Background: Significant morbidity is often observed in inadequately managed Empyema cases. Aims and Objectives: To evaluate the different treatment modalities in the management of Paediatric Empyema Thoracis. Materials & Methods: 70 Cases of Empyema turning up to the department of Paediatric surgery in a tertiary care hospital and managed with aspiration, intercostal tube drainage, video-assisted thoracoscopic surgery (VATS) and thoracotomy decortication between January, 2017 to December, 2018 formed the study group. Data was collected and analysis done. Results: Most patients presented late. Intercostal tube drainage had low success rate (only 29.41%); Primary VATS was successful in 90% cases with minimal morbidity where it was chosen as first choice; Late presenters and failed /complicated cases did well with thoracotomy decortication (22/70= 31.43%): There was one mortality in the study. Conclusion: Optimal results with least morbidity are seen if Early VATS is done when Empyema is still in its exudative or fibrinopurulent stage; late presenters with organised Empyema or failed cases should undergo thoracotomy decortication.

Cervical cancer is the fourth most common cancer among women worldwide. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in the assessment of extension and staging of cervical malignancy and comparison with clinical staging. Materials and Methods: This prospective study was conducted on 50 newly diagnosed patients with cervical cancer at a tertiary care centre at IGIMS, Patna. Patients were examined and staged according to FIGO system. MRI was done in each patients. Then we compared the predicted stage for each patient with the two methods. Results: Based on clinical staging twelve patients (24%) were observed at stage 1, MRI staging was in coordination with clinical staging in eight of them while three patient were staged 2b, and one patient was staged IIa on MRI. Based on the clinical staging four patients (08%) were diagnosed as stage 2a. MRI staging was in coordination with clinical staging in three cases and one was staged Ib. Based on clinical staging 18 patients (36%) were stage 2b. MRI staging was in coordination with clinical staging in fifteen of them and for other two patients MRI diagnosed as stage IIIb and in one staged Ib. Based on clinical staging fifteen patients were stage 3b. MRI staging was in coordination with clinical staging in thirteen of them and for the two patient MRI diagnosed stage IVa. Based on clinical staging one patients (7.5%) was staged IVa. MRI staging was in coordination with clinical stage. MRI had a sensitivity of 100% and specificity of 81.26% in detection of parametrial infiltration, and sensitivity of 100% and specificity of 88.84% in detection of vaginal infiltration Conclusions: MRI is an optimal non-invasive modality but expensive for preoperative staging of uterine cervical malignancy, and crucial in subsequent more accurate treatment planning.

Background: Cancer of the uterine cervix is the second most common female cancer, representing approximately 15% of all neoplasm’s. Cervical cancer ranks as the 4th leading cause of female cancer in the world and it is the 2nd most common female cancer in women aged 15 to 44 years. HPV DNA testing is preferred cervical screening method for woman 30-65 years old as HPV is the proved causative agent of cervical carcinoma. Due to the high costs involved in doing HPV DNA test there is a need for a biomarker such as Bcl-2 which can indicate the initiation of carcinogenic process of HPV infection. The E6 oncoprotein of HPV binds to p53, a tumour suppressor gene and inactivates it resulting in increased cell proliferation and decreased apoptosis. Apoptotic cell death is also blocked by the increased transcription of survival genes such as bcl2. Therefore, the expression of p53 and Bcl2 may be used as sensitive and specific biomarkers for cells with active expression of HPV oncogene. Objectives: 1. To evaluate the sensitivity and specificity of three methods of assessment-cytology, HPV DNA typing and detection of biomarkers (p53 & Bcl2) in cervical neoplasia considering histopathological examination as gold standard. 2. To determine the prevalance of HPV infection in cervical neoplasia patients. Material and Methods: This study was conducted in Regional Cancer Centre at Indira Gandhi Institute of Medical Sciences, Patna, and Bihar. 15 women were enrolled in this study and sample was taken for both conventional cytology and HPV, p53 and Bcl2 cytology. The results were compared and analyzed statistically. Results: A total of 15 cases of premalignant and malignant lesion were included in the study. HPV was positive in 9 out of 15 (60%) cases and was negative in 6 (40%) cases. In this study we found that p53 showed higher frequency of positivity in cases of carcinoma cervix when compared to premalignant lesion and it was statistically significant. Bcl2 expression showed higher positivity rates in both carcinoma cervix and premalignant lesion.. Conclusion: A larger case series is required to assess the association between HPV infection and over expression of p53 and bcl2 proteins in these lesions. Bcl2 IHC staining may be used as a diagnostic marker to differentiate malignant lesions from premalignant lesions but its role as a prognostic marker needs to be further evaluated.

