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

Volume12,Issue1

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
Abstract
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
Abstract
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
Abstract
Aim: Study of fungal elements by potassium hydroxide mount in chronic otitis media. Methods: This retrospective study conducted in the Department of ENT, Nalanda Medical College and Hospital, Patna, Bihar, India. Total 100 Patients chronic otitis media were included with no history using ear drops for last one week and using two sterile 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
Abstract
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
Abstract
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
Abstract
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.

7. An Observational Assessment of the Various Etiologies of Acute Small Intestinal Obstruction
Diwakar Yadav, Sanjay Kumar Chaurasia, Vivek Bhaskar
Abstract
Aim: To find out the common causes of the acute small intestinal obstruction in adult patients. Methodology: An observational study was conducted at Department of General Surgery at Shaheed Nirmal Mahto Medical College, Dhanbad, Jharkhand. Patients admitted for small intestinal obstruction were analyzed. The patients who were above 14 years of age and operated for mechanical obstruction of the small bowel and whose complete medical record was available were included in the study. The patient’s particulars such as age, gender, pre-operative clinical examinations and investigations, history regarding previous surgeries, post-operative morbidity and mortality were noted from files. The etiologies for small bowel obstruction were identified by analysis of radiological and intra-operative findings obtaining from patients records. Results: Total 95 operated cases of small intestinal obstruction were recorded in the study. Ages of patients ranged from 18 years the youngest one to 84 years the oldest with a Mean age of 48.35±31.84 years. Out of 95 cases, 54 (56.8%) were male, and 41 (43.2%) were female. Out of 95 patients, 29 (30.5%) were suffered from abdominal tuberculosis. Postoperative adhesions were found in 27 (28.4%) patients. 17 (17.9%) patients were noted with various form obstructed hernias like an inguinal, femoral, ventral hernia. In 11 (11.6%) patient’s obstructions found due to malignancy. Mesenteric ischemia found in 3 (3.2%) patients. Intussusception found in 2 (2.1%) cases and 2 (2.1%) cases of Meckel’s diverticulum were noted. Post radiation strictures and Gossypiboma were observed with the same frequency of 1 (1.05%) patient of both. Conclusion: Our study presented that the most common etiological reason for small intestinal obstruction is abdominal tuberculosis and adhesions, respectively. Etiology of small intestinal obstruction has changing pattern from area to area; more studies are needed over small geographical areas to know the pattern of etiologies of small bowel obstruction.

8. Retrospective Assessment of Intertrochanteric Fractures of Femur Managed Using Proximal Femoral Nail
Kumar Satyam, Shankar Niwas, Shashi Kant Kr Singh
Abstract
Aim: Study of proximal femoral nail in management of unstable intertrochanteric fractures of femur. Materials and methods: A retrospective study was conducted in the Department of Orthopaedics, SB Medical College & Hospital, Hazaribagh, Jharkhand, India for 1 year. 100 patients with unstable intertrochantric fractures AO type 31-A2.1, 31-A2.2, 31- A2.3,   31-A3.1,   31-A3.2,   31-A3.3   were included in study and which had been treated with Proximal femoral nail at our institution. Results: There were 55% left and 45% right side hip fractures. Mean operative time was 35 minute (range 24-89 min). Average length of follow up period was 12 month. The Cleveland zone 8 (central – inferior) was the most favourable position for lag screw on postoperative radiograph. 82% of cases showed fracture gap of less than 3mm and 15% cases showed fracture gap on acceptable range (3-5mm). Very good to good Garden alignment index was found in 75% of cases. Conclusion: We have suggested that proximal femoral nail offers advantages for the fixation of unstable intertrochanteric fractures with less operative time. It can be easily inserted and provide stable fixation with less complications.

9. A Randomized Controlled Trial to Evaluate Effect of Prophylactic Antibiotics in High-Risk Patients Undergoing Laparoscopic Cholecystectomy
Prabhakar Krishna, Anisha Kishore
Abstract
Aim: Prophylactic antibiotics in high-risk patients undergoing laparoscopic cholecystectomy. Methods: A randomized controlled trial study was conducted in the Department of General Surgery, MGM Medical College Kishanganj, Bihar, India from May 2019  to May 2020. Patient admitted for Laparoscopic cholecystectomy were randomized into two groups A (who did not receive prophylactic antibiotics) and B (those who received antibiotics). Results: A total of 200 patients were included with Group A and B included 100 and 100 patients, respectively, with similar baseline demographic characteristics and preoperative indications for cholecystectomy. Surgical site infection occurred in 7 patients in group A and 2 patients in group B (p=0.048) respectively. All Surgical site infections were superficial and responded to conservative management only. None of the infected patients required intravenous therapy or hospitalization. Mean duration of hospital stay in patients not having received prophylactic antibiotics (Group A) approached significance (p=0.07) though the range (in days) was the same in both the groups. Conclusion: Prophylactic antibiotics play an important role in the prevention of SSI in patients at high risk, undergoing laparoscopic cholecystectomy.

