Background: The burgeoning field of psychopharmacology is confronting the conventional concept of psychotropic drugs, questing new and superior drugs claimed to be safe and more efficacious. Despite the fact that these drugs have had an exceptional impact in past, their use, effectiveness and safety needs continuous study. Aim: The present study was thus designed to analyse the prescribing trend of psychotropic drugs and their adverse drug reactions (ADRs). Materials & Method: This was an observational, prospective study conducted for three months in which 180 patients were studied for pattern of psychiatric disorders, psychotropic drugs prescribed and their ADRs. The ADRs were further analysed for their gender & age distribution, pattern/types, suspected drugs, causality, severity and preventability. Result: Depression was found to be the most common psychiatric disorder (32.7%). Anxiolytics (24.3%) in which clonazepam (38.3%) was the most frequently prescribed drug. The prevalence of ADRs was more in females (58.2 %). ADRs mostly occurred in the age group of 20-39 years (42.2 %). The most common ADR was weight gain (17.41 %). Causality, severity and preventability assessment revealed that 78(51.6%), 134(88.7%) and 102(67.5%) ADRs were of probable/likely, mild and non-preventable category. Conclusion: Perpetual vigil about psychotropic drugs might help in early detection of their ADRs and can reduce the risk caused by them. This may further, improve the quality of care, reduce the treatment cost and can improve the patient’s compliance. Such a database can provide early warning signals of drug reaction if kept under active scrutiny.

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Maxillo-mandibular fixation (MMF) or intermaxillary fixation (IMF) is one of the procedures in the management of maxillo-facial trauma fracture cases. This is done to ensure immobilization of jaws, which is necessary in the management of trauma. The drawback of conventional IMF includes viz; time consuming technique, risk of transmission of disease via blood-borne pathogens and pricks by the wire, multiple armamentariums required for arch bar placement and removal and final removal of IMF further needs secondary procedure. The aim of this article is to present a case of mandibular fracture treated with orthodontic bracket and elastics method which shall alleviate the drawbacks of conventional arch bar method of IMF.

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Background and purpose: Bell’s palsy occurs due to impairment in facial nerve which leads to loss of complex and multidimensional functions of the face, including expression of emotions, facial identity, and communication. However, most interventions for Bell’s paralysis are unidimensional and impairment oriented. Thus, a functional training program with patient education intended to address various dimensions of disability caused by Bell’s paralysis was devised. This patient-centered, multidimensional approach to the rehabilitation of people with Bell’s paralysis consists of patient education, functional training, and complementary exercises. This approach is focused on various dimensions of disability, including the physical, emotional, and social dimensions, by encouraging context-specific facial functions, positive coping strategies, and social interaction skills. Case description: Patient was a 16 year old girl, She was diagnosed with Bell’s palsy at age of 2 years. The patient’s problems were evaluated with the Facial Disability Index (physical function subscale score 60/100, social/well-being function subscale score 68/100) and an informal interview exploring her experiences and priorities, and facial symmetry measured with Facial Grading System (64/100) Study Design: Single Case study Outcome measures: The primary outcome measure for facial symmetry and social participations measured by using Facial grading system (FGS) and Facial disability index (FDI). Intervention: Patient education and functional training. Results: Post intervention FGS & FDI scores shows significant changes. Conclusion: The functional training of the facial muscle in the context of patients’ social environment is effective intervention in improving the patients’ physical as well as social function.

