International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1.Study on the Association of Dietary Habits with Cardiovascular Disease in South-Eastern Rajasthan
Hemlata Sharma, Varun Kumar Saini, Mayank Sarawag, Jitendra Ahuja
Abstract
Introduction: Unhealthy Dietary patterns have an important role-playing factor in rapidly progressing cardiovascular incidences. Regional differences, nutrition accessibility, and lifestyle factors can lead to differences among the dietary intake of populations. This research focuses to establish a clear relationship between the type of nutrient & cardiovascular disease in the population of southeastern Rajasthan. Materials & Methods: 200 patients (30-80 yrs) with an established CVD or related symptoms who were admitted in the IPD were included in this study. Using  Semiquantitative food frequency Questionnaire Socio-demographic variables, cardiovascular events, and dietary information(carbohydrate and fat uptake), history of smoking tobacco & chronic alcohol use was collected. Results: A total of 189 patients (131 males and 58 females) were included in the study. Out of these 131 were males(69.%) and 58 were females (30.7%). The mean and standard deviation for the age was 58.62 ± 12.49 years. 81% of the patients had below-normal energy uptake from carbohydrates (i.e. below normal lower limit & up to 500 kCal) with a mean of 714.68 kCal/day. 80% of the patients had a higher dietary fat intake with a mean of 62.01 grams/day. 52.3% ( out of 109) hypertensives,74.2% (out of 62) of chronic tobacco smokers & 81% (out of 21)  experienced MI incidences. Conclusion: To the best of our knowledge this cross-sectional study is the first of its kind to evaluate the association between dietary habits and cardiovascular disease in South-eastern Rajasthan. The intake of fats was higher and that of carbohydrates was low-normal in maximum patients, implying that there is an association between higher fat intake and cardiovascular disease but the causal association is unknown. Strikingly, carbohydrates intake was not found to be associated with cardiovascular disease. Low carbohydrate consumption is probably related to the poor socio-demographic structure of the study population.

2.In-Vitro Cytotoxicity Assay of Crude Extract of Ethnobotanical mixtures used in Indigenous Treatment of Tuberculosis
Jyoti Tomar, Vijaylatha Rastogi, P C Garg, Tarun Patni, Mukul Chaurasia, Chhavi Vijay
Abstract
Introduction: Use of ethno botanical therapies is more vigorously being explored in combating diseases. Studies published mentioned that crude essential oil (EO) extract of herbal formulary (HS) indigenously used in inhalational & oral treatment of Tuberculosis (TB), is a promising natural product with potential for new drug development in the treatment of TB. Cytotoxicity studies of HS on cell lines are not available in published literature. Materials and Methods: Extraction of essential oil (EO) from the mixture was done by hydro distillation and chemical characterization was done by Gas Chromatography and mass Spectroscopy (GCMS). Cytotoxic effect of two different ethnobotanical mixtures (HS1 and HS2) was studied by MTT assay using human monocyte THP-1 cell line. Statistical Analysis: The IC50 of HS1and HS2 was determined by constructing a dose-response curve of the effect of different concentrations of HS1 and HS2. IC50 values for cytotoxicity tests were derived from a nonlinear regression analysis (curve fit) based on sigmoid dose response curve (variable) and computed using Graph Pad Prism 6 (Graph pad, San Diego, CA, USA). Results: HS1 showed an IC50 value of 454.7µg/ml in THP-1 cells. HS2 did not show significant cytotoxicity. Conclusion: This study proves that the HS1 and HS2 with potent in-vitro anti TB effect are non-cytotoxic on THP-1 cell line, thus proving biological safety of use of these ethno botanical mixtures, traditionally used in TB treatment. This is a milestone development towards novel anti TB drug development.

3.Prevalence of Various Reasons for Donor Deferral In Blood Bank, Jhalawar Hospital and Medical College Society, Jhalawar
Manish Kumar, Brajendra Shakyawal, Ummed Singh Solanki
Abstract
Introduction: Blood donation and its subsequent transfusion to recipients are considered as an important life-saving intervention in healthcare emergencies. Materials and Methods: The present retrospective study was carried out at Jhalawar Hospital and medical college society blood bank, Jhalawar district, Rajasthan, India, during the 1‑year period from January 2020 to December 2020. The data and information of deferred donors were retrieved from deferral donor register, donor selection form. This study aims to study donor deferral rate and determine the prevalence of various reasons for donor deferral at-Jhalawar hospital and medical college society, Jhalawar, Rajasthan. Result: In the present study, Out of total 11559 registered pre donation screening interviews 11223 were males (97.093 %) and 336 (2.906 %) were females. Total number of deferrals due to various reasons were 231 giving an overall incidence of 1.99 %. Out of these 231 deferrals, 185 (80.086%) were voluntary and 46 (11.913%) were replacement donors. Out of these 231 deferrals, 203 (87.88 %) were deferred due to temporary causes and 28 (12.12 %) were deferred due to permanent causes. Most common causes for deferral were underage/underweight (35.06%) and low haemoglobin (34.63%). Conclusion: Most common causes for deferral were low haemoglobin, low body weight and underage donor. Strict donor selection criteria and donor education regarding self-exclusion is the key point of safe blood supply. A large number of temporarily deferred donors can be recruited back into the donor pool if managed actively. This will also help in maintaining a healthy donor pool in the long run & improvement of efficiency of the donor programme.