10. A Case Control Study to Evaluate Iron Deficiency Anemia as a Risk Factor for the First Episode of Febrile Seizure
Ashish Kumar Basant, Ankur Gautam
Abstract
Aim: Iron deficiency anemia as a risk factor for the first episode of febrile seizure. Methods: This prospective observational study was carried out in the Department of Pediatrics, Rama Medical College and Hospital, Hapur, India for 4 months. Cases (n=80) were patients with typical febrile convulsions between 1 year to 5 years (AAP clinical practice guidelines). A control group (n=80) was selected from age and sexmatched children admitted with febrile illness but without a seizure. Hematological investigations include Haemoglobin, MCV, MCH, RDW, Serum Ferritin, Serum Iron, TIBC and Peripheral blood smear. Results: 87.5% (n=70) children had Hb <11 gm/dl from the case group as compared to 26.25% (n=21) in control group with significant p-value (p <0.01). The proportion of cases with anemia was significantly higher as compared to that of controls (p=0.019). Mean hemoglobin level and MCV in cases were significantly lower as compared to that in controls (p <0.04). RDW value is significantly higher in cases as compared to control (p <0.04). No significant difference between the two groups was observed with respect to mean MCH levels (p>0.04). Serum ferritin and serum iron levels in cases were significantly lower as compared to that in controls (p <0.01). TIBC value is significantly higher in cases as compared to control (p <0.01). Conclusion: The findings suggest that a considerable percentage of children having febrile seizures suffer from iron-deficiency anemia and low serum iron. This means the low serum iron and the presence of anemia can serve as a reinforcing factor for febrile seizures in children.

11. A Prospective Comparative Assessment of Functional Outcome of Primary Total Knee Replacement in Severe Flexion Deformity and without Flexion Deformity
Amit Kumar, Neha Kumari, Alok Kumar
Abstract
Aim: To know the functional outcome of Primary TKR in Severe fixed flexion deformity of knee compared with TKR in knees without fixed flexion deformity (FFD). Methodology: This is a prospective comparative study of the patients with and without severe flexion deformity of knees underwent primary TKR. Total of 100 knees were taken for the study with 52 with FFD of more than 30 degree and 48 were without FFD which were kept as a control. This study includes both inflammatory and non-inflammatory arthritis. We recorded the preoperative ROM, KSS-Pain and functional score of all patients; all patients were evaluated with radiographs of knee AP/lateral and whole leg (if patients were able to stand). Clinical measurement of FFD was done with goniometer one limb of goniometer along the long axis of tibia and another limb along long axis of femur directed towards greater trochanter. All patients were started on preoperative physiotherapy for at least of 4 weeks (average 6 weeks), all the cases were operated by single surgeon with MBK (Mobile bearing knee) or FBK (Fixed bearing knee) and data was recorded at follow up at 6 weeks, 12 weeks, 6 months and then yearly. At every follow up, patient’s KSS (Pain and functional score) were recorded. Results: In 87 patients, there were 26 bilateral cases and 74 unilateral cases with a total of 100 knees. 66 knees were inflammatory arthritis and 34 with non-inflammatory arthritis. There were 40 females and 47 male patients. Average age of the patients was 59.6 years (28-75 years). Average follow up was 1.5 years (1-3 years). In Primary TKR in FFD – Average FFD was 44 degree, Pre-operative average KSS-pain score was 27.5 and functional score was 15, post operatively KSS pain score was 82.7 and function score was 79.1. In Primary TKR in no FFD – Pre-operative average KSS-pain score was 31 and functional score was 24, post operatively KSS pain score was 85.3 and function score was 80.2. Conclusion: There was no significant difference in postoperative KSS- pain and functional score, in patients with no FFD was comparable with patients with FFD. TKA is successful in correcting flexion deformity, although the amount of correction obtained depended on the degree of preoperative flexion deformity.

