Patna Medical College Research Articles

A retrospective observational study of orbital cellulitis in children - Recent trends

ABSTRACT Purpose: Orbital cellulitis is an acute post-septal orbital infection caused mostly by bacteria. This may result in serious complications including blindness, meningitis, cavernous sinus thrombosis, brain abscess, and even death. The delay in treatment increases morbidity and mortality. The purpose of present study was to review cases of orbital cellulitis in recent years regarding its clinical presentation, diagnostic evaluation, treatment policy, complications, and disabilities. The outcome of study will help in early diagnosis and better management of orbital cellulitis cases. Materials and Method: Total 20 cases of orbital cellulitis in children from March 2021 to February 2024 were evaluated and analyzed in department of ophthalmology, Patna Medical College and Hospital, Patna. Result: Total 20 children with ages <18 years were evaluated. The average age of presentation was 7 years (range between 1 year and 17 years). 70% of cases were seen in male children. All patients presented with chemosis, congestion, eyelid swelling, proptosis, and restriction of eye movement. Orbital CT scan diagnosed 100% cases of orbital cellulitis (P < 0.01). In 45% of children, sinusitis was initial site of infection (P < 0.01). Swab culture was positive in 40% of the cases, organism being gram-positive cocci. Complete recovery was seen in 75% with 25% having some deficit in visual acuity or eye movement. Conclusion: Clinical symptoms and signs aided with orbital CT scan help in early diagnosis early detection and aggressive treatment with multidisciplinary approach may limit the complications of orbital cellulitis and also aid in complete recovery without any visual deficit.

A cross-sectional survey of ocular problems after COVID-19 infection among healthcare workers at a teaching hospital.

The COVID-19 pandemic was caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV2). The impact of the pandemic is becoming more apparent now on various tissues and body organs. Limited knowledge is present about the characteristics, duration, and long-term sequelae of ocular problems post-COVID-19 infection. The purpose of the present study was to evaluate and analyze the ocular problems occurring in healthcare workers after COVID-19 infection. This was a cross-sectional survey study conducted in the Department of Ophthalmology, Patna Medical College and Hospital, Patna. The participants were healthcare workers who were exposed to COVID-19 infection ≥6 months back. A questionnaire was prepared. Responses were evaluated and analyzed. Patient consent and institutional committee permission were taken as per norms. A total of 210 healthcare workers who were infected with COVID-19 >6 months back responded with complete answers. The maximum number of respondents was between the ages of 31 and 60 (73.3%). The pre-covid ocular problems were present in 25% of the participants, especially in those having chronic diseases (such as diabetes, hypertension, or both). Post-ocular problems were faced by 60% of the participants, which was significant (P < 0.01). Dry eye, itching, and foreign body sensations were present in 60% of those facing ocular problems (P < 0.01). Ocular surface manifestations were more common. A knowledge, understanding, and awareness about ocular problems and their long-term sequelae in post-COVID-19-infected patients will help in early diagnosis and better management of such patients.

Understanding pediatric snakebites: Clinical and epidemiological insights from a healthcare center in Bihar, India.

Snakebites are a common medical emergency and occupational hazard for children in India, particularly in rural areas where poverty is prevalent. However, there is limited data on the epidemiology of snakebites on the Indian subcontinent. This cross-sectional, observational study aims to investigate the epidemiology, major clinical manifestations, and outcomes of snakebites in children under the age of 15 who were admitted to a tertiary care center in Bihar, a state in East India, and draw attention to this public health concern. A cross-sectional observational study was conducted at the Department of Paediatrics, Patna Medical College and Hospital, Patna. The study included all cases of snakebites with features of envenomation involving patients less than 15 years of age who were brought to the department over a 2-year period. Data were collected using a data collection form and analyzed using the Statistical Package for the Social Sciences, version 11.0 (SPSS Inc., Chicago, IL, USA). A total of 59 cases were recorded, with 62.71% (n = 37) being male and 37.28% (n = 22) being female. Kraits were responsible for 38.9% (n = 23) of cases, vipers for 42.3% (n = 25), and cobras for 5% (n = 3). Fang marks were present in 67.7% (n = 40) of cases, and the majority of bites (84.7%, n = 50) occurred on a lower limb during the day. The age distribution showed that 16.9% (n = 10) were below 5 years old, 44% (n = 26) were between 5 and 10 years old, and 22% (n = 13) were above 10 years old. Traditional treatment was used in 44.7% (n = 22) of cases, with the most common treatments being local incision + tourniquet (22%, n = 13) and no traditional treatment (55.9%, n = 33). The highest number of cases occurred during July-September (35.5%, n = 21). Snakebites are a significant public health issue in Bihar, India, with the majority of cases occurring in rural areas. The study highlights the importance of increased awareness and preparedness among healthcare providers and the general public, particularly during the monsoon season. Early hospital transfer, prehospital management, and prevention should be promoted through regular public health initiatives.

