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


1. A Study of Correlation Between Serum Triglyceride Levels and Severity of Stroke
Dhanju AS, Kathait A, Salwan S, Chhabra A
Introduction: Stroke is one of the leading causes of mortality and morbidity. Dyslipidemia in the form of triglyceridemia and hypercholesterolemia is an increasingly recognised condition in vascular diseases. This study aims to find the correlation of triglycerides with stroke severity. Aims and Objectives: The aim of the study was to determine correlation between serum triglyceride (TG) levels and severity of stroke. Materials and Method: This study was conducted at Government Medical College Amritsar in 50 stroke cases to correlate the triglyceride levels, in these patients, with stroke severity on the basis of Scandinavian Stroke Scale. Results: It was concluded from the study that mean serum triglyceride levels were significantly lower in severe stroke patients [109.35± 36.43mg/dl] than mild to moderate stroke patients [154± 62.33mg/dl]. Conclusion: It was concluded that low levels of triglyceride adversely affected stroke severity in our subset of population. Global studies may be required to assess variations across populations.

2. Prospective Assessment of the Clinical Correlation of Glaucoma with Systemic Hypertension and its Effect on Visual Morbidity
Nandani Priyadarshini, Vikash Vaibhav, Uday Narayan Singh
Aim: To evaluate the association between hypertension and occurrence of glaucoma. Methodology: A prospective study was conducted in the Department of Ophthalmology, NMCH, Patna, Bihar, India from November 2017 to October 2018.  including 72 patients between the age groups of 30 to 70 years diagnosed with hypertension. Patients with other systemic diseases or vascular pathologies were excluded from the study. All the patients were followed up for atleast 6 months and the need for regular review visits was explained to them. During the first visit and each follow up opinions regarding the progress of hypertension was obtained from departments of cardiology and internal medicine. The oral hypertensive medication taken by patients were categorized into 5 groups as calcium channel blockers (CCB), diuretics, angiotensin converting enzyme inhibitors (ACE), angiotensin receptor blockers and beta blockers. A detailed history of age, sex, duration of hypertension, history of other co-morbidities and treatment were collected. The participants then underwent a detailed ophthalmological evaluation. IOP measurement was done by applanation tonometry with Goldman Applanation Tonometer. The same procedure was repeated in the other eye. Phasing technique of repeating recordings was done and the average IOP was used in the study. Results: Among the 72 hypertension patients involved in the study, 40 patients (55.5%) were found to have glaucoma. 39 patients (54.2%) were female, and 33 patients (45.8%) were male. Age group affected was 9.7% between 30-40 years, 15.3% between 41 to 50 years, 23.6% between 51 to 60 years and 51.4% between 61 to 70 years. 51.7% patients taking CCB, 58.8% taking ACE inhibitors, 54.6% taking ARB, 55.6% taking beta blockers, and 66.7% taking diuretics had reduced IOP. The range of IOP in the treated population was between 10-16mmHg and this difference in those on hypertension medications was statistically significant. Conclusion: It can be concluded from this study that there is a correlation between higher systemic blood pressure and higher intraocular pressure, and this also produces effects to be regarded as risk factors for glaucoma. Patients taking oral hypertensive drugs also had reduced intraocular pressure and prevent further progression of glaucoma.

3. Ergonomics in Laparoscopic Surgery
MP Singh, Rahul Agarwal, Pradeep Kumar Saxena, Rajesh Lonare
Objective: Ergonomics is essential in today’s practice and especially in laparoscopic surgeries due to concerns with hand movements, loss of proper view, moniter placement and longer duration. This paper aims to audit the ergonomic practice amongst laparascopic surgeons in Bhopal, India. Methods: To audit the ergonomic practice amongst laparascopic surgeons in Bhopal, India. In this audit, personal assessments of 50 surgeons were done while they were performing surgery based on accepted guidelines, after taking their consent. The assessment data included demographics, surgeon’s posture, moniter position and operating room configurations. Results: Majority (more than 55%) of surgeons followed proper ergonomics when keeping themselves in line with target organ and monitor, maintaining proper angles at the elbow joint and forearm. More than 60% of operating rooms had appropriately functioning tables and instruments. Less than 60% of surgeons maintained proper head and neck posture. Monitor height was more than the operating MIS surgeon’s height in 33% of operating rooms. Conclusion: Although many surgeons showed good ergonomic practice overall, it was found that there were many areas for improvement with respect to the ideal posture.

