Electronic-ISSN:0975-5160| Print-ISSN: 2820-2651

Volume11,Issue6

1. A Prospective Research to Assess the Association of type 2 Mellitus Diabetes with HbA1c, Lipid Profile, and CRP
Ramchandra Kumar, Jainendra Kumar, Raghvendra Kumar Singh
Abstract
Aim: The aim of this study to determine the relation between HbA1c, Lipid profile and CRP in individuals with type 2 diabetes mellitus. Methods: This prospective observational study was carried out in the Department of General Medicine Nalanda Medical College and Hospital, Patna, Bihar, India .The patients above 28 years with fasting venous blood glucose value equal or more than 100 mg/dl and postprandial glucose >140 mg/dl were include in this study. FBS and PPBS, CRP (immunoturbidimetric method), and HbA1C (ion exchange chromatography using HPLC) lipid profile samples were drawn at entry and at subsequent follow-up with a minimum gap of 3-6 months. Results: Total cholesterol was compared to CRP. Number of patients with total cholesterol   <100 was 5, 100-200 were 35 between 200-300 were 22 with mean CRP of 1.78, 0.81, 2.87. There was a significant positive correlation between CRP and total cholesterol (p<0.05). LDL cholesterol was compared with CRP. Patients with LDL cholesterol <60 were 12, between 60-80 were 26, between 80-100 were 15, between 100-120 were 24, between 120-140 was 1,  >140 were 12 with mean CRP levels of 1.85, 0.84, 1.82, 0.75, 1.34, 2.29. There was no significant correlation between CRP and LDL cholesterol (p>0.05). HDL cholesterol was compared with CRP. Patients with HDL cholesterol between  0-20 were 3,  between  20-40  were  43, between 40-60  were  41  and  HDL  cholesterol  >60  were  3 with mean CRP levels of 2.14, 1.41, 1.22, 1.16, respectively. There was a negative correlation between HDL cholesterol and CRP triglyceride levels were compared with CRP. Patients with triglyceride levels between 100-200 were 45, between 200-300 were 30, between 300-400 were 8, between 400-500 was 3 and with levels >500 were 4 with mean CRP levels of 0.71, 0.84, 1.84, 2.45, 2.45, respectively. There was significant positive correlation between CRP and triglyceride levels (p<0.05). Conclusion: The CRP is an additional marker of better Glycaemic control and also correlates with the dyslipidaemia profile seen in type 2 diabetes mellitus. Keywords: C-reactive protein, Glycemic control, Hemoglobin A1C, Type 2 diabetes mellitus.

2. Sex Determination of Scapular Height and Breadth in the North Indian Population
Pranay Kumar, Pawan kumar Mahato, C Kishan Reddy
Abstract
The scapula is a triangular bone with thick edges and a thin centre. It articulates with the humerus at the glenohumeral joint and with the clavicle at the acromioclavicular joint on the posterolateral part of the thoracic wall. The aim of this study was to sex determination of scapular height and breadth in the north Indian population. Maximum scapular height is 136.05 ± 6.51 in male and 119.44 ± 5.16 in female and Maximum scapular breadth is 119.44 ± 5.16 in male, 92.93 ± 3.08 in  female respectively. The present study sex determination of scapular height and breadth in the north Indian population clearly shows that males have significantly higher statistical values for all parameters when compared to females.

3. Morphometric Analysis of Scapular Glenoid Cavity to Determine Sexual Dimorphism
Pawan Kumar Mahato, M. Pranay Kumar, C Kishan Reddy
Abstract
The scapula is a triangular bone with thick edges and a thin centre. It articulates with the humerus at the glenohumeral joint (shoulder joint) and with the clavicle at the acromioclavicular joint on the posterolateral part of the thoracic wall. The scapula is a triangular bone with thick edges and a thin centre. It articulates with the humerus at the glenohumeral joint (shoulder joint) and with the clavicle at the acromioclavicular joint on the posterolateral part of the thoracic wall. Glenoid cavity height is 34.87 ± 2.5 in male and 31.14 ± 1.52 in female, glenoid cavity breath is 24.19 ± 2.23 in male and 21.61 ± 1.87 in female respectively. The present study morphometric analysis of scapular glenoid cavity to determine sexual dimorphism clearly shows that males have significantly higher statistical values for all parameters when compared to females.

4. Characteristics of Infections in Immediate Post Renal Transplant Period: A cross-sectional study
Gupta A, Singh PP, Krishna A, Vardhan H, Sharma RK, Prasad N
Abstract
Background: Infections are an important cause of increased morbidity and mortality in renal allograft recipients. Use of newer more potent immunosuppressive agents may increase the risk of infections particularly in immediate post-transplant period. Issues like poverty, unemployment, overcrowding unique to developing countries like India, have significant impact on the type and characteristics of infections. Objective: To estimate the occurrence of infections in renal allograft recipients in immediate post-transplant period. Materials and Methods: This was a retrospective observational study conducted at a tertiary care institute. Patients who underwent renal transplant at the centre were included and followed for 12 months post-transplant period. Details of infections in first year of post-transplant period were retrieved from hospital records. Continuous variables were recorded as mean (standard deviation) and categorical variables were expressed as number (percentage). Results: A total of 199 renal transplant recipients were included, of these, 174 were men. Total of 160 episodes of infections occurred in first year affecting 117 (58.8%) patients. Urinary tract infection (UTI) was the most common infection (32.5%). Sixty-five (45.1%) episodes of infection occurred in 1st post-transplant month; majority were caused by Pseudomonas (26.2%), CoNS (23.1%), E. coli (13.8%) and Klebsiella (7.7%); while 51 episodes (31%) occurring in next 1-6 months period were due to Pseudomonas (23.5%), E. coli (19.6%), Klebsiella (7.8%), CoNS (9.8%) and CMV (9.8%). During 6-12 months period, 30 episodes (18%) of infection occurred primarily due to E. coli (20%) and pseudomonas (16.6%). Conclusions: More than half of the renal allograft recipients had at least one episode of infection within one year following renal transplantation. UTI remains the most common infection. Causative organisms were mostly gram-negative organisms especially Pseudomonas, E coli, CoNS and Klebsiella. Mycobacterial and viral infections are less common and systemic fungal infections are rare.