Background: The nasolabial flap is a simple and versatile flap for reconstruction of small intraoral defects created after the excision of malignant tumors. Methods: A retrospective analysis of patients of oral cancer who presentented in surgical oncology department of IGIMS, Patna in the period of 1 year (april 2017 to march 2018) and treated with primary excision of lesion and nasolabial flap reconstruction was carried out. In all cases the primary lesion was excised and combined with neck dissection. In two cases facial artery was ligated during neck dissection. Result: Good cosmetic and functional outcome was observed in almost all cases. Wound infection developed in one patient. No patient developed orocutaneous fistula. No trismus was observed in any patient in followup. Conclusion: The nasolabial flap is a good and versatile flap for the reconstruction of small oral defects after excision of primary tumors and it has good overall cosmetic and functional outcome.

Introduction: In patients with epithelial ovarian cancer (EOC) , the volume of residual tumour after debulking is the prognostic factor for survival. We examined the relationship between postoperative decline in serum cancer antigen(CA125) and residual disease after cytoreductive surgery and evaluate post operative changes in serum CA125 levels as predictor for disease-specific survival. Material and methods: This retrospective study consisted of evaluation of serum CA125 in 173 patients with EOC treated with cytoreductive surgery, either primary or secondary surgery after neoadjuvant treatment between June 2015 and Jan 2018 in a tertiary care centre of Bihar. Preoperative and postoperative CA125 value were recorded and simultaneous diagnosis of histological subtype, clinical stage and differentiation grade of the tumour (n=173) were studied in order to determine the prognostic value of CA125. Result: We found irresectable mass in 58 EOC patients out of which 56(96.55%) had preoperative CA125 >500 [p <0.001]. A postoperative decline in serum CA125 level of ?80% was associated with complete primary cytoreduction (p=0.035). On analyses there was favorable associations with survival for both the degree of decline in serum CA125 and residual tumor after primary cytoreduction [p < 0.001]. Conclusion: The current retrospective study suggests that the preoperative CA125 value determine the resectability of ovarian mass and also post operative decline in serum CA125 is an early biomarker that predicts disease-specific survival in patients who underwent cytoreductive surgery for EOC.

Introduction: Complication of diabetes mellitus (DM) includes coagulation impairment. Hypercoagulable state in patient with DM may accelerate thromboembolic risk for cardiovascular diseases (CVD). Hyperglycemia in diabetes contributes to hyperfibrinogenemia and activates the coagulation cascade thereby producing atherothrombotic events. Objective: This study was designed to evaluate the coagulation profile (Activated partial thromboplastin time, Prothrombin time and Fibrinogen) in Type 2 diabetes Mellitus. Methods: This study included 100 type 2 diabetics and 50 controls. Fasting blood glucose, coagulation parameters such as prothrombin time, activated partial thromboplastin time and fibrinogen along with other biochemical parameters were investigated. Results: In this study fibrinogen was found to be significantly higher (p-value = 0.000) in diabetic patients as compared to the control group. Prothrombin time in Diabetes Mellitus type 2 is shortened as compared to Non- Diabetic Population whereas APTT is slightly prolonged in DM Type 2. Conclusion: From this study, it may be concluded that diabetic patients are prone to develop coagulation impairment.