12. A Case Control Assessment of Lipid Profiles Mainly Triglycerides in Diabetic Patients in Bihar Region
Chandra Shekhar Das, Rajeshwer Kumar Ranjan, Chirag Agrawal
Abstract
Background: Dyslipidemia is one of the common disorders which is seen in most of the diabetes patients, which causes cardiovascular disorders. Objective: To detect the lipid abnormality in diabetic patients. Methods: The present study was planned in Department of General Medicine, Nalanda Medical College & Hospital, Patna over a period of 5 months. For the present study total 100 patients were selected and a total of 50 patients were enrolled in the group A as diabetic group and remaining 50 patients were enrolled in group B as normal patients. Results: The biochemical parameters like Fating glucose level, Glycated haemoglobin (HbA1c), Total cholesterol, Triglycerides, High Density Lipid, and Low-Density Lipid were estimated. Conclusion: Diabetes has now become a global endemic in both developing and developed countries. Hence it is the need of the hour for early detection and prevention of this non-communicable disease.

13. Observational Study to Assess the Sleep Quality Among Residents, Interns, Staff Nurses and Medical Students Using Pittsburgh Sleep Quality Index Scale Questionnaire (PQSI Score)
Shravan Kumar, Suhail Ahmed Azmi, Rakesh Kumar Gaur, Deoshree Akhouri
Abstract
Aim: Study of sleep quality among residents, interns, staff nurses and medical students. Material and Methods: Total 240 samples were collected from study population, among them 60 Medical students, 60 Residents, 60 Interns and 60 Staff nurses. Confidentiality of privacy was assured to all participants, and verbal consent was taken from each participate. Pittsburgh Sleep Quality Index Scale Questionnaire and Questionnaire of Demographic information and other study variable like shift work or duty detail, habits of alcohol, coffee or caffeinated drink intake, Cigarette smoking, mobile use at the time of going for sleep. Results: In this study mean (standard deviation) age for medical students were 22.3(1.01), Interns were 24(1.60), Staff nurses were 24.32(1.60), residents 27.4(0.98). Among study population,61.67% female and 38.33%male in medical students, 50% male and same male in Interns,63.33% male and 36.67%female in Staff nurses,60%male and 40%female in Residents. There were 71.66% Staff nurses had rotation shift work or duty, 61.66%Interns and 31.67% Residents had rotation shift duty. Poor sleep quality was founded highest among medical students with the global mean (standard deviation) PQSI score 6.6(3.68) than Residents with mean global PQSI score 5.97(3.28), and Staff nurses with mean global PQSI score 5.13(2.33). Interns were found to be a having good sleep quality with mean global PQSI score 3.85(2.9). There was significant sleep quality score among them (p<0.002). There were significant association between global poor sleep quality score and Daytime dysfunction among medical students, Residents, Staff nurses (p<0.00002) (table 3) In component of Daytime dysfunction score, there were daytime dysfunction were found higher 68.33% in medical student followed by 65% in Staff nurses, 60% in Residents and 30% in Interns (p=0.003). Conclusion:Poor sleep quality was founded in medical students, Residents and Staff nurses. Poor Sleep quality was high among medical students compare to Residents and Staff nurses, Interns. Poor sleep quality association with daytime dysfunction was found among medical students, Residents, Staff nurses.

14. Prevalence of Anemia in Children Between 2 to 10 Years of Age: An Observational Study
Vijay Kumar Gupta, Amit Patidar, Neeta Singh, Yusuf Ahmed
Abstract
Introduction: Anaemia is the most common hematological disease of the pediatric age group. Highest prevalence of anaemia is seen in childrens of developing countries. The present study was conducted in Shrimant Rajmata Vijyaraje Scindia Medical College Shivpuri, Madhya Pradesh to identify prevalence of anemia in children between 2 to 10 years of age. Material and methods: This is a observational study conducted in SRVS , Medical college and associated District Hospital from January 2021 to June 2021 and includes 500 children coming to OPD and admitted in IPD . Complete blood count was obtained by taking 5ml of blood using fully automated MINDRAY Hemat analyser-BC5800. Peripheral blood smear study was performed on all the children. Anemia was diagnosed according to the World Health Organization (WHO) standard for the given age. The data was analyzed and interpreted using descriptive and inferential statistics. Results  (47%) were male and 265 (53%) were female. A total of 410 (82%) children were anemic and mild, moderate, and severe Anemia was found in 60.97 %, 25.60 %, and 13.41%, respectively.Both mild and moderate Anemia was more prevalent in girls (54.33% and 27.92%) compared to boys (45.10% and 13.19). Conclusion: Anaemia is still a major health problem in children between 2 to 10 years. Nutritional deficiency, particularly, iron deficiency is the leading cause of anemia. This can be primarily prevented by proper nutritional habits and adequate treatment.