5. A Survey of the Mental Health of the People in Kanyakumari District During the Second Wave of Corona Lockdown in 2021
K Athis Kumar, S R Sri Ramkumar, Ashiq, S Vinoth, R S Uma, V Kumaresan, N Mugunthan
Abstract
The present survey shows the mental health of the people in Kanyakumari district of India during the second wave of Covid-19. While the infection causes the unique symptoms of the disease and even death, the disease outbreak has adversely affect the mental health of the people because of the consequences of the lockdown and home confinement. About 1000 people including males and females in rural and urban areas were selected randomly and asked to complete a questionnaire with questions relevant to the symptoms of anxiety, stress, depression, fear, trauma and helplessness, whereupon the data was analyzed statistically. These mental distresses were slightly higher in the urban areas than in the rural areas and females were found to be more affected by these illnesses than the males.  The severity ratings of the mental health issues were mild or moderate. The 21-44 and 45-59 age groups were most affected by these mental health issues than the 7-20 and above 60 age groups. Anxiety, stress, depression, fear and helplessness were serious treats to farmers, main workers and marginal worker while students, teachers, government employees and non-workers were little affected by the illness. The unavailability of daily essentials led to mental distress in many people. These distresses were however in low proportions compared to mental health of people in other countries because of effective implementation of mental health management by the efforts of the Government during the lockdown.

6. A Cross Sectional Study to Assess the Demographic Profiles of Victims of Fatal Road Traffic Accidents
Kaushal Kishore, Bipin Kumar
Abstract
Aim: Demographic profiles of victims of fatal road traffic accidents in Bihar population. Methods: The cross sectional study was conducted in the Department of Forensic Medicine and Toxicology, SKMCH, Muzaffarpur, Bihar, India for 1 year. Total 200 dead bodies of victims of road traffic fatalities brought to mortuary for medico-legal post mortem examination in the department of forensic medicine. Results: Age group of 21-30 years comprising 28% (56 cases) followed by age group 31-40 years i.e.20% (40 cases). Male victims accounting for 83.50% (167 cases) of road traffic accidents as compared to female victims 16.5% (33 cases). 61.50% (123 cases) of road traffic accidental victims were belonging from urban area whereas 38.50% (77 cases) were belonging to rural area. 37 cases (18.50%) of road traffic accident had occurred in between 6am to12pm while 92 cases (46%) of road traffic accidents had occurred during 12pm to 6pm. In 54 cases (27%), road traffic accidents had occurred during 6pm to12am while 17 cases (8.50%) of road traffic accidents occurred during 12am to 6am. Two wheelers were offending vehicle in 24 cases (12%), three wheelers were in only 2 cases (1%) and four wheelers and above were in 112 cases (56%) of road traffic accidents. 55 cases (27.50%) and 4 cases (2%) of road traffic accidents had occurred because of skidding of two wheelers and four wheeler respectively. Four wheeler and above indicates vehicles having four or more than four wheels that includes car, buses, truck, tractor, etc. 90 cases (45%) of road traffic accident victims were two wheeler riders, 28 cases (14%) were pillion rider of two wheeler, 6 cases (3%) were four wheeler driver while 9 cases (4.50%) were passengers of four wheeler and above. 12 (6%) cases of accident victims were bicycle rider, 2 cases (1%) were bullock cart driver and 53 cases (26.50%) were pedestrian. 85 cases (42.50%) of road traffic accidents were transported to the nearest hospital by police mobile van (PMV), 31 cases (15%) were by ambulance, 50 cases (25%) by auto, 25 cases (12.50%) by private and 9 cases (4.50%) by two wheeler. Helmet was applicable in 118 cases (59%) but none of victim used helmet as safety measure. Conclusion: The road accidents are occurring most often due to the reckless and speedy driving of the vehicles, violation of traffic rules, overburdened public transport vehicles, poor maintenance of the vehicles.

7. A Study to Evaluate the Rate of Caesarean Deliveries, Various Indications of the Procedure as well as the Associated Maternal Morbidity and Mortality
Sudha Kumari
Abstract
Aim:   To evaluate the prevalence of cesarean section in a tertiary care hospital. Methods: A retrospective study on women who underwent LSCS over a period of 1 year. Department of Obstetrics and Gynecology, Katihar Medical College and Hospital,Katihar, Bihar, India .  Out of the 489 deliveries, 200 were delivered by cesarean section. Variables including age, parity, gestational age, CS timing (elective or emergency), and indications for LSCS were collected from their case records and entered in the proforma. Results: A total of 489 deliveries were performed in the study duration of 1 year, of which 200 cases underwent cesarean section. The LSCS prevalence was 40.89% in our institution. We have assessed the common indications of LSCS performed in this study population. The majority of the LSCS were delivered between 37-40 weeks (69.5%) of gestation. Mode of conception was spontaneous for 96.5%, and 3.5% received infertility treatments the distribution of various indications for LSCS in the study population. LSCS was mostly done for ‘previous LSCS’ indication (87 cases, 43.5%), followed by failure of induction of labor (45 cases, 22.5%). Fetal distress was an indication in 18 cases (9%), Breech presentation in 13 cases (6.5%), PPROM in 11 (5.5%), CPD in 10(5%). Diabetes mellitus was found in 10% of the total LSCS population and pregnancy induced hypertension (PIH) in 4%. It was found that the lower segment was well formed in 90.5%, was thin in 5% and not formed in 4.5% of the study population. Adhesions were observed in 3% and scar dehiscence was present in 1% of cases. Conclusion: Although LSCS indications seen in our institute are the same in most institutions worldwide, efforts should be made to focus on reducing the primary LSCS rates thereby reducing the most common indication of previous LSCS in subsequent pregnancies.

