1. Prospective, Open Labelled, Randomised, Parallel Group Study To Evaluate The Efficacy And Safety Of Metformin Add- On Therapy To Standard ATT In Newly Diagnosed Pulmonary Tuberculosis Patients
Ritesh Kamal, Amit Kumar Ambasta
Aim: Clinical Evaluation of Efficacy and Safety of Metformin add- on Therapy to Standard ATT in Newly Diagnosed Pulmonary Tuberculosis Patients. Methods: This was a prospective, open labelled, randomised, parallel group study conducted in KMCH,Katihar, Bihar in Department of Pulmonary Medicine for 1 year. involving 100 tuberculosis patients. Patients were screened and those who fulfilled the selection criteria were included in the study. Patients were randomly allocated to either of the two groups – Control group and Metformin group with 50 patients in each group. In control group, patients received only standard ATT and in Metformin group, patients received Metformin 250 mg twice daily along with standard ATT. Results: The mean age of the patients in control group was 44 (±11.8) years and in Metformin group, it was 40.3 (±11.1) years. In control group, there were 35 males and 15 females and in Metformin group, 33 males and 17 females. There was no significant difference seen in age and gender distribution of the patients between two groups, as evidenced by the p value more than in unpaired t test for age and chi square test for gender. The average time taken for sputum smear conversion was significantly lower in the Metformin group in comparison with the control group (p = 0.011, unpaired t-test). It was about 3.5 (±1.64) weeks in Metformin group while it was 4.8 (±2.21) weeks in the control group. All the subjects enrolled in the study were non-diabetics. At the time of enrollment, their fasting and post prandial blood sugar and HbA1c values were measured and only those who were having normal values were selected for the study. The mean fasting blood sugar was 96.5±8.8mg/dl and 92.2±11.4mg/dl and the mean sugar values at post prandial state was 127.22±24.15 mg/dl and 125.98±30.11 mg/dl in control and Metformin groups respectively at the time of enrollment. In control group, the baseline HbA1c was 4.82±0.41 % and it was 4.95±0.63 % in Metformin group. Adverse events were seen in 5 patients (10%) in control group and 7 patients (14%) in Metformin group. The difference was not statistically significant (p value = 0.81, chi square test). All of the adverse events were only minor in nature and gastrointestinal related problems like nausea, vomiting and gastritis. Conclusion: It was observed that the average time taken for sputum smear conversion was 3.5 weeks in Metformin group and 4.8 weeks in control group. There were no serious adverse events and most of the adverse events were gastrointestinal related and minor in nature.

2. Functional Outcome and Clinico-Demographic Profile of Scaphoid Nonunion Treated with Herbert Screw and Bone Grafting
Baidyanath Kumar, Swati Sinha, Satyendra Kumar Sinha
Aim: The aim of this study to evaluate the functional outcome of scaphoid nonunion treated with bone grafting and Herbert screw fixation. Methods: This study was done the Department of Orthopedics, Nalanda Medical College and Hospital, Patna, Bihar, India for 12 months. 70 cases were referrals from peripheral centers with a possible diagnosis of scaphoid nonunion after failed conservative treatment. 70 patients were initially assessed with fresh radiographs and MRI wrist was taken in all cases. The injuries were classified according to Herbert’s Classification. Clinical examination included the assessment of tenderness, active and passive range of movement in wrist, and grip strengths were also measured. A firm padded removable splint were used to support the wrist for the first two weeks and after the suture removal, patients are advised to start mobilizing exercises of the wrist. Results: The mean age of the patients was 29.15 years. The occupations of the patients in terms of weight loading of the wrist were heavy loading in 43 patients, light loading in 12 patients and clerical work in 15 patients. All the 70 patients were regularly followed up and were evaluated for clinical and radiological outcomes. Our study resulted in 61.43% excellent, 25.71% good and 12.86% fair functional outcomes. 2 patient each in good and fair groups had mild pain post operatively. 97.14% of patients were satisfied with the outcome of the procedure mostly because they could return to job with a painless joint. Conclusions: We concluded that the healing of the nonunion is better than that in other surgeries like k wire fixation or bone graft surgeries alone.