15. Prospective Assessment of the Clinical and Radiological Parameters for Predicting the Difficult LC and its Conversion
Ajay Kumar, Ashutosh Kumar Singh, Anupama Kumari
Abstract
Objectives: To assess the clinical and radiological parameters for predicting the difficult LC and its conversion. Materials and Methods: The present prospective study was performed on 100 patients of gallstone disease undergoing LC in the Department of Surgery at Nalanda Medical College and Hospital, Patna, Bihar, India over a period of 10 months.  The statistical analysis was done to investigate a significant association between the study variables (pre-operative clinical and sonological findings) and per-operative difficulty in the surgery (evaluated as stated above), using Chi-square test and Student t-test. P < 0.05 was considered to be statistically significant (confidence interval = 95%). Results: Mean age and BMI of the study cohort were 35.1 ± 14.2 years and 26.5 ± 3.06 kg/m2, respectively. There were 15 males and 85 females. Out of 100 patients, 30 had a difficult LC. Therefore, an incidence rate of 30% for difficulty during surgeries was encountered in the present study. Of the 30 difficult LC, 15 patients had the procedure converted to open cholecystectomy, and hence, conversion rate was 13%. Conclusion: BMI, history of previous abdominal surgery, tenderness in the right hypochondrium, and thickening of the GB are the significant predictive factors for difficult LC, whereas conversion to OP was high in patients with thickening of GB and GB contracted.

16. A Case Control Study to Explore the Relationship Between Vit-D and Cellular Senescence Measured Using the Enzyme Telomerase in pre-HTN
Anant Kumar, Rajiva Kumar Singh, Priyanka
Abstract
Aim: The aim of the study was to explore the relationship between Vit-D and cellular senescence measured using the enzyme telomerase in pre-HTN. Materials and Methods: This investigation was carried out in 50 pre-hypertensives and equal number of age- and gender-matched controls. Cellular senescence was measured by increased levels of telomerase and Vit-D was assessed with using commercially available ELISA assay kits. Results: Weight and BMI, Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP), rate pressure product ( RPP) and telomerase levels were high and vi-D levels were low in pre-HTN group. Low levels of Vit-D were negatively correlated with telomerase, HR, SBP, and PP. Conclusion: The lower Vit-D levels in pre-HTN could lead to derangements in cardiovascular homeostatic mechanism and enhance the speed of cellular senescence measured by telomerase.

17. Prospective Observational Evaluation of the Serum Levels of Zinc, Copper and Magnesium in Polycystic Ovarian Syndrome
Anumeha Anand
Abstract
Aim: Evaluation of serum levels of zinc, copper and magnesium in polycystic ovarian syndrome. Material and methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for 11 months. A total of 200 patients were included in the study and they were further divided into two groups i.e.100 cases and 100 healthy control of age group (15-36 years) from same socioeconomic status. Results: Serum zinc levels in PCOS women and control group were 167.31± 6.8 mcg/dl and 156.48 ±1.6 mcg/dl respectively and the difference was significant. It was found that except for the age category of 30- 35 years, all other age categories (15- 30 years) had significantly higher levels of serum zinc concentration among study group as compared to controls. Mean serum copper levels in study group was 201±37.66 mcg/dl and in control group was 231.59± 51.88 mcg/dl (p< 0.01). Serum copper levels were found to be significantly lower in the patients with younger age categories i.e. 15-20 years and 20-25 years (p= 0.87 and 0.356). Present study depicted significantly higher serum magnesium levels in study group (2.16 ± 0.13meq/l) as compared to the control group (1.94 ±0.08meq/l). Conclusion: Serum zinc and magnesium levels were found significantly higher among study group (women with PCOS) than control group in the present study. Higher serum zinc concentrations have been related to increased oxidative stress in PCOS women. Serum copper levels were found to be significantly lower in study group as compared to control group, though they were above the normal range in both the groups.