8. Hospital Based Cross Sectional Study to Assess the Serum Vitamin D Deficiency in NICU Hospitalized Neonates and Its Association with Neonatal Outcomes
Mani Bhushan, Bimal Kumar, Archana Bharti
Abstract
Aim: Serum Vitamin D Deficiency in NICU Hospitalized Neonates and Its Association With Neonatal Outcomes. Methods: Hospital based cross sectional study conducted in the Department of Pediatrics, Madhubani Medical Colleges and Hospital, Madhubani, Bihar, India,for 1 year. All the neonates with medical and surgical diseases hospitalized in NICU were enrolled in this study. The subjects were breast fed before admission. Immediately on admission, serum sample for vitamin D measurement was obtained along with routine blood sampling, thus the impact of the affecting factors was minimized. Serum vitamin D and calcium levels were measured by Electrochemiluminescence immunoassay and Calcium Assay kit (colorimetric) methods, respectively. Results:  From the studied neonates, 10 had normal vitamin D level, 50 had insufficient vitamin D level and 40 had vitamin D deficiency. So, vitamin D deficiency and insufficiency were present in 90% of our patients. The mean±SD serum level of vitamin D was 14.93±17.96 ng/ml (Min=2, Max=151 ng/ml) in our patients. The mean±SD values between hospitalized neonates due to medical and surgical causes were 15.11±18.95 and 14.36±14.61 ng/ml respectively. The mean serum value of vitamin D was similar among both gender (p=0.31). There were no significant differences in the neonatal vitamin D status regarding medical or surgical causes of admission (p=0.77). Moreover, longer length of hospital stay was not associated with lower levels of vitamin D (p=0.87). A significant association was observed between vitamin D status and season of birth. Most of the neonates with vitamin D deficiency were born in winter (p=0.015). More than half of the neonates (55%) with vitamin D deficiency were also hypo calcemic (p=0.026). There was no significant difference between the term and preterm neonates regarding the   prevalence   of   vitamin D deficiency, insufficiency and sufficiency (p=0.19), but the mean value of vitamin D in term neonates was significantly lower than preterm neonates (11.74 ng/ml vs. 21.63 ng/ml; p=0.032). Conclusion: The vitamin D deficiency and insufficiency were common among neonates admitted to NICU. Low levels of vitamin D were not associated with neonatal outcomes including longer hospital stay or increased mortality rate during hospital admission.

9. A Retrospective Study to Evaluate the Maternal and Fetal Outcome of Malaria in Pregnancy
Sudha Kumari
Abstract
Aim: The aim of this study to evaluate the maternal and fetal outcome of malaria in pregnancy. Methods: this retrospective study of pregnant women was conducted in the Department of Obstetrics and Gynecology Katihar Medical College and Hospital,Katihar, Bihar, India .  Detailed history and clinical examination was done to ascertain the cause of fever. Haemoglobin, total and differential leucocyte count, rapid diagnostic tests (RDTs) for malaria, routine urine examinations were done. Microscopy of blood smears was done for species identification for all malaria positive pregnant women. A total of 50 patients were found to be smear positive for plasmodium. Results: A total of 12100 pregnant women attended our hospital  during study period out of which 50 were positive for malaria. Prevalence of malaria in pregnancy during the study period was 0.41%. Among the malaria cases, 30 cases were primigravidae and 20 were multi-gravidae, accounting for 60% and 40% respectively. Out of 50 cases, P. falciparum, vivax, and mixed malaria accounts for 24%, 30% and 8% cases respectively showing the predominant pathogen as P. vivax. Out of 50 cases, maternal anemia was present in 16 cases of which 10 (20%) were primigravida and 6 (12%) were multi-gravida. Maternal thrombocytopenia was seen in 14 cases of which 10 (20%) were primigravida and 4 (8%) were multigravida. Complications caused by different pathogens accounted for maternal anemia were 83.33% and 16.67%, maternal thrombocytopenia were 42.86% and 57.14% of P. vivax and falciparum respectively.Obstetric complications caused by P. vivax and falciparum accounted for 33.33% and 66.67% of spontaneous miscarriage, 75% and 25% of preterm deliveries, 75% and 25% of low birth weight babies, 0% and 100% of perinatal deaths respectively.Obstetric outcomes includes, 10 cases (20%) of spontaneous miscarriage, all belonging to first trimester, 12 cases (24%) of preterm deliveries, 16 (32%) cases of low birth weight babies and 1 case (2%) of perinatal death. Conclusions: We concluded that the malaria affects both pregnant female and  fetus. So all patients with fever in pregnancy must have screening for malarial parasite and treated adequately by medicine and help to improve the maternal and fetal outcome.

10. A Study to Evaluate the Rate of Caesarean Deliveries, Various Indications of the Procedure as well as the Associated Maternal Morbidity and Mortality
Sudha Kumari
Abstract
Aim:   To evaluate the prevalence of cesarean section in a tertiary care hospital. Methods: A retrospective study on women who underwent LSCS over a period of 1 year. Department of Obstetrics and Gynecology, Katihar Medical College and Hospital,Katihar, Bihar, India .  Out of the 489 deliveries, 200 were delivered by cesarean section. Variables including age, parity, gestational age, CS timing (elective or emergency), and indications for LSCS were collected from their case records and entered in the proforma. Results: A total of 489 deliveries were performed in the study duration of 1 year, of which 200 cases underwent cesarean section. The LSCS prevalence was 40.89% in our institution. We have assessed the common indications of LSCS performed in this study population. The majority of the LSCS were delivered between 37-40 weeks (69.5%) of gestation. Mode of conception was spontaneous for 96.5%, and 3.5% received infertility treatments the distribution of various indications for LSCS in the study population. LSCS was mostly done for ‘previous LSCS’ indication (87 cases, 43.5%), followed by failure of induction of labor (45 cases, 22.5%). Fetal distress was an indication in 18 cases (9%), Breech presentation in 13 cases (6.5%), PPROM in 11 (5.5%), CPD in 10(5%). Diabetes mellitus was found in 10% of the total LSCS population and pregnancy induced hypertension (PIH) in 4%. It was found that the lower segment was well formed in 90.5%, was thin in 5% and not formed in 4.5% of the study population. Adhesions were observed in 3% and scar dehiscence was present in 1% of cases. Conclusion: Although LSCS indications seen in our institute are the same in most institutions worldwide, efforts should be made to focus on reducing the primary LSCS rates thereby reducing the most common indication of previous LSCS in subsequent pregnancies.

