duration of illness than other age groups (P < 0.04). Mean rank of the frequency of headache attacks in case of females was 71.4 (P < 0.04). Thus, females had more frequency of illness. No correlation between gender/age group and frequency of headache attacks was found. 75% (n = 150) of individuals had nausea and vomiting. No association with gender or age group with nausea or vomiting was found. 62% (n = 124) had photophobia and photophobia. Conclusion: We concluded that the mood disorders are comorbid with migraine at a rate comparable to or less than that described in many studies in international literature and the occurrence of comorbid mood disorders significantly contributes to migraine associated disability.

51.Prospective Comparative Evaluation of the Sociodemographic Profile and Fetal Outcome in Teenage and Adult Mother
Gunjan, Smita Kumari, Anjana Sinha
Aim & Objective: To find out the incidence of teenage pregnancy, to study the maternal and fetal outcome in teenage pregnancy and to compare the outcome of teenage pregnancy with that adult mother. Material and Method: It is a prospective comparative study. 100 cases of teenage pregnancy (13-19 years) were compared with 100 cases of adult pregnancy (20-26 years) for fetal outcome. After randomization, assessment of Sociodemographic details was done with the help of semi-structured performa. Results: The mean age of teenage mother and adult mother was 19.36 and 21.58 years respectively. Our study showed that preterm delivery was higher in teenage mothers (17%) as compared to adult mothers (6%). A Higher proportion of neonatal morbidity was present in teenage mothers (70%) as compared to adult mothers (24%).  Birth asphyxia is a most common complication and seen in 12% of cases.

52.Comparative Assessment of Post-dural Puncture Headache Using three Different types of Needles on Sub-arachnoid Block- a Randomized Clinical Study
Ajay Chaudhri, Om Prakash, Anil Kumar Sinha, Moti Lal Das
Objective: Comparison of post-dural puncture headache using three different types of needles on sub arachnoid block- a clinical study. Material: This prospective randomized comparative study in Department of Anaesthesiology, NMCH, Patna, Bihar, India for 1 year. 120 patients ASA I and II grades in the age group of 20 to 50 years and the height between 150 to 168cms, giving informed consent were included.  Patients with h/o chronic headache, any contra indication to sub arachnoid block and who did not give consent to participate in the study were excluded. Patient was randomly allocated in to three groups.  B.P., ECG, HR and SPO2 monitored non-invasively rate, of injection 1ml/15sec, volume 3ml of 0.5% bupivacaine heavy, lateral position and L3-4 interspace, were kept constant. The following parameters were compared: Number of attempts, PDPH, Back ache, NPDPH, and Patient acceptability. The results were compared statistically using Fischer exact test, Analysis of variance and Chi square test. Results: Statistically analyzing, there was no significant difference in number of attempts in three types of needles with the use of introducer. PDPH 7.5% in Group 2.5, 2% in Group 2, and 0% in group 3 inferring that group1 is associated with higher incidence P.D.P.H. Conclusion: All three types of needles were easy to insert when used with an introducer. Thus, pencil point Whitacre needle is better choice in view of low incidence of PDPH. However, cost factor which again should be weighed against the complication.

53.Hospital Based Cross Sectional Study to Determine the Clinical and Demographic Profile of the Children Diagnosed with Nutritional Anaemia
Upendra Prasad Sahu, Buwan Kumar Singh
Background: In recent 10 years, with the rapid socioeconomic development and the extensive implementation of children nutrition improvement projects, the previous epidemiological data cannot reflect the actual level of anemia among children. Methodology: A cross sectional study was undertaken in children with nutritional anemia attending Department of Pediatrics RIMS, Ranchi, Jharkhand, India from October 2020 to September2021. Results: Out of the 210 children studied, 115 children belonged to the age group of 6 year to 18-year group. Majority was males and accounted for 121 of the subjects with females accounting for 89. Majority (73 cases) belonged to class IV (upper lower), with 48 cases belonging to class III (lower middle) socio-economic status according to modified kuppuswamy classification. Majority were vegetarians constituting 127 cases and the rest 83cases belong to non-vegetarians. Conclusion: This study has revealed that the prevalence of anemia in children is high and a severe public health problem in the study area. Therefore, the policymakers should make a strategy that can reduce poverty and increase the awareness of nutrition, and other associated factors to reduce anemia.

54.Assessment of Analgesic Efficacy of Femoral Nerve Block and IV Fentanyl in Femur Shaft Fracture Patients for Positioning them for Neuraxial Block: Randomized Prospective Study
Anil Kumar Sinha, Ajay Chaudhri, Om Prakash, Moti Lal Das
Objective: To compare the analgesic efficacy of femoral nerve block and IV Fentanyl in femur shaft fracture patients for positioning them for neuraxial block. Methods: A randomized prospective study was conducted in Department of Anaesthesiology NMCH Patna for 12 months,100 patients belonging to ASA grade I and ASA grade II status undergoing surgery for fracture femur. Patients were randomly allocated to either of the two groups with the help of computerized randomization into: Group A: Femoral Nerve Block and Group B: IV Fentanyl. Data was analyzed using ANOVA test. Results: Both femoral nerve block and IV Fentanyl provided analgesia. The hemodynamic parameter variations (H.R., SBP, DBP, and MAP) in Fentanyl and femoral nerve block groups were statistically significant after 10 min interval. It was found that in femoral nerve block group no rescue analgesia was required and in IV Fentanyl group 100% rescue analgesia was required. Conclusion: Femoral nerve block provides better analgesia, patient satisfaction and satisfactory positioning than IV fentanyl for position during spinal anesthesia in patients of fracture femur.