4. Irreducibility in Trochanteric Hip Fractures: An Observational Study
Gaurav Agarwal, Raghvendra Choubey, Roopa Agrawal, Rajesh Kumar Jain
Aim: To understand X Ray features and Surgical Management of trochanteric hip fractures not reducible by the standard closed reduction methods. Methods: During a 3-year period (from October 2018 until October 2021), 140 patients with trochanteric hip fractures were treated at our Institute. A retrospective observational review study was undertaken to understand which of these fractures were not reducible by the standard closed reduction methods and required open reduction. These fractures were assessed for X Ray features suggesting irreducibility, intra operative surgical findings & reduction methods, and complications, if any. Results: Sixteen patients had fractures not reducible by standard closed reduction methods and underwent open reduction. These fractures could be grouped into 3 types. One, in which proximal fragment was found locked below the shaft (3 cases), second where the posteromedial fragment was stuck at the fracture site (4 cases) and third where the proximal fracture fragment was flexed due to lesser trochanter (9 cases). Conclusion: Trochanteric hip fractures, which are not reduced by the standard closed reduction methods can be understood by special X Ray features. These special X Ray features can warn the Orthopaedician about any possible difficulty in achieving closed reduction. Hence, they can be aware of any need of open reduction in such patients beforehand thereby helping in planning the perioperative course better.

5. To Determine The Prevalence And Etiological Profile Of Dermatophytosis: An Observational Study
Nandlal Kumar, Animesh Kumar, Rajeev Ranjan, Chandra Shekhar Jha, Nusrat Perween
Aim: To understand X Ray features and Surgical Management of trochanteric hip fractures not reducible by the standard closed reduction methods. Methods: During a 3-year period (from October 2018 until October 2021), 140 patients with trochanteric hip fractures were treated at our Institute. A retrospective observational review study was undertaken to understand which of these fractures were not reducible by the standard closed reduction methods and required open reduction. These fractures were assessed for X Ray features suggesting irreducibility, intra operative surgical findings & reduction methods, and complications, if any. Results: Sixteen patients had fractures not reducible by standard closed reduction methods and underwent open reduction. These fractures could be grouped into 3 types. One, in which proximal fragment was found locked below the shaft (3 cases), second where the posteromedial fragment was stuck at the fracture site (4 cases) and third where the proximal fracture fragment was flexed due to lesser trochanter (9 cases). Conclusion: Trochanteric hip fractures, which are not reduced by the standard closed reduction methods can be understood by special X Ray features. These special X Ray features can warn the Orthopaedician about any possible difficulty in achieving closed reduction. Hence, they can be aware of any need of open reduction in such patients beforehand thereby helping in planning the perioperative course better.

6. Prospective Hospital-Based Study To Assess The Radiological Union And The Clinical Outcomes Associated With Dual Plate Osteosynthesis In Type V & VI Proximal Tibial Fracture
Amit Kumar, Neha Kumari, Alok Kumar
Aim: To assess the radiological union and the clinical outcomes associated with dual plate osteosynthesis in type V & VI Proximal tibial fracture. Methodology: The present study was conducted in the department of Orthopedics Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 15 months. Total 50 patients who presented with Schatzker types V and VI tibial plateau fractures and who had been treated with minimally invasive dual locking and buttress proximal Tibial plate were included in the study. Following mention inclusion and exclusion criteria were included in study. Preoperative radiographs were reviewed and classified according to Schatzker classification system. All patients had a similar postoperative regimen and were followed up at regular intervals at 6, 8, 12, 24 weeks for at least 6 months. During each follow- up period, radiograph and functional score measure and also maintain the record of any complication during follow up period. Functional evaluation of knee joint was performed at least after 6 months according to Knee Society Scores. Results: Out of 50 patients, 28 (56%) patients were male, while 22 (44%) were female. Age range of patients included was 18 years to 60 years, with mean age 41.33 ± 14.52 years. 36 (72%) fractures were Schatzker type 5 fractures, and 14 (28%) were Schatzker type 6 fractures. 11 (22%) patients had left side fracture while 39 (78%) patients had right side fracture. Out of 50 patients, 27 (54%) achieved excellent knee score (80-100), 16 (32%) achieved good (70-79), 7 (14%) achieved fair (60-69) and no patient had poor (<60) knee score. Complications included 3 patients (6%) with superficial infection which were treated by I.V. antibiotics and surgical wound management and 1 patient (2%) with significant pain. Conclusion: The overall functional and radiological outcomes are excellent to good in most of the cases which indicates that this technique is a good treatment option for type V and VI bicondylar tibial plateau fractures with less complications.