4.LASER Lipolysis at 1060 nm: A Promising Tool for Non Surgical and Non-Invasive Fat Reduction
Arvinder Singh
Abstract
Obesity is state of excess of adipose tissue mass. Obesity is global cause of concern. Lots of medical conditions are linked with Obesity, like insulin resistance, glucose intolerance, diabetes mellitus, hypertension, dyslipidaemia, sleep apnoea, arthritis, hyperuricemia, gall bladder disease, PCOD, coronary artery disease and certain types of cancer. Non-invasive and nonsurgical methods are gaining lot of reputation and interest for fat loss and to combat obesity. The study was conducted at Arth Skin and Fitness Centre, Udaipur and machines of Woxmen Company were used. CALYSTA – Woxmen for LASER lipolysis was used, while for tightening, help of Unipolar and Bipolar Radiofrequency technology was taken. 30 patients were selected between age of 24 to 64 years having Body Mass Index of 27 or above. 20 patients were Male, and 10 patients were Female. All the patients showed good response in terms of reduction of abdominal girth. The average reduction in abdominal girth was 9.9 cms which is approximately 4 inches in single session within 6 weeks of therapy. The highest decrease was 16.5 cms and lowest was 4 cms. Male and female patients responded almost equally to the LASER and Radiofrequency technology. LASER lipolysis at 1060 nm coupled with radiofrequency tightening is promising nonsurgical tool for fat reduction around abdominal areas.

5.Evaluation of Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) Spectroscopy for Characterization of Trichosporon Species Isolated from Clinical Samples
Rastogi V, Parashar A, Bhatnagar M, Sharma M, Rudramurthy SM
Abstract
Background: Trichosporon is a medically important genus that includes causative agents of deep-seated, mucosa associated and superficial infections. Rapid and accurate identification is very important in institution of appropriate therapy, thereby reducing morbidity and mortality related to Trichosporonosis. The genotypic methods commonly used to discriminate these species are laborious and very expensive. Being cost effective, Fourier-transform infrared spectroscopy with attenuated total reflectance (ATR-FTIR) was evaluated in this study to discriminate between Trichosporon species. Methods: A collection of 75 clinical isolates pre-characterized by phenotypic and PCR-based sequencing techniques and belonging to 5 different Trichosporon and related species [T. asahii (n=62), T. inkin (8), C. dermatis (3), T. asteroids (1), A. loubieri (1)] of Trichosporon were subjected to ATR-FTIR. Standard strains from different genera were used as outliers. Spectral data acquired in the ATR mode under controlled microbiological and physical parameters for all measurements were compared. Infrared spectra were analyzed with Hierarchical cluster analysis (HCA) and Principal component analysis (PCA). A new mathematical operation, Reference & Threshold calculation (R&T) was proposed here for rapid & reliable identification of Trichosporon to species level. Results: The current study using ATR-FTIR method has sharply demonstrated 100% genus level discrimination with protein specific spectral window (1800-900 cm-1). All the 5 different Trichosporon species could be successfully discriminated using second derivative spectra. Clustering data using statistical tools showed that the polysaccharide specific signatures (1200–900 cm-1) were critical markers for species discrimination. The results have been further correlated using PCA. R&T operation applied on the genus and species level resulted in 100% identification concordant with PCR sequencing results. Conclusions: This study has confirmed that ATR-FTIR spectroscopy along with reference and threshold calculation is a promising diagnostic tool for rapid, reliable and cost-effective characterization of clinical Trichosporon species, compared to conventional/molecular techniques.

6.A Comparative Study of Efficacy and Safety of Conventional Versus Newer Antidepressants in Patients with Depressive Episode in A Tertiary Care Hospital
Satyendra Kumar Pathak, Dinesh Sah, Shankar Dayal Singh
Abstract
Background: Depression is a clinical syndrome that is characterised by a cluster of emotional, behavioural, and cognitive features. Depression also poses a significant economic burden to society as it leads to reduced productivity, treatment costs and loss of human life by suicide. Aims and Objectives: To compare the efficacy and safety of newer antidepressants like Escitalopram and Desvenlafaxine versus conventional antidepressant like Imipramine in patients with Depressive episode. Material and Methods: An open label, prospective, comparative study was conducted in the Department of Pharmacology, Sri Krishna Medical College (SKMC), Muzaffarpur, Bihar associated with psychiatry outpatient department (OPD), Sri Krishna Medical College and Hospital (SKMCH), Muzaffarpur, Bihar during last 3 months. Results: 72 newly diagnosed patients of depressive episode according to ICD-10 criteria were divided into three groups of 24 each receiving Imipramine (Group A), Escitalopram (Group B) and Desvenlafaxine (Group C) and followed up for 6 weeks. Efficacy measurement was reduction in MADRS, CGI-S and CGI-I scores. Safety assessment was by number, severity and dropouts due to adverse drug reactions and laboratory investigations. Data was analyzed using ANOVA and Chi square test. Response rate was 51% in Group B, 43% in Group A and 40% in Group C, but this difference was not statistically significant. Initial response was seen as early as 2 weeks in 51% in group B and 40% in group C but none in group A and showed statistical significance. No statistically significant difference was seen in CGI-S and CGI-I scores at the end of 6 weeks. Conclusion: Newer antidepressants like escitalopram and desvenlafaxine were equally efficacious in treating moderate to severe depressive episode compared to conventional drugs like imipramine however they had an advantage of faster onset of action, better safety and tolerability.