Background: The standard advocated line of treatment of locally advanced cervical cancer is concurrent chemo radiotherapy. Still, there are some discussions about completion surgery following chemo radiation and their benefits in the survival of patients. This study aims at studying the feasibility of such surgery and to document any significant complications and morbidity due to such surgery. Methods: 17 patients with cancer of the cervix of stage IIB to IIIB who showed residual disease following concurrent chemo radiation and who consented to the trial were recruited from December 2015 to June 2017. 16 patients underwent laparotomy and type 2 hysterectomy and one patient was found to be inoperable on laparotomy. The operative time, blood loss, intra and post-operative complications and duration of hospital stay were recorded and analyzed. Results: From December 2015 to June 2017, 16 patients were operated. The median age was 55 years (range, 33-65 years). Histologic finding revealed squamous cell carcinoma in 15 (93.75%) cases and adenocarcinoma in 1 (6.25%) cases. International Federation of Gynecology and Obstetrics stages distribution were as follow: IIB, n = 9 (56.25%); IIIA, n = 1 (6.25%); and IIIB, n = 6 (37.50%). Mean estimated blood loss was 400 mL (range, 250-800 ml),and mean operative time was approximately 102 minutes (range, 85-130 minutes). Hospital stay was in average 12 days (range, 10-21 days). Out of 16 cases 4 patients had wound infection, 2 had paralytic ileus, 3 patients had urinary tract infection and 2 developed bladder atony. Secondary resuturing was required in one patient and one patient developed incisional hernia. The patients are on follow up. Conclusion: Completion surgery by trained surgeons on properly selected patients in institutional settings can be carried out with minimal morbidity to the patients. The effectiveness of this surgery and survival benefits to the patients’ needs to be investigated in bigger trials.

Background: Staged surgery for Hirschsprung's disease involves an initial stoma formation with biopsies to determine the level of aganglionic segment, followed by a pullthrough procedure like Duhamel's pullthrough. Stoma type with the least complication rate and providing considerable ease during subsequent pullthrough procedure would be the preferred stoma technique as the initial step in Hirschsprung's disease. Aims and Objectives: To compare loop colostomyand end colostomy as the initial stage in managing Hirschsprung's disease. Materials and methods: Data regarding 70 cases of Hirschsprung's disease operated for levelling biopsy and stoma formation (either loop or end colostomy) between 01.01.2017 to 31.12.2018 in the department of Pediatric surgery in a tertiary care hospital were collected prospectively and analyzed. Results: Although loop colostomies with levelling biopsies took less time to be fashioned (mean 58 minutes) compared to End stoma with biopsies in Hartmann's fashion (mean 72 minutes), they were associated with more incidences of wound dehiscence, wound infection, stomal prolase, peri-stomal herniation and peri-stomal skin rashes. Subsequent pullthrough procedure was faster with less dissection and blood loss and overall complications including stump leak in patients who had been diverted via end stoma compared to those who had had loop colostomy at the time of initial surgery. Conclusion: End colostomy in Hartmann's fashion is the preferred and safer mode of diversion in Hirschsprung's patients lessening the complication rate and making subsequent pullthrough easier and safe when compared to loop colostomies.

Background: Air pollution is a major threat to human health. World Health Organization (WHO) estimated 4.2 million premature deaths due to ambient air pollution in 2016. It's a serious problem in metropolitan cities like Delhi, Patna and Gwalior in India. Average daily exposure of traffic policemen to dust particles and toxic gases from automobile exhaust exceeds about 8-10 hr/day. Aims: The purpose of this study was to determine the effects of ambient air pollution on pulmonary functions of the traffic policemen. Materials & Methods: A cross-sectional study with 100 traffic policemen was conducted. The inclusion criteria were non- smoker males, aged between 25-50 years, working for last 1-5 years in the traffic department. The exclusion criteria were history of respiratory or cardiovascular disease or declined participation. Anthropometric measurements of the subjects were taken as per standard protocols, approved by the WHO. Pulmonary functions of the traffic policemen were assessed by determination of Forced vital capacity (FVC), Forced expiratory volume in 1st second (FEV1), FEV1/FVC%, Peak expiratory flow rate (PEFR) and Forced expiratory flow during 25-75% of expiration (FEF25-75%) by using the nomogram of Indian settings with a computer based Spirometer, Spiro Excel manufactured by Medicaid Systems Pvt. Ltd. The association of percentage of predicted values of the pulmonary function parameters with the duration of exposure to air pollutants was analysed by using Pearson correlation. Results: There were significant correlation between the duration of exposure to ambient air pollution and pulmonary function parameters FEV1(r=-.041), FEV1/FVC% (r=-.349), PEFR (r=-.027), & FEF25-75% (r=-.401) expressed as correlation-coefficient (rvalue). Conclusion: The findings showed that prolonged exposure to ambient air pollution leads to a trend of development of obstructive features among traffic policemen.