STUDY TO DETERMINE THE ASSOCIATION BETWEEN INFLAMMATORY MARKER (C-REACTIVE PROTEIN) AND HBA1C IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objectives: Patients with type 2 diabetes exhibit subclinical inflammation and nearly all signs of systemic inflammation, which characterized by high circulating levels of inflammatory parameters. The present study aimed to assess the levels of the inflammatory markers such as C-reactive protein (CRP) in patients with type 2 diabetes mellitus and to correlate their values with the hemoglobin A1c (HbA1c) levels. Methods: This cross-sectional study was conducted on 78 patients with type 2 diabetes in Patna Medical College and Hospital, Patna. All patients had laboratory investigations including HbA1C and CRP, patients were assessed according to glycemic status, patients with under control of diabetics (HbA1C level was equal to or &lt;6.5%), and patients with poorly-controlled diabetics (HbA1c level was &gt;6.5%). Results: Statistically significant association was observed between CRP levels and level of HbA1c. The CRP level was significantly higher in poorly-controlled diabetic patient than who with well-controlled diabetics (p=0.017). Conclusions: There is positive correlation between the level of glycemic control (HbA1c) and CRP levels; better glycemic control results in significant reduction in the highly sensitive C-reactive protein levels.

AN OBSERVATION ON DESARDA TECHNIQUE OF INGUINAL HERNIA REPAIR

Background: Inguinal hernia repair is one of the most commonly performed procedure in surgical practice throughout the world. The non-mesh repair technique of inguinal hernia by Mohan P. Desarda is becoming popular nowadays. Study of the outcomes of the procedure and comparison with other workers is desirable for wider acceptance of the procedure. To study the Objective: outcomes of inguinal hernia repair by Desarda technique. This is an observational study of 32 patients with inguinal hernia repair by Desarda techn Methodology: ique carried out in Dept. of general surgery, Patna Medical College and Hospital, Patna from October 2020 to October 2022. Out of 32 patients included in the study 18 Result: right sided,12 left sided and 2 bilateral inguinal hernia was there. The mean age of study population was 42.72±12.137 years. Mean operating time was found to be 60.81±10.91 minutes. Majority (87.5%) of the patients experienced moderate pain (measured by VAS ) on the rst post-operative day which gradually decreased with the time. Different postoperative complications ; hematoma in 1 patient (3.125%), seroma in 2 patients (6.25%), surgical site infection in 1 patient (3.125%), scrotal swelling in 2 patients (6.125%) and cord swelling in 1 patient (3.125%) were seen. Conclusion: Non mesh Desarda repair of inguinal hernia repair is associated with less operating time, early ambulation, less post operative pain and complication. As it doesn't use mesh so it is cost effective also and should denitely be encouraged.

Histomorphological Analysis of Ovarian Neoplasms According to the 2020 WHO Classification of Ovarian Tumors: A Distribution Pattern in a Tertiary Care Center.