55.A Prospective Study to Assess Outcome and Complications in Children Less than 5 years of Age Admitted to Hospitals with Severe and Very Severe Pneumonia
Hiralal Ram, Soumyabrata Panda, Mounish Nizampatnam
Aim: To assess outcome and complications in children less than 5 years of age admitted to hospitals with severe and very severe pneumonia. Materials and Methods: The present prospective longitudinal observational study was conducted in the Department of Paediatrics, Bokaro General Hospital, Bokaro Steel City, Jharkhand for One year. At admission demographic data of all 299 patients such as name, age, sex, socioeconomic status and clinical details of all the enrolled cases (severe and very severe pneumonia) were recorded in a predesigned proforma. Their detailed history / symptomatology (fever, cough, difficulty in breathing, altered sensorium, convulsion, inability to feed, level of consciousness, respiratory rate, chest retraction, grunting dehydration and auscultatory signs-crackles and wheeze, lab findings like leukocytosis, oxygen saturation at the time of admission were recorded. They were subjected to chest radiography and radiological findings of all the enrolled subjects were recorded. They were treated with parenteral antimicrobial therapy along with supportive measures as per standard treatment protocol adopted by the treating paediatrician. They were also assessed for presence of hypoxia (oxygen saturation SpO2 <95 %) need for assisted ventilation and final outcome during hospitalization. The possible outcome was “discharged (those children who recovered after treatment as per treating pediatrician) or” Death”. Results: Out of 299 subjects 65.9% (197) children were diagnosed as severe pneumonia, and 34.1% (102) were diagnosed as very severe pneumonia according to the WHO criteria for defining pneumonia severity. Out of 299 subjects, 195(65.2%) subjects with severe and very severe pneumonia were below 1 year of age. 203 (67.9%) were males, 96(32.1%) were females.  Out of 299 subjects, 203(67.9%) had no h/o refusal to feed and 96(32.1%) had h/o refusal to feed. 90(30.1%) had only intercostal retractions, 208(69.6%) had both subcostal+intercostal retractions. 232(77.6%) had bilateral crackles. out of 299 subjects, 110(36.8%) were exclusively breast feed, 189(63.2%) were received formula feed. Out of 299 subjects, 110(36.8%) children had previous NICU admission. Only single death (0.3%) was occurred, 298 patients (99.7%) were recovered.  Out of 299 subjects, 262(87.6%) children had complications and 37(12.4%) children had no complication. Conclusion: The present study concluded that 65.2% subjects with severe and very severe pneumonia were below 1 year of age. Only single death was found. Early diagnosis and treatment is very essential to avoid the complications, morbidity and mortality.

56.A Retrospective Observational Study to Evaluate Anesthetic Management of Idiopathic Pulmonary Arterial Hypertension for Cesarean Section
Prabhanjan Kumar Choudhary, Kishore, Ashok Kumar
Aim: Anesthetic management of idiopathic pulmonary arterial hypertension for cesarean section in Bihar region. Material and methods: This retrospective observational study was carried out in the Department of Anaesthesiology, Nalanda Medical College and Hospital, Patna, Bihar, India for 12 months. We studied the obstetric case records of 4 patients with IPAH who underwent elective cesarean section. We studied the maternal and fetal outcome and anesthetic management of these high-risk patients. The demographic variables, details of pregnancy, preoperative   maternal   evaluation    by New York Heart Association classification, signs and symptoms, echocardiographic assessment, medications (prostonoids, calcium channel blockers, oral anticoagulants), anesthetic management (general or regional), intraoperative monitoring, hemodynamic supports, number of days of hospital and intensive care unit (ICU) stay, maternal complications, and fetal outcome were noted. Neonatal outcomes studied included Apgar score, birth weight, and neonatal ICU admission. Results: All the 4 patients studied had severe pulmonary arterial hypertension.   Our   maternal mortality rate was 25%. Except for the first patient, all the others received regional anesthesia. Invasive central line and arterial line were used for all our patients. Pulmonary artery catheter was not used in any of our patients. All the patients went on inotropic support that was gradually tapered in the ICU. Two babies were shifted to neonatal ICU in view of poor Apgar scores. Conclusion: Multidisciplinary approach involving cardiologist, obstetrician, and anesthetist is required in planning and management of these high-risk obstetric patients. Epidural anesthesia seems to be an alternative to general anesthesia for cesarean section in patients with IPAH.

57.A Hospital Based Research to Assess the Clinico-pathological Correlation in Abnormal Uterine Bleeding (AUB)
Ila Priyanka, Sonali, Geeta Sinha
Aim: To study the clinico-pathological correlation in abnormal uterine bleeding. Material and methods: The study was conducted in the Department of Obstetrics & Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India from June 2020 to June 2021.100 patients who presented in this hospital with a history of AUB and who underwent D&C or hysterectomy were included in the study. Relevant clinical data regarding age, pattern and duration of abnormal bleeding, menstrual history, obstetric history, use of exogenous hormones, physical and gynecological examination findings, lab investigation results, and sonological and hysteroscopic findings were obtained from case records from Medical Records Department. Results: A total of 100 endometrial specimens submitted with a clinical diagnosis of AUB were studied. Patients’ age ranged from 20-69 years and most of them were seen in the age group of 45-55 years, followed by 35-45 years. The   commonest   complaint   was   menorrhagia   in 51 patients (51%). Parity in the present study ranged from para 1 to para 8. 74 (74%) of them were in the low parity group (para 1-2) followed by para 3-4 (26%). In our study, 74% of the patients were of normal weight, 21% patients were overweight, and 3% were obese. The commonest pathology observed in the study was endometrial hyperplasia in 24 (24%) patients. Secretory endometrium was the next commonly observed pattern seen in 17 (17%) patients, followed by proliferative and disordered proliferative endometrium in 11 (11%) patients each. Endometrial carcinoma was seen in 3(3%) cases. Endometrial hyperplasia and polyps the most common patterns seen in the age group ≤35 years. Between 35-45 years, secretory pattern was the most common followed by proliferative change. In the 45-55 age group, endometrial hyperplasia was the most common pattern followed by disordered proliferative pattern. Most of the endometrial and other carcinomas were presented after age 55 years. Conclusion: Abnormal uterine bleeding predominantly affects women of perimenopuasal age group which is alarming and needs thorough evaluation as it could be the only clinical manifestation of endometrial cancer.