18. A Prospective Study of Clinicopathological Evaluation of benign Breast Diseases in Women in a Tertiary Care Hospital
Ashutosh Kumar Singh, Ajay Kumar, Anupama Kumari
Abstract
Aim: Aim of this study was to evaluate the clinicopathological profile of benign breast diseases in women in a tertiary care hospital in bihar region. Methods: This prospective study conducted in the Department of surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 24 months.  Patients presented with different breast related problems like lump in breast, nipple discharge, associated fever and mastalgia were admitted in surgical ward for evaluation. Results: In the present study, 100 cases were examined and analysed. Fibroadenoma formed the most common benign breast disease accounting for 40 cases (40%), followed by fibroadenosis in 23 cases (23%). Benign breast disease was commonly seen in the age group of 20-30years constituting 45% of all patients followed by 28% cases in age group of 30-40years. Among all the benign breast diseases, left sided breast involvement was more common onstituting 48 (48%) cases while right breast involvement was less common constituting 41 (41 %) patients. Bilateral involvement was seen in only 11(11%) patients. Considering the pattern of benign breast diseases, fibroadenoma was the most common lesion constituting 40 (40%) cases followed by fibroadenosis (fibrocystic disease) constituting 23 (23%) cases, fibroadenoma with fibrocystic changes constituting 15(15%) and breast abscess constituting 6(6%) cases. Other benign breast diseases include phylloides tumour 4 (4%), lipomas 2(2%) and 2(2%)galactocele. Patients with breast lump 81%, patients with breast pain 37% and patients with nipple discharge 3%. Conclusion: In short, a comprehensive clinical history and a triple assessment would suffice the tool for effective diagnosis of benign breast diseases within 72 hrs. With correct radiological and cytological assessment unnecessary morbidity associated with surgeries can be avoided in some patients.

19. A Retrospective Epidemiological Assessment of Feto-maternal Outcomes in Cases of Imminent Eclampsia and Eclampsia
Varsha Sinha, Swetabh Verma
Abstract
Aim: To Study Epidemiology and fetomaternal outcomes in cases of imminent eclampsia and eclampsia- retrospective study. Materials and Methods: Perinatal mortality rate was defined as the number of all fetal (after 28 weeks of gestation) and neonatal (during the first 28 days after birth) deaths/1,000 births. Data was expressed as mean, percentages, proportions. Chi-square test was used to find association between various categorical variables. p-value <0.05 was considered to be statistically significant. Results: There were 120 mild and severe pre-eclampsia cases and 80 imminent eclampsia and eclampsia cases. Most of the subjects were in age group of 20-25 years that is 77(38.5%) and 35.5% were either <20 years or >35 years in age. Among the preeclampsia group of patients, 54% delivered vaginally and 44% underwent Caesarean section. Among the imminent eclampsia/ eclampsia group of patients, 59% patients underwent Caesarean section, 37.5% delivered vaginally, 3.5% underwent assisted vaginal delivery and 0.50% required hysterotomy. This finding is significant with chi square = 36.4548 and P- value <.00001. That majority of patients were taken up for Caesarean section in view of previous cesarean delivery (33.5%) and Unfavourable cervix (32%). Other indications for Caesarean section being failed induction (15%), Doppler abnormalities (10%), Cephalo Pelvic Disproportion (CPD) (4%) and abruptio placentae (3%). Maternal complications were seen in 42 (21%) cases. Maternal complications seen were HELLP syndrome (9%), PPH (7%), Abruptio placentae (6%), Pulmonary edema (2%) and HELLP syndrome with AKI in 7% cases, renal failure in 3% cases, DIC in 1.5% cases, ARDS, AKI with DIC, HELLP syndrome with IVH in 1% cases each. Conclusion: Pre-eclampsia is one of the medical complications which occur during pregnancy and is responsible for significant feto-maternal morbidity and mortality. As pre-eclampsia cannot be fully prevented, diagnosis of high-risk patients and timely treatment can help prevent complications.

20. To Determine the Clinico-Demographic Profile and Morbidity Pattern in Menopausal Women: Cross Sectional Study
Rashmi Raginee
Abstract
Aim: To determine the clinico-demographic profile and morbidity pattern in menopausal women. Materials & Methods: It is a cross sectional study carried out in the Department of Obstetrics and Gynaecology, Mahila chikitsalaya, Sawai Man Singh Medical College, Jaipur, Rajasthan, India. over a period of one year.Patients will be examined for their symptoms and gynaecological examinations. On a decided proforma the age, socio economic demographic data, symptoms will be noted. General, systemic and obstetric examination findings will be noted. Results: About 50% of women have menstrual disturbances of varying degrees for about 6 months to 2 years in premenopausal period before attaining menopause. Conclusion: Health promotion must address obesity, hypertension and smoking to reduce the negative effects of menopause.

