Cervical cancer has a major impact on the lives of Indian women with an estimated 1,22,844 new cases diagnosed and out of them 67,477 die from disease every year. Incidence of cervical cancer in Bihar is very high. Locally advanced cervical cancer is commonly seen because of the high prevalence of associated risk factors like low socioeconomic states, poor access to health care, high parity, early age of marriage and first pregnancy, persistence of genital infection specially HPV, low immune status, poor genital hygiene and nutritional status. Besides, there is lack of organized screening programme and treatment facilities for these patients in Bihar. Increasing awareness about early signs and symptoms especially among the rural population, widespread use of HPV vaccination and simple screening techniques like visual inspection with acetic acid is urgently required to control the rising number of cervical cancer cases in the state of Bihar. A tremendous boost is also required in the availability of gynaecological oncology and radiotherapy units, other infrastructure and trained personnel in the field of oncology.

Introduction : Complicated grief is a debilitating illness with millions of people suffering from this condition globally. In Indian setting, where still the majority of such patients are being seen by primary care physicians, it is imperative for clinicians to understand the phenomenology of grief and to provide evidence-based pharmacotherapy only to those who need it. Materials and Methods : A literature search was done in Pubmed database using the keywords: complicated grief, traumatic grief, prolonged grief. Research articles of pharmacological treatment of complicated grief were also included. Discussion : Various terms related to grief like; bereavement, traumatic grief, prolonged grief as well as the recently introduced terms Persistent complex bereavement disorder (PCBD) and prolonged grief disorder (PGD) were discussed and differentiated. The pharmacological trials targeting complicated grief were also highlighted. Conclusion : Although psychotherapeutic options are available for complicated grief, but there is a need to study drugs of better safety and efficacy profile to be able to provide faster relief to the ever increasing population of persons with complicated grief.

Objective: This study was designed to evaluate the efficacy of topical ofloxacin, pefloxacin, lomefloxacin, sparfloxacin in the experimental model of corneal ulcer. Methods: Twenty New Zealand albino rabbits of either sex weighing 1.5-2 kg body weight were used for the corneal ulcer efficacy study, Staphylococcus aureus was cultured in 1% peptone water by incubating it at 37? c for 48 hrs. The colony forming unit (CFU) was estimated by using standard McFarland’s tube. Sterile Saline (0.05 ml) containing Staph. Aureus 5x 10⁶ CFU per ml was used for the induction of corneal ulcer. About 10-15μl of the incoculum was injected intrastromally into the peripheral cornea of rabbits using a 1 ml tuberculin syringe fitted with 30G needle. After delivery of inoculums, the epithelial layer was carefully removed by scratching with scalpel blade just above the inoculums delivery site. Before induction of corneal ulcer, all the rabbits were anaesthetized. The antimicrobial therapy was initiated after 18 hrs of the inoculation. 50 μl of formulation were instilled four times a day. Treatment was given up to 4 weeks in each group. Results: After 14 days of treatment with lomefloxacin and sparfloxacin a significant reduction in ulcer size was recorded in the animals. Where as the same was achieved in 7 days after topical ofloxacin treatment. Based on this observation, the efficacy of the tested formulations can be graded in this following order i.e pefloxacin = nanoparticulated sparfloxacin> sparfloxacin> lomefloxacin> ofloxacin. While comparing the percentage healing that occurred after two weeks of therapy, (using the ulcer size) pefloxacin (0.3%) showed 100% healing. Conclusion: Efficacy wise pefloxacin was found to be superior as compared to other fluoroquinolones studied.