In 2018, ovarian carcinoma ranked as the eighth most common cancer diagnosed and the leading cause of cancer death in women. High-grade serous carcinoma is the most common histological type seen among malignant cases. A diverse group of neoplasms is seen in the ovary with variable clinical, morphological, and histological features, so assessing the nature of ovarian neoplasms further assists in the treatment of the disease. This study was conducted to assess the different histopathological variants of ovarian neoplasms according to the latest 2020 World Health Organization (WHO) classification of ovarian tumors. Further analysis of the frequency, age, clinical features in patients, and distribution of various ovarian tumors is assessed. A retrospective study was conducted in the Department of Pathology at Patna Medical College and Hospital (PMCH), Patna. The data of the patients from the past three years, from February 2020 to February 2023, were retrieved and assessed. Gross and microscopic findings, including clinical details of patients with ovarian masses, were analyzed from the previous records. A total of 110 cases of ovarian neoplasms on histopathology were analyzed. The age range was 11-70 years. The types of specimens received were those of total abdominal hysterectomy, salphingoopherectomy, and unilateral or bilateral ovarian cystectomy. The most common presentation was an abdominal mass, followed by pain in the abdomen.The majority ofthe tumors were benign (69%), malignancy was observed in 24.5% of cases, and borderline tumors were seen in 5.4% of cases. Epithelial tumors were the commonest tumors, accounting for 70%, followed by germ cell tumors (21%). Serous cystadenoma was the commonest benign tumor, followed by mature teratoma and serous cystadenocarcinoma. High-grade serous cystadenocarcinoma was the commonest malignant ovarian tumor (9%), followed by low-grade serous cystadenocarcinoma (4.5%) and metastatic carcinoma of the ovary. Krukenberg tumor was seen in two cases, and a very rare case of sclerosing stromal tumor was seen in one of the cases. Ovarian neoplasms usually present with a variety of clinicomorphological and histological features. The most common neoplasm observed in the ovary is surface epithelial tumors, which are benign lesions that commonly affect reproductive age groups. Newer advancements like immunohistochemistry(IHC) and genetic studies have made the diagnosis easier and more precise. However, in institutes with limited resources, a histopathological study is still the gold standard in the diagnosis and prognostic evaluation of these tumors.

Dr. Dukhan Ram: For the greater good.