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Introduction: After world war two, this time world is facing the corona virus COVID-19 pandemic as a greatest challenge to humanity. It has been declared as a global public health emergency by WHO. COVID-19 has brought enormous economic, social and healthcare disruption worldwide. The impact of the infection is more in the elderly and those with known co-morbid illnesses including cancer. India reported its first confirmed case of the Corona virus infection on 30 January 2020 in Kerala who had a travel history from Wuhan, China. Indian people accepted nationwide lockdown from 24th march 2020. Lockdown was enforced to reduce community transmission of COVID 19 cases. Lockdown caused more hazards to the most vulnerable section of health sectors mostly to cancer patients. This study was designed to study the reason which compelled gynecological cancer patients to reach tertiary care centre even in lockdown period and their triage done during COVID time. Materials and methods: This is a retrospective observation study which was carried out in department of gynecological oncology of IGIMS, Patna, a tertiary care centre during period of complete nationwide lockdown. All new patients with gynecological complain who presented at emergency or outpatient department were included in this study. Patients were asked about the reasons which compelled them to visit this regional cancer centre in the current scenario of complete lockdown. Patients who were previously diagnosed with gynecological malignancy and were receiving treatment in this centre were excluded from the study. Result: A total of 70 patients of which 37 patients visited with complain of increased vaginal bleeding followed by 33 patients with abdominal pain and distension. Watery discharge per vagina was found in 2 patients.6 patients came with ultrasound report without any complain. Most of the cancer patients reached in advanced stage. Discussion: Cancer patients are at increased risk of COVID infection due to their decreased systemic immune state. There is insufficient data available to support the impact of this novel infection on cancer patients. Lockdown on the other hand has reduced the visit of needy cancer patients to the health sectors. And also further delay in providing care in the current lockdown situation is likely going to upstage the disease and increase the burden of more advanced, inoperable cancer cases. In the present scenario of complete lockdown all over country, symptoms like vaginal bleeding and abdominal distension forced these cancer patients to reach tertiary care centre. Conclusion: Throughout the course of history, many disease outbreaks have been seen ravaging humanity, sometimes altering the course of history and, sometimes, signaling the end of entire civilizations. The pandemic impact on cancer care is yet to be seen. Lock down situation and ongoing crisis should not cause delay in management of cancer patients. Vaginal bleeding and abdominal distension can be considered as prime symptoms which forced patients to travel a long distance even in this curfew like situation. Gynecological Cancer patients are often seen for first time in advanced stages. So it is duty of oncologist to urgently triage cancer patients when they reach to them even in this tough curfew like situation.

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Background: Till the enigma of COVID-19 unfolds, we as health personnel should come out slowly from this imposed lockdown. We should provide our essential services to our needy patients taking all the safety measures during this pandemic. Medical services are in catch22 like situation regarding admission of non-COVID emergency cases and their management. These problems are going to multiply if not tackled properly and for this we, need a clear-cut guideline from the competent authority. Objectives: To assess the real burden of paediatric surgical emergency cases during COVID-19 forced lockdown at a tertiary hospital. Methods: Data of all paediatric surgical emergency cases from 22nd March, 2020 to 21st May, 2020 (after lockdown enforcement and both before and after employment of institutional SOP) were collected retrospectively and analysed on the basis of the demographic status of the patients, diagnosis, and duration of stay in hospital with their outcome. Before institutional SOP (13th April 2020) was formulated, all emergency cases were operated without knowing their COVID status; however, later strict adherence to institutional SOP made it possible for only COVID-19 negative patients to be operated. Results: Seventy patients were admitted for different surgical problems. Sixty three of them treated and discharged subsequently after successful outcome. Seven patients succumbed because of the severity of the disease and sepsis. Conclusion: Every institute and hospital should develop their own SOP. Following our institute’s SOP, we saved more than sixty babies who would not have survived otherwise during this lockdown period.

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Aims and objective: PTV margin is given to take care of set up uncertainity and internal motions. We analyzed the 15 patients of prostate cancer to generate PTV margin treated by Image guided Radiotherapy using fiducial marker matching at our center. Material and methods: Between Jan 2009 - Dec 2010, Fifteen patients of prostate cancer underwent Image guided Radiotherapy (IGRT). A retrospective study was conducted. Consent was taken from each patient according to department and institute protocol. Patients were immobilized with ankle rest. Three gold fiducial markers were placed under transrectal ultrasonography. Radiotherapy target volume was prostate only RT to a dose of 76Gy/38# by IGRT. Population based PTV margin of 10 mm was given in all direction except 5 mm (posterior) in marker matching and 7 mm in bone matching. Image guidance was done either by using 3 fiducial gold marker matching. Daily on board KV images (OBI) were taken before treatment and shifts were applied for treatment. Systematic error, random error and PTV margin were calculated using Von Herk formula from daily 2D orthogonal portal images obtained during online Matching on couch before treatment. Wri Results: Systemic error in Medio-Lateral(ML), Cranio-caudal(CC), Anterior-Posterior(AP) direction were 2.59, 3.74 & 2.59 mm and random error in Medio-Lateral(ML), Cranio-caudal(CC), Anterior-Posterior(AP) direction were 4.49,5.58 & 3.19 mm respectively and derived PTV margin in Medio-Lateral(ML), Cranio-caudal(CC), Anterior-Posterior(AP) direction was 9.62,13.53 & 8.71 mm respectively. This suggested that prostate moves independent of bony pelvis movements. Conclusions: Prostate moves independent of pelvis therefore bony pelvis is a poor surrogate for daily on board matching. Every institute should generate its own PTV margins based on their immobilization and setup accuracy.