Objective: To evaluate the clinical presentation, management, complications, surgical management and long term outcome of Posterior urethral valve. Methods: A retrospective study was done on 203 patients of Posterior urethral valve treated in the Department of Paediatric surgery, Indira Gandhi Institute of Medical Sciences, Patna from January, 2011 to December, 2016. Data regarding clinical history, examination findings, investigation results and treatment given were collected from their case records. Data collected were analyzed. Results: A total of 203 patients with a mean age of 31.78 ± 9.11 months presented to the Paediatric surgery department with dribbling, poor urinary stream (55.17%) and urinary tract infection (36.94%) as the major symptoms. Ten patients had an antenatal diagnosis and twenty five patients presented early as neonates. Vesico-ureteric reflux was found in 55.66% cases. While 71.92% patients had cystoscopic fulguration, in 13.79% patients we had to use Chooramani Hook to ablate the valves and 14.29% patients had to be diverted to treat urosepsis. Residual valves were seen in 15.76% cases. Valve bladder syndrome occurred in 60.59% cases. There were seven deaths in the study. Mean follow-up in our series was 2.6 ± 1.1years. Conclusion: Urinary drainage by feeding tube in neonatal period, followed by cystoscopic valve ablation is the appropriate treatment in patients of PUV. Urinary diversion helps in cases of urosepsis which don’t settle on catheterization or valve ablation. Early diagnosis, early valve fulguration and management of Valve bladder syndrome have significant impact on outcome.

Background : This comparative study was conducted to compare the efficacy and safety of 50 μg of intravaginal misoprostol with 0.5 mg of intracervical dinoprostone gel in terms of the induction-initiation interval, induction- delivery interval , mode of delivery and associated maternal and fetal complications. Methods: 50 patients who were admitted for induction of labour were included in this study. They were randomly selected to receive either intravaginal misoprostol or intracervical cerviprime gel. 25 women received intravaginal 50 μg Misoprostol (Group A) every 4 hours for maximum of 6 doses and 25 women received 0.5 mg of intracervical cerviprime gel (Group B) till maximum of 3 doses. Comparison was done in terms of time taken for induction to delivery, mean time taken for onset of labour, mode of delivery , maternal complications, APGAR score at 1 and 5 minutes and the neonatal outcome in either of the groups. Result: The mean time taken for onset of labour was less in the misoprostol group than in the cerviprime group (6.7 hours v/s 7.5 hours, P = 0.47). Similarly duration from induction to delivery was less (23.5 hours v/s 25.8 hours, P >0.33) for misoprostol than cerviprime gel. Cesarean section rate was slightly less in misoprostol group (40% v/s 44%). Maternal complications were minimal in either group & the neonatal outcome was good in both the groups. The induction cost was much less in the misoprostol group. Conclusion: Compared to cerviprime gel; misoprostol is safe, efficacious, cheap, well tolerated drug by mother and fetus. It was found to be a better inducing agent, has short induction to delivery interval thus short duration of labour.

Purpose : To review the results of patients who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL) done in IGIMS. Methods : Patients having symptomatic ACL-deficient knees and who wanted to continue an active lifestyle or maintain sporting activities were included. ACL reconstruction using the quadrupled hamstring autografts in more than 100 patients were done . One-year follow up was completed in 56 patients who were then reviewed. The mean age of patients reviewed was 26.8 years (range, 21-39 years), of whom 35 (62.5%) were aged between 26 and 30 years. There were 52 male and 4 female patients (ratio, 13:1). Injuries on the left side was greater than right (32 versus 24).Both motor vehicle accidents as well as Sports injuries accounted for 46.4% (n=26) of patients, while household injuries accounted for 7.2% (n=4). Results : Excellent and good-to-excellent results were achieved in 6 (10.7%) and 40 (71.4%) of patients respectively. Residual knee swelling (n=13) was the most common complication, followed by difficulty in regaining full range of motion (n=9) and divergence of femoral screw (n=6). Conclusion : This procedure at IGIMS provided consistent and reproducible results and allowed patients, an early return to daily activities with minimal morbidity.