Dr. Dukhan Ram was born on July 15, 1899, in Sasaram, Bihar. He was born into a Vaisya family with poor financial means, it was needless to say that his childhood was riddled with hardships, losing his father at a tender age of four. As a young boy herding cattle, he would listen attentively to the village teacher teaching the students, from afar.[1] Once the teacher discovered him reciting everything that he had taught the students a day ago. Surprised and sensing a hidden potential, the teacher kindly allowed him to sit for the classes.[1] He admired and was possibly inspired by the village doctor, Dr. Jaffer Hasan, who would go on visits in a palanquin and was revered by all the villagers.[1] Dr. Ram started doing part-time jobs as a tutor and selling ready-made garments to supplement his income and continue his studies.[1] A sincere and hardworking student from the beginning, he received several scholarships, which helped him to fulfill his academic desires. He joined Calcutta Medical College and simultaneously enrolled in BSc classes in the evening. He graduated in both medicine (1926) and a Bachelor of Science (1925). After an internship at Patna Medical College, Bihar, he was selected by the Government of Bihar to go to England for specialization in ENT and Ophthalmology.[2] He completed his DLO and DOMS Ophthalmology from the coveted Royal College of Surgeons of London. On his return to India in 1934, he joined Patna Medical College as faculty in the Department of Ophthalmology and Otorhinolaryngology. The Patna Medical College was founded in 1925 and was the sixth-oldest medical college in India.[3] He became a professor in 1944 and built a robust department, initializing DO, DLO, MS (Eye), and MS (ENT) courses. In 1959, he was appointed the Principal of the institution. Raj Kumari Amrit Kaur, the then health minister of India, nominated him as a member of the Governing Body of AIIMS, New Delhi, a role which he served until the Institute was fully established.[1] He was also the Vice Chancellor of Babasaheb Bhimrao Ambedkar Bihar University and supported the establishment of the Rajendra Institute of Medical Sciences, Ranchi, and medical colleges in Muzaffarpur and Bhagalpur. In 1945, the British Government bestowed on him the title of Rai Sahib. He was an active member of Pradhan of Arya Samaj, founded by Dayanand Saraswati, and was the President of the Bihar chapter of the Arya Pratinidhi Sabha in 1951, Vice President of the All India Pratinidhi Sabha in 1956 and President of the International Arya League held in Mauritius in 1957. Dr. Ram was the Founding President of the Bihar unit of the All India Ophthalmological Society and helmed the conferences held in Patna (1952) and Jamshedpur (1956) and was the President of the AIOS in 1961. He was the President of the A.O.I and chaired the national conference of ENT in 1953.[2] He was also the President of the Bihar chapter of the Indian Medical Association from 1954–1955. He was the Founding President of the Institute of Administrative Studies at Patna for higher studies in administration and management. A surgeon with exceptional skills, he respected the ocular tissues and was devoted to his patients and students. He was requested to operate on the first President of India, Dr. Rajendra Prasad, for cataract in 1957. This tradition continued and he was the honorary ophthalmic surgeon for four subsequent Presidents, Dr. Sarvepalli Radhakrishnan, Dr. Zakir Husain, V.V.Giri, and Fakhruddin Ali Ahmed. Dr. Ram was also a member of the Mudaliar Committee of 1959, set up by the Government of India as a Health Survey and Planning Committee for reviewing and proposing guidelines for medical relief and public health services, chaired by A. Lakshmanaswami Mudaliar. In 1962, Dr. Ram contested as the candidate for the Indian National Congress from Sasaram against Bipan Behari Sinha of the Praja Socialist Party in the Bihar Legislative Assembly election and won by a margin of 11,984 votes! The Government of India awarded him the third highest civilian honor, the Padma Bhushan in 1962. Dr. Ram passed away on April 16, 1990, at the ripe age of 90. He is survived by his six children and an untarnished glowing legacy. The Dr. Dukhan Ram DAV Public School in Patna, the Bihar and Jharkhand State Branch of The Association of Otorhinolaryngology and Head and Neck Surgeons of India’s annual oration, Dr. Dukhan Ram Memorial Oration, are named after him. He is fondly remembered as a gifted surgeon and an understanding teacher.[2] Image credits Soft pastels on paper by Dr. Suhas Sarawade, Professor of Ophthalmology, Dr. V. M. Government Medical college, Solapur, Maharashtra, Inda. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

A STUDY OF CONVENTIONAL METHOD AND MICROFLAP BASED TECHNIQUE FOR EXCISION OF NON MALIGNANT VOCAL FOLD NODULAR LESIONS

Introduction: Management of benign vocal fold nodular lesion provides a particularly good window into the revolution of voice surgery. The changes in approach to surgical management have resulted largely because of advancement in knowledge of anatomy and physiology of the vocal fold layered structures &amp; technological developments that have improved our ability to examine and quantify voice function and the availability of better surgical instruments. Aims: Comparison of Microap technique with conventional method for benign vocal fold nodular lesion and Comparison of Intropertive and post-operative parameters like operative time, primary bleeding, operative procedures, residual tissue, collateral damage, postoperative complication, recovery time and so on between two methods. Materials and Methods: This study was Prospective Randomised single blind trial study. This study was conducted at Patna Medical College &amp; Hospital, Department of ENT from Feb 2020-August 2022. Result: We found in Conventional Group, the mean Total Score of Pre-op Video Stroboscopy (Individual) (mean± s.d.) of patients was 9.2632± 1.9268. In Micro Flap Group, the mean Total Score of Pre-op Video Stroboscopy (Individual) (mean± s.d.) of patients was 8.7857± 1.6898. Difference of mean Total Score of Pre-op Video Stroboscopy (Individual) with both Group was not statistically signicant (p=0.2413). In Conventional Group, the mean Total Score of Post-op Video Stroboscopy (mean± s.d.) of patients was 2.2895 ± 3.3684. Conclusion:We found that Mean Total Score of Post-op Video Stroboscopy was higher in Conventional compared to Micro Flap group which was statistically signicant. It was showed that Mean Video Stroboscopy Outcome Difference (Pre-Post) was less in Conventional compared to Micro Flap group which was statistically signicant