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Background: Direct laryngoscopy and endotracheal intubation (DL-ETT) is associated with transient but marked stress response, resulting in serious hemodynamic disturbances. The intubating laryngeal mask airway (ILMA) is a relatively new device that has been introduced to facilitate tracheal intubation without direct laryngoscopy thus attenuating the autonomic stress response. Objective: To compare the immediate hemodynamic effects of the insertion of ILMA with DL-ETT in adults undergoing elective surgery. Material and Methods: Sixty patients, between age 18 and 60 years, were distributed randomly into two equal groups, i.e. 30 in DL-ETT (Group 1) and 30 in ILMA (Group 2) group. To determine the hemodynamic response, heart rate (HR), blood pressure (BP), mean arterial pressure (MAP) and rate pulse product (RPP) were recorded during premedication (baseline); at induction and after 1-, 3-, 5- and 15- minutes of successful intubation in each group. Procedure-related complications such as laryngeal mucosal injury, hoarseness of voice, dental injury and laryngospasm were also recorded. Observation: A significant hemodynamic response (increase in HR, SBP, DBP, MAP and RPP) was observed after intubation in both groups as compared to their baseline values. However more significant increase in hemodynamic response was seen in DL-ETT group. 3 patients (10%) in DL-ETT group and 2 patients (6.6%) in ILMA group sustained laryngeal mucosal injury. Conclusion: ILMA triggers minimal cardiovascular stress response and seems to be a safer alternative to conventional DL-ETT.

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Background: One of the most common modes of fixation of olecranon fractures is Tension Band Wiring even after complaints of pain in few persons due to subcutaneous position of the hardware. This study was done to evaluate the elbow function and the outcome as per rating by the patient after olecranon fractures were fixed by Tension Band Wiring. Methods: 20 patients were studied (13 men and 7 women) with an average age of 43.2 years (range, 19–75 years) who had undergone TBW for isolated olecranon fractures. Assessment was done by clinical and radiological (X-Rays) evaluation. Visual Analogue Scale (VAS) score was used to know the functional outcome. Follow up was done for 1-2 years. Results: The incidence of fractures was more in males when compared to females. Simple fall onto the point of elbow was the main mode of injury. Implant removal was done in 13 patients (65%) but 7 of them (53.84%) were still complaining of mild pain during activities of daily life. The average satisfaction level was 9.3 out of 10 (range, 6–10). 12 patients (60%) were fully satisfied with the final result. Conclusion: TBW can be accepted as a “gold standard” for the treatment of displaced and slightly comminuted fractures of olecranon. Mild pain may be present regardless of whether implant is removed or not when followed up for a long period.

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Introduction: Pleomorphic adenoma is a benign salivary gland tumour that exhibits wide cytomorphologic and architectural diversity. These are less common in submandibular and other salivary glands other than parotid but remains most common benign tumour for each of these glands. Material and Methods: This study was done in the department of General Surgery at Indira Gandhi Institute of Medical sciences, Patna, Bihar from April 2018 to December 2019 in twenty eight patients. Prior institutional Ethical Committee (IEC) approval was also obtained for this study. Results: Out of 28 patients included in this study, maximum number of patients were females. Male to female ratio was 1:1.8. The maximum number of patients(42.9%) presented between 3 to 6 months. Painless enlargement of the gland was noticed in 85.7% of cases. Maximum number of patients were in age group 31 to 40 years ie 35.7% (10/28). Fine needle aspiration cytology (FNAC) gave diagnosis of pleomorphic adenoma of submandibular salivary gland in 92.9% (26/28) of the patients. Conclusion: Submandibular gland pleomorphic adenoma being most common in females occurs commonly between the third and fourth decade of life and is a slow growing painless tumour. Complete submandibular gland excision along with tumour should be done to prevent recurrence. However further studies with large number of patients and longer follow up is required to savvy about tumour recurrence.