21. Correlation with Microalbumin and Glycosylated Haemoglobin in Type 2 Diabetes Mellitus
Ashok Singh, Bachchoo Singh
Abstract
Introduction: One of the consequences of type 2 diabetes mellitus that can progress to end-stage renal disease is nephropathy. Microalbuminuria that persists is the strongest indicator of a high risk of diabetic nephropathy. The relationship between HbA 1c and microalbuminuria and diabetes duration is unclear. Material method: The current study is a prospective study conducted at this medical college and hospital’s Department of Biochemistry and Department of Medicine. In the present study, the total number of subjects included was 150 having age group between 31-70. The subjects were grouped into following two types Control Group 1: 75 Healthy subject and Study Group 2: 75 Type 2 diabetes mellitus. Written consent form was obtained from every subject involved in this study. Institutional Ethical clearance was obtained for the study. Result: HbA1c, microalbumin and serum creatinine levels were significantly increased in study group as compared to control group. Significant positive correlation of microalbumin with HbA1c in Diabetic patients (P < 0.0001) and significant positive correlation of serum creatinine with HbA1c (P < 0.0001). Conclusion:  The Present study concluded that estimation of microalbumin, serum creatinine and HbA1c is required for early detection and treatment of diabetic nephropathy. All diabetic patients should be regularly monitored their glycemic status and renal profile to prevent complications associated with diabetes mellitus.

22. A Polarised Microscopy Investigation using Two Unique Stains for Collagen Fibres in Oral Submucous Fibrosis
Neha Mittal, Anshul Kumar
Abstract
Introduction: According to research, the main etiological cause of oral submucous fibrosis is areca nut. Epidemiology studies currently being conducted (OSF). Submucosal fibrosis, which affects the majority of the oral cavity, pharynx, and upper third of the oesophagus, is the disease’s hallmark. Detecting collagen fibres in tissues has traditionally relied on stains like Van Gieson and various forms of trichromes, which rely on differential binding by tissue. These stains can distinguish between thick and thin fibres under polarisation microscopy and can be utilised in both light and polarising microscopy. Because of their unique reactivity to most collagen subtypes, picrosirius red dyes are also commonly utilised components. Material and Methods: The trial group consisted of 100 patients who had been clinically diagnosed with OSMF and agreed to get a biopsy. For patients who were clinically diagnosed with OSMF, a complete case history was taken. Patients were assessed, and relevant information was recorded into Performa, a clinical data collection system. The severity of fibrosis was clinically staged using Lai’s categorization, in which the OSMF population was classified into four groups depending on the interincisal distance. Van Gieson Staining and Picrosiriusred staining technique was carried out. Results: Van Gieson and picrosirius red stains were tested for staining characteristics, overall polarisation colours, and collagen fibre bundle orientation under a polarising microscope. Van Gieson’s polarisation was overall reddish, but picrosirius red had a wide variety of birefringence hues, including greenish yellow, yellowish orange, and reddish orange birefringence. A tendency was discovered when collagen fibre distribution in the lamina propria and submucosa were compared. In the lamina propria, reddish orange birefringence was detected in 39% of instances, increasing to 56% in the submucosa. Yellowish orange birefringence was seen in 49 percent of instances in the lamina propria, but only 39 percent of cases in the submucosa. Similarly, greenish yellow birefringence was observed in 14% of instances in the lamina propria, but only 7% in the submucosa. As a result, it’s possible that yellowish orange and greenish yellow fibres predominated in the lamina propria, whilst reddish orange fibres predominated in the submucosa. In 90 percent of the Van Gieson stained sections, collagen fibre bundles were arranged parallel to the epithelium. 21 (21%) of the 100 cases had a parallel arrangement of collagen fibre bundles in relation to the epithelium, 75 (75%) had a parallel arrangement with presence of greenish yellow perpendicular fibres, 4 (4%) had no parallel arrangement, with presence of greenish yellow perpendicular fibres. Conclusion: Collagen fibres were thicker and more firmly packed in the submucosa than in the lamina propria, indicating that the fibrosis process began there. Because of its stability and ability to stain both thick and thin collagen fibres, Picrosirius red stain outperformed Van Gieson. When stained with Van Gieson, most of the cases showed a parallel arrangement of collagen fibres, but picrosirius red stained sections revealed a majority of parallel type I collagen fibres with perpendicular type III fibres that increased with histopathological grade, suggesting that type III fibres play a role in increased fibrosis.