7. A Comparative Study to Explore the Behavior of Platelet Indices in Sepsis and their Clinical Prognostic Value
Chandra Shekhar Das, Rajeshwer Kumar Ranjan, Chirag Agrawal
Background: Sepsis is still one of the main causes of infants and children mortality especially in developing, economically challenged countries with limited resources. This study aims to explore the behavior of platelet indices in sepsis and their clinical prognostic value. Material and Methods: A total of 70 patients diagnosed with Sepsis were included in the study. All of them were thoroughly evaluated in terms of routine and specific biochemical investigations and complete blood count including platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT) and platelet large cell ratio (PLCR). To establish the diagnosis of Sepsis, SIRS (Systemic Inflammatory Response Syndrome) criteria were followed. Results: A total of 70 patients of either sex admitted in Nalanda Medical College & Hospital, Patna. Complete Hemogram of the patients. Mean hemoglobin in the Survivors group and Non survivors’ group was 12.62±1.29 and 9.82±1.28 respectively. Mean hemoglobin and Mean Total Leucocyte count value came out to be statistically significant. Mean platelet counts in the Group I (Survivors group) and Group II (Non survivors’ group) were found to be significant (p <0.01). Mean plateletcrit of both the groups. In group I, it was 276.49±43.90   and in group II, it was 0.16±0.08. On statistical analysis, the difference among both the groups was found to be comparable and thus statistically insignificant (p >0.05). Conclusion: A statistically significant difference was seen between survivors and non-survivors for platelet indices which make the platelet indices easily available, cheap and useful prognostic markers for patients in septic shock.

8. Effect of Amitriptyline and Fluoxetine in Patients Presenting with Mixed Anxiety and Depression: Comparative Study
Chandra Shravan Kumar, Rakesh Kumar Gaur, Suhail Ahmed Azmi, Deoshree Akhouri
Aim: Comparative study of efficacy of amitriptyline and fluoxetine in patients presenting with mixed anxiety and depression. Materials and Methods: This comparative study was carried out in the Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India, for 15 months.  Fifty-eight patients (25 male and 25 female) from 3 sites were enrolled in the study. Ages ranged from 20 to 60 (mean = 41.11 k 9.11) years. Results: 50 patients were taken in the study and were divided into two groups with each group holding 25 patients. Two drugs namely fluoxetine and amitriptyline taken in study to determine their effects on two groups (25 on fluoxetine and 25 on amitriptyline) completed. As noted, fluoxetine was given at a fixed dose of 20 mg/day for the duration of the study. The dose of amitriptyline was gradually increased to 150 mg over the first 2 weeks. By week 6, 12 (55%) of the patients on amitriptyline were taking 200 mg/day and the remainder 150 mg/day. Compliance as reported to the treating physician varied from 85-100% of patients at any one visit. Approximately half of the patients in each treatment group (fluoxetine 16/25, amitriptyline 17/25) were on concomitant non-psychotropic medications at the start of the trial (p>O. 1, chi square test). Both treatments produced a statistically significant reduction in HDRS score from baseline as assessed by the repeated measures analysis of variance (p<O.O001). Conclusion: We concluded that the fluoxetine 20 mg/day is effective in the acute treatment of patients with moderately severe depression. It appears to be well tolerated, with a different side-effect profile from that of amitriptyline.

9. A Prospective Study to Determine Complications Associated with Brachio Cephalic Arterio-Venous Fistula at Medanta- The Medicity, Gurugram, Haryana
Prasad G, Choudhary D, Palsania K
Introduction: The pattern of disease burden in the 21st century has significantly shifted towards chronic kidney disease. The focus in CKD has changed from treating a terminally ill patient, to dealing with a person who has a manageable chronic disease that requires long term care. As for CRF patients, hemodialysis should be repeated three times a week for at least three to four hours per dialysis; thus it is the best method to use arteriovenous fistula (AVF) as a vascular access. Aim: to determine the prevalence of associated complications (Steal,infection, pseudoaneurysm) in BC AVF’s. Methodology: This was a single centre, observational longitudinal study done on 98 patients with Brachio-cephalic arterio-venous fistula (BC-AVF). Procedure was conducted in the department of peripheral vascular and endovascular surgery at Medanta – The Medicity Hospital, Gurgaon, Haryana from October 2015 to April 2017. Results: In our study, 3 patients had complications (2 Pseudoaneurysm and 1steal phenomena).