11. A Cross Sectional Study to Assess the Demographic Profiles of Victims of Fatal Road Traffic Accidents
Kaushal Kishore, Bipin Kumar
Abstract
Aim: Demographic profiles of victims of fatal road traffic accidents in Bihar population. Methods: The cross sectional study was conducted in the Department of Forensic Medicine and Toxicology, SKMCH, Muzaffarpur, Bihar, India for 1 year. Total 200 dead bodies of victims of road traffic fatalities brought to mortuary for medico-legal post mortem examination in the department of forensic medicine. Results: Age group of 21-30 years comprising 28% (56 cases) followed by age group 31-40 years i.e.20% (40 cases). Male victims accounting for 83.50% (167 cases) of road traffic accidents as compared to female victims 16.5% (33 cases). 61.50% (123 cases) of road traffic accidental victims were belonging from urban area whereas 38.50% (77 cases) were belonging to rural area . 37 cases (18.50%) of road traffic accident had occurred in between 6am to12pm while 92 cases (46%) of road traffic accidents had occurred during 12pm to 6pm. In 54 cases (27%), road traffic accidents had occurred during 6pm to12am while 17 cases (8.50%) of road traffic accidents occurred during 12am to 6am. Two wheelers were offending vehicle in 24 cases (12%), three wheelers were in only 2 cases (1%) and four wheelers and above were in 112 cases (56%) of road traffic accidents. 55 cases (27.50%) and 4 cases (2%) of road traffic accidents had occurred because of skidding of two wheelers and four wheeler respectively. Four wheeler and above indicates vehicles having four or more than four wheels that includes car, buses, truck, tractor, etc. 90 cases (45%) of road traffic accident victims were two wheeler riders, 28 cases (14%) were pillion rider of two wheeler, 6 cases (3%) were four wheeler driver while 9 cases (4.50%) were passengers of four wheeler and above. 12 (6%) cases of accident victims were bicycle rider, 2 cases (1%) were bullock cart driver and 53 cases (26.50%) were pedestrian. 85 cases (42.50%) of road traffic accidents were transported to the nearest hospital by police mobile van (PMV), 31 cases (15%) were by ambulance, 50 cases (25%) by auto, 25 cases (12.50%) by private and 9 cases (4.50%) by two wheeler. Helmet was applicable in 118 cases (59%) but none of victim used helmet as safety measure. Conclusion: The road accidents are occurring most often due to the reckless and speedy driving of the vehicles, violation of traffic rules, overburdened public transport vehicles, poor maintenance of the vehicles.

12. Hospital Based Cross Sectional Study to Assess the Serum Vitamin D Deficiency in NICU Hospitalized Neonates and Its Association with Neonatal Outcomes
Mani Bhushan, Bimal Kumar, Archana Bharti
Abstract
Aim: Serum Vitamin D Deficiency in NICU Hospitalized Neonates and Its Association With Neonatal Outcomes. Methods: Hospital based cross sectional study conducted in the Department of Pediatrics, Madhubani Medical Colleges and Hospital, Madhubani, Bihar, India,for 1 year. All the neonates with medical and surgical diseases hospitalized in NICU were enrolled in this study. The subjects were breast fed before admission. Immediately on admission, serum sample for vitamin D measurement was obtained along with routine blood sampling, thus the impact of the affecting factors was minimized. Serum vitamin D and calcium levels were measured by Electrochemiluminescence immunoassay and Calcium Assay kit (colorimetric) methods, respectively. Results:  From the studied neonates, 10 had normal vitamin D level, 50 had insufficient vitamin D level and 40 had vitamin D deficiency. So, vitamin D deficiency and insufficiency were present in 90% of our patients. The mean±SD serum level of vitamin D was 14.93±17.96 ng/ml (Min=2, Max=151 ng/ml) in our patients. The mean±SD values between hospitalized neonates due to medical and surgical causes were 15.11±18.95 and 14.36±14.61 ng/ml respectively. The mean serum value of vitamin D was similar among both gender (p=0.31). There were no significant differences in the neonatal vitamin D status regarding medical or surgical causes of admission (p=0.77). Moreover, longer length of hospital stay was not associated with lower levels of vitamin D (p=0.87). A significant association was observed between vitamin D status and season of birth. Most of the neonates with vitamin D deficiency were born in winter (p=0.015). More than half of the neonates (55%) with vitamin D deficiency were also hypo calcemic (p=0.026). There was no significant difference between the term and preterm neonates regarding the   prevalence   of   vitamin D deficiency, insufficiency and sufficiency (p=0.19), but the mean value of vitamin D in term neonates was significantly lower than preterm neonates (11.74 ng/ml vs. 21.63 ng/ml; p=0.032). Conclusion: The vitamin D deficiency and insufficiency were common among neonates admitted to NICU. Low levels of vitamin D were not associated with neonatal outcomes including longer hospital stay or increased mortality rate during hospital admission.