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Objectives: This study was done to study the prevalence of cardiac manifestations of dengue fever in patients presenting to our hospital and to find out the correlation of cardiac manifestations to warning signs of dengue fever and severe dengue. Materials and methods: The study was conducted at Indira Gandhi Institute of Medical Science, Patna which is a tertiary care hospital, in the Department of Medicine in the month of July 2019 to December 2019. Only seventy consecutive patients aged 19 years or above with positive dengue serology were interviewed and examined. ECG was done for all patients and selected patients underwent echo evalua-tion. The data was analyzed using statistical significance tests. Results: 30 patients had no warning signs, 30 patients had one warning sign or the other. Ten patients had severe dengue. The minimum pulse rate was 38/ minute. Sinus bradycardia was most common car-diac manifestation noted, which was found in 32 patients. There was statistically significant correlation between cardiac manifestations and all the warning signs. Persistent vomiting had no significant relation. Acute respiratory distress among severe dengue fever patients was found to have a significant cor-relation with the cardiac manifestations. Conclusions: Sinus bradycardia was the most common cardiac manifestations noted in this study which resolved spontaneously within 2 to 3 days duration. There was no any evidence of myocarditis found in this study group. There was statistically significant correlation between cardiac manifestations and all the warning signs. In severe dengue fever causing acute respiratory distress was found to have a significant correlation with the cardiac manifestations.

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Crouzon syndrome is the most common craniosynostosis syndrome as it represents approximately 4.8% of all craniosynostosis cases at birth. It is characterized by premature closure of one or more cranial sutures and produces the characteristic craniofacial and other associated abnormalities which begins in the first year of life. Described by a French neurosurgeon “Octave Crouzon” in 1912, it is rare genetic disorder, and its worldwide prevalence rate is approximately 1 per 25,000 live births. It is caused by mutation in fibroblast growth factor receptor 2 gene (FGFR 2) at chromosomal locus 10q 25.3 - q 26, and more than 30 different mutations within the gene have been documented in separate families. CS has no racial or sex predilection, however, coronal craniosynostosis is more common in girls. The clinical presentation varies in severity from a mild presentation with subtle midface deficiency to severe forms with multiple cranial sutures fused and marked midface and eye problems. Management of crouzon syndrome is complex and difficult. In this article, we present a case of 45 year old female patient of Crouzon syndrome who survived long without any treatment and presented with uterine leomyoma.

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Background: Small phallic size leads to tissue deficiency making reconstructive procedure for Hypospadias difficult to perform. Any means to increase the size of the phallus would ensure a better outcome and fewer complications after surgery for Hypopadias. Objectives: To study the effects of parenteral Testosterone on (1) phallic size and (2) outcomes of hypospadias surgery. Methods: A prospective study was done on all patients of Hypospadias with small penis at a tertiary care centre. The dimensions of the penis and levels of Testosterone before and after the administration of intramuscular Testosterone was collected and analyzed. Results: All the 17 patients with Hypospadias and small phallus had significant increase in stretched penile length, transverse Preputial diameter and diameter at the base of penis. There were no major side effects except appearance of fine pubic hair in one patient. Three patients (two penoscrotal and one perineal) had fistula after surgery which were corrected subsequently after duration of one year with fistula repair and Tunica vaginalis flap. Rest of the patients (14/17) had a complication free result with good cosmesis. Conclusion: Parenteral Testosterone in cases of Hypospadias with small phallus betters the surgical outcome by increasing phallic size and its vascularity with minimal complication.