7.Drug Utilization Pattern of Anti-Epileptic Drugs in Tertiary Care Hospital
Shankar Dayal Singh, Satyendra Kumar Pathak, Dinesh Sah
Abstract
Background: Epilepsy is a chronic neurological disorder that requires therapy over prolonged period of time to keep patient seizure free. Although patients respond with monotherapy, refractory epileptic patients require polytherapy. Drug utilization studies provide insight to rational drug prescribing. Aim and Objective: This study was designed to analyze and to study prescription pattern of antiepileptic drugs in patients with epilepsy in tertiary care hospital. Materials and Methods: The present study was conducted in Department of Pharmacology, SKMC, Muzaffarpur, Bihar by collecting data from medical record department. Detailed data of patients diagnosed with epilepsy including demographic details, comorbidities, and allergies admitted during last 3 months in study pro forma were collected. Results: A total of 150 patient’s data were analyzed and it was found that male patients were most affected with epilepsy compared to females. Generalized tonic-clonic seizure (GTCS) was the most commonly diagnosed in majority of the patients. Levetiracetam (42.0%) was the most commonly prescribed drug as monotherapy, followed by phenytoin (12.66%), sodium valproate (8.66%), and carbamazepine (5.33%). The most common combination of drugs in polytherapy were levetiracetam and carbamazepine (13.33%), phenytoin with carbamazepine (7.33%), phenytoin with sodium valproate (6.66%), and phenytoin with lamotrigine (4.0%). Conclusion: The higher incidence of epilepsy is noted in males of all ages. GTCS was the most common type of epilepsy diagnosed and majority of the patients were prescribed with monotherapy. As it is a retrospective study, there were several limitations in the study such as quality of life of patients, compliance to the drugs, adverse reactions to the drugs were not assessed. Hence, further prospective studies with more sample size should be conducted to assess various factors on drug utilization in epilepsy.

8.Case Control Study to Assess the Association Between Glycated Haemoglobin, Total Protein and Albumin Levels in Patients with Type 2 Diabetes Mellitus
Akhalesh Kumar, Rituraj, Pradeep Kumar Singh
Abstract
Aim: The aim of the study to assessment of glycated haemoglobin, total protein and albumin levels in patients with type 2 diabetes mellitus. Methods: This case control study was done in the Department of Pathology, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India, for 10 months. A total of 120 subjects comprising of 60 diabetic subjects and 60 controls aged between 35 and 70 years were recruited for the study. 5mls of blood sample was collected from each patient and 1ml was dispensed into EDTA for the estimation of glycated haemoglobin, and 4ml was dispensed into plain containers for estimation of serum albumin and total protein levels. Determination of glycated haemoglobin level, estimation of serum albumin level and estimation of total protein done by standard methods. Results: The mean level of HbA1c was significantly higher in the diabetic subjects when compared with control group (11.56±1.79Vs 7.21±0.98; p=0.001). There were no significant differences observed between the age, the serum levels of Albumin and Total protein in the test and control subjects (p>0.05). Conclusion: We concluded that the present study showed significantly higher mean levels of HbA1c in the diabetic patients compared with the control subjects.

9.An Investigation of the Functional and Anatomical Outcomes of Displaced Intraarticular Calcaneal Fractures Treated with Locking Plate Fixation: A Prospective Research
Baidyanath Kumar, Swati Sinha, Satyendra Kumar Sinha
Abstract
Aim: The aim of the present study determines the Functional and anatomical outcome of displaced intraarticular fractures of calcaneum treated using locking plate fixation. Methods: This Prospective study was done the Department of Orthopedics, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. A total of 50 patients aged 18 years, displaced intra articular fractures of calcaneum were included in this study. Post-operative management involved, immobilization using a below the knee slab for a duration of 2-3 weeks to ensure wound healing. Subsequently on the second post operative day non weight bearing mobilization was advised followed by ankle movements on removal of the slab. Complete weight bearing was recommended only after ensuring fracture union on x-ray. Follow up- Patients were followed up at an interval of 6 weeks, 3 months and 6 months post-surgery and imaging via x-ray, at each visit was done to assess the fracture healing.  Results: In our study we included 50 patients, amongst them 7 were female and the rest 43 were male. The mechanism of injury was noted to be road traffic accident in 9 patients and fracture sustained as a result of fall from a height in the rest.  According to this scale, 35 patients (70%) had good outcome, 11 patients had fair outcome (22%) while 4 patient (8%) had poor outcome. 4 out of the 50 patients, was noted to have wound dehiscence where suture removal was delayed until 3 weeks and the wound healing was ensured at the end of 8 weeks. Regular dressings were done, and the wound healed with secondary intention without any further intervention. For this patient regular cultures were taken, and the antibiotics were changed accordingly. 4 patient developed superficial wound infection, for which regular dressings were done and antibiotics changed according to culture reports. Conclusion: we concluded that the anatomic locking plate can be used effectively in the treatment of displaced intraarticular calcaneal fractures using simple reduction techniques with a potentially shortened operating time.