58.A Comparative Research to Examine the Risk Variables for Pediatric Patients Hospitalized with Community Acquired Pneumonia at Darbhanga Medical College
Vaibhav, Rizwan Haider, Sachin Kumar
Aim: Comparative study to evaluate the risk factors for patients admitted with community acquired pneumonia in Pediatric patients. Methods: Patients of Community- Acquired Pneumonia aged 2 months upto 5 years of age who were admitted to the Paediatrics department were taken as cases (N=100). Controls (N=100) taken from healthy children between the ages of 2 months upto 5 years of age of age visiting the Department of Paediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. All the cases of community-acquired Pneumonia aged 2 months upto 5 years of age who were admitted to the Paediatric department were included in this study. Results: In the present study, 60% of males were infected with CAP in contrast to 40% of females. The majority of the cases (75%) belonged to the urban locality. Lower socioeconomic status, lower maternal and paternal education, overcrowding and indoor air pollution were associated with CAP. In our study, 47% of the cases and only 11% of the control have a history of LRTI/ asthma/ allergy/ rhinitis/ CHD/ diarrhea in the last 3 months that was statistically significant. In our study, 17 % of cases have a family history of Asthma/Allergy/TB/Rhinitis in comparison to 5% in the controls. In the present study, 28% of the cases of CAP were incompletely immunized in contrast to 6% in the controls. In the present study among those who were previously treated 80% landed up with severe pneumonia in comparison to 50% in those who presented directly. Conclusion: Concentrated efforts are needed to strengthen the health facilities and immunization coverage in the population. Public awareness should also be increased to improve the better utilisation of available resources. Improving the socio-economical status of people are welcome, this can take a long time to bear fruit.

59.Comparative Assessment of the Effectiveness of Both Non-Operative Management as Well as Operative Management of Liver Injury Patients
Ajay Kumar, Ashutosh Kumar Singh, Anupama Kumari
Objective: To analyze the effectiveness and morbidity and mortality of both non-operative management as well as operative management of liver injury patients admitted to our hospital. Methods: A retrospective study of the patients admitted with the diagnosis of isolated liver injury due to blunt abdominal trauma over the two years of time period. Data collected of 80 patients of isolated liver injury who either treated conservative management of operative management. Results: A total of 80 patients were analyzed of isolated liver injury due to blunt abdominal trauma, 75 patient sustained minor liver injury (grade I, II and III), whereas 5 patients had major liver injury (grade IV, V and VI). Majority of the patients presented with abdominal pain (100%) and abdominal tenderness (100%). Associated extra-abdominal injuries were found in 21 cases. A total of 77 (96.2%) patient discharge and 3 (3.75%) patient expired in our study. Conclusions: Isolated liver injury is common in the blunt abdominal trauma patient. Most of the patients with the liver injury with hemodynamically stable treated conservatively. Only a few of them require surgical management if they are hemodynamically unstable.

60.Assessment of the Effect of Body Compositions Such as BMI, Waist Hip Ratio, Body Fat Composition on Vital Capacity Index
Anant Kumar, Rajiva Kumar Singh, Priyanka
Aim: To study the effect of body compositions such as BMI, waist hip ratio, body fat composition on lung function and also to correlate any changes with gender difference. Materials and Methods: A total of 164 medical students aged 18-23 years were taken into study. Height, weight, waist hip ratio (Wt HR), Body M ass Index (BMI), were recorded. Data was analyzed statistically by using SPSS 20.0 software. Results: Lung function assessed as vital capacity index (VCI) was negatively correlated (r<0;p<0.05) with VAT, SAT, BMI, Wt HR, BFP for both male and females. Body anthropometric measurements like waist to hip ratio (Wt HR), BMI and lung function tests like vital cap a city index (VCI) are more in males. There was no much significant difference in Intra-abdominal adipose tissue (IAAT) in males and females. Conclusion: There was an inverse correlation between lung function with fat accumulation in the body.

61.Evaluation of Three Different Treatment Protocol of OSMF
Anshu Kumar, Pramod Kumar, Rana Pratap Thakur
Aim: To compare various medical treatment protocol of OSMF, so as to arrive at definitive and effective protocol for the management of OSMF. Material & Methods: A total of 150 patients of OSMF attending the ENT OPD and satisfying the criteria for inclusion were enrolled for the study. The subjects were randomly divided into age sex matched into three study groups (Dexamethasone with hyaluronidase, Oral vasodilator, Muscle relaxant) in which the relief in symptoms was noted. Lycopene was given in all patients. Results: In group A, we have given intralesional injection Dexamethasone with Hyaluronidase biweekly for five weeks, which showed marked improvement in cases with pain with spicy food 16 cases (80%). oral vasodilator Tablet Pentoxifylline 400 mg TDS, which showed improvement in difficulty in protruding tongue 7 cases (53.8%). muscle relaxant Tablet Myosone 50 mg BD showed improvement pain with spicy food 10 cases (45.5%). Conclusion: As there is still paramount of controversy regarding the ethology of OSMF there is no definite treatment protocol. Patients which received intralesional dexamethasone and hyaluronidase along with oral lycopene showed better clinical and symptomatic improvement in comparison to others groups, which at present appears to the best option for OSMF.

62.TAS/TVS Versus Histopathological Diagnosis in Abnormal Uterine Bleeding: Analytical Cross Sectional Study
Anumeha Anand
Aim: The aim of this study to evaluate the TAS/TVS versus histopathological diagnosis in abnormal uterine bleeding. Methods: This analytical cross sectional study was carried out in the Department of Obstetrics and Gynecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for 1 year. 100 females of various age groups, with a clinical diagnosis of AUB were included in this study. Patients fulfilling the inclusion criteria were selected through detailed clinical history, examination: general physical, systemic, gynecological (per speculum, per vaginal) and all general and specific investigations were carried out. Written informed consent (form attached) was taken from patient interviewed, examined and investigated as per the predesigned proforma (attached). All the patients were subjected to premenstrual dilatation and curettage and hysterosopic guided biopsy accordingly. Tissue obtained was subjected to histopathological examination. Results: 67 patients had menorrhagia as a primary complaint. Heavy Menstrual bleeding (HMB) in 35 (35%) and Heavy and Prolonged Menstrual Bleeding (HPMB) in 32 (32%), 21(21%) patients have irregular menstrual bleeding patterns, while 12(12%) patients had post- Menopausal bleeding. Histopathological examination maximum number of patients were found having Myoma in 18 cases (18%) followed by Adenomyosis in 16 cases (16%) and Myoma+ Adenomyosis existed in 16 (16%) cases. Least frequently condition was myoma with endometrial carcinoma and 1 case (1%) of Adenomyosis with endometrial carcinoma. The sensitivity and specificity of TAS for Diagnosing Polyp as compared to HPE was 52.87% and 98.56% while positive predictive value and negative predictive value were 95.10 % and 79.11% respectively. Conclusion: Transabdominal or transvaginal ultrasound is low cost primary modality for screening and should include as a first line screening method. Though the investigation and management of AUB among the non-gravid women was confusing, histopathological diagnosis proved to be the gold standard.

