In current scenario world is entering into the antibiotic resistant era. Serious infections caused by bacteria are increasingly becoming resistant to the currently available antimicrobial agent. These infections are not only causing morbidity and mortality but also leads to financial burden to the individual, society and ultimately to the nation. The greater concern is spread of these infections from hospitals to the community. Microbes have developed resistance to nearly all different classes of antibiotics discovered till date. Resistance found commonly is acquired and transmitted horizontally via the conjugation of a plasmid. Recently new mechanisms of resistance have resulted in the simultaneous development of resistance to several antibiotic classes creating very dangerous multidrug-resistant (MDR) bacterial strains, some also known as “superbugs”. Indiscriminate and inappropriate use of antimicrobial in outpatient clinics, hospitalized patient and in livestock is the most important factor for antimicrobial resistance. Recently pharmaceutical industries have slowed or terminated their anti-infective research programs due to economic reasons. This decrease in the number of new antimicrobial along with the antimicrobial resistance has triggered the post antibiotic era i.e., age when the antibiotics will be the thing of past. Now it is high time to think about formulatingthe strategies by the industry, academia and the government for safe and effective use of antibiotics.

Background: Variation in the morphology of suprascapular notch is associated with suprascapular nerve entrapment neuropathy. So, the knowledge about different shapes of suprascapular notch is important for clinicians in understanding the source of the entrapment syndrome. Aims & Objectives: The aim of this study is to document the incidence of morphological variations in shape of suprascapular notch in Indian dry scapulae & compare it with incidence among various races of world to know its clinical significance. Materials & Methods: A total of 226 dry human scapulae of both sides are analyzed to see the variation in the shape of suprascapular notch on superior border of scapula. Results: In the present study, we found five different shapes of suprascapular notches. Out of 226 scapulae, 81 (35.84%) scapulae has Deep U Shaped, 72 (31.86%) scapulae has shallow U Shaped, 49 (21.68%) scapulae has J Shaped, 13 (5.75%) scapulae has V Shaped & 11 (4.87%) scapulae has indented suprascapular notch. Among these different types, Deep U shape is most common & Indented is least common type of shape of suprascapular notch. Conclusion: The knowledge about the different shapes of suprascapular notch and its involvement in suprascapular nerve entrapment neuropathy helps the clinician in early diagnosis and planning about the most suitable surgical intervention.

Introduction: Propofol causes pain on injection in 28% - 90% of patients. A number of techniques have been tried for minimizing propofol induced pain with variable results. Objectives: To compare the use of lignocaine, metoclopramide and metoclopramide &lignocaine combination for the reduction of pain during injection of propofol in adult patients. Design: A prospective, double blind, randomized study. Setting: Department of Anaesthesiology and Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna Period: From June 2007 to March 2008 Materials & Methods: 150 subjects (ASA I-II) scheduled for elective operations under general anaesthesia were allocated into three groups and treated as follows: Group A:40mg lignocaine 2%(2ml) and 2ml normal saline; Group B: 10 mg metoclopramide(2ml) and 2ml normal saline ,Group C 40mg lignocaine 2% &: 10 mg metoclopramide. Pain intensity was graded by a single blinded observer and recorded as either severe, moderate, mild or no pain according to the response of the patients to the injection. Results: The incidence of pain was 46% in metoclopramide group compared to 26% in the lignocaine and 12% in the lignocaine& metoclopramide group. Conclusion: lignocaine & metoclopramide combination is more effective than metoclopramide and lignocaine alone in decreasingthe pain of propofol injection.

Cervical Cancer has a high incidence amongst Indian women. More than 70% of cancers in females occur at the age group of 3564 year, and that these cancers produce an adverse influence on the productive role of women in our society. Over 70% of female patients in India, report for diagnostic and treatment services atan advanced stage of disease, resulting in poor survival and high mortality rates. Objective: To estimate the sensitivity and specificity of conventional method i.e pap smear as primary screening for cervical intraepithelial neoplasìa (CIN). Material and Method: Pap smear was done on 4957 women aged between 15 to 68 years in IGIMS from 2008-2014. Each woman had at least four cervical biopsies (at 2,4,8, or 10 o’clock at the squamo columnar junction in each normal quadrant), after abnormal cytology report. Results: 190(3.81%) women were reported as ASCUS, 25(0.50%) as AGUS, 25(0.50%) women had biopsy-proven as LSIL, 20 (0.4%),as HSIL and 35(0.7%) had invasive cancer. Cytological inspection yielded normal results in 975 women (19.6%), inadequate cytology in 595 (11.99%), inflammatory cytology report in 2840(57.48%), atrophy 110(2.2%), metaplasia in 140(2.8%). Conclusion: Conventional cervical cytology is an efficient tool for cervical cancer screening followed by biopsy according to abnormal pap smear finding and treatment (if cervical dysplasia is diagnosed).