10. Stapler Hemorrhoidectomy vs. Open Haemorrhoidectomy (Milligan Morgan): Outcome and Postoperative Complications Assessment
Ajay Kumar, Ashutosh Kumar Singh, Anupama Kumari
Aim: The goal of this study was to look into and evaluate the outcomes and post-operative problems in patients with grade III and IV haemorrhoids who underwent Stapler or Milligan Morgan hemorrhoidectomy. Methods: A total of 120 individuals with grade III and IV haemorrhoids, ranging in age from 38 to 50 years, were randomly assigned to one of two groups. There are 60 patients in Group 1 who are getting Stapler hemorrhoidectomy and 60 patients in Group 2 who are undergoing Open hemorrhoidectomy/Milligan Morgan. Patients in both groups were evaluated post-operatively for bleeding, discomfort, recurrence, and long-term consequences in comparison to their pre-operative symptom profiles. Results: Stapler hemorrhoidectomy technique was quicker to perform in comparison with Open hemorrhoidectomy (p value < 0.001). Hospitalization and duration of resumption to daily activity was less in Stapler hemorrhoidectomy group as compared to Open hemorrhoidectomy/Milligan Morgan group (p value < 0.001). Conclusion: Both procedures were efficient for hemorrhoidectomytherapy, however Stapler hemorrhoidectomy had advantages in terms of shorter operative times, less intra- and post-surgical bleeding, and a decreased incidence of various post-operative sequelae.

11. Prospective Comparative Evaluation of Feto-Maternal Outcome in Overweight/Obese and Normal Weight Pregnancy
Anumeha Anand
Aim: Comparative study of feto maternal out come in overweight/obese and normal weight pregnancy. Methods: This prospective comparative study was carried out in the Department  of  Obstetrics and Gynecology, Netaji Subhas Medical College and Hospital, Bihta , Patna, Bihar, India for 13 months.  All primigravidas with singleton pregnancy admitted at ≥37 weeks of gestation with accurate weight and height recorded at 1st booking visit were included and were categorized into two groups. Study group: 100 primigravidas with BMI ≥25. Control group: 100 uncomplicated primigravidas with BMI between 18.5 – 24.99. Results: 28% of women in the study group and only 5% of women in control group were treated for infertility and the difference was statistically significant with a p value = 0.004, the main cause for infertility being polycystic ovarian disease. Hypertensive disorders and diabetes mellitus were the two most common antenatal complications encountered in the study group. 59% of mothers in the study group had their labour induced when compared to only 38% in the control group and this difference was statistically significant with a relative risk of 2.45 and 95% confidence interval 1.5-3.96 and p value = 0.0007. 62% of mothers in the study had Cesarean section when compared to only 10% in the control group with a RR- 5.83, 95% CI 3.86-8.83 and a p value = 0.00007. Mean first stage duration: Mean first stage duration is prolonged significantly in the study group (7.5 hours) when compared to the control group (5.9 hours). The three most common statistically significant indications for Cesarean Section were failed induction, failure to progress and prolonged period of infertility in the study group. Macrosomia and NICU admissions were also found to be statistically significant in the study group. Incidence of prolonged hospital stay was 34% in the study group when compared to only 18% in the control group with a statistically significant p value = 0.001. Conclusion: The dramatic increase in the prevalence of obesity in pregnancy is of significant public health concern. Obesity in pregnancy is associated with increased rate of antepartum, intrapartum, postpartum complications in the mother and adverse outcome in the neonate as well.