23. A Research of Diagnostic Evaluation of Inherited Malformations of Urinary Tract: A Cross Sectional Research at Tertiary Health Care Center
Amarjeet Singh,Vishvendra Singh
Abstract
Background: Pre-natal determination of inherited disease gives information for making pregnancy-related decisions and providing appropriate management to parents, with the goal of improving perinatal and long-term outcomes. Renal abnormalities are frequently detected during pregnancy, accounting for 20-30% of all detectable defects. Aims & objectives: The goal of this research was to look at methods of diagnosing inherited urinary system abnormalities at a tertiary health care facility. Material and Methods: A prospective observational research was conducted in neonates who were delivered at our institute or referred within 24 hours of birth, completed 6 months of follow-up, or died within 6 months of birth and whose antenatal anomaly scans revealed the presence of CAKUT (Inherited anomalies of the renal and urinary tract). Results: 136 instances were studied over the course of the research period. Initially, all abnormalities were discovered during a USG test (86.76 percent antenatally and 13.24 percent post-natally). Only a few patients had further radiological tests, such as an MRI (antenatally 7.35 percent and post-natally 5.88 percent) and a post-natal CT scan (also 5.88 percent) (as antenatally CT is relatively contraindicated). The commonest inherited malformation of the urinary tract was hydronephrosis (30.88%), followed by polycystic renal disease (20.59%), pelviureteric junction obstruction (19.12%), posterior urethral valve (17.65%), ambiguous genitalia (4.41%), epispadius (2.94%), duplicated collecting system (2.94%), hypospadias (1.47%), and bladder exstrophy (1.47%). (1.47 percent ). Conclusion: CAKUT discovered hydronephrosis most frequently both antenatally and post-natally. Antenatal imaging detected renal collecting system defects better than other renal anomalies.

24. Study of Serum Magnesium Level in Newborn with Indirect Hyperbilirubinemia Before and after Phototherapy
Vishvendra Singh, Pankaj Kumar Jain
Abstract
Introduction: Newborn jaundice, also known as hyperbilirubinemia, is a common occurrence in neonatal medicine. Severe sickness can potentially result in kernicterus and neurological damage. The most important N-methyl-D-aspartate receptor antagonist is magnesium ion. Phototherapy is the most popular treatment for jaundice, although the effect of phototherapy on serum magnesium has received less study. Material and method: This prospective study was conducted in the paediatric department of this hospital from March 2019 to March 2020. This study comprised healthy term neonates weighing more than 2400 g who were hospitalised to the pedatric department with a birth age of 3-13 days due to hyperbilirubinemia. All parents or guardians of the babies were thoroughly told about the study before it began, and we ended up with a sample size of 140 newborns. Result: Serum bilirubin magnesium and ionised magnesium concentrations in the examined newborns before and after phototheraphy showed a statistically significant decrease in bilirubin levels between groups before and after phototheraphy. Conclusion: Extracellular Mg movement, which occurs as a result of generalised cellular injury in neurons and erythrocytes, may have a neuroprotective and cardioprotective effect by compensating for the effects of hyperbilirubinemic state, which increases the risk of bilirubin toxicity to grey matter of the brain or cardiocyte. Phototherapy decreases bilirubin proportionately to IMg, implying that bilirubin and Mg levels in the blood have a positive relationship. To assess the effectiveness of magnesium therapy in the treatment of baby hyperbilirubinemia, more research is needed.

25. A Research of Gestation Outcomes with Respect to BMI in the First Trimester on Females from Central India
Dhan Singh Sinsinwar, Mahesh Chandra Agrawal
Abstract
Background: The BMI (body mass index) in early gestation has a major impression on the gestation outcome. Lesser and raised BMI females are more likely to have an undesirable gestation outcome. According to the American College of Obstetricians and Gynecologists, all expectant females should have their BMI measured during their first appointment (ACOG). Aim: The goal of this research was to see how females’s BMI in the first trimester affected their maternal and fetal outcomes. Materials and Methods: A prospective observational research was done in the Department of Obstetrics and Gynecology over a two-year period. A total of 300 expectant females in their first trimesters were screened for various prenatal and postnatal disorders based on inclusion and exclusion criteria. Results: In under-weight subjects, anemia and intra-uterine growth restriction (IUGR) were found to be more prevalent. Postpartum hemorrhage (PIH), gestational diabetes, and macrosomia were all more common in subjects who were over-weight or obese. Subjects with a raiseder BMI were more likely to have a lesserer (uterine) segment caesarean section (LSCS), instrumental delivery, wound infection, and PPH. SGA babies were more common in lesser-BMI individuals, while LGA babies were more common in raised-BMI subjects. The neonatal critical care unit was more likely to admit subjects with a lesser or raised BMI (NICU). Conclusion: Subjects with BMIs on either side experienced significantly more gestation difficulties, as well as severe gestation and newborn issues (under-weight and obese). As a result, it’s reasonable to conclude that a patient’s BMI has a direct bearing on the gestation’s prognosis.