A STUDY OF TYMPANOPLASTY AND ITS OUTCOME IN VARIOUS AGE GROUPS USING THE MIDDLE EAR RISK INDEX SCALE

troduction: Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world-wide especially in developing countries where large percentage of the population lacks specialized medical care. With a large number of patients frequently undergoing tympanoplasty for chronic suppurative otitis media (CSOM), it is important to assess the severity of the disease and predict the outcome of the surgical management.Aims: To study MERI and result of tympanoplasty according to the risk category. Materials and Methods: The present study was a Prospective study. This Study was conducted from November 2021 to November 2022 at Department of Ear, Nose, and Throat (ENT), Patna Medical College &amp; Hospital , Patna, Bihar, India. Result: In our study, Forty-nine of the 58 patients had unilateral and 18 had bilateral perforations. The surgical success rate was 92% in the former and 78% in the latter group (P =0.67). Conclusion: Our study showed that myringoplasty is a good treatment modality in the paediatric population and MERI scoring can be useful in predicting the outcome of tympanoplasty in all age-groups.

Short- and Long-term side effects of Concomitant Chemoradiation treatment for Cervical Cancer

Concomitant chemoradiation (CRT) for locally advanced cervical cancer has become an established treatment based on randomised trials. Major concerns, however, remain over the acute and late toxicity and hence the generalisability of the conclusions of these studies. The study period was from October 2020 to May 2022. A total of 126 patients with Stage IIB to IIIB Cervical Cancer were taken for the study from Patna Medical College Hospital, Patna, Bihar with consent from the patients. Most of the patients were of stage IIIB (47.60%) in group A and (54%) in group B. Most of the patients had parity ˃5 (68.30%) in group A and (87.30%) in group B. Most of the patients (58.73%) in group A and (66.66%) in group B completed EBRT within the schedule time of 35 days. Twenty seven (42.85%) patients in group A and twenty three (36.50%) patients in group B had break during EBRT due to toxicity. In conclusion, observation during follow up after 6 months group A patients 74.60% had no evidence of disease and in group B 76.19% had no evidence of disease or no residual disease. In group A 25.40% had residual disease and in group B 24.60% had residual disease.

A STUDY OF CONVENTIONAL SEPTOPLASTY VERSUS ENDOSCOPIC SEPTOPLASTY

Introduction:Adeviated septum can be asymptomatic or can cause functional and cosmetic abnormalities. Different studies have been proposed for the correction of deviated septum, but septoplasty has been the treatment of choice. Septoplasty is a more conservative surgery and endoscopic septoplasty has become increasingly popular over the past few decades. Materials and Methods: The study was carried out to compare the postoperative results among patients of conventional and endoscopic septoplasty and to assess the efcacy of endoscopic septoplasty with other surgeries. The present study was conducted among 40 patients of deviated nasal septum admitted in the Department of Otolaryngology of Patna Medical College &amp; Hospital , Patna for 12 months. Patients were selected by simple random sampling and were divided into Groups Aand B, with 20 patients in each group. Group A underwent conventional septoplasty and Group B underwent endoscopic septoplasty. Results: The male-tofemale ratio in the present study was 3:1. Deviated nasal septum was commonly associated with inferior turbinate hypertrophy (44%) and concha bullosa (28%). Postoperatively, a signicant relief from the symptoms of nasal obstruction (80%), nasal discharge (30%), headache (30%), and postnasal drip (55%) was observed in endoscopic septoplasty. Complication rate was higher in conventional septoplasty. The endoscopic approach facilitates proper alignment by limited and precise resection of pathological areas. Conclusion: Endoscopic septoplasty provides precise resection of the pathological areas and better illumination with limited ap dissection and exposure.