12. Prospective Observational Study to Evaluate the Parameters Associated with Severity of Acute Pancreatitis
Ashutosh Kumar Singh, Ajay Kumar, Anupama Kumari
Aim: Assessment of parameters associated with severity of acute pancreatitis. Methods: This prospective study conducted in the Department of surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 1 year Total 80 patients diagnosed as acute pancreatitis on the basis of clinical signs, biochemical markers and radiological signs were included in this study. they were investigated by various blood investigations like haemoglobin, total leukocyte count, differential count, haematocrit, calcium, Blood urea nitrogen (BUN), arterial blood gas analysis, serum electrolytes, Random blood sugar (RBS), liver function tests, Lactate dehydrogenase (LDH), serum amylase, serum lipase, ultrasound abdomen and contrast Computed tomography (CT) for those indicated. The two commonly used scoring systems in our institution were also analysed viz. Ranson’s score and modified Glasgow score. Results: Majority cases were seen in between 40 to 50 years 30(37.5%). In our study the 56 cases were mild acute pancreatitis (70%), 15 cases were moderately severe acute pancreatitis (18.5%) and 9 cases severe acute pancreatitis (11.25%). In our study the majority of cases who presented with acute pancreatitis were of alcohol induced type, 56 (70%). Gall stone pancreatitis accounted for 14 (17.5%) cases. In our study 50 (62.5%) patients had diabetes mellitus, 32 (40%) had hypertension and 40 (50%) had dyslipidemia. Major co-morbidity was diabetes mellitus among the studied population.  In our study the 38 cases were having a Body mass index (BMI) of 18.5 to 24.9 (47.5%) and 8 (10%) were having a BMI of above 30 and 34 (42.5%) had BMI between 18.5 to 19.9. Majority of the cases 56 (70%) who presented were having habit of consuming alcohol. 4 (5%) patients in our study died due to complications of severe acute pancreatitis. The mean BMI in those with mild acute pancreatitis was 25.47±0.21 (Standard error (SE)), moderately severe acute pancreatitis was 29.54±0.62 and severe acute pancreatitis was 29.87±1.67. ANOVA test was done and found significant difference in mean values of BMI across mild, moderate and severe acute pancreatitis with F value of 17.79 and p value of 0.001 (significant). seen in those with hypertension. On analysis hypertension was found to be statistically significant with Pearson Chi- square test value of 9.87, df of 2 and a p value of 0.005. Conclusions: One should not wait for any single scoring system to get scored for effective treatment. A diagnosis of pancreatitis should be made using clinical, laboratory and radiological means and treatment in the form of aggressive crystalloid resuscitation should be started with intensive care monitoring at the earliest.

13. Thyroid Stimulating Hormone As A Biomarker and its Role in Predicting IUGR
Varsha Sinha, Swetabh Verma
Aim: To Study Predictive value of thyroid stimulating hormone as a biomarker in IUGR. Materials and Methods: This observational prospective study was carried out in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. A total of 98 consecutive clinically suspected cases of IUGR with singleton pregnancies at 34-40 weeks of gestation attending the hospital were enrolled in the study after taking an informed consent. The gestational age was determined on the basis of the date of last menstrual period or by first trimester ultrasound if available. Results: The Body Mass Index (BMI) ranged from 15.2 kg/m2 to 26.6 kg/m2 with the average BMI being 20.93 kg/m2 The BMI of <19.6 kg/m2 was observed in 28 underweight antenatal mothers (28%) whereas only ten (10%) of the subjects evaluated was overweight with a BMI of 26.6 kg/m2. The average height of the subjects was 154.72 cm 4.08 SD and the average pre-pregnancy weight as recorded was 48.17kg 5.92 SD. The TSH levels below 0.3 mIU/L was recorded in three antenatal mothers in the age-group of 26-30 years. All three antenatal mothers were from rural background and vegetarian. In these, one was born dead while the other two babies were born alive. The antenatal mother with normal BMI delivered live babies. However, the mode of delivery in the two born alive was LSCS due to fetal distress. Both neonates had a very low birth weight; less than1.5 kgs and required admission to neonatal intensive care unit for 2-5 days. Conclusion: Many studies indicate a possible effect of thyroid dysfunction and IUGR. However, the results between studies are variable, and drawing clear cut conclusions is difficult though it is widely accepted that overt hypothyroidism increases the risk for deleterious outcomes and the risk for IUGR.