13. A Retrospective Clinical Analysis of Outcome in Management of Head Injury in Patients with Highway Road Accidents
Bipin Kumar, Kaushal Kishore
Abstract
Aim: A clinical analysis of outcome in management of head injury in patients with highway road accidents. Methods: A retrospective study was conducted in the Department of Forensic Medicine and Toxicology, SKMCH, Muzaffarpur, Bihar, India for 15 months. The data was collected regarding demography, mode of injury, clinical presentation, and condition at admission, treatment given, hospital stay and outcome of these patients. All patients were clinically evaluated by a team comprising of doctors from surgical, medical and orthopedics specialties in the emergency department and subsequently admitted and treated at Neurosurgery. Plain CT scan head along with X-ray of cervical and for dorso- lumbar spine were carried out to rule out other injuries. Whenever necessary, CT scans of spine, USG abdomen (FAST). Results: Out of total number of cases, 100 were present with road traffic accidents with 16(16%) patients with head injury as cause of death. According to the data collected 50 (50%) patients were under alcoholic influence, 95(95%) patients had history of LOC, 52 (52%) patients had ENT bleed and 9 (9%) had CSF leak at the time of admission. At the time of admission Glasgow coma scale (GCS) score of less than 8 was seen in 33 (33%) cases. GCS between 9 to12 was seen in 51 (51%) cases and GCS between 12 to 14 was seen in 16 (16%) patients. 35 (35%) patients were managed conservatively using anti-epileptics, diuretics and osmotic agents. In patients with less than 8 GCS, ICP monitoring was done initially, 40 (40%) patients underwent craniotomy and evacuation, 3 (3%) patients underwent craniotomy and decompression and 25(25%) patients underwent burr hole and evacuation of clot. According to Glasgow outcome scale (GCS) of these patients, 85 (85%) of patients had good recovery, 15 (15%) patients died in the course of treatment. Conclusion: It is concluded that, RTA is an unfortunate economic burden for our nation. Head injury due to RTA is a recognized major public health problem causing death and disability among the population.

14. An Observational Study to Evaluate the Trans-nasal Endoscopic Repair of Cerebrospinal Fluid (CSF) Rhinorrhoea
Chandan Kumar,  Satyendra Sharma
Abstract
Aim: To study of trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea. Materials: An observational study was carried out in the Department of ENT, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. Total 20 patients (13 males and 7 females) who had CSF rhinorrhoea and underwent trans-nasal endoscopic repair in Department of ENT. Patients were assessed for demographic profile, etiology of CSF leak and its duration, endoscopic findings, radiographic findings, location of leak, surgical repair and post-operative outcome. Inclusion criteria were cases with defect size less than 1.5 cms; cases involving cribriform, ethmoid, sphenoid or frontal recess region of skull base. Results: In present study 20 patients (13males and 7 females) were assessed. Mean age of patients was 29.20 years with range of 10-49 years. Etiological factor for CSF leak was found to be accidental trauma in 65% cases. In 2 patient cause was iatrogenic resulting from polypectomy. Spontaneous rhinorrhoea was observed in 25% subjects. Majority of patients (80%) presented with intermittent leaks whereas 20% were suffering from continuous type of leakage. 40 percent of cases had 1-2 episodes of meningitis. Radiographic examination revealed bony defects in all these cases with concurrent meningocele and meningo- encephalocele in 10% and 55% cases respectively. Most common location of defect in this cohort was cribriform plate of ethmoid (80%) whereas it was fovea ethmoidalis in 20% patients. No post-surgical complications were encountered in this study. Hospital stay in most of the cases (80%) was less than 2 weeks and in 20% of patients it was up to 4 weeks. Conclusion: Endo-nasal endoscopic closure is a safe and effective technique for repair of CSF rhinorrhoea. There is minimal intranasal trauma. An overall rate of successful repair was 100%. No surgical complications were encountered in present series. Etiology of leak and size of defect did not have any adverse effect on surgical outcome.

15. The Sight Restoration Rate (SRR): Metric for Assessing the Effect of Cataract Surgery on the Patient’s Vision
MD. Jabir Hussain, Sheel Mani, Ram Kumar Satyapal, Uma Shankar Singh
Abstract
Aim: Study Sight restoration rate (SRR), Useful indicator to measure impact of cataract surgery. Methods: This prospective study was carried out in the Department of ophthalmology,  Jawaharlal Nehru medical college and hospital, Bhagalpur, Bihar, India, for 12 months. Medical records of patients who did Cataract Surgery either SICS or Phacoemulsification, best corrected visual acuity (BCVA) was conducted using the Snellen chart and a pinhole. All of the eye examinations were performed by the same operator. Pre- and post-BCVA were categorized into four categories according to WHO classification. The categories are 6/6-6/18, 6/18-6/60, 6/60-3/60, and 3/60-No Light Perception. Out of all data we excluded patient who did not follow up and all patients with comorbidities which may influence post-operative outcome remaining data considered for analyses. Results: Our cohort included 1100 eyes; 100 had comorbidities in form of corneal opacities, optic nerve atrophy, retinal detachment, congenital anomalies and were excluded from the final sample. The SRR of the surgery in our study 50%. SRR is an indicator to determine the impact of conducting cataract surgeries on people’s productivity. In measuring SRR, the best visual acuity of either eye in a patient before the surgery is used. If the best visual acuity of either eye is already more than 3/60, then the cataract surgery is not considered as having an effect on people’s productivity. This is the key difference which differentiates SRR from other indicators which are used to determine the success of cataract surgery. Visual outcome <3/60 in 10 eyes (1%). Conclusion: SRR of the surgery in this research is 50%, while our poor surgical outcome is 5%. High SRR means that a lot of these patients can return to work, while poor surgical outcome means that the surgeries have very good standard. This will optimize “peoples right for sight” as was suggested with Vision 2020 motto.