A study of reporting pattern of adverse drug reactions in a tertiary care teaching hospital

Background: Adverse drug reactions (ADRs) are one of the prime causes of morbidity and mortality, increase in hospital stay and socioeconomic burden on the patients. Periodic monitoring aids in formulating methods for safe usage of medicines in hospitals. Identification of ADRs and their reporting pattern can provide useful information for their prevention. Hence this study was done to see the pattern of reported ADRs in Patna Medical College and Hospital, Patna in a 3 months of study.Methods: It was an observational and retrospective study carried out between July 2022 to September 2022. Both outpatients and inpatients were included in the study. The ADRs in the form of Individual Case Safety Reports (ICSRs) were sent to the nearby adverse drug reaction monitoring centre (AMC).Results: The occurrence of ADRs was more common in females (56.25%) as compared to males (43.75%). Patients of age-group 21-40 years (40.625%) were most commonly involved. Medicine department (34.375%) reported the maximum percentage of ADRs. Antimicrobials (37.50%) was the most common drug-group causing ADRs. Maximum reported ADRs (81.25%) were probable, 9.375% were possible, 6.25% were certain, while 3.125% were unlikely with the suspected drug as per Naranjo scale.Conclusions: The pattern of ADRs reported in our hospital is comparable with the results of studies conducted in hospital setup elsewhere, along with a few differences. The study results revealed opportunities for interventions in ADR management especially for the preventable ADRs to ensure safer drug use.

Adverse drug reactions due to gabapentin-nortriptyline in patients with neuropathic pain in a tertiary care teaching hospital

Gabapentin and Nortriptyline are used to treat neuropathic pain. Gabapentin belongs to a group of drugs called anti-convulsant and Nortriptyline belongs to tricyclic antidepressant. Gabapentin acts by binding to the specific site on voltage- gated calcium channels. This helps in relieving nerve pain and lowers the risk of seizure. Nortriptyline works by preventing the released chemical messengers in brain (serotonin and norepinephrine) from being reabsorbed back into the nerve cells. As a result, it prolongs the effect of serotonin and norepinephrine in the brain and over time, this helps to relieve depression and lighten the mood. We are reporting a case series including 3 patients having neuropathic pain and taking tablet gabapentin-nortriptyline in department of neurology, Patna medical college and hospital, Patna developed some adverse drug reactions. Causality assessment was done in each case by Naranjo scale. Each case was filled properly in ADR (adverse drug reaction) reporting form and was sent to nearby adverse drug reaction monitoring centre (AMC). During the posting for pharmacovigilance in neurology department of Patna medical college and hospital, Patna from 01/07/2022 to 30/09/2022 we got three adverse drug reactions due to gabapentin-nortriptyline. Two of them were due to Gabapentin and one was due to nortriptyline. Gabapentin-nortriptyline is one of the most commonly used drugs in neurology department. It causes some frequent as well as some rare adverse drug reactions which are required to be assessed and finally reported to the nearby AMC.

Alcohol Induced Toxic Optic Neuropathy- A Prospective Study

Introduction: We report cases of methanol induced toxic optic neuropathy with their clinical and MRI brain findings. Methods: Prospective study of four consecutive cases presented between July to December 2021 at emergency department of Patna Medical College, Patna, India. Visual acuity and MRI brain findings noted in each case. Results: All the patients were males and chronic drinkers with history of consuming adulterated alcohol. All presented with altered consciousness, metabolic acidosis and almost complete painless visual loss bilaterally. MRI brain showed bilateral T2W hyperintansity in putamen and blooming on GRE suggestive of bilateral putaminal hemorrhagic necrosis. None of the patient had improvement after Intravenous methyprednisolone. Conclusion: Alcohol related toxic optic neuropathy is a serious disorder causing bilateral, almost complete visual loss. Typical MRI brain findings could point towards diagnosis.

Comparing Non-invasive Prenatal Testing With Invasive Testing for the Detection of Trisomy 21.