The burden of corneal blindness is increasing in India and estimates currently suggest that there are 1.6 Million people suffering from the disorder. Despite being treatable, the number of corneally blind people during 2005 and 2011 has grown by 0.34 Million in India. This suggests that the treatment of corneal blindness is currently taking place much slower than its incidence. One of the main reasons for this is the fact that there is a huge mismatch between the total corneas collected and that required for transplantation. In order to increase the number of cornea collections WHO and AIIMS undertook this project to examine and evaluate how effective grief counselors can be in the collection of eyes in comparison to trained nurses. Before the project was initiated there were already 4 senior grief counselors working with the national eye bank. The project involved appointing 5 additional junior grief counselors to analyze their impact in cornea collection. During July-November 2011, it was found that the number of cornea collections were directly proportional to the number of grief counselors. Results also suggested that the significance of grief counselors in cornea collections was more than that of hospital staff. This can be attributed to the fact that grief counselors are appointed specifically for cornea collection while hospital staff can only spend a limited time on counseling for cornea collection.

Empty sella syndrome (ESS) is an anatomical/ radiological entity, in which the pituitary fossa is enlarged and is filled with Cereberospinal fluid (CSF) owing to arachnoids’ herniation, while pituitary gland is compressed. This retrospective study was done to evaluate the clinical features, medical and surgical management and outcome in 34 cases with ESS presented to our department for a period of seven years (2011- 2017). ESS is divided into primary and secondary type, depending on the presence or absence of pituitary pathology. 21 Patients presented with primary ESS and 13 had secondary ESS. 4 patients were asymptomatic. 30 patients presented with headache, 15 patients with endocrinological dysfunction, 12 patients with visual manifestation and 8 patients with CSF rhinorrhea. 10 patients (29.4%) underwent surgical treatment and the remaining 24 patients (70.6%) underwent medical management. CSF rhinorrhea, visual disturbances and persistent raised ICP were the main indications of surgery. The type of surgery depended on clinical presentation and radiological finding. The outcomes in the surgical cases were favorable.

Background: Hyponatremia is a common electrolyte disorder in admitted patients, defined as a serum sodium level less than 135 mEq/L. It is associated with different clinical condition and its clinical presentation has a wide spectrum. Aims: To find out prevalence, clinical profile and mortality of hyponatremia among hospitalized patients. Material & Method: We carried out a observational study on patients aged 15 years or above admitted in General Medicine department IGIMS over a period of 6 months. Patients were screened for hyponatremia, then clinical profile of these patients along with outcome was recorded. Statistical analysis was done to find out p value. Results: Prevalence of hyponatremia was 15.97% , hyponatremia was common in male (59.14%) and among older patients (38.26%). Mortality among hyponatremia was 13.91%, p- value was 0.127031, so result was not significant. Conclusion: Hyponatremia is common at admission among hospitalized patients, however hyponatremia among hospitalized patients with different clinical condition is not a predictor of mortality in this study.

Background: Neonatal sepsis is one of the important causes of neonatal morbidity and mortality particularly in the developing countries. In order to avoid unnecessary NICU admissions and antibiotic therapies, it is very important to make early diagnosis of neonatal sepsis with utmost accuracy. Blood culture though gold standard requires lot of time for diagnosis, hence it's necessary to rely on early diagnostic markers such as blood counts, micro-erythrocyte sedimentation rate(ESR), C reactive protein (CRP), Procalcitonin(PCT). Out of the early diagnostic markers available, CRP and pro-calcitonin has the highest sensitivity and specificity rates. Methods: The present study was a hospital based prospective observational study Conducted for a period of one year from 1year (May 2016- April 2017) On neonates admitted to NICU, at Kurji Holy Family Hospital, Patna Bihar which is a tertiary care referral hospital for children. Proper consent was taken from the parents of all neonates. Specimen of blood obtained from each neonate with proper aseptic conditions and prior to commencement of antibiotics. Results: Total of 155 neonates satisfying the inclusion criteria were taken in the study group, based on the above criteria, they were grouped into 3 categories, 93/150 neonates had clinical/no sepsis, 45/155 had probable sepsis and definite sepsis was found in 17/155 neonates. Appropriate investigations were done. Blood culture was positive in 17 neonates. Procalcitonin was negative in 96 neonates, positive (>0.5ng/ml) in 59 neonates, PCT is positive in 12/17 blood culture positive cases. CRP was positive in 43/155 cases, and negative in 112/155 cases. CRP was positive in 11/17 blood culture positive cases. Procalcitonin in comparison with CRP, sensitivity was100%, specificity was 85.72%, positive predictive value (PPV) was 72.88%, and negative predictive value (NPV) was 100%. CRP in comparison with Procalcitonin, sensitivity was 72.88%, specificity was 100%, PPV was 100%, and NPV was 85.72%. Conclusions: Procalcitonin in comparison with CRP shows better sensitivity and negative predictive value.