16. Diagnosing Chronic Rhinosinusitis: A Comparative Study between Diagnostic Nasal Endoscopy and Computed Tomographic Scan Paranasal Sinuses
Manoj Kumar, Vikram Satyarthy, Rana Pratap Thakur
Abstract
Aim: Comparative study between diagnostic nasal endoscopy and computed tomographic scan paranasal sinuses. Methods: This prospective comparative study was carried out in the Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 1 year, after taking the approval of the protocol review committee and institutional ethics committee. 100 patients who visited the ENT OPD, those suffering from at least two of the previous mentioned symptoms of chronic rhinosinusitis and not responding to 3 weeks of medical treatment were selected. Results: Most common symptom experienced was nasal obstruction 91%, followed by nasal discharge 83%, facial pain/headache 77%, anosmia/hyposmia 37%, sneezing 33%, nasal bleeding 9%. Among 100 patients who underwent for nasal endoscopy, edematous mucosa was found in 45% patients, among them 15% had mild edema and 30% had severe edema. According to scoring system 91% patients were diagnosed on CT scan and 85% patients were diagnosed on nasal endoscopy. 9% and 15% were not diagnosed on CT scan and nasal endoscopy respectively. So, by considering CT scan as accurate diagnostic procedure, the accuracy of nasal endoscopy was calculated. The sensitivity of nasal endoscopy is 89.88%. So, the probability of diagnosing CRS when it is present is 89.88%. The specificity is 61%. So, NE has 61% ability to exclude the disease. The chi square value at degree of freedom 1 was 8.12 and p value was 0.0041, which was significant at p<0.05, indicates that CT PNS was more accurate than diagnostic nasal endoscopy in diagnosing chronic rhinosinusitis. Conclusion: Nasal endoscopy should be performed in all patients who meet diagnostic criteria of chronic rhinosinusitis as an early diagnostic tool as it has an advantage of being harmless, no radiation exposure, less cost, less time consuming and is an OPD based procedure.

17. The Efficacy of 3 Doses Versus 7 Days Course of Prophylactic Antibiotics following Caesarean Section – An Experience from A Tertiary Care Hospital
Kamal Kumar Dash, Anjan Dasgupta, Abirbhab Pal
Abstract
Introduction: Surgical site infection (SSI) is one of the common problems following caesarean section . Antimicrobial prophylaxis used to reduce the microbial burden of intraoperative contamination to a level that can not overwhelm host defenses. Amoxycillin-clavulanic acid is a broad spectrum antibiotic that is active against most of the organisms implicated in post-caesarean infections. Objectives: The objective of the study was to evaluate the efficacy of 3 doses of amoxicillin-clavulanic acid (study group) versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole (control group) as prophylactic antibiotics following caesarean section. Methods: A randomized controlled trial conducted for a year from July 2019- June 2020 at Midnapore Medical College,India. Patients were randomly assigned in : Group A: Those who received 3 doses of intravenous Amoxycillin-clavulanic acid 1.2 gm 12 hours apart with first dose given 30- 60 minutes before incision. Group B: Those who received intravenous Amoxycillin-clavulanic acid 1.2 gm twice daily for 7 days along with 3 doses of intravenous metronidale 8 hours apart. Results: The distribution of mean age, mean weight , mean gestational age and parity were statistically not significant, hence placement of groups was homogenous in nature. E.Coli was the commonest microorganism responsible for SSI in both arms. Mean hospital bed occupancy and the mean cost of antibiotics was much less in Group A and is statistically significant (p<0.05). Conclusions: The current study has demonstrated that short term prophylaxis is equally effective as with long term with the added benefit of reduced rate of acquiring nosocomial infections.

18. Histopathological Study on Autopsy Liver Specimens in a Tertiary Care Institute of Punjab
Ishwer Tayal, Parul Garg, Sarita Nibhoria, Shilekh Mittal, Bikramjit Singh
Abstract
Introduction: Autopsy also known as postmortem examination is done to find out the cause of death, time since death and to know the extent of disease. It also helps to identify any undiagnosed disease present in the person which can be confirmed histopathologically. This helps in increasing the knowledge of both pathologist and forensic experts. Liver being the principal site of many metabolic activities, is most frequently injured organ in the body. Various liver diseases are classified as primary and secondary. This study was done to analyse the various disease patterns of liver found at autopsy and histopathologically which were either incidental or were directly related cause of to death. Aim and objectives: To study the spectrum of liver diseases in autopsy specimen along with histopathological examination. Material and Methods: This retrospective study was carried out in a tertiary care hospital in the department of pathology over a period of four and a half years. A total of 110 cases of liver specimens of postmortem cases, received as part of liver or whole liver were included in the study. The specimens were received in 10% formalin. After gross examination, sections from representative area were submitted for histopathological processing. After processing tissues were sectioned and stained with H&E stain. Slides were examined and the findings were noted. Findings were calculated as percentage. Results: Liver diseases are more common in males as compared to females. Out of 110 cases, 86 (78.19%) were males and 24 (21.81%) were females (Ratio M: F 3.5:1). and the most affected age group being 31-40 years. Congestion was seen in maximum number of cases (37.27% cases) followed by fatty change (28.18%) and least were seen with necrosis (0.91%). Conclusion:This study highlights the importance of histopathological report in liver autopsy cases.

19. An Observation Research to Evaluate the Effect of Intra-Lesional Corticosteroids in Management of Patients with OSMF
Chandan Kumar, Satyendra Sharma
Abstract
Aim: The effect of intra-lesional corticosteroids in management of patients with OSMF. Materials and Methods: The present clinic-observational study was conducted among 100 diagnosed patients of OSMF who attended the OPD of Department of ENT, Nalanda Medical College and Hospital, Patna, Bihar, India. The collected data were subjected to statistical analysis using SPSS version 20 software. Results: Mean age of the study population was 29.12 years. Study shows a definite male predominance (74%). Statistical analysis revealed that there was a significant improvement in the mouth opening and VAS. Conclusion:The present study concluded that dexamethasone (2 ml Decadron 4 mg/ml) injection and hyaluronidase 1500 IU with 2% lignocaine was administered, and there was significant improvement in mouth opening and VAS.