Background Non-invasive prenatal test (NIPT) is an intermediate step between serum screening and invasive diagnostic testing. It involves analysis of the cell-free fetal DNA (cffDNA) present in the maternal blood sample for determining the likelihood of fetal aneuploidy. Owing to its high sensitivity and specificity, NIPT has quickly gained popularity across the globe since its introduction to clinical practice, making it an attractive alternative to the available screening and diagnostic tests in use.Amniocentesis is currently the gold standard test for obtaining fetal DNA and diagnosing fetal trisomy prenatally, but it is invasive and has procedure-related adverse effects.This study aims to compare NIPT and amniocentesis in pregnancies screened positive for fetal trisomy. Material and methods This is an analytic cross-sectional prospective study conducted in the Department of Obstetrics & Gynecology, Patna Medical College and Hospital, for two and half years from December 2018 to June 2021. A total of 34 pregnant women screened positive for trisomy 21, attending the antenatal care outpatient department, in their second trimester, with their written consent, were enrolled in the study. Results Out of 34 pregnant patients, three refused NIPT and directly opted for amniocentesis. A total of 31 pregnant women have undergone NIPT. A total of 28 cases were positive for trisomy 21 on both NIPT and amniocentesis. The sensitivity of NIPT was 100% with the confidence interval being 87.66% to 100.00%. The specificity of NIPT was 100% with the confidence interval being 29.24% to 100.00%. Conclusion The high performance and effectiveness of NIPT are undeniable. Thoughthe process by which this test has to be integrated into the clinical practice needs more study and should be determined with meticulous assessment.

HISTOPATHOLOGICAL PROFILE OF THE ENDOMETRIUM IN PRE AND POSTMENOPAUSAL WOMEN WITH ABNORMAL UTERINE BLEEDING AT TERTIARY CARE CENTRE

Introduction Pre and postmenopausal bleeding is one of the commonest conditions for which patients seek advice in the gynaecological outpatient department. Endometrial biopsy is the gold standard for evaluating such cases.Aims And Objectives To determine various histological pattern of endometrium in pre and post-menopausal women and to study the spectrum of lesions of the endometrium with respect to age and clinical features. Methods This is a prospective study of the histopathology prole of the endometrium among 100 cases of premenopausal(45+/-5yrs)and postmenopausal (50 yrs and above)patients with AUB symptoms and D and C /endometrial biopsy/hysterectomy done in department of Obstetrics and Gynaecology,Patna Medical College and Hospital over a period of two years which was histopathologically examined in department of pathology,Patna Medical College and Hospital. Results Maximum incidence of AUB was found in 40-50 yrs age group(53%).Menorrhagia was the commonest bleeding pattern.on histopathological examination,proliferative endometrium constitutes 36% followed by atrophic endometrium (33%).In 40-50 yrs age group proliferative endometrium (49%) followed by secretory endometrium (23%),Atrophic endometrium (15%),hyperplasia without atypia (9%),Atypical Hyperplasia(4%).In &gt;50 yrs ,Atrophic endometrium(53%),proliferative endometrium(21%),secretory endometrium(9%),chronic endometritis(9%),hyperplasia without atypia(2%),atypical hyperplasia(2%), endometrial carcinoma type I(2%),type II(2%). Conclusion Histopathological examination of the endometrium is an inexpensive and accurate method for diagnosis of such cases.It helps to differentiate benign and malignant causes and plan further line of management of the patient.

Post-graduate Psychiatry Teaching and Training in India

In India, the history of psychiatry is approximately 80 years of post-graduate education. The first psychiatrist who received an MD degree from an Indian medical institution was Late Prof. L.P. Verma, who received his degree in 1941 from Patna Medical College, Bihar.1 In India, a post-graduate course in psychiatry is taught in two forms (MD in Psychiatry and DNB in Psychiatry). MBBS is the minimum educational requirement to be eligible for pursuing MD or DNB Psychiatry course. The duration of the post-graduate course in psychiatry is three years in India. A recent study revealed that the post-graduate degree courses in psychiatry are unequally distributed in the country, which might be responsible for the not-so-equitable distribution and generation of mental health manpower in the country.2 In India, general hospital psychiatry units (psychiatry units attached to medical colleges) play an instrumental role in training post-graduate students of psychiatry. Other than this, mental hospitals also provide teaching and training facilities for post-graduate psychiatry trainees.