14. Assessment of Mean Hemoglobin Values for Various Blood Groups and Association of Hemoglobin Values Between the Predominant Blood Groups
Anant Kumar, Rajiva Kumar Singh, Priyanka
Aim: The aim is to find the mean hemoglobin values for various blood groups and to find out if there are any significant differences in the values in different blood groups. Materials and Methods: The present study was conducted in the Department of Physiology, Patna Medical College & Hospital, Patna, Bihar, India for the duration of 1 year. A total number of 350 subjects were recruited for the study. The randomly selected population consisted of 158 males and 111 females. The randomly selected population consisted of 211 males and 139 females. Blood hemoglobin levels were estimated using the instrument hemo control. Blood hemoglobin levels were estimated using the instrument hemo control. Results: A+ve was the most common followed by B+ve blood group. A−ve, with around 5.70% prevalence, was the least of all blood groups and we did not have any AB−ve and O−ve blood group subjects in our study population. There was a significantly high value of hemoglobin occurring in the O+ve individuals (hemoglobin values of 15.22±1.91 g/dL) as compared to the A+ve individuals though the absolute values and mean values of the hemoglobin fall in the normal range only. Conclusion: The rural population of Bihar showed significantly higher hemoglobin values in O blood group than the A and B blood groups. Rh-negative blood groups had low hemoglobin values when compared with Rh+ve blood groups.

15. An Institutional Research on Maternal Thrombocytopenia and Anemia in Pregnant Women: A Cross Sectional Study
Mahesh Chandra Agrawal, Ravi Kumar Gupta
Background: Thrombocytopenia and anemia in pregnancy are major causes of maternal and perinatal morbidity and death, thus it is vital to pay close attention to pregnant women and treat them as soon as possible to avoid catastrophic complications. Aims & Objectives: The goal of this study was to find out how common gestational thrombocytopenia and anemia are in pregnant women. Materials and Methods: This was a 9-month cross-sectional study of 220 pregnant women who visited the Department of Obstetrics and Gynecology’s outpatient department and wards. A random blood sample was taken for a peripheral blood film and haemoglobin count in order to assess platelet and haemoglobin levels. Results: Pregnant women were on average 24.29.33 years old. The majority of the study participants are from rural areas, are employed by occupation, and are in their second trimester of pregnancy. Anemia and thrombocytopenia were shown to be prevalent in this study at 67 percent and 19 percent, respectively. Conclusion: Thrombocytopenia and anemia are major concerns for both the mother and the infant, therefore antenatal care should include platelet and hemoglobin counts, as well as health education and dietary assessments.

16. Study of Haematological Parameters in Iron Deficiency Anaemia in Females
Sangeeta Singh, Neha Mittal
Introduction: Anemia moves one-fourth of the world’s people, and iron deficiency is the leading root. Anemia is linked to prolonged weariness, diminished cognitive function, and a lower sense of well-being. Patients with iron deficiency anemia of anonymous cause are frequently mentioned to a gastroenterologist, as the condition is almost always of gastrointestinal beginning. Anemia affects about a quarter of the world population, and iron deficiency is a major reason. Anemia is related with chronic fatigue, decreased mental function, and decreased well-being. Patients with iron deficiency anemia for unidentified reasons are often discussed to an intestinal surgeon, as the condition may be intestinal. Aim: Study of Hematological Parameters in Iron Deficiency Anemia in Females. Material and Method: The research was carried out by the Department of Pathology. This study comprised 30 anemic patients ranging in age from 18 to 45 years old, as well as 15 subjects who were referred to as such. Patients were referred to the Department of Medicine’s Observed Treatment Short-course emphasis. Result: Table 1 shows that comparison between IDA and Non-IDA subjects  Hb, Rbc, Mcv ,Mch ,Mchc, and Serum iron, Ferritin, and TIBC level are decreased in IDA Subjects but in Non-IDA subjects are excepts Hb ,Rbc other parameters are normal the value shows that  statistically significant P < 0.001. Conclusion: Present study shows that in Iron deficiency anemia patients following hematological parameters are sufficient to detect iron deficiency anemia and normocytic normochromic anemia.

17. Outcome of Spiritual Practices on Patients Suffering from Depression
Devi Singh, Chaudhary Ranjeet Singh
Depression is one of the most affected disorders all over the world. Studies have found that around 43% of Indians suffer from depression, out of which 11% suffer from moderate depression and 9% suffer from severe depression symptoms. Most youth of India show symptoms of depression because of various life changes, relationship issues, family issues, cyber bullying, etc. Some studies have shown that spirituality and religiosity can be a supplementary method to cure depression and lower the dosage of anti-depressant prescribed. The following study was carried out to check the outcomes of spiritual therapy given along with their medications. Material and method: Following group of 100 people were chosen for study. They were called up for face-to-face interview to explain the study and detect their level of depression. They were given spiritual therapy along with the anti-depressant with provided dosage from the prescribed doctor for 4 weeks. At the end of every week the patients were monitored to check the level of depression. Result: The patients were found responsive towards spiritual therapy but not all were found healthy at the end of sessions. As differed by depression level, those suffering from mild depression symptoms, were found helped by the end of therapy weeks but those suffering from severe depression did not respond well and anti-depressant medications were continued. Conclusion: As the study came up to end, it was concluded that spirituality and religiosity can be affected in both positive and negative way to a patient suffering from depression.