63.Prospective Clinical Study to Assess the Novel Technique of Collagen Application Over Meshed Split Thickness Graft for Wound Coverage
Ashutosh Kumar Singh, Ajay Kumar, Anupama Kumari
Aim: A Novel Technique of Collagen Application over Meshed Split Thickness Graft for Wound Coverage. Methods: This prospective study conducted in the Department of surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year. All cases with a raw area of 5-20% of total body surface area with the need for STSG for wound coverage, irrespective of the sex of patients, were included in the study. Children < 10 yrs and adults > 70 yrs were not part of the study. Results: Causes for wounding requiring STSG included trauma (8 cases), burns (5 cases) and its sequelae contracture (4 cases), diabetic ulcer foot (3 cases) and a case of Meleney’s gangrene. The lower extremity (10 cases) was the most common area requiring skin grafting in this study, followed by the trunk (7 cases) and upper extremity (3 cases). A total of 10 patients had co-morbidities. 2 patients were on treatment for diabetes mellitus, hypertension and congestive heart disease. Out of the other 8 patients, 5 typed II DM on oral hypoglycemic, 2 were on anti-hypertensives, and 1 was on treatment for hypothyroidism. All patients were adequately prepared for surgery. The majority of the patients were discharged after 2nd dressing between 5-11 days. Characteristics of grafted area: Vancouver scar scale (VSS) was used to determine the outcome of the grafted area. A score of more than 4 was considered a hypertrophic scar. The mean score of 20 patients at the end of 2 weeks, 1, 2, 4 and 6 months was 0.13, 0.25, 0.54, 1.07 and 1.48.  Since the scoring used to determine the outcome of this technique did not take into account patient satisfaction, the same was individually determined. Conclusion: As observed in the results, this technique has produced a very favourable outcome. However, it requires evaluation of procedure in a large cohort.

64.Assessment of Various Clinical Presentation, Hepatic Abnormalities, and Ultrasonographic Findings in Dengue Fever And its Association with Severity of the Disease
Binit Singh, Ved Prakash Gupta, Rizwan Haider
Objectives: The goal of this study is to look at the clinical presentation, hepatic abnormalities, and ultrasonographic findings in dengue fever, dengue hemorrhagic fever, and dengue shock syndrome, and to see how these connect to the severity of the disease. Material & Methods: Based on their clinical symptoms, 205 hospitalized Dengue fever patients were categorized as DF/DHF/DSS. SGOT, SGPT, PT, APTT, and INR were all monitored in the lab. Abdomen and thorax ultrasonography were performed. Results: The study analyzed hepatic enzymes, coagulation workup, and ultrasonographic markers in DF/DHF/DSS. Conclusion: The treating physician may have difficulties when dealing with severe dengue. Thus, utilizing hepatic and ultrasound indicators, early detection of deterioration in clinical condition may be reasonably assessed which will improve the management of dengue sickness and thus reduce mortality and morbidity.

65.Prospective, Comparative Assessment of Nuclear Size in Mature and Hypermature Cataract
Dhananjay Prasad, Atul Kumar Anand, Sumit Kumar, Rajesh Kumar Tiwary
Aim: To study Comparison of nuclear size in mature and hypermature cataract. Materials and Methods: This prospective, comparative study conducted in the Department of Ophthalmology, Nalanda medical College and Hospital Patna, Bihar, India, for 1 year. The inclusion criteria were patients with senile white cataract opting to undergo MSICS technique, and uneventful surgery. Only cases with intact nuclei after removal were taken up for further evaluation. Results: The mean axial length (23.96mm + 0.68 in mature and 24.05 + 0.96 mm in hypermature group), central corneal thickness (519.9 + 48 vs. 519.1 + 20) and AC depth (3.12 + 0.59 vs.   3.02 + 0.50) in both the groups were comparable. Average lens thickness in mature cataract group was 4.40mm (+ 0.56, range 3.39-5.39) while in the hypermature group it was 3.80mm (+ 0.30, range 3.11- 4.32). The average lens thickness differed significantly between the two groups. The average nuclear thickness was 3.67 mm (+ 0.40, range 3.18-4.39) in mature vs. 3.37 mm (+ 0.31, range 2.67- 3.96) in the hypermature group. This difference was statistically significant. The average nuclear diameter in mature group was 7.56mm (+ 0.53, range 6.57-8.50) and in hypermature group was 7.37 mm (+ 0.43, range 6.36-8.08). The nuclear diameter did not differ significantly between two groups (p=). The ratio between nuclear thickness and lens thickness was similar in both groups (0.83 in mature and 0.90 in hypermature group). The thickness to diameter ratio of nucleus also was similar in both the groups (0.49 + 0.03 in mature and 0.47 + 0.03 in hypermature). Conclusion: The lens and nucleus in mature cataract are thicker than hypermature cataract thus indicating need to use higher machine parameters. On the other hand the lens and nucleus are thinner in hypermature cataract. This requires lower setting of parameters during phacoemulsification.