Introduction: Phalanx fractures are among the most common fractures of the hand. They may lead to loss of function if treated inappropriately. These injuries can be treated conservatively. However, in case significant shortening, rotational deformity and angulation occurs, surgical treatment is required. Materials and Methods: The retrospective study consists of 15 patients who had undergone surgical management of phalanges fracture of hand at the department of orthopedic surgery, IGIMS, Patna from Aug 2016 to Dec 2018. Patients had suffered injuries of phalanges. The mechanisms of injury were finger crush at work, fall from motorcycle or bicycle, and fall from own height or during physical assault. In this article, results of Phalanx fractures treated with open reduction and internal fixation with mini plates were presented Result: The treatment of phalanx fractures with plates ORIF got bone healing in all cases and satisfactory results in 90% of the cases, with low complication rates of joint stiffness Discussion: Nowadays osteosynthesis has replaced the traditional method of AO steel plates for mini fragment fractures of hand. Their multiple designs, many of them being pre-contoured, their delicate craft and their low profile allow the surgeon to get rigid internal fixation with less interference in the normal tendon sliding, and give the patient the possibility to develop early joint mobility and better functional results.

Introduction: Superficial mycoses are among the most frequent forms of human infections, affecting more than 20-25% of the world's population. They are predominantly caused by a group of closely related keratinophilic mycelial fungi, dermatophytes and less frequently by nondermatophytic fungi like Malassezia. These infections are especially common in tropical countries like India due to environmental factors like heat and humidity. Aims and objectives: The aim of this study was to analyze the trends of fungal species causing superficial fungal infections among patients presenting to dermat clinic in tertiary care center.. Materials and methods: This was a cross-sectional study carried out over a period of three months from August 2018 to October 2018 in Narayan Medical College & Hospital Jamuhar Sasaram. Samples were obtained from patients who attended the dermatology department of NMCH Jamuahr Sasaram. These samples were collected with standard mycological protocol and then sample were subjected to10% KOH mount for direct microscopy and culture in Sabouraud dextrose agar (SDA) with cycloheximide chloramphenicol and speciation with Lactophenol Cotton Blue(LCB) mount. Result: A total of 310 sample were processed of which skin scraping was 305 (98.38%) followed by nail clipping 3 (0.96%) and plucked hair 2 (0.64%). Out of 310 sample examined 260 sample showed septate fungal hyphae with direct microscopy; Of which 78(30%) showed growth on SDA. Among 78 isolates, 74(94.88%) were dermatophytes, of which Trichophyton mentagrophytes were maximum 26(32.05%) followed by T. verrucosum 21 (26.92%), T. tonsurans 16 (20.51%), T. rubrum 7(8.9%) and non speciated Trichophyton species were 6(7.6%). Conclusion: Our study showed that T. mentagrophytes was the commonest dermatophyte causing superficial fungal infection.

Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis. Pancreatic necrosis is associated with high mortality and morbidity. In the last few decades, there has been a significant revolution in the treatment of infected pancreatic necrosis. A step-up approach has been proposed, from less invasive procedures to the operative intervention. Minimally invasive treatment modalities such as endoscopic drainage and necrosectomy, percutaneous drainage, and minimally invasive surgery have recently replaced open surgical necrosectomy as the first-line treatment option. Endoscopic intervention for pancreatic necrosis is being increasingly performed with good success and a lower complication rate. The objective of this paper is to update the concepts of endoscopic interventional therapy of pancreatic necrosis^[1].