Objective : Intussusception is the most common cause of acute intestinal obstruction in infants and young children. Very few studies on the epidemiology of intussusception have been done in India, particularly the eastern part of our country. Government of India recently introduced rotavirus vaccine in national immunisation schedule (NIS). Earlier some licensed rotavirus vaccine had been seen to be associated with occurrence of intussusception. Though newer rotavirus vaccines have not been seen to be associated with intussusception, background data on epidemiology, clinical presentation and outcome of intussusception cases are required to correctly compare and analyse the scenario in pre and post introduction of rotavirus vaccine. Methods : Retrospective surveillance of intussusception cases of age group 0-2 years admitted during period of 5 years, from March 2012 to February 2017 at IGIMS, Patna was done. For diagnosis of intussusception, Brighton collaboration working group definition was used. The baseline demographic data, clinical signs and symptoms, immunisation history (with particular emphasis on rotavirus vaccine) and diagnostic and treatment procedures were extracted for analysis. Results : There were 31 confirmed cases of intussusception during study period. The median age of diagnosis was 9 months with male to female ratio of 3.2: 1. The mean time of presentation to hospital from onset of symptoms was 56.4 hours. Vomiting (80%), blood in stool (76%), abdominal pain (72.5%) and diarrhoea (52%) were the most common symptoms. Intussusception case occurred round the year with peak occurrence from January to March. No intussusception associated death was recorded. The commonest type of intussusceptions was ileo-colic (80. 4%) followed by colo-colic (12.6%). Direct surgical intervention was carried out in 66.5% cases where as in 18.2% cases surgery was required after failure of non-surgical measures. Out of 31 cases, immunisation records were found in 22 cases. None of them had been vaccinated with rotavirus Vaccine. Conclusion : This study provides the baseline data of epidemiology, clinical presentation and outcome of intussusception at a tertiary care hospital. A prospective surveillance study is highly needed to assess impact of rotavirus vaccine on intussusception occurrence in the post rotavirus vaccines introduction scenario.

Background : Thyroid function has been suggested to interfere with tumour biology and affect the prognosis of various cancers. The present study was performed to evaluate pre-therapeutic serum thyroid-stimulating hormone (TSH) levels in all endometrial cancer (EC) and to study the relation between thyroid hormone and endometrial cancer. Material And Methods : This retrospective study was done in 46 diagnosed patients of endometrial cancer and a control group of 50 patients with no cancer. The pretheraputic levels of thyroid stimulating hormones were recorded and analysed. Results : In our study we found significant number of endometrial cancer patient had deranged thyroid profile as compare to control group with p value 0.0057. Most of endometrial cancer patients were menopausal (86.96%) and mean BMI was 28.78 (in control BMI was 21.01). Conclusion : The results showed that TSH may increase the incidence of uterine cancer especially after menopause as it increases the BMI and estrogen and decreases adiponectin leading to hormonal imbalance. Hence TSH is a possible risk factor for uterine cancer especially after menopause. Thus women should pay attention to their thyroid function during menopausal age to reduce the risk of uterine cancer.

Benign cystic ovarian teratoma is the most common ovarian neoplasm accounting for 10-25% of all ovarian tumours. They may remain asymptomatic and may be discovered as an incidental finding on ultrasound of pelvis or can present as acute abdomen in case of torsion (16%), infection (1%) or rupture. It can rupture into the bladder, small bowel, rectum, sigmoid colon, vagina, anterior abdominal wall and peritoneal cavity^[1]. Symptom develop once complication set in. Invasion into adjacent viscera such as the rectum, the small bowel, the peritoneum and the Urinary bladder is extremely rare. We present a rare case of mature cystic teratoma perforating into the urinary bladder. Presenting with irritative lower Urinary tract symptoms characterized by Urgency, frequency, dysuria, poor urinary stream.

Leptospirosis and scrub Typhus are zoonoses with worldwide distribution. Both are important causes of acute febrile illness. The clinical presentation is wide for both disease ranging from mild to fatal. A diagnosis of confection with leptospirosis and scrub typhus may be underdiagnosed due to lack of clinical suspicion. we are reporting a case of confection with leptospirosis and scrub typhus who presented with fever, breathlessness and altered sensorium at emergency and admitted under general medicine department of Indira Gandhi institute of medical science, Patna. Patient was initially treated empirically as a case of acute febrile illness with encephalopathy, later on specific therapy started after serological confirmation of leptospirosis and scrub typhus and the patient responded very well to the therapy without any sequelae during hospital stay and follow up.

Adenexal torsion is partial or complete rotation of adenexa around its pedicle. Ovarian torsion occurs predominately in the reproductive age group. Diagnosis is based on the clinical and the radiological findings with color Doppler imaging showing decreased or absent blood flow in the ovarian parenchyma depending on the degree of torsion. If diagnosed early cystectomy can be done, however if the ovary becomes gangrenous oophorectomy may be required. Here we report a case of torsion of left ovarian cyst in 21 yrs old primigravida in her second trimester of pregnancy who presented in our emergency with complain of acute abdomen and vomiting since one day. She was diagnosed on the basis of clinical and ultrasonographic finding. Emergency laparotomy was planned and left salpingooophorectomy was done. Specimen was sent for histopathological examination which showed benign serous cystadenoma with unremarkable tube. Patient was kept under regular antenatal checkup. She delivered alive female baby of birth weight 3.0Kg at term by caesarean section.