66.An Observational Study to Identify Different Bacterial Etiologies of Surgical Site Infections
Shiv Kumar Mehi, Amit Kumar
Aim: The aim of the present study is to identify bacterial etiology of surgical site infections. Material and methods: The study was a cross sectional study which was carried in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 1 year. Using sterile cotton swabs, two pus swabs/ wound swabs were collected aseptically from each patient suspected of having SSI. Gram stained preparations were made from one swab for provisional diagnosis. The other swab was inoculated on nutrient agar, 5% sheep blood agar (BA) and MacConkey agar (MA) plates and incubated at 37°C for 24-48 hours before being reported as sterile. Growth on culture plates was identified by its colony characters and the battery of standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by Kirby Bauer disk diffusion technique on Muller Hinton Agar. Results: Out of 230 samples, 120 samples were culture positive (52.17%). Among 120 positive samples 67(55.83%) were males. Maximum no. of culture positive samples in age 20-30 years (32.5%) followed by 30-40 (17.5 %) and then followed by 40-50 (15.83%) of age group respectively. Out of 120 culture positive samples S.aureus (26.67%) was the most common pathogen isolated followed by Escherichia coli. (23.33%), Citrobacter spp. (15.83% ) and Pseudomonas aeruginosa (9.17%), Klebsiella spp 10(8.33%), CONS 8(6.67%),Enterob -acter spp. 7(5.83%), Acinetobacter spp 3(2.5%) and Proteus spp. 2(1.67%) respectively. Conclusion: We conclude that SSIs are common among patients undergoing surgeries.

67.A Prospective Hospital-Based Research on Acute Exacerbations of COPD
Neeraj Kumar, P.K. Sinha
Aim: To evaluate the acute exacerbations of COPD in Bihar region. Methods: This prospective study was done the Department of Medicine, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year. The outcomes of interest were in-hospital mortality and one-year mortality after discharge. The demographics, comorbid diseases, concomitant medications and COPD medications. The COPD-related medications, including short-acting and long-acting b2 agonists, anticholinergics, inhaled corticosteroids and theophyllines, were measured in the 6 months before the index hospitalization. Result: 100 patients were included in this study. the mean age of the entire population was 74 years and 70% of them were male. The majority of the patients had comorbidities and the average score on the Charlson comorbidity index was 3.7. The most commonly observed comorbidities were hypertension (64%), coronary artery disease (37%) and stroke (30%). About three-fourths of the patients were placed on #2 COPD medications and the number of emergency visits for COPD was #2 in 79% of patients. The length of stay in hospitals was 13±20 days. 11% of patients had been admitted to the ICU with an average stay of 8.5days. Mechanical ventilation was required in 8% patients and the median duration of ventilatory support was 7.5days. 4% patients were placed on non-invasive ventilation. During the index hospitalization, 10 (10%) of patients died. 11% of patients had been admitted to the ICU with an average stay of 8.5days. Mechanical ventilation was required in 8% patients and the median duration of ventilatory support was 7.5days. 4% patients were placed on non-invasive ventilation. Conclusion: In conclusion, an exacerbation requiring hospitalization denotes a poor long-term outcome in COPD patients; even it is the first-ever one. The burden of comorbidities has a significant role in determining mortality risks, and should be carefully evaluated and managed.

68.Prospective Comparative Assessment of Astigmatic Outcomes and Incisional Integrity in Temporal Clear Corneal Incision and Superior Scleral Incision Phacoemulsification Surgery
Priyanka, Rajnee Sinha
Aim: Comparative study of astigmatic outcomes and incisional integrity in temporal clear corneal incision and superior scleral incision phacoemulsification surgery. Methods: This prospective comparative study was conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India, for 1 year. 200 patients were included in this study. Preoperative evaluation was done including visual acuity, intraocular pressure, sac syringing, thorough examination of anterior segment by slit lamp examination, posterior segment examination by 90D. Keratometry was done preoperatively and post operatively using automated keratometry, Axial length measured with a contact ‘A’ scan unit and the IOL power was calculated using SRK II formula. Results:  Mean age of patients in group A was 66.54± 6.91 years and that in group B was 67.07 ± 7.31 years. There was no statistical significant difference between two groups regarding age. Hence, the study was age matched Group A had 60males and 40 females and in group B were 59 males and 41 females. Both the groups were comparable. We observed significant change in type of astigmatism on all postoperative days and between the two groups. It shows significant with the Rule (WTR) shift in astigmatism in group A (Wilcoxon: Z value = 4.19, P<0.001) and significant Against. The Rule (ATR) shift in astigmatism in group B (Wilcoxon: Z value = 3.48, P<0.001). In our study, SIA in temporal clear corneal on 1st, 8th, 40th, 90th, 180th post-operative day were as follows 1.12(0.60), 1.16(0.49), 0.99(± 0.427), 0.91((±0.447) and 0.90(±0.466). There was a mild increase in the SIA from 1st to 8th post-operative day that decreased significantly by 40th post-operative day. There was mild further decrease in SIA by 3rd month which was not statistically significant and remained same by 6th month. Conclusion: The study concludes that there is statistically significant post operative shift to WTR astigmatism in temporal clear corneal incision as opposed to ATR astigmatism in superior sclera incision; hence it is better to plan temporal incision as mostly elderly patients have preoperative ATR astigmatism.

69.Efficacy Of Amitriptyline and Fluoxetine in Patient with Mixed Anxiety and Depression: A Comparative Clinical Study
Rajeev Kumar, Amardeep Kumar, Sushil Kumar
Aim: To compare the efficacy of amitriptyline and fluoxetine in patient with mixed anxiety and depression. Methods: Study was carried out in the outpatient Department of Psychiatry, Department of Psychiatry, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for 1 year. Newly diagnosed cases of depression (moderate to severe according to ICD 10 criteria) were included for the study. Study Participants were divided into two groups and group I was given amitriptyline and group II was given fluoxetine. Patients were given treatment for a period of 8 weeks and they were followed were once in two weeks. Complete blood count, Liver function test, renal function test, Thyroid profile, blood glucose and serum cholesterol were estimated at baseline and at the end of study for all the patients. Results: A total of one hundred ten patients were recruited after satisfying the inclusion and exclusion criteria. The efficacy rate for fluoxetine group was 82.10 %. In the amitriptyline group, out of 55 patients 5 patient did not achieve remission, i.e. the HDRS score less than or equal to seven at the end of 8 week. The remission was 90 % with amitriptyline, while in the fluoxetine group out of 55 patients 3 patient did not achieve remission. The remission in the fluoxetine group was 92%. Conclusion: Depression is a disorder of major public health importance, in terms of its prevalence, morbidity, mortality and economic burden. The prevalence of depression is more in women than men. Fluoxetine and amitriptyline were equally efficacious in the treatment of depression.