20. To Investigate the Relationship Between the Duration of Diabetes Mellitus, Microalbuminuria, and Hyperlipidemia and the Severity of Diabetic Retinopathy
Sheel Mani, MD. Jabir Hussain, Pummy Roy, Uma Shankar Singh
Abstract
Aim: The aim of this study to evaluate the correlation of duration of diabetes mellitus, microalbuminuria, hyperlipidemia with severity if diabetic retinopathy. Methods: The prospective cross-sectional study which was carried in the Department of Ophthalmology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India, for 18 months Total 200 patients were included in this study. For the study, type II DM is defined as a fasting plasma glucose of more than or equal to 126 mg/dl or 2-hour post glucose load plasma glucose of more than or equal to 200 mg/dl or a random plasma glucose of more than or equal to 200 mg/dl in the presence of symptoms of hyperglycemia. All the biochemical assessments were done using an Auto analyzer. Results: A total of 200 subjects of either gender were included in our study, out of which 110 (55%) were females and rest were males (90; 45%). Majority of the patients lied in the age group of 40-60 years (55%). Out of 100 patients in the retinopathic group, 50 (25%) of them suffered from very mild to moderate NPDR, 30 (15%) patients showed signs of severe to very severe NPDR and only 20 (10%) had proliferative diabetic retinopathy. Proportion of Group I (No retinopathy) was higher in younger patients i.e. below 40 (73.33%) and 40-60 (49.09%) as compared to elderly cases i.e. 60-80 (37.93%) and this difference was found to be statistically significant (p < 0.001). It was found that proportion of Group I (non-retinopathy) patients was higher in patients with duration of diabetes < 10 years (70%) as compared to patients with duration 10-20 years (51.43%), 20-40 years (6.67%) and > 40 years (30%). Majority of patients with duration of diabetes 20-40 years and > 40 years belonged to Group IIA. (Very mild to moderate retinopathy). Majority of patients (86.49%) of Grade 0 microalbuminuria (< 2.5 mg/mmol) had no Retinopathy. Out Of 200 patients of diabetes, total cholesterol was found to be desirable (< 200 mg/dl) in only 60 (30%) patients. Total cholesterol was found to be high (240 mg/dl) in 30 (15%) patients. Prevalence of retinopathy was 60%, in patients having high total cholesterol levels. Proportional difference in severity of retinopathy in patients with different total cholesterol levels was found to be statistically significant (p = 0.001). On doing a trivariate analysis between severity of retinopathy, microalbuminuria and serum cholesterol levels, it was observed that in microalbuminuria grade 0, difference in prevalence of retinopathy in patients with different serum cholesterol levels was not found to be statistically significant (p = 0.612). In microalbuminuria grade l, prevalence of retinopathy in patients having desirable cholesterol levels was lower as compared to those having borderline or high cholesterol levels and this difference was found to be statistically significant (p = 007). In microalbuminuria grade II, proportional differences in grades of retinopathy and serum cholesterol levels were observed and these differences were found to be statistically significant (p = 0.021). Conclusion: Duration of diabetes and microalbuminuria have been found to be the independent risk factors for diabetic retinopathy, but serum cholesterol levels did not show an independent role in our study. The findings in present study endorsed the view that microalbuminuria poses a risk for diabetic retinopathy which is affected by duration of diabetes, level of glycemic control and lipid levels.

21. Prospective Observational Assessment of the Radiological Outcome of total Hip Arthroplasty in Displaced Neck of Femur Fracture
Baidyanath Kumar, Swati Sinha, Krishna Kumar
Abstract
Aim: The Purpose of this study is to assess the Radiological outcome of Total Hip Arthroplasty in Displaced fracture Neck of femur. Methods: This prospective observational study was carried out in the Department of Orthopedics, Nalanda Medical College and Hospital, Patna, Bihar, India for 18 months. Total 100 patients were patients treated with total hip replacement. Radiographic evaluation includes Loosening of the acetabulum and femoral components, Inclination of Acetabular cup, Stem position of femoral component, Vertical subsidence, Migration of the Acetabular cup and Heterotopic Ossification. Modified Harris hip score was used for clinical and functional evaluation of patients. Plain X‐ray pelvis with both hips and proximal femur—AP view and X‐ray of the operated hip lateral view for radiological evaluation. Results: Out of 100, 74 patients were male and 26 female, most of the patients in were above 50 year and followed by 40-50 year. Patients scored 54% excellent, 27 good, 9% fair and 10% patients scored poor. In our study 79% neutral, 11% vertical and 10% horizontal position were seen. The ideal position of stem of femoral component is central. In this study we had 79% central, 13% each in valgus and 8% varus position. Varus position of the stem may lead to complications such as anterior thigh pain and periprosthetic fractures. There were 4% subsidence and 3% migration seen and Class II heterotopic ossification was noted in 6 hip, i.e., 5 % incidence who underwent THA. Conclusion: we concluded that the total hip arthroplasty gave better results in displaced Intracapsular neck of femur fractures radiologically.

22. Prospective Study Comparing Topical Travoprost 0.004% and Dorzolamide 2% in Primary Open Angle Glaucoma
Prerana Agarwal, Suryadev Tayal, Rinky Agarwal
Abstract
Background: To compare the efficacy and safety of travoprost 0.004% with dorzolamide 2% eye drops in naive primary open‑angle glaucoma (POAG). Design: Prospective, randomized, comparative, interventional study. Setting: Tertiary eye-care centre. Methods: 40 systemically healthy adult patients with newly diagnosed unilateral POAG with intraocular pressure (IOP) between 22-36mmHg were divided into two groups (n=20 each). One group was administered travoprost 0.004% at 9:00pm while the other was instilled dorzolamide 2% at 6:00am, 2:00pm and 10:00 pm). IOP was measured at baseline, 2 weeks and 6 weeks follow-up at 9:00am and 4:00pm. All patients were monitored for any side effects. Results: Both groups were comparable in baseline parameters such as age, gender and IOP. The mean IOP at the baseline, 2 weeks and 6 weeks follow-up was 25.02±1.40mmHg and 20.12±0.99mmHg, 17.85±0.80mmHg in travoprost group, and 23.40±1.10mmHg, and 20.90±1.12mmHg and 19.35±1.14mmHg in dorzolamide group respectively. The mean reduction in IOP at final follow-up was significantly higher in travoprost group (7.17±1.12mmHg) when compared to dorzolamide group (4.0±0.81mmHg) (p =0.0021). The incidence of ocular side-effects was marginally lower in travoprost group (6/20; foreign body sensation (4), conjunctival hyperemia (2)) when compared to dorzolamide group (7/20; foreign body sensation (2), conjunctival hyperemia (2), stinging (1), headache (1), and dryness of eye (1)). Conclusion: Both travoprost 0.004% and dorzolamide 2% may be employed as primary monotherapy in POAG eyes. However, travoprost shows greater reduction in IOP when compared to dorzolamide.