18. In Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Renal Stone Disease, Plasma Homocysteine Was Measured as a Marker of Acute Renal Injury
Anil Kumar Saxena, Hubb Lal Rajput
Background: Severe kidney damage (AKI) by biomarker release may occur during extracorporeal wave lithotripsy (ESWL), a common treatment used to treat high urinary tract stones. Severe kidney damage has been linked to extracorporeal shockwave lithotripsy (ESWL) due to damage to the arteries and tissues. Because less developed countries do not have real-time glomerular filtration parameters, effective indicators are needed to prevent tubular kidney damage. Shock wave lithotripsy (SWL) for kidney stones is becoming more popular every year, and as a result, post-operative complications such hematuria and acute kidney injury (AKI) are expected to develop. The importance of plasma total homocysteine ​​(tHCy), serum high-sensitivity C reactive protein (hs CRP), and serum creatinine as symptoms of severe kidney damage, as well as their association with kidney dysfunction will be investigated. Aim: The goal of the study is to compare plasma tHCy to other markers of AKI, such as serum creatinine and serum hs CRP, in patients receiving ESWL for renal stone disease. Material and method: Plasma tHCy, serum creatinine, and serum hs CRP were measured in 60 patients receiving ESWL for renal stone disease 24 hours before and after the surgery. AKI and non-AKI patients were separated into two groups. Statistical Analysis: Rates, ratios, percentages, and mean standard deviation using SPSS statistical software. Statistical significance was defined as a P<0.05 at a 95% confidence range. Results: AKI grew in 26.25 percent of patients after ESWL. Patients with AKI had significantly higher plasma thHCy levels after ESWL than those who did not have AKI. In people with AKI, moderate levels of creatinine in the blood and mean changes after ESWL were very high. Patients with AKI and those who did not have AKI had similar post-ESWL mean serum hs CRP values. However, following ESWL, which is the only 24-hour kidney transplant, 62.22 percent of patients with AKI experienced a significant increase in blood pressure hs CRP (2≥fold of baseline). Conclusion: ESWL is a safe and effective method for treating renal stone disease, although it has the potential to produce acute renal damage. Following acute renal damage produced by ESWL, plasma, total homocysteine, and serum hs CRP, as well as serum Creatinine, all rise markedly. As a result, in individuals with renal stone disease, plasma total homocysteine, serum hs CRP, and serum creatinine can be employed as acute renal damage markers after ESWL.

19. A Study of Comparisons of Normal Suturing and Adhesion of Skin Closure Tissues in Surgery of Inguinal Hernia
Akhlesh Kumar Saxena, Anil Kumar Saxena
Background: Suture material has evolved into advanced wound closure procedures such as skin staplers, skin glue, and sticky tapes. Based on the success of enhanced suturing procedures, patients may experience improved cosmesis, less postoperative discomfort, less wound infection, and a shorter stay in the hospital. The researchers wanted to see how adhesive glue compared to suture material for skin closure in hernia procedures. Closing wounds in an aesthetically acceptable manner has always been difficult. Surgeons have attempted to create “invisible scars” since the dawn of time. This, on the other hand, has always eluded me. ‘Scar’ is a surgeon’s signature. Technically, the skin closure procedure should be simple, acceptable, quick, and cost-effective. Sutures and staples are still the most commonly used procedures. The usage of GLUE, on the other hand, is becoming more common in clinical practise. With regard to time management, postoperative pain, ulcer problems, cosmesis, and cost-effectiveness, the authors compared all three procedures. Aim: The study aims to comparison of conventional suturing and tissue adhesive (2-octyl cyanoacrylate) for skin closure in inguinal hernia surgeries. Material and Method: There were 70 people in this study who underwent inguinal hernia surgery. Skin closure was performed on 35 patients with traditional suturing (3-0 ETHILON) and tissue glue on the remaining 35 patients (2-octyl cyanoacrylate). Postoperative discomfort, duration of skin closure, and scarring tests were all detected, and the findings were compared. In the General Surgery Department, a 2-year randomized controlled trial comparing tissue glue and wound-closing sutures following selection procedures was performed on 70 healthy patients. Results: The average skin closure time in the adhesive group was 1.521.444 minutes, while the average skin closure time in the suture group was 3.661.33 minutes. With a p value of 0.001, this difference is significant. The mean visual analogue value of the suture group was 4.5 ± 0.58, while the average skin group value was 2.38 ± 0.72. With a p value of <0.001, this value was very significant. The tissue glue group had less postoperative pain than other groups. At regular intervals, the postoperative scar was tested using a Vancouver scale. The average score for the suture group was 7.4 ± 0.4, while the average skin glue group was 1.9 ± 0.65. At p value of <0.001, these changes in effect were significant. Conclusion: In clean elective procedures, adhesive glue outperforms traditional suturing. It is a safe and successful form of skin closure that results in decreased postoperative pain and improved scar cosmesis. Staples are easier to use and take less time to apply than glue and stitches. In terms of post-operative discomfort, wound asepsis, cosmesis, and cost-effectiveness, skin glue delivers the best results.