Background & Aims: Buccal mucosa graft is now established as tissue of choice for urethral reconstructive procedure. However, common habit of tobacco and betel nuts chewing in our part of the country affects buccal mucosa and often found not suitable for use as graft in urethral reconstruction. Lingual mucosa may be a good alternative since it is usually spared from fibrotic process observed in buccal mucosa. We present our experience of lingual mucosa graft urethroplasty for anterior urethral stricture. Material & Method: Thirty four prospectively selected patients with anterior urethral stricture fulfilling selection criteria underwent lingual mucosa graft(LMG) urethroplasty from August 2006 to February, 2012. The mean length of stricture was 4.7 cm(2.0-7.0 cm). Lingual mucosal graft was harvested after assessing the length and breadth of urethral defect using standard operative technique. Patient were followed up with subjective and objective urinary flow rate. Retrograde urethrogram(RGU) and urethroscopy were performed when needed. Result: Urethral stricture recurred at proximal or distal end of the graft in 8 patients during the mean follow up of 21.7 months. Success rate was 77.5%. Conclusion: Lingual mucosa is a good substitute for urethral reconstruction and should be considered when buccal mucosa is not suitable for its use.

Background: Dorsolumbar segment is more mobile and become more unstable spine after the injury. The goal of ourtreatment is early neural decompression with stable rigid internal fixation using pedicular screws. Objective: To prevent the complication of traumatic paraplegia and further neurological deterioration by early mobilization and to achieve the neurological improvement by neural decompression is the main objective of this study. Materials & Methods: This study was done on forty five patients (M: F=5.4:l ratio), 20-65 yrs of age (mean=38yrs), with post traumatic instability (duration <3weeks) of lower thoracic or lumbar spine. All were managed surgically. All the patients were mobilized within a week with thoracolumbar spinal brace (Rigid type). The spinal support was used post operatively in all the casesfor 1st three months. Results: The neurological statuses of the patients were recorded as per Frankel grading pre and postoperatively. The patients with incomplete neurological injuries had recovery in 77.78% of cases; little changes were seen with complete neurological injury. Complications like bed sore, superficial skin infections and peroperative durai tear were encountered but all were managed successfully. Conclusion: Study indicated that, Early Short Segment Pedicular Screw Fixation method is a safe, effective and also incurs low cost.

Introduction: Hydatid disease is relatively uncommon in children. The disease is endemic in many parts of the world. It is well recognized and documented in some parts of India also, but not in Bihar. The aim of this study was to share experience on the clinical history, diagnosis, and treatment outcome of hydatid cyst in paediatric age group in Bihar. Materials and Methods: The study was conducted as a single case series of current cases in paediatric patients at Indira Gandhi Institute of Medical Sciences, Patna over a time period of two years. Surgical specimen of clinically and radiologically suspected cases were sent for confirmation of hydatid disease, by histopathological and simple microbiological examinations. The cases were managed by surgery with oral Albendazole perioperatively. Results: Six cases (60%) were male and 4 (40%) female. Mean age of cases was 8.1 years. Youngest case was 3 years old male. All the cases (100%) belonged to rural area. Only liver and lungs were found to be the organs involved. Presence of Echinococcus was confirmed in all the suspected surgical samples (100%) by histopathological and simple microbiological examinations. There was no intra or post operative complication. There was no mortality. Conclusion: Hydatid disease should be suspected in the patients, who present with cysts in any organ of the body; even if they belong to a paediatric age group and “not documented for endemicity” area for the disease, but have a rural residence history.

Background: Epilepsy is the most common neurological disorder of childhood. Most of the cases are idiopathic. Some are benign, needs no treatment and self-remits in adulthood. Aims: To study the clinical profile, aetiological factors, correlation between seizure semiology, EEG, brain imaging and prognosis of childhood epileptic syndromes. Material & Methods: A total of 840 epilepsy patients seen over 1 year of study. Out of which 177 were between 1-14 years of age, but only 100 were included in the study according to inclusion criteria. Proper clinical history, surface EEG and brain imaging were performed. Results: Childhood epilepsy accounted for 21% of all epilepsy patients. The incidence of idiopathic localisation related epilepsy was 6.2% ,Idiopathic generalised epilepsy accounted for 18%. The commonest seizure type among localisation related epilepsies was partial seizures evolving to secondarily generalized. Conclusion: Childhood epilepsies are a common neurological problems accounting for 21.1% of the total epilepsy patients. Benign epilepsy of childhood with centro temporal spikes was the commonest idiopathic localization related epilepsy, whereas Juvenile myoclonic epilepsy was the commomest idiopathic generalized epilepsy. A family history of epilepsy was more commonly noted in JME. Therapeutic response were better observed in idiopathicepilepsies.