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

4. A Retrospective Study to Correlate Cytological Findings with Histopathological Findings and to Determine the Accuracy of FNAC in the Diagnosis of Breast Lesions
Vivek Kumar Pandey, Rituraj, Vimal kumar Gupta, Awadhesh Singh
Aim: The aim of the present study was to correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. Methods: This retrospective study was carried out in the Department of Pathology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, for 12 months. Total 50 all cases of breast lump FNAC in which cytological impression could be given were included in the study.  Slides of the entire breast FNAC conducted during the above period were surveyed and those fitting in to C3 and C4 categories were selected for study. The cytological diagnosis was compared with histopathological diagnosis in the cases where biopsy was done subsequent to FNAC diagnosis. Results: A total of 400 breast FNACs were done in the above- mentioned period. C3 and C4 categories constituted 30 (7.5%) and 40 (10%) cases respectively. Histopathological diagnosis was available in 20 cases of C3 (40%) and 30 cases of C4 (60%). All the malignant cases in both these categories were infiltrating ductal carcinomas (33 cases). Benign histological diagnosis between both categories included fibroadenoma (10 cases), fibrocystic disease (4 cases) and proliferative breast disease (3 cases). Among C3 category, 14/20 cases in which histopathological examination was available showed benign lesions (70%) and 6/20 cases were malignant (30%). Among C4 category, 3/30 cases available for histopathological examination showed benign lesion (10%) and 27/30 cases turned out to be malignant (90%). There was a significant statistical difference between benign and malignant diagnosis of C3 & C4 categories (p< 0.001). The accuracy of present study in diagnosing breast neoplasms is 96%. The specificity of 97% and the sensitivity of 96%. Conclusion: FNAC of breast is a simple, safe, rapid and inexpensive diagnostic modality and plays a very important role in diagnosis of breast lesions especially malignancies. However it is important that clinicians understand the limitations of FNAC. C3 and C4 categories should still be continued with, as there was a statistically significant difference in benign & malignant diagnosis for these categories in our study.

5. A Prospective Observational Study to Evaluate the Maternal and Fetal Factors Associated with Intrauterine Fetal Death
Priyadarshini, Geeta Sinha, Sushma Singh
Aim: To Study the maternal and fetal factors associated with intrauterine fetal death. Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India, from July 2020 to June 2021. The cases of intra-uterine fetal death either with ultrasound reports proving IUFD or diagnosed on clinical examination by absence of fetal heart rate and fetal movements were studied. All 100 cases of IUFD with gestational age >20 weeks and <42 weeks period of gestation. Detailed obstetric history, details about present complaints and duration of present pregnancy, past obstetric performances and outcomes (including previous abortions, previous IUFD, associated toxemias, etc.,) were studied. Result: In the present study mean maternal age was 26.03 years (Mean±SD: 27.03±4.62). Out of 100 women, 2% were <20 years, 80% were 20-30 years, 16% were 30-40 years and 2% were >40 years of age. In present study, out of 100 fetuses, 53% were female and 47% were male foetuses. Weight of the foetuses were as follows: 48(48%) weighed <1000 grams, 20 (20%) weighed 1001-1500 grams, 10 (10%) weighed 1501-2000 grams, 10(10%) foetuses weighed 2001-2500 grams, 10(10%) were 2501-3000 grams and 2 (2%) weighed > 3000 grams. Mean weight of the fetus in present study was 1334 gms (Mean±SD: 1334.59±814.36). In present study, 20 (20%) IUFD were unexplained, 10 (10%) IUFD were due to abruption placentae, 5 (5%) were due to cord accidents, 16 (16%) were due to Hypertension related complications, 5 (5%) were due to diabetes, 8 (8%) were due to severe oligohydramnios, 3 (3%) were due to premature rupture of the membranes, 5 (5%) were due to Rh isoimmunisation, 22 (22%) were having major congenital anomalies, 3 (3%) were having nonimmune hydrops and 2 (2%) was due to polyhydramnios. In present study, 16(57.14%) of women had hypertension related complications. 5 (17.86%) were diabetics.5(17.86%) had Rh isoimmunisation, 1 (3.57%) had bicornuate uterus and 1 (3.57%) had septate uterus. Conclusion: PIH (hypertensive disorders of pregnancy) abruption placenta and congenital anamolies were the leading causes of the IUFD. Significant proportion of IUFD due to PIH and abruption placenta is preventable by regular ante natal care and timely intervention and treatment for PIH.

6. Role of L-lysine in Ethanol Induced Behavioral Changes in Mice
Sumit Rathod, Vinay Bhalerao, Mangesh Deokar, Shirish Jain
Lysine, (S)-2,6,-diaminohexanoic acid, is a basic amino acid. Following ingestion, L-lysine is absorbed by the active transport process from the lumen of the small intestine into the enterocytes. L-lysine is a 5-HT4 antagonist that can increase and decrease ethanol intake when they are given intraperitoneal administration. 5-HT4 antagonist can block the rewarding and motivation effect as indicated by attenuation of sensitization to the locomotors stimulant effect of ethanol, decreased ethanol-induced conditioned placed preference, and reduced ethanol drinking. Young healthy mice (21–30 g) were group-housed (five per cage) in opaque polypropylene cages Animals were naive to drug treatment and experimentation at the beginning of all studies. Each experimental group was comprised of five mice. Testing was carried out in counterbalanced order concerning the treatment conditions in the noise-free room. Locomotor activity and conditioned place preference was assessed followed by acute and chronic exposure of ethanol to animals. The results revealed that acute as well as administration of L-lysine (20 and 40 mg/kg, i.p.) pre-treatment, 30 min before the test significantly reduced place preference in ethanol control-treated groups. In locomotor activity L-lysine (20 and 40 mg/kg, i.p.) pre-treatment, 30 min before the test significantly reduced locomotor count in ethanol control-treated groups in both acute and chronic groups. In conclusion, Results indicated that l-lysine exhibited an inhibitory influence against ethanol-induced behavioral changes in mice.