10.A Prospective Cross-Sectional Study to Evaluate the Balance of Serum Calcium and Phosphorus in Diabetic Nephropathy and Its Correlation with Glycated Hemoglobin (HbA1c)
U.C. Jha, Maadhav Gopal Bansal, Md. Belal Ashraf
Abstract
Aim: To evaluate the balance of serum calcium and phosphorus in diabetic nephropathy and its correlation with glycated hemoglobin (HbA1c). Materials and methodology:  Across-sectional study conducted in 40 patients with diabetic nephropathy admitted in DMCH, Laheriasarai, Darbhanga, Bihar, India during the period for 1 year. The subjects were sub-grouped into 2 groups on the basis of HbA1c levels i.e. Poor glycemic control (HbA1c > 7%) and good glycemic control (HbA1c < 7%). Fasting blood sugar, serum creatinine, calcium and phosphorus levels were measured and analyzed at daily level. Results: Out of 40 patients, 21 (52.5%) were males and 19 (47.5%) were females. 42.5 % of the patients distributed in stage 3, 25 % in stage 4 and 32.5% in stage 5 of diabetic nephropathy. With decline in eGFR values, increased phosphorus, increased creatinine and decreased calcium levels were seen. A significant increase in phosphorus levels were observed with decline in eGFR values. A highly significant increase in creatinine levels were also seen at stage 5 of diabetic nephropathy. Conclusion: This study showed a highly significant negative correlation with creatinine, phosphorous, HbA1c and a highly significant positive correlation with serum calcium level. Correlation between eGFR and other parameters in all the stages of diabetic nephropathy showed a highly significant decrease in serum calcium.

11.Prospective, Observational Study Looking at How Much Pain (VAS) Endometriosis Patients Experience, As Well As the Types and Degrees of Adhesions
Priyanka Rani, Sanjeev Kumar, Sweta Singh, Sadhana Singh
Abstract
Aim: Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, NSMCH, Amhara, Bihta, Patna, India for 10 months.  Total 80 women; aged 20-50 years, diagnosed as having endometriosis by clinical history, abdominal and pelvic examination, trans vaginal sonography and colour Doppler were included in the study. Pain intensity was assessed by visual analogue scale (VAS). Pain intensity was scored from 0 to 10, in which score 0 means no pain and 10 means worst pain. A score of 1-3, 4-6 and ≥7 was classified as mild, moderate and severe pelvic pain respectively by looking at the facial expression of the patients. Results: Out of 80 women with endometriosis, 20 women (25%) had mild pain, 50 women (62.5%) had moderate pain and 10 women (12.5%) had severe pain. Forniceal thickening was present in 65 women (81.25%), cyst was felt in 44 women (55%), uterine mobility was restricted in 32women (40%) and pouch of Douglas (POD) thickening was present in 27 women (33.75%). Out of 80 women with endometriotic cysts, 64(80%) had unilateral cysts while the remaining 16(20%) had bilateral cysts. Unilateral tubal adhesions were present in 64(80%) women and bilateral adhesions were present in 16(20%) women. Among the types of adhesions, flimsy adhesions were most common, being present in 64(80%) women, isolated dense adhesions were present in only 2(2.5%) women, while combination of flimsy and deep adhesions were present in 14 (17.5%) women. Less than 1/3rd tubal adhesions were present in 10(12.5%) women, 1/3rd-2/3rd tubal adhesions were present in 41(51.25%) while more than 2/3rd tubal adhesions were present in 29(36.25%) women. All the ovarian adhesions were flimsy. Out of 80 women with endometriosis, ovarian adhesions were present in 15(18.75%) women while absent in 65(81.25%) women. Less than 1/3rd ovarian adhesions were present in only 4(5%) women, 1/3rd-2/3rd ovarian adhesions were present in 7(8.75%) women and more than 2/3rd ovarian adhesions were present in 4(5%) women. Conclusion: The severity of pain correlated with type of adhesions being more commonly associated with dense adhesions as compared to flimsy adhesions.