Colorectal cancer generally seen in elderly around 5th-6th decade of life and rarely seen in pediatric age group with an incidence of only 1.3-2 cases per million noticed. Due to the nonspecific symptoms and lack of awareness often diagnosed at advanced stage which results in poor prognosis. Children with altered bowel habits not responding to symptomatic treatment should be evaluated with simple digital rectal examination, followed by sigmoidoscopy or colonoscopy if required.

Arteriovenous malformation is rarely seen in the foot. It is mostly found in the brain, lungs, pelvis and thigh of the lower extremity. It occurs as a result of failed fetal vascular development. It may be associated with dermatologic and osseous manifestations. Chronic ulcerations in foot due to malformation may lead to amputation. Once identified, it should be completely evaluated. We report a case of an adult female with arteriovenous high-flow malformation of the foot. The diagnostic dilemma has been highlighted.

The intestinal parasites interfere in nutritional and immune status, causing secondary infections, like Mycobacterium tuberculosis. Here we report a case with Entamoeba histolytica, Hookworm and Gastrointestinal tuberculosis co-infection which was not easy to diagnose. This 25 year old female patient, complained of vomiting, lower abdominal pain and giddiness. left iliac fossa mass was observed. On stool examination, trophozoites of Entamoeba histolytica was found. Stool for occult blood was negative. On Ultrasonography abdomen colitis was suspected. In repeated USG live worm was seen in bowel loop. Solitary enlarged mesenteric lymph node with cystic degeneration at umbilical region, of >10mm size was suspected to be tubercular node. Albendazole was given. After 15 days, on repeated Ultrasonography it was found that lymph nodes were matted and necrotic, Further USG guided FNAC was done from the lymph node and pathological report confirmed it as a case of tuberculosis. Antitubercular treatment was given to the patient. Patient responded well.

Dental traumatic injuries occur in 2-5% of the cases, most commonly involving the maxillary incisors. The resultant traumatic injuries cause immediate disfigurement resulting in unappealing aesthetics which can make an individual psychologically depressed and socially restrained. A fractured tooth or a malposed tooth can give an individual a reason to feel conscious about oneself. With the advancement in cosmetic dentistry and endodontics, the aforementioned plethora of esthetic woes can be changed and restored to more desirable form. Treatment protocol will depend on a number of factors which are:- preservation of natural tooth structure, patient’s expectations and the expertise of the treating doctor. The present case report emphasizes on immediate aesthetic management of crown root fracture with a fibre post followed by composite restoration; all aimed at providing the ‘Perfect Smile’.

Secondary gynaetresia may occurs due to trauma to the female genital tract with secondary infection and adhesions. Post traumatic vaginal stenosis after full term vaginal delivery is rarely seen in gynaecological practise. We report a case of 25 years old women presenting with secondary infertility, scanty flow during menses and pain lower abdomen. On per speculum examination she was found to have vaginal septum. She had full term vaginal delivery 8 years back with history of traumatic post partum haemorrhage in the first delivery. Ultrasonography showed normal uterus, 7x4 cm right sided dermoid cyst. Laparotomy was done along with right oophorectomy. With help of combined abdomino-vaginal approach septum was incised horizontally. Continuous interlocking suture were taken at raw bleeding edge of vaginal septum to secure hemostasis.

Median raphe cyst is a rare benign cystic lesion, located in the midline, anywhere between the external urethral meatus and the anus. We report a case of 60 year old male, who presented with a recently enlarging, cystic, mobile, painful, fluctuant swelling in the foreskin. He underwent excision of the prepucial cyst along with circumcision. Histopathological features were consistent with prepucial median raphe cyst. This case is being presented for it’s rare location, uncommon clinical presentation and an interesting mixed lining epithelium on histopathological examination.