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Introduction: Surgical site infections (SSIs) are defined as wound infection following an invasive surgical procedure. In class IV surgical wounds, the rate of Incisional Surgical Site Infection (Incisional SSI) is reported in more than 30% cases. Laparotomy is one of the commonest operations performed in general surgical units and any wound collection in such patients increases their morbidity. Corrugated drain is inexpensive, easy to use and readily available. It should be used in all cases of class-IV (dirty contaminated) surgical wounds after closure of sheath. It causes significant reduction of wound complications and increases patient compliance, reduces length of hospital stay without increasing nosocomial infection. The main aim of this study is to evaluate role of subcutaneous drain in reduction of SSI (Surgical site infection) in class 4 laparatomy wounds. Methodology: This Quasi Experimental Study was carried out on Department of General Surgery at HSK Hospital, Bagalkot. Patients of more than 15 years of age attending outdoor (OPD) or emergency for emergency laparotomy surgery who were admitted to the hospital were studied during the study period one & a half year from 1st December, 2016 to 31st may 2018 in this study with a sample of Interventional group: 55, control group: 55. Results: Recovery on the basis of removal procedures of drain (outcome) and the association of Removal of corrugated drain (days), Wound dehiscence, Total days of dressing and Secondary Suturing were found to be statistically significant which shows drain group as better group whereas hospital stay was showing no significance among the groups. Conclusion: Subcutaneous drain in class IV laparotomy wounds will not affect post operative pain, redness but associated with decreased discharge from wound. Hospital stay was comparatively higher in without drain group. Wound dehiscence and Secondary Suturing was seen in few cases of without drain group. E. coli was commonly occurring culture organism in both the groups followed by Klebsiella. Surgical site infection was observed in 58.2% cases of without drain group while only 16.4% of cases in drain group. This indicates that the subcutaneous drain play significant roles in reduction of SSI (Surgical site infection) in class 4 laparotomy wounds irrespective of associated comorbidities. However their findings need to be confirmed with further large scale clinical trials.

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Background: Presence of retro-pulsed bony fragments in the spinal canal in some cases of thoracolumbar fracture or tuberculosis may influence the decision of surgical treatment. A number of different methods of decompression have been tried to improve the neurological status. Commonly performed anterior approach provides more direct access to the anterior aspect of the spinal canal and allows more effective reconstruction of anterior column by grafting. Nevertheless, this method is complex and associated with higher morbidity and often requires the presence of cardio-thoracic surgeon in the operation theatre. The posterior approach to the Dorso-lumbar spine is more familiar to spine surgeons. The goals of surgical treatment namely decompression, realignment and stabilization can be achieved through the posterior approach of transpedicular decompression. Materials and method: In this prospective study, 30 cases (26 traumas and 4 tuberculosis) of thoracolumbar spine fracture with neurodeficit were reviewed and evaluated retrospectively from January 2016 to January 2019 (3 Years) with follow up till may 2020. Male: Female=23:7. They were treated by decompression and stabilization by transpedicular screw and rod fixation. A neurological recovery scale evaluated the results. Results: Results were evaluated by neurological grading scale. Most of them were benefited by this procedure. Plain radiograph had help to stage the position occurred within 9 months. Kyphosis angles were measured and compared. Conclusion: Transpedicular decompression is a safe procedure and easy technique. Excellent decompression, stabilization or fixation can be obtained through this method.

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Primary ovarian leiomyosarcoma is a very rare tumor of teratomatous or nonteratomatous origin which is most commonly seen in postmenopausal women. Ovarian leiomyosarcomas (OLS) have a poor prognosis due to their late presentation and aggressive nature. We report a case in a 50-year-old female who presented with abdominal pain and lump. The patient underwent laparotomy with peritoneal lavage, total abdominal hysterectomy, bilateral salpingo-oophorectomy and total omentectomy. Primary ovarian leiomyosarcoma was diagnosed on the basis of microscopic and immunohistochemical findings. Optimal surgery is a key element in the treatment of these tumors if diagnosed at an early stage, or due to aggressive nature of this tumor, multimodality treatment will generally be required.