12.An Observational Study to Evaluate the Clinical, Demographic Profile and Admission Blood Pressure as Prognostic Marker in Acute Nontraumatic Intracerebral Hemorrhage Patients
Sanjeev Kumar, Janardan, Priyanka Rani
Abstract
Aim: To evaluate the clinical, demographic profile and admission blood pressure as prognostic marker in acute nontraumatic intracerebral hemorrhage patients. Methodology: The present study was mainly centered on stroke patients (only hemorrhagic). The stroke was defined by criteria in WHO1. Stroke types were defined based on the criteria of the Oxford Community Stroke project. The detailed history and thorough clinical examination were done in each patient to assess the neurological deficit, to know the risk factors, and coincident diseases according to the proforma. Every patient underwent brain CT scan within 24 hours of onset of symptom. Then all the patient was assigned to subtypes (Hemorrhagic, Ischemic stroke) based on neuroimaging finding (CT-Scan) and those having nontraumatic hemorrhagic stroke were taken in our study. Blood pressure was measured in each patient in the supine position on arrival at the S.R.N. hospital, Allahabad. Patients in whom the cause of death was directly related to the hemorrhage were classified as patients with fatal outcome. Results: Mean age of presentation was 61.549±12.38 years. The commonest anatomic location was thalamus 40.45 % (n=53) followed by basal ganglia 39.70% (n=52). The hematoma was visible on COMPUTED TOMOGRAPHY (CT) scan in 100% (n=131) of the patients with acute intra cerebral haemorrhage. The mean systolic blood pressure of all patients was 176.93±33.84 mm of mercury (n=131). The mean diastolic blood pressure of all patients was 100.09±17.47 mm of mercury (n=131). The mean arterial pressure in fatal group is higher in all groups except in pontine group where mean arterial pressure in nonfatal group is higher 140.00 (n=1)>115.53±43.39. Mean arterial blood pressure in fatal group was significantly higher 132.91±24.26 mm of mercury than in nonfatal group 119.36±16.59 mm of mercury (p<.05). Conclusion: The mean systolic blood pressure and diastolic blood pressure at the time of admission was high. The commonest anatomic location was thalamus followed by basal ganglia. The Mean arterial blood pressure in fatal group was found significantly higher than in nonfatal group. Control of mean arterial blood pressure can reduce the fatal outcome.

13.A Prospective Clinical Study on Catheter Associated Urinary Tract Infections (CAUTI) and Antibiotic Sensitivity Pattern
Shamim Ahmad, H.L. Mahto
Abstract
Aim: A study on catheter associated urinary tract infections (CAUTI) and antibiotic sensitivity pattern of uropathogens causing CAUTI from a tertiary care hospital. Methods: This prospective study was done the Department of Microbiology, Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. Total 400 catheterized patients were included. Infection control nurse collected all the details like name of the patient, age, sex, date of catheterization, laboratory reports during her daily rounds. The diagnosis of CAUTI was done as per the CDC guidelines published in 2009. The selection criterion for the inclusion in the study was above 18 years and patients of both genders and who were put on Foley’s catheter for at least 48 hours were included in the study. Results: Out of 400 catheterized patients, 20 developed CAUTI. The overall incidence was 5%. Male patients were more than the female patients for catheterization. The most common uropathogens were E. coli (30%) and Klebsiella pneumoniae (30%) followed by Pseudomonas aeruginosa (20%) and Acinetobacter species (20%) from the cases of CAUTI. Bacterial uropathogens isolated from patients with CAUTI revealed the presence of multidrug resistant pathogens. Imipenem was the single best antibiotic for all pathogens except Pseudomonas aeruginosa where Amikacin was the drug of choice. The Acinetobacter species also showed very high resistance to all antibiotics except Imipenem. Conclusion:CAUTI remained a great burden to patient safety and a challenge to the infection control team. Implementation of proper care bundles and continuous education to health care workers plays a key role in reducing the CAUTI rates, thereby decreasing the morbidity and hospital stay to the patients.

14.A Retrospective Histopathological Analysis of Soft Tissue Tumours in A Tertiary Care Center
Vivek Kumar Pandey, Rituraj, Vimal  Kumar Gupta, Awadhesh Singh
Abstract
Aim: Histopathological analysis of soft tissue tumours in a tertiary care hospital in bihar region. Methods: This retrospective study was carried out in the Department of Pathology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. Total 100 patients of all the soft tissue tumors, both benign and malignant were included in this study. Results: Benign soft tissue tumours formed 85% of all soft tissue tumours while malignant soft tissue tumours constituted 15%. The commonest benign tumour was lipoma (50%) of all benign tumours of soft tissue followed by vascular tumours (20%) peripheral nerve sheath tumours (17%), fibrous tumours (3%), fibrohistiocytic tumours (4%) smooth muscle tumours (2%) and tumours of uncertain differentiation (1%) in the decreasing order to frequency. The benign adipocytic tumours accounted for the majority of benign soft tissue tumours (47%) followed by vascular tumours (16%). Benign tumours of smooth muscle (1%) and tumours of uncertain differentiation are nil encountered. 38% benign soft tissue tumours were seen in extremities followed by head and neck 30% and for the malignant soft tissue tumours mainly lower extremities followed by trunk and abdomen. Conclusion: The diagnosis and management of soft tissue tumors require a team perspective. Even though soft tissue sarcomas are rare and usually present just as painless mass, the clinician must be able to diagnose it early for better management.

15.A Case Control Study to Assess the Role of Platelet Count in the Early Identification of Preeclampsia and Eclampsia
Rituraj, Akhalesh Kumar, Pradeep Kumar Singh
Abstract
Aim: The study aimed to evaluate the platelet count in the pregnant Women. Methods: This cross-sectional study was carried out in the Department of Pathology, Government Medical College and Hospital, Bettiah, West Champaran, Bihar, India, for 8 months. Total 100 patients were divided in two groups as Cases and Control. Cases study group includes 50 females with the thrombocytopenia and Control includes 50 females without thrombocytopenia. Results: The data from the 100 pregnant females were collected and presented as below. The study population was divided in two groups as Cases and Control. Cases study group includes 50 females with the thrombocytopenia and Control includes 50 females without thrombocytopenia. The Most effective age group in which thrombocytopenia seen was between 20 to 25 years. Out of 100 patients with thrombocytopenia, mild preeclampsia was present in 22 cases (44%) and while the rest 28 (56%) had Severe Pre-eclampsia with thrombocytopenia. In women with Mild Pre-eclampsia Platelet Count (x 109/L) was 65-277, Severe Pre-eclampsia Platelet Count (x109/L) was 27-249 and women without thrombocytopenia had normal Platelet Count. Conclusion:The clinically platelet indices can be a useful screening test for early identification of preeclampsia and eclampsia. Also, platelet indices can assess the prognosis of this disease in pregnant women and can be used as an effective prognostic marker because it correlates with severity of the disease.