Pedophilic disorder is a paraphilic disorder in a person atleast 16 years or older and is characterised by sexual fantasies and attraction to children who have not yet attained puberty. These fantasies are acted upon causing marked distress or interpersonal difficulties in patient and risks the child victims well being, negatively affecting their psychosocial development. It remains a challenge for clinicians and researchers in terms of under reporting and effective treatment measures. In the present case we report a case with this disorder in order to better understand this clinical construct.

Pancreatic pseudocysts are complications of acute orchronic pancreatitis. Most common site of pseudocyst is lesser sac. Mediastinal extension of pseudocyst is rare. Most pseudocystsresolve spontaneously with conservative management. The size and duration of pseudocyst formation has been present as poor predictors forpseudocyst resolution, but in general, larger cysts are more likely to be symptomatic or cause complications. This patient presented withheaviness in chest and dysphagia. Computed tomography abdomen and thorax showed a large thoraco-abdominal pseudocyst. It was confirmed to be pancreatic pseudocyst by analyzing fluid for amylase and lipase intraoperatively. In our patient, the pseudocyst was accessible transabdominaly. Cystogastrostomy was not possible as cyst wall was not adhered with stomach. So, we did retrocolic and retrogastric Roux-en-Y cystojejunostomy.

Coxa vara due to femoral neck non union is a common presentation. It is treated by abduction osteotomy usually fixed with DHS or double angle DCS. Narrow DCP was used to fix the osteotomy and fracture site together in 12 patients with average age of 6.1 yrs. Pre operative average neck shaft angle was 91.660 Pauwel's angle was 61.250, shortening was 1.75 cm and neck was retroverted 10.410. Postoperative average neck shaft angle was 115.80, Pauwel's angle was 38.50, persistent limb shortening was noticed in 3 cases and lengthening of 1.0 cm in one case. All the cases had complete union of osteotomy site in 7.5 weeks and fracture site in 12.5 weeks on average. No bone grafting or hip spica was done. Over 2 yrs follow up the implant position was intact, no loosening and change of neck shaft angle was noted. We conclude that narrow DCP is a good implant to fix these osteotomies and Pauwel angle correction is more important than correction of neck shaft angle.

Incidence of Situs inversus, rare condition is 1 in 10,000. In a patient with situs inversus, anaesthetic management becomes challenging due to anatomical abnormalities and transposition of thoraco-abdominal viscersa. We are reporting a patient who had situs inversus with dextrocardia and was posted for laproscopic cholecystectomy. The present case report emphasize on various difficulties during anaesthetic management and its various implications.

Multiple primary malignancies, metachronous or synchronous in a single patient is a relatively rare event, however during the past decade there has been an increase in the incidence of multiple primary malignancies being reported. These malignancies seem to be diagnosed in a higher incidence than that predicted by influence of hazards. Furthermore increased survival of cancer patients, the growing life expectancy and the development of improved diagnostic techniques all have contributed to the increased frequency of multiple primary malignancies. Whenever these malignancies are found they raise questions regarding not only possible common etiologic factors or same pathogenetic mechanisms, but also pose challenge to clinicians to find anticancer therapy strategy that covers both cancer types without increased toxicity or relevant pharmacological interactions and without negative impact on outcome. Case Presentation: A 65 year old Hindu female presented to opd of gynecological oncology of IGIMS, Patna with the complain of pain and lump in left breast for 6 months and something coming out per vaginum for 10 years. Histopathology of cervix showed squamous cell carcinoma grade 2 (large cell non keratinising) and clinical stage was Ib2. HPE of mastectomy specimen showed infiltrating duct carcinoma with no lymphovascular invasion. Patient was treated with surgery for cancer of both the sites. Patient is on regular follow up having no fresh complains and clinically no evidence of disease. Thus it was concluded that patient responded well to treatment. Treatment strategies in case of synchronous double malignancy depends on treating the malignancy that is more advanced first or both could be treated simultaneously. In our case we concluded that synchronous double malignancy may be treated successfully simultaneously. Both tumors should be treated fully as if they were occurring independently.