20. Zinc Supplementation’s Role in School-Age Children with the Common Cold: Study from Central India
Jagdish Kumar, Avadhesh Kumar Gupta
Background: Malnutrition is the cause of zinc deficiency in school-age children. Zinc deficiency decreased overall immunity and increased the risk of illness. Aim: This study assessed the impact of zinc supplementation on schoolchildren’s susceptibility to the common cold and their need for antibiotic therapy. Materials and Methods: Between April 2021 and October 2021, a community-based, randomised trial was conducted. The study received permission from the institutional ethical committee. Results: Age in months for the zinc group was 92.5, while it was 92.8 for the placebo group. P equaled 0.08. In the zinc group, there were 76 males and 74 females, while in the placebo group, there were 74 males and 74 females. When zinc was given to patients, the average frequency of the common cold was 1.34 0.40, compared to 3.56 0.33 when a placebo was given to patients. Per student, the zinc group missed 0.29 to 1.10 days of class, compared to 1.76 to 1.43 days in the placebo group. Two participants reported having stomach and intestinal discomfort, which went away in a few days. Conclusion: According to the findings of this study, taking zinc supplements reduced the frequency of colds, as well as the severity and length of cold symptoms.

21. Study of Cardiac Symptoms in Dengue Infection Patients Visiting a Tertiary Hospital
Lal Babu Prasad, Ajay Abel Mall
Background: One of the most significant viral diseases that is linked to mortality is dengue fever. Clinical signs of cardiac involvement might range greatly, from a quiet illness to a fatal myocarditis. Aims & objectives: The goal of the current investigation was to evaluate the cardiac effects of dengue fever and find any subclinical or latent cardiac involvement. Material and Methods: Patients who were above the age of 18, of either gender, were admitted with a diagnosis of dengue fever (confirmed by a serological test) and were willing to participate in the study. Results: 284 patients who met the inclusion and exclusion criteria for the study were evaluated. The age range of 31–40 years represented the largest percentage of patients (28%) followed by that of 41–50 years (12%). (23 percent ). In this study, men made up the majority (57%) of the patients. According to serology results, the majority of patients were IgG (+20%), IgM (+20%), and NS1 (+48%) positive (13 percent ). In the current study, 15% of participants tested positive for troponin T, and 18% had high CK-MB values (> 25). Sixty percent of patients had normal electrocardiograms; noteworthy findings included broad QRS complex (11%), diffuse T wave inversion (10%), non-specific ST segment changes (10%), sinus bradycardia (9%), and low voltage QRS complex (0.70 percent ). Significant 2D ECHO findings were anterior wall hypokinesia (3%) minor PAH + mild TR + hypokinesia anterior wall (1%) mild PAH + mild TR (0.70%), LVH (0.70%), DCM secondary to dengue myocarditis (0.70%), and mild AML prolapse. In 93 percent of patients, the 2D ECHO was normal (0.70 percent ). Conclusion: Patients with dengue fever who have transient cardiac abnormality—as indicated by changes in heart rate, rhythm, and elevated CK MB and troponin I levels—should continue extensive assessment and follow-up even after being discharged.