16.Efficacy and Tolerability Comparison of Olopatadine, Ketotifen, and Epinastine in Seasonal Allergic Conjunctivitis: A Prospective Open-Label Comparative Study
Dinesh Sah, Satyendra Kumar Pathak, Shankar Dayal Singh
Abstract
Background: Seasonal allergic conjunctivitis (SAC) is the most common allergic disease affecting the eye, with an estimated prevalence of 15–20%. Although sequelae affecting patients’ vision are rare, the symptoms are distressing and may have a significant socioeconomic impact, affecting the quality of life, daily activities, productivity, school performance, etc. The latest generation multiple action topical antiallergic agents such as olopatadine, ketotifen, and epinastine possess antihistaminic, mast cell stabilizing, and anti-inflammatory actions and has now been recommended as the first-line agents in the treatment of SAC. Aims and Objectives: This study aims to compare the efficacy and tolerability of olopatadine, ketotifen, and epinastine in SAC. Materials and Methods: A prospective, comparative study was conducted at Department of Pharmacology, SKMC, Muzaffarpur, Bihar associated with Department of Eye, SKMCH, Muzaffarpur, Bihar during last 3 months. Patients enrolled 90 subjects with SAC. They were randomized into three groups of 30 each, to receive olopatadine, ketotifen, or epinastine. The study medications were instilled into the affected eyes (one/both) twice daily for 4 weeks. The primary outcome measure was changed in clinical parameters of SAC, which was assessed by grading on a 4-point scale (none to severe). The treatment response was monitored during the follow-up visits at 1, 2, 3, and 4 weeks. The tolerability was assessed by monitoring the adverse events (AEs). Results: All the study drugs showed comparable efficacy in reducing conjunctival hyperemia, papillary reaction, and itching. Among them, olopatadine was distinctly more effective than other two drugs at all the visits. Ketotifen and epinastine were equally effective in relieving conjunctival hyperemia, and epinastine was more effective in relieving papillary reaction and ocular itching compared to ketotifen. The study medications showed good tolerability with less severe AEs. Conclusion: In the present study, olopatadine was more effective in relieving symptoms and signs of SAC compared to epinastine and ketotifen.

17.Study of the Placenta in Relation to the Birth Weight of Full Term Neonates Using Morphometric Analysis
Amrendra Prasad Sinha, P.K. Verma, Rajendra Prasad
Abstract
Aim: The present study was aimed to explore the morphometric examination of placenta in birth weight of full-term newborn babies. Methods: The present study was the conducted in Department of Anatomy. Total 120 discarded placentae were collected at random from deliveries (both vaginal and caesarian) conducted Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for 8 months. 60 out of the 120 placentae were from controls (birth weight > 2500gms) and 60 from low-birth-weight deliveries (birth weight <2500gms). In the collected placenta, the weight, volume, diameter and thickness of placenta were measured. Results: The 70% of  placenta had birth weight 400-500 gms and followed by 30% >500 gms in group A, and 60 %  of placenta had birth weight <400 gms in group B. 45% of placenta had  volume 401-499 ml  and followed by 28.33% of  placenta had volume ≤ 400 ml in group A and 78.33%  of placenta had ≤ 400 ml volume in group B. the mean placental weight was 466.88±30.67gms in normal birth weight group and 393.71±57.21 gms in the low birth weight group. The mean placental diameter was 19.13±0.78cm in normal birth weight group and 16.84±2.16cm in the low-birth-weight group. The mean placental thickness was 1.80±0.17cm in normal birth weight group and 1.72±0.17cm in the low-birth-weight group. The mean placental volume in the normal birth weight group was 440.26± 39.83ml and in the low birth weight group it was 377.25±45.88 ml. The mean feto-placental ratio in normal birth weight group was 6.25 whereas in low birth weight group, it was 5.23. All the parameter was found to be statistically significant. In the present study the placental coefficient in normal birth weight group was 0.159 ± 0.014 and in low birth weight group was 0.189± 0.031. Conclusion:We conclude that the morphometric observation of placenta is associated with foetal weight. So an early examination of not only the fetus, but also the placenta by non-invasive techniques like ultrasonography will be helpful to predict and to avoid low birth weight babies with better preventive measures.