70.An Observational Assessment of the Clinicopathological Relation of the Uterine Leiomyoma
Rashmi Raginee
Objective: To analyze the clinico pathological spectrum in cases of Leiomyoma of the uterus. Materials & Method: A clinical study of 130 cases of fibroid uterus was made in the Department of Obstetrics and Gynecology, Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar for 1 year. The cases are selected by random allocation. On admission, a detailed history, clinical examination and investigations were made. Diagnosis was confirmed by scanning in all cases. Diagnostic curettage was done to rule out any endometrial pathology especially in elderly patients. Results: The most common benign tumor of the pelvis is Leiomyoma. Intramural fibroids were the commonest variety comprising about 55.3% of the cases. Histopathology report showed proliferative endometrial in 85 cases. Conclusion: Leiomyoma is the most common benign tumor of the pelvis. Presence of proliferative endometrium, adenomyosis and cystic ovaries are all indicative of hyper estrogenic state associated with development of fibroids.

71.Comparative Evaluation Clinical Outcome of Strip Crowns and Primary Anterior Zirconia Crowns in 3-5 Years Old Children
Shagufta Syreen, Ahtashtam Anwar, S. Kokay
Objective: To evaluate and compare clinical outcome of strip crowns and preformed primary anterior zirconia crowns at one year follow up in 3-5 years old children. Material and methods: Forty maxillary primary incisors were restored by either strip crown or zirconia crown. Permuted block randomization method was used for allocation of participants. Data was analyzed using Chi-Square test. Results: Comparing the gingival health at one year from baseline within each group, there was decrease in the mean gingival health score in strip crowns (mean difference ¼ 0.03) and zirconia crowns (mean difference ¼ 0.60). Zirconia crowns showed significantly less gingival bleeding at the 3- and 6-months follow up periods (p < 0.005, p < 0.001; respectively). Conclusion: Overall, zirconia crowns were found more successful than strip crowns for the rehabilitation of caries affected primary incisors. Based on our data we conclude that overtime teeth covered with zirconia crowns show better gingival health and less bleeding, plaque accumulation as well as less loss of material. On the other hand, zirconia can cause more loss of opposing tooth structure.

72.An observational assessment of the correlation of laparoscopic finding with USG and HSG findings in females diagnosed with infertility
Varsha Sinha, Swetabh Verma
Aim: Correlation of laparoscopic finding with ultrasonography and hysterosalpingography findings in females with infertility. Material and methods: This observational prospective study was carried out in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. Couples who had not lived together for at least 12 months and patients with absolute or relative contraindication for laparoscopy i.e. any pre-existing cardiovascular or respiratory condition, generalized peritonitis, intestinal ileus or obstruction and abdominal hernia, were excluded. Sample size taken was 100. Results: Out of the 50 patients with abnormal findings on USG, 20 had polycystic ovaries (20%) which was the most common finding. The other findings were fibroid uterus in 5 (5%), ovarian cyst in 3 (3%), adnexal mass in 4 (4%), endometrioma in 5 (5%), uterine polyp in 4 (4%) patients. Out of the 50 patients with abnormal findings on hysterosalpingography, most common finding was tubal block. 10 patients (10%) had bilateral tubal block, left tubal block in 20 (20%), right tubal block in 20 (20%) patients. The other findings were intra uterine filling defects in 4 patients (4%), extravasation in 1(1%) patient, intra uterine septum in 5 (5%) patients and hydrosalpinx in 5 (5%) patients. On hysteroscopy, 7 patients (7%) had septum and in 3 (3%) ostia were not seen. One patient had bicornuate uterus confirmed on laparoscopy. On laparoscopy 60 patients (60%) had abnormal finding. Most common finding was endometriosis in 20 patients (20%). The other findings were B/L tubal block in 12 (12%) patients, left tubal block in 20(20%) and right tubal block in 18 (18%) patients, pelvic adhesions in 12 (12%), fibroid in 10 (10%), PCO in 10(10%), endometrioma in 7 (7%), ovarian cyst in 4 (4%), hydrosalpinx in 4 (4%) patients. Conclusion: HSG and Laparoscopy are complimentary rather that competitive procedures. The accuracy of diagnosis is enhanced when two procedures are combined especially in those cases where the result of one of the tests is doubtful.

73.A Comparative Assessment of the Outcome of Term and Preterm Neonates with Severe Sepsis Undergoes Exchange Transfusion
Ved Prakash Gupta, Binit Singh, Rizwan Haider
Aim: To compare the outcome of term and preterm neonates with severe sepsis undergoes exchange transfusion. Material and methods: This is a hospital-based, time-bound, analytical observational study conducted in the NICU of DMCH, Darbhanga, Bihar, India for 1 year. The data was collected in pre-designed proforma, entered in Microsoft Excel and analysis was done using SSPS v 22.0. Result: About 53 neonates were diagnosed with severe neonatal sepsis. Out of 30 of which 30 preterm neonates, 19 (63.3%) died and 11 (36.6%) were discharged after treatment and out of 23 term neonates 11 (47.8%) died and 12 (52.1%) were discharged after treatment. Maternal risk factor in study subjects, 22 (41.5%) had PROM, 8 (15.0%) had > 3 vaginal exam and 6 (11.3%) each had maternal fever. Conclusion: Significant reduction of mortality in patients who underwent exchange transfusion, together with the no adverse effects observed, suggest that this procedure should be considered for the treatment of neonates with severe sepsis.