COMPARATIVE STUDY OF SINGLE LAYER INESTINAL ANASTOMOSIS AND DOUBLE LAYER INTESINAL ANASTOMOSIS

Background: Gastrointestinal anastomosis is one of the most common procedures being performed in oesophagogastric, hepatobiliary, bariatric, small bowel and colorectal surgery. There are still conflicting views regarding suitability of single layer and double layer anastomotic technique. Methods: This comparative study was conducted at Patna Medical College and Hospital,Patna in which 48 patients were repaired with single layer anastomosis and 48 were repaired with double layer intestinal anastomosis. Single layer intestinal anastomosis was carried using extramucosal technique with 2-0 vicryl suture (round body). Double layer anastomosis was carried out using interrupted 2-0 vicryl suture for both inner (continuous) and outer ( Interrupted) layer.End to end colocolic,end to side ileocolic,end to end ileoileal,side to side ileoileal,end to end jejunoileal and end to end jejunojejunal anastomosis were performed. Each group was compared for anastomotic leak, time required to construct the anastomosis and length of hospital stay. Results: The mean time taken for anastomosis (15±2 minutes in single layer anastomosis versus 32±5 minutes in double layer) and the length of hospital stay was same in both the groups.There was 1 anastomosis leak in single layer anastomosis group and 3 in double layer group. Conclusion: It can be concluded that single layered extramucosal continuous intestinal anastomosis is equally safe and perhaps more cost effective than the conventional double layered method and may represent the optimal choice for routine surgical practice.

Risk factors of mucormycosis in post-COVID-19 patients– A Retrospective study

Background: Rhino-orbito-cerebral mucormycosis was seen in increasing severity in the recent second wave of COVID-19 in India. The incidence of mucormycosis is increased significantly in patients with diabetes. The most common cause attributed to the rise of mucormycosis in COVID-19 patients are uncontrolled diabetes. Lymphopenia and increased levels of certain cytokines, such as IL-6, have been closely associated with the disease severity. Aims and Objectives: The aims of this study were to analyze risk factors involved in Mucormycosis in 2nd wave of COVID-19. Materials and Methods: The study was done in the Mucormycosis ward, Department of ENT, Patna Medical College and Hospital, Patna, between May 2021 and July 2021. A total of 100 patients of both gender and all age groups were taken into the study. Results: Out of 100 patients included in the study, 57% (n=57) of patients had history of steroid intake, while 43% (n=43) had no history. About 41% (n=41) of patients needed oxygen support during treatment,while 59% (n=59) had no history of oxygen inhalation. About 88% (n=88) of patients had prior history of diabetes or detected during treatment, while 12% (n=12) had no prior history of diabetes or detected during treatment. About 91% (n=91)of patients had uncontrolled hyperglycemia, while 9% (n=9) had controlled blood sugar level. Conclusion: Uncontrolled hyperglycemia and delta strain are mainly associated major risk factors that lead to such high number of mucormycosis cases in India (post 2nd wave of COVID-19). Steroid role is not that much significant in our study and oxygen inhalation is not associated with mucormycosis.

Body &amp; organ donation in Bihar – A multicentre study on awareness among students of 1st professional MBBS course

Background: With the attendant rise of the number of medical colleges in India over past few decades, the demand for cadavers used in medical education and research is growing. However, there is an insufficient supply of donated cadavers available for dissection. Objective: The present study aimed to assess the awareness about Body &amp; Organ Donation among students of 1st Professional MBBS course in Bihar, India. Materials and Methods: This retrospective, longitudinal cohort, observational multi-center study was carried out between March-2022 to May-2022 on consecutive 500 medical students admitted in 1st Professional MBBS course, studying at KATIHAR MEDICAL COLLEGE, KATIHAR, MADHUBANI MEDICAL COLLEGE, MADHUBANI and PATNA MEDICAL COLLEGE, PATNA, between the study duration. Inclusion criteria composed of only newly admitted first year medical students, following their informed consent whereas, second year, third year and fourth year medical students were excluded from this study. Approval was obtained from Institutional Ethics Committee. A structured questionnaire containing 29 items was administered after due consent by the department of anatomy of each of the above-mentioned medical colleges. The collected data was entered in Microsoft Excel to maintain the quality of data.