18.A Comparative Assessment of Norepinephrine and Terlipressin in the Management of Hepatorenal Syndrome
U.C. Jha, Natwar Lal Das, Brajesh Kumar
Abstract
Aim: Assessment of norepinephrine and terlipressin in the management of Hepatorenal Syndrome. Materials and methods: A total of 40 patients with HRS type 1, presenting at the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, were prospectively evaluated. Patients were randomized to either terlipressin or noradrenaline group i.e. half for terlipressin (group A) and half for noradrenaline (group B). Patients in either group received treatment with terlipressin or noradrenaline with 20 g albumin/day. Patients in group A received terlipressin as an intravenous bolus of 0.5 mg every 6 h. Patients in group B received a continuous infusion of noradrenaline at an initial dose of 0.5 mg/h, designed to achieve an increase in MAP of at least 10 mmHg or an increase in 4-h urine output of more than 200 ml. All patients were admitted for 15 days in hospital and followed-up to 30 days. Clinical and biochemical parameters were assessed at baseline, and day 15. An arterial blood sample was collected after overnight fast and bed rest for at least 8 h in supine position for plasma renin activity and aldosterone concentration. Results: 8 (40%) patients in group A and 10 (50%) in group B responded to therapy. 22 (group A-12; group B-10) patients did not respond to treatment. There was a significant decrease in serum creatinine from baseline in both groups. Mean arterial pressure and urine output increased significantly in both groups at day 15. Plasma renin activity and aldosterone concentrations   decreased significantly in both groups at day 15. Conclusion: In conclusion, norepinephrine and terlipressin had similar response rates or equally effective in cases of hepatorenal syndrome. But this study was based on a small population size. More studies are needed on a large scale to establish this as an alternate drug.

19.A Prospective Understanding of the Prognostic Markers of Multiple Myeloma Disease
Krishna Kumar Jha, Md. Belal Ashraf, Maadhav Gopal Bansal
Abstract
Aim: Understanding the prognostic markers of multiple myeloma disease hoping to incorporate the new therapeutic modalities to convert the disease into curable one. Materials and methods: A total of 100 patients diagnosed as MM according to the criteria of the Chronic Leukemia-Myeloma Task Force (Committee of Chronic Leukemia-Myeloma Task Force, 1973) admitted to DMCH, Darbhanga, Laheriasarai, Bihar, India were evaluated. In each patient, factors like anemia, urea, serum calcium, percentage of plasma cells, renal insufficiency, infections, performance status, Bence-Jones proteinuria, and para-protein index are evaluated for their prognostic significance. Results: Out of 100 enrolled patients, 56 were males and 44 were females. Four variables that had the highest correlation with the first component were creatinine, haemoglobin, performance status and paraprotein index. Conclusion: We found that the combination of clinical performance status, serum creatinine, haemoglobin and paraprotein index allowed us to discriminate three groups of patients with different survivals. It can be a useful complementary tool for classifying patients according to prognostic factors.

20.To Study the Hematological Indices and CRP in the Screening of Neonatal Sepsis
Nilesh Ahire, Suhas Vasantrao Patil, Dipak Marakwad, Rajendra Gaikwad, Jeetendra Singh
Abstract
Introduction: To study the haematological indices and serum CRP levels for the early diagnosis of neonatal septicaemia. Purpose of study: Establishment of a modified sepsis screen score which is easy, cost effective and less time consuming for the early diagnosis of neonatal septicaemia. Results: Total 80 newborns were studied; consecutive 3 days sepsis screen score is established considering blood culture as a gold standard. Overall sensitivity and specificity of septic screen was 94.5% and 80% respectively while PPV and NPV was 91.2% and 87%. Overall diagnostic accuracy of septic screen was 90%.  Conclusion: Sepsis screening methods using CRP and haematological indices are easily available, rapid, cost-effective screening method and effect rapid diagnosis of neonatal sepsis and save lives due to timely detection and interventions.

21.Safety Profile of Intravenous Colistimethate Sodium among Critically Ill Neonates with Sepsis in Terms of Serum Creatinine Clearance, Serum Electrolyte Levels and Apnea Incidence
Nilesh Ahire, Suhas Vasantrao Patil, Urmila Murtadak, Rajendra Gaikwad, Jeetendra Singh
Abstract
Introduction: There has been increased neonatal mortality and morbidity due to emergence of gram-negative bacteria which is multi-drug resistant (MDR). Neonatal sepsis is the one of the leading causes of neonatal mortality and morbidity in developing and developed countries. Colistin (colistimethate sodium), potent antimicrobial, a cyclopeptide antibiotic of the polymyxin class, has been re-evaluated over the last few decades against certain gram-negative bacteria causing multi drug resistant sepsis. The most common adverse effect of colistin treatment is renal toxicity along with electrolyte imbalance. Objectives: Study was performed to analyze an effect of use of intravenous colistimethate sodium on serum creatinine clearance, serum electrolyte levels and apnea incidence in critically ill neonates with sepsis. Methods: Total 62 neonates (28 days) admitted in the hospital with evidence of blood culture positive sepsis and who have received intravenous colistimethate sodium for more than 7 days were included in the study. Serum creatinine levels and serum electrolytes levels were documented before starting colistin, on 7th day of colistin and on discharge. Apnea count was done daily during administration of colistin therapy for 7 days. Results: Most of the study population were of 1 to 7 days (61.3%) followed by 8 to 14 days (16.1%), 15 to 21 days (14.5%) and more than 21 days (8.1%). There was male predominance (59.7%) amongst study population. Most of the babies were preterm (56.5%) followed by term (40.3%) and post-term (3.2%). Pseudomonas (33.9%) was one of the commonest organisms isolated on blood culture followed by Acinetobacter (21%), Candida (19.4%) and Klebsiella (16.1%). There was significant change in potassium and chloride level on 7th day after colistin as compared to pretreatment and discharge level but both values lie in the normal range. No significant difference was observed in serum creatinine and sodium level. Incidence of apnea was observed significantly in preterm babies (100%) as compared to term (0%) and post term babies (0%). Incidence of apnea was not increased after administering Colistin. Interpretation And Conclusions: Intravenous Use of Colistimethate sodium in neonates who are critically ill was not associated with drug related adverse effects like electrolyte imbalance, raised serum creatinine level and increased incidence of apnea episode.