74.A Randomized Comparative Study to Assess the Intraocular Pressure Lowering Efficacy of 0.5% Timolol Maleate Versus 1% Brinzolamide in Cases of Primary Open Angle Glaucoma and Ocular Hypertension
Vivek Prasad, Sangita Kumari, Sachin Kumar
Aim: The aim of this study to study the intraocular pressure lowering efficacy of 0.5% timolol maleate versus 1% brinzolamide in cases of primary open angle glaucoma and ocular hypertension. Material and methods: Patients selected were randomised into two groups of 50 each. Group I and Group II instilled 1 drop of timolol 0.5% and brinzolamide 1% respectively, into study eye twice daily at 8.00 a.m. and 8.00 p.m. for 12 weeks. During the study patients visited the hospital on day 0, week 4, week 8 and week 12. IOP readings were taken from the study eye with the Goldmann applanation tonometer at each visit. IOP was measured on day 0 at 8.00 a.m. and 10.00 am before administration of the study drugs to get the baseline IOP and then on each follow-up visit at 8.00 a.m. and 10.00 a.m. to record the peak and trough of each medication. Results: Comparison between the two groups showed that across all time points and visits during the 12 week treatment period IOP lowering produced with timolol maleate 0.5% was more as compared to brinzolamide 1%. At the end of the study period, IOP lowering with timolol 0.5% was significantly more than brinzolamide 1% for both peak readings (p = 0.0045) and for trough readings (p = 0.004). Thus there was a statistically significant (p value < 0.05) difference between the IOP reduction with timolol maleate 0.5% and brinzolamide 1%. Conclusion: We concluded that treatment with timolol 0.5% was more effective than brinzolamide 1%.

75.To Determine the Impact of A Bleeding Care Pathway in the Treatment of Acute Upper Gastrointestinal Bleeding: An Observational Study
Amit Kumar, Papu Kumar safi, Surendra Kumar, Sachindra Kumar Astik
Aim: The aim of our study to evaluate the Impact of a bleeding care pathway in the management of acute upper gastrointestinal bleeding. Methods: The prospectively observational study was conducted in the Department of General Medicine, Nalanda Medical College and Hospital, Patna, Bihar, India, 150 upper GI bleeding patients were included in this study. In order to assess our objectives, these data were compared with data of matched patients with upper GI bleed admitted in SCU prior to implementation of GI (BCP)s in bleeding control unit (pre-BCU). The data collected for both the groups of patients included the history, examination, laboratory investigations, and different outcomes. Results: A total of 150 patients were admitted with UGI bleed.  Of the 150 patients studied, 50 belonged to pre-BCU group and 100 patients were admitted in BCU. There were 25 (50%) patients with variceal and 19 (38%) with non- variceal bleed; while 3 (6%) had variceal and non-variceal source of bleed and in 3 (6%) patients the source was not identified after gastroscopy and colonoscopy. The distribution of demographics, such as age, gender, and co- morbid condition, number of patients requiring transfusion, and number of blood products transfused were similar in the two groups. The number of patients with upper GI bleed due to esophageal varices was higher in the BCU period 60(60%] vs. pre-BCU 25 [50%]; p = 0.005). There were 34 (34%) patients in BCU period with non-variceal bleed. The mean (SD) time from admission to EGD improved after implementation of BCU and pathways from 20.9 (7.5) to 9.55 (10.5) hours (p-value <0.001). We found BCU stay improvement (BCU 1.97 [1.5] days vs. pre-BCU (2.44 [1.5] days); p <0.001). Conclusion: A BCU implementation showed improvement in time to UGI endoscopy, and did not reduce BCU stay or impact survival.

76.An Observational Prospective Assessment of Prevalence of Dermatophytes in Patients Attending A Tertiary Care Facility
Amit Kumar, Shiv Kumar Mehi
Aim: To Study prevalence of dermatophytes in patients attending a tertiary care facility. Material and methods: This observational prospective study was carried out in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 12 months.  Total of 120 patients showing lesions typical of dermatophytes infection based on the clinicians’ preliminary diagnosis from outpatient Department of Dermatology. Result: Samples were collected from patient’s various anatomical sites such as epidermal layers of skin, hair and nail. Among them tinea corporis was predominant in 73/120 (60.83%) patients followed by tinea cruris in 20/120 (16.67%) patients. Tinea unguium was found in 15/120 (12.5%) patients, tinea manuum was observed in 4 (3.3%) patients, tinea pedis was seen in 3 (2.5%) patients and tinea capitis, tinea facei were 2 and tinea barbae  were seen in 1(1.67%) and one (0.83%) patient respectively. Conclusion: Dermatophytoses are worldwide distributed with increased incidence especially in tropical countries like India. Several factors such as age, sex, illiteracy, poor hygiene and social economy influence the infection with dermatophytes.

77.Prospective, Comparative Assessment of Safety and Efficacy of Various Nsaids with Prednisolone Acetate After Uneventful Phacoemulsification
Rajnee Sinha , Priyanka
Aim: A comparative analysis of topical corticosteroids and non-steroidal anti-inflammatory drugs to control inflammation and macular edema following uneventful phacoemulsification. Methods: This prospective, comparative study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India, for 12 months.  This study comparing nepafenac (0.1%), bromfenac (0.07%), preservative-free ketorolac (0.4%), nepafenac (0.3%), and prednisolone acetate (1%) eye drops in patients undergoing uncomplicated phacoemulsification. The local ethics committee approved the study protocol. The trial was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent is routinely obtained from all patients undergoing cataract surgery. Results: There was no significant difference in the percentage of patients with AC cells grade of 0, 1+, and 2+ between the steroid group (group 1) and NSAIDs groups at 1‑week follow‑up. However, the number of patients with grade 0 AC cells was maximum in the nepafenac 0.3% group (58/96, 60.4%) and least in the bromfenac 0.07% group (33/93, 35.5%) at 1-week follow-up. None of the patients had cells at 6-week follow‑up. Thus, the bromfenac group showed the least potency and the nepafenac 0.3% group showed maximal potency in control of AC inflammation though not statistically significant. At 6-weeks, the mean increase in CMT from baseline was similar between the prednisolone group and NSAIDs group except in the nepafenac 0.3% group that showed less increase in CMT as compared to prednisolone (P = 0.004). Thus, nepafenac 0.3% might be more effective than prednisolone in preventing CME. The mean (SD) of the change in CMT from baseline to 1-week postoperative period was compared between prednisolone and NSAIDs groups. It was found that there was an increase in CMT at 1 week in all groups, which was minimum in the nepafenac 0.3% group. On comparison with prednisolone, there was a significantly lower increase in CMT in the nepafenac 0.3% group (P = 0.003) but a significantly higher increase in CMT in the ketorolac and bromfenac group (P = 0.006 and 0.004, respectively). Conclusion: Nepafenac 0.3% can be used as a sole anti-inflammatory agent in patients with uneventful phacoemulsification and combination therapy can be used in high-risk cases.