23. An Online Questionnaire Based Survey to Assess the Effect of COVID-19 Pandemic on Medical Education and Training of Surgical Residents
Diwakar Yadav, Sanjay Kumar Chaurasia, Tarak Baxla
Abstract
Aim: To assess the effect of COVID-19 pandemic on medical education and training of surgical residents. Methodology: An online survey was conducted to assess the effect of COVID-19 on the residents in various surgical specialties in Shaheed Nirmal Mahto Medical College, Dhanbad, Jharkhand. All the surgical residents were invited to participate in the survey using WhatsApp and other social platforms. The questionnaire consisted of 5 sections: Demographic details, surgical residents and COVID-19 related work, impact of COVID-19 on surgical training of residents, and academic activities during COVID-19. The data was collected and analyzed. Results: A total of 70 surgical residents completed the survey. Out of the 70 respondents, 42 (60%) were male, and 28 (40%) were female. 34.3% percent of respondents were in the first year of their residency, 38.6% in their second year, and the remaining 27.1% were in the final year. Out of 70 participants, 54.3% residents worked for 1-5 weeks, 35.7% worked for 5-10 weeks, and 10% residents worked for >10 weeks. Among them, 42.8 % were worried about getting infected and 41.4% were worried about transmitting infection to family members. 15.7% of residents was afraid of death due to COVID-19. 29 (41.4%) reported poor visibility with goggles or face-shield as most difficult part of working with PPE kits. There was a significant reduction in working hours since the pandemic began (6.84±3.66 hours) when compared to pre-pandemic time (12.65±3.54 hours). Hands-on surgical training was significantly affected. Only 30.1% of the participants agreed that online learning programs are more effective than in-person classes, while 69.9% of residents were still in favor of offline teachings. Conclusion: The decrease in working hours due to the pandemic has provided more time for research work but the limited hands-on experience and lesser clinical exposure are worrisome for which a substitute or a balanced midpoint is needed.

24. A Retrospective Observational Study to Evaluate the Mesh Related Infections in A Tertiary Care Facility
Prabhakar Krishna, Anisha Kishore
Abstract
Aim: The aim of this study to analysis of mesh related infections in a tertiary care centre. Methods: A retrospective observational study was conducted in the Department of General Surgery, MGM Medical College Kishanganj, Bihar, India from July 2019 to July 2020. 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 analysed. Results: In our study, 20 cases of mesh infection were recorded out of 600 hernia surgeries (230 laparoscopic repairs and 370 open repairs). Total incidence of mesh infection reported was 20/600=3.33%). Incidence of infection in open repair was 6/370=1.62% and Lap repair showed incidence of 14/230=6.08%). In this study, 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 comorbidities. HbA1c of all diabetic patients was >16 is note worthy, 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. In our study, 17 patients underwent mesh explantation, i.e. complete removal of the mesh, the infected sinus, and the surrounding infected tissue, followed by proper drainage of the surgical site. 1 patient was managed conservatively with an antibiotic wash, and parenteral antibiotics and 2 patients were tried to manage conservatively but later underwent mesh explantation. Conclusion: In our study incidence was more common after laparoscopic surgeries because there was a lapse in the sterilization process of the laparoscopic instruments, which was rectified with timely culture sensitivity tests and stringent sterilization process.

25. Prospective Observational Assessment of Early Developmental Outcomes Among Infants Born Early Term
Ashish Kumar Basant, Ankur Gautam
Abstract
Aim: Early developmental outcomes among infants born early term. Methods: This prospective observational study was carried out in the Department of Pediatrics, Saraswathi Institute of Medical Sciences, Hapur, India. For 3 months. We included all singleton newborns delivered at term (37 to 42 weeks of gestation). Gestational age calculation was based on first trimester ultrasound estimates. Neonates with congenital malformations and who are born to mothers < 18 and > 30 years of age were excluded. Cases were recruited during the first 6 months of study period to facilitate the follow-up until 4 months of age. Eligible neonates were categorized into early term babies (37 weeks and 38 weeks +6 days gestation) and full-term babies (39 weeks and 41 weeks +6 days gestation). Results:  The study included 100 eligible neonates of which 50 were early term and 50 were full term. The mean USG- GA was 38.7 ± 1.63 (37.7; 39.1) weeks with lowest of 37 weeks and highest of 41.1 weeks. The mean birth weight of study population was 2741±1.12 grams, constituting with a range of 1590 grams and 4010 grams as the lowest and highest respectively. Neonatal morbidities of early term consist of 46% as compared to 14% among infants born full term which was statistically insignificant. Social smile attained at a mean age of 32.38 days among term babies and 49.26 days among early term infants. The difference was statistically significant. The mean age of assessment of head control was 4.14 months (range of 4.2 to 4.4 months). At 4 months of age, all infants born at term gestation had head control. In the early term group 20% of children were classified as delayed in attaining head control. Conclusion: Our observations in addition to the existing data have important implications in considering the definition of “term”. Present analysis found evidence of delayed ability for early term group for attaining early developmental milestones when compared to full-term birth.

26. A Retrospective Study to Assess the Efficacy and Patient Compliance with the Postpartum Intrauterine Device
Rashmi Raginee
Abstract
Aim: This study aims to look at the efficacy and patient compliance with the Postpartum Intrauterine Device. Materials and Methods: This study is a retrospective study conducted in Department of Obstetrics and Gynecology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India over a period of one year. Results: Patients fulfilling medical eligibility criteria were 1700. PPIUCD patients counseled were 900. 300 patients were the number of patients who accepted service and participated in the study. The maximum number of patients was in the age group of 21-25 years and constituted 50.0%. The majority of patients had IUCD acceptance reason of no need for 2nd visit for contraception (53.6%). Conclusion: PPIUCD is a highly effective, non hormonal, long-acting, and reversible contraceptive method. To increase the use of this method, extreme motivation and counselling from the couple’s antenatal period are required.