22.A Cross Sectional Study of Serum Uric acid with Urine Albumin and Serum Creatinine in type 2 Diabetes Mellitus Patients at SMS Medical College and Attached Hospital, Jaipur
Karamveer Singh, Alpana Goyal, Ajay Saxena, Vipul Garg, Balveer Singh Gurjar
Abstract
Background: Diabetes is a major worldwide health problem, leading to markedly increased mortality and serious morbidity. Type 2 DM is the most common form of DM characterized by hyperglycemia, insulin resistance, and relative insulin deficiency. This study was done to evaluate the level of serum uric acid in type 2 Diabetes mellitus patients and to correlate the parameters of diabetic nephropathy like albuminuria and serum creatinine levels with uric acid. Aims & Objectives: The aim of the study was to compare Serum Uric acid with Serum Creatinine and Urine Albumin levels in Diabetes Mellitus patients and find association between them. Methods: This study was a cross sectional study in which clinically diagnosed cases of Diabetes mellitus from OPD of department of Endocrinology, S.M.S. Medical College and Hospital, Jaipur were taken as cases. Results: 100 cases of Type 2 Diabetes mellitus above the age of 18 were analyzed in this study. The Mean Uric Acid levels in cases with Urine Albumin < 30 mg/24h, Urine Albumin 30-300 mg/24h and Urine Albumin > 300 mg/24h was 5.27 ± 1.25 mg/dl, 8.27 ± 1.63 mg/dl, and 12.76 ± 1.76 mg/dl respectively. These values were statistically significant after applying ANOVA test (p value <0.00001 and f ratio = 62.45). There was statistically significant Positive correlation Serum Uric acid & Urine albumin (r = 0.8126 and p < 0.0001). Mean Uric Acid levels in cases with Serum Creatinine < 1.2 mg/dl was 7.47 ± 1.95 mg/dl and with Serum Creatinine > 1.2 mg/dl was 9.32 ± 2.46 mg/dl. These values were statistically significant after applying Student T test (p value 0.000045) and also statistically significant Positive correlation Serum Uric acid & Serum Creatinine was seen (r = 0.3172 and p value = 0.001302). Conclusion: The levels of serum uric acid and microalbuminuria are significantly correlated in nephropathy in Type-2 diabetic patients. There was also significant correlation between Serum Uric acid and Serum Creatinine. Hence Serum uric acid level can not only be used as early diagnostic marker but also for the prognostic monitoring of diabetic nephropathy.

23.Study of Serum Electrolyte Levels in Thyroid Disorder Patients
Ummed Singh Solanki, Pradhuman Upadhyay, Manish Kumar, Neeraj Singh Songara
Abstract
Background: Thyroid disorders are frequent, potentially serious clinical entities resulting from deficiency or excess of thyroid hormones or due to their impaired activity which may affect electrolyte levels as well as lipids in circulation. There is relationship between thyroid hormones and metabolic rate through the influence of these hormones on the metabolism of carbohydrates, fats and proteins and thus, energy produced from the hydrolysis of these compounds. The objective of this study was to find out the effect of thyroid disorders on certain electrolytes. Material & Methods: In the present study a total of 60 subjects were included, 30 were confirmed hypothyroidism and 30 were confirmed hyperthyroidism patients in the age group 18-55 yrs. Serum electrolyte levels (Na+, K+, Cl) were measured in both groups. Results: Analysis of serum electrolytes showed that the sodium was significantly higher in hyperthyroidism patients (P value = 0.014). Chloride levels were also found to be significantly elevated in hyperthyroidism patients in comparison to hypothyroidism patients (P value = 0.049). Conclusion: The study concluded that electrolyte derangements are common in thyroid disorders as shown in results by the correlation of thyroid hormones with serum electrolytes but they are not of severe grade and the patients of hypothyroidism and hyperthyroidism should be screened for electrolytes disturbances.

24.Study of the Association of Lipid Profile with Chronic Kidney Disease SMS Medical College and Attached Hospital, Jaipur
Paridhi Gupta, Vipul Garg, Balveer Singh Gurjar, Mahesh Bairwa, S K Vardey
Abstract
Background: Chronic kidney disease (CKD) is a pathophysiological process with multiple etiologies resulting in the inexorable attrition of functional nephrons and frequently leading to End Stage Renal Disease (ESRD) necessitating hemodialysis as a mandatory therapeutic measure. Dyslipidemia has been hypothesized to cause kidney damage and to play an important role in the progression of renal failure. Hence, the aim of the present study was to evaluate the pattern of different lipoprotein changes in the CKD