78.An Assessment of Early Predictor of Severe Hyperbilirubinemia in Healthy Full-Term Newborns Aged 72 Hours: Prospective Observational Study
Sachin Kumar, Rizwan Haider, Vaibhav
Aim: The aim of this study to evaluate the early indicator of significant hyperbilirubinemia in healthy full-term infants at 72 hrs of age. Methods: This prospective observational study was conducted in the Department of Pediatrics, Darbhanga medical college and Hospital, Laheriasarai, Darbhanga, Bihar, India. 100 patients who full filled the inclusion criteria; Full-term newborns delivered at our Hospital of >36 weeks of gestation, Birth weight >2 kg were included in this study. Bilirubin level at or above high intermediate risk zone at 24 and 48 hrs of age was considered a cut-off value to find out the association with significant hyperbilirubinemia at 72 hrs of age. Results: Of 100, 54% of the newborn were male and 46% were female. 91(91%) newborns included were between 37 to 40 weeks, and 9% were above 40 wk of gestation. 85(85%) were appropriate for gestational age, 12 newborns (12%) were Short for gestational age, and 3 newborns were Large for gestational age. Out of 100 newborns 5 newborns (33.33%) developed hyperbilirubinemia above high intermediate zone at 48 hrs while 9(30%) newborns developed subsequently developed hyperbilirubinemia at 72 hrs. Median values for gestational age and birth weight were 38 weeks, 3.1 kg respectively, in study groups. 12 newborns (12%) showed signs of dehydration and out of these 12 newborns, 7 developed hyperbilirubinemia subsequently at 72 hrs of life. 31% received top feeding or mixed feedings, while 17% newborn first feeding was delayed for more than 3 hrs due to inadequacy of lactation on first few days. In our study birth weight <2.5 kg, delayed first feeding, dehydration, and 48 Hr serum bilirubin >11.8 mg/dl were significantly associated with significant hyperbilirubinemia(p<0.05). Conclusion: The present study concluded that healthy full-term newborns with birth weight <2.5 kg, higher 24 and 48-hour serum bilirubin were more likely to experience significant hyperbilirubinemia who are  often discharged from hospital early.

79.Open Label, Prospective Study to Assess the Efficacy of Topical Cyclosporine and Osmoprotective Lubricating Eye Drops in Treating Dry Eye Disease and Inflammation
Sumit Kumar, Atul Kumar Anand, Dhananjay Prasad, Rajesh Kumar Tiwary
Aim: Efficacy of topical cyclosporine 0.05% and osmoprotective lubricating eye drops in treating dry eye disease and inflammation. Methods: This drug interventional, open label, prospective study conducted in the Department of Ophthalmology, Nalanda medical College and Hospital Patna, Bihar, India, for 12 months.  A total of 100 eyes of 50 patients were included in the study. All patients underwent detailed slit‑lamp examination, noncontact tonometry, and dilated fundus examination in addition to dry eye evaluation as part of the routine clinical examination. Patients with mild to moderate aqueous deficiency and evaporative dry eye with two or more of the following criteria were included in the study: Ocular Surface Disease Index (OSDI) >12, tear break up time (TBUT) between 6 and 10 s; Schirmer’s test I result 8–10 mm/5 min and ocular surface staining. Severity of DED was graded as per the Dry Eye Workshop Study classification. Results:  36 eyes (36%) had minimal punctate epithelial erosions (PEEs) inferiorly scored as 1, while 64 eyes (64%) did not show any PEEs and were scored as 0.  Patients with MMP‑9 positivity were associated with higher OSDI score with a mean OSDI score among these patients being 28.7 ± 7.1, P = 0.0057. MMP‑9 positivity was also significantly associated with decreased Schirmer’s test values, P = 0.0011. The average Schirmer’s level in this group of patients was 9.41 ± 4.61 mm. Patients with lower TBUT were found to have higher OSDI and more MMP9 positivity. P =0.07 Dendritic cell density is measure on the IVCM. The variation in dendritic cell density was noted, and 70% DED eyes were found to have high dendritic cell density on IVCM. There was an improvement in clinical parameters like the TBUT and ocular surface staining. Mean TBUT of the DED patients improved from 7.87 to 8.35 s (P = 0.07), and the percentage of eyes with corneal staining reduced from 35% (35 eyes) to 19% (19 eyes). There was no statistically significant change in Schirmer’s test values (P = 0.15). Out of 70 eyes that tested MMP‑9 positive, 70eyes (70%) showed a negative test after treatment (P = 2.5), while the remaining 30 eyes (30%) showed no change in the MMP‑9 status post-treatment. There was also a reduction in dendritic cell density observed on IVCM. There was a significant improvement in the mean OSDI scores of patients on treatment (14.2 ± 7.4 after 6 months compared to 24.7 ± 10.8 at baseline, P < 0.001. Conclusion: The treatment of DED can be extremely challenging due to the varied subjective symptoms and objective signs with which the patient presents.

80.Comparison Between Efficacy of Epley’s Maneuver with Medical Therapy Versus Medical Therapy Alone in Treating BPPV Patients
Pramod Kumar, Anshu Kumar, Rana Pratap Thakur
Aim: To Epley’s maneuver with medical therapy versus medical therapy alone in patients with BPPV. Materials and Methods: This prospective observational study was conducted among the patients attending Department of ENT, ANMMCH, Gaya, Bihar, India, for a period of 12 months. In this study 100 Patients presenting to OPD who have been diagnosed with BPPV via a Positive Dix Hallpike were randomized into two age and sex matched groups of 25 each: 50 to the group A, and 50 to the group B. Results: A total of 100 patients were divided into two groups: 50 to the group A which received Epley’s maneuver with drug therapy and 50 to the group B which received only drug therapy. In our study, Epley’s maneuver with medical therapy was found to be more effective than medicine given alone. Conclusion: This study shows that the Epley maneuver with medical therapy provides effective and long-term control of symptoms in patients with BPPV. It benefits over medical therapy alone in terms of avoiding the delay in vestibular compensation and recurrence.

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