26. Study of Antioxidant Activity Marker and Oxidative Stress Marker in Myocardial Infarction Patients with Admitted to Intensive Care Unit
Laxman Prasad Gupta, Ashok Singh
Abstract
Introduction: The death or necrosis of myocardial cells characterizes acute myocardial infarction (MI). Myocardial ischemia or acute coronary syndromes are diagnosed toward the end of the spectrum. MI can strike at any age, although it is more common as people get older. The actual incidence of atherosclerosis is determined by preexisting risk factors. Material Method:  The research was conducted department of medicine and Biochemistry.  Carefully designed to provide a random sampling of patient samples that accurately reflect the current state of MI. Patients admitted to this hospital provided samples for this study. Result: Mean level of MDA, peroxynitrite and Vitamin C in study group and control group .a significant higher (0.512±0.025) in serum MDA concentration was observed in MI patient as compared to the control group (0.12±0.4) with p < 0.001. The study also shows a significant higher (0.19±0.018) in the concentration of peroxynitrite in serum of MI patient as compared to control group (0.07±0.001) with P < 0.001.  The result also shows a significant lower (14.2±1.3) in serum of patient with control group (31.09±1.12) with P < 0.001. Conclusion: The importance of assessing serum MDA, peroxynitrite, and vitamin C levels as a diagnostic and predictive tool for myocardial infraction patients is reflected by the imbalance of MDA, peroxynitrite, and vitamin C activity in myocardial infarction patients.

27. Study of Pancreatic Enzyme in Type 2 Diabetes Mellitus Patient
Bachchoo Singh, Laxman Prasad Gupta
Abstract
Introduction: Type 1 and type 2 diabetes are frequently associated by exocrine pancreatic insufficiency, which is usually moderate. Despite its great prevalence, little is known about the clinical implications of exocrine pancreatic insufficiency and how best to treat it (nutritionally). Even little is known about whether and to what extent exocrine pancreatic insufficiency impacts diabetes glycemic management. This article attempts to summarize current clinical information on screening, diagnosis, and treatment of exocrine pancreatic insufficiency in diabetes, as well as provide an overview of the pathophysiology of exocrine pancreatic insufficiency. Result: mean plasma fasting blood sugar level higher in study group (190.8±65.0) as compared to control group (80.4±11.70). Serum amylase level lower in study group (27.90±2.39) as compared to control group (47.39±22.90). Serum lipase level lower in study group (33.01±2.80) as compared to control group (68.90±32.95). Conclusion: According to our findings, decreased serum amylase and serum lipase concentrations in type 2 diabetes mellitus might be connected to a disruption of the exocrine-endocrine axis, resulting in altered exocrine pancreatic function.

28. A Retrospective Study of Carcinoma Esophagus in Western Rajasthan
Rameshwar Lal, Indra Singh Choudhary, Suresh Rulaniya
Abstract
Background: Esophageal cancer is a deadly malignancy with a very low survival. Esophageal cancer is the 6th most common cancer and cause of cancer-related deaths in India. Objectives: To evaluate the incidence, clinical profile and varies treatment modality in esophageal cancer in the western Rajasthan population. Materials and Methods: This retrospective analytic study was conducted in Department of General Surgery at M. G. Hospital attached to Dr S. N. Medical College, Jodhpur.  A total of 32 patients with Esophageal Cancer were registered in the 8 year duration. The socio-demographic parameters including age, gender, locality, socioeconomic status, religion, education, occupation, and the addiction patterns of the patients were studied. All the patients were treated with the standard protocol. Results: Out of 35 patients, 43.75 % were males and 56.25 % female. Male: female ratio in study was (0.77:1). The age were range from 21-73 years, the incidence was highest in 5th decade followed by 6th and 7th decade in the study patients. The most common symptom was dysphagia. In management Surgical resection (35.48%), Surgical resection + chemo / RT or both (16.12%), palliative resection and chemoradiotherapy (3.22%) , Feeding jejunostomy ± chemo / RT or both (25.90%) was done. longest survival period was 18 month as reported in our study. Conclusion: Esophageal carcinoma is important cancers prevalent in western Rajasthan, with peak incidence was in 5th decade of life. Multimodality treatment is advocate in young patients with advanced disease. Surgical resection was the mainstay of treatment in absence of systemic metastasis. Terminally ill patients were treated by palliative measures like feeding jejunostomy / stenting.