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Primary leiomyosarcoma of the broad ligament is extremely rare and is an aggressive mesenchymal tumor. To the best of our research and knowledge, only 24 cases of primary leiomyosarcoma of the broad ligament have been reported till date. High mitotic index, cytological atypia and areas of necrosis are the crucial histological criteria sought for the diagnosis of leiomyosarcoma. We hereby report a rare case of this highly malignant tumor in a postmenopausal female with an intent to make the treating physicians thoughtful of this rare entity and to keep this as one of the differentials while dealing with pelvic tumors in this age group. Along with total abdominal hysterectomy and bilateral salpingo-oophorectomy, adjuvant chemotherapy and radiotherapy may also be considered in the management of high grade leiomyosarcoma for better patient survival and outcomes.

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Foreign body bronchi are life-threatening paediatric surgical emergencies which merit urgent intervention to save the patient’s life. It requires a lot of suspicion and excellence on the part of the treating physician to diagnose and manage such a case. Two rare and unexpected foreign bodies in infants are described with review of relevant literature.

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Tuberculosis of breast is an uncommon form of extra pulmonary tuberculosis. Here we report a case of 21 year old female with lump in right breast with history of fever and no positive family history. Primary breast tuberculosis was diagnosed on the basis of Gene xpert and fine needle aspiration cytology. Anti tubercular drugs were given in full course in two cycles earlier but no relief of symptoms was noted. Surgical resection was advised with third course of anti tubercular therapy.

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Introduction: The surgical management of thoracolumbar burst fractures frequently involves posterior pedicle screw fixation. However, the application of short- or long-segment instrumentation is still controversial. The aim of the present study was to compare the functional and radiological outcome in patients with thoracolumbar burst fractures treated by short-segment pedicle screw fixation with screws in fractured vertebra also. Methods: Twelve patients coming to the Patna Bone and Spine Hospital from January 2016 to December 2018 with single level burst fracture of the thoracolumbar vertebra (from T11 to L1) with or without variable degree of neurological deficit were included in the study. Fracture dislocation were not included in the study. Local kyphosis angle of fractured vertebra, canal compromise and Asia Impairment Scale were evaluated. Final follow-up 18 months was compared with the pre-op, immediate post-op x-rays and noted for the results. Results: The neurological recovery is not the goal of spinal column fixation in SCI patients in most of the cases. The only goal is stabilization of spinal column, pain relief, rehabilitation, prevention of bedsore, RTI by achieving vertical chest, UTI by preventing stasis of urine in bladder etc. However we see better alignment of the spine after final follow-up as compared to the other study in past of short segment fixation with only four screws and two rod construct. Conclusions: The presenting operative procedure for achieving this goal of stabilization is very well achieved in 11 out of 12 cases. The improvement in alignment and restoration of anatomy of spinal column, restoration of spinal canal diameter as judged radiologically is achieved in 11 of out of 12 cases. However neurological recovery was as unpredictable as in other short and long segment fixations. Although it is an effective method of preventing kyphosis after stabilization. Thus preventing secondary neurological loss.

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VP shunt is a well-established procedure for the treatment of congenital hydrocephalus. Although, there are many complications associated with VP shunt procedure. Appearance of Parietal encephalocele at anterior frontanelle associated with proximal shunt migration as a complication of VP shunt surgery relieved by redo shunt surgery has not been reported in the literature search. This case is reported due to rarity of its presentation.

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Ovarian cancer which is the most common cause of death among all gynecological malignancies tends to metastasize through peritoneal cavity. Skin metastasis of ovarian cancer is rare, and conveys a poor prognosis. There are no treatment protocols for ovarian cancer with skin spread. We report a 24-year-old patient with ovarian cancer FIGO stage IIIc with skin metastasis in the periumbilical region as Sister Josheph nodule (SJN), and at previous laparotomy scar. This case indicates that with debulking surgery along with resection of skin metastasis and palliative chemotherapy survival of patients with skin metastases in ovarian cancer may not be as poor as previously reported, as our patient is surviving after 21 month of diagnosis of biopsy proven skin metastasis. It is the first case of skin metastasis from carcinoma of ovary reported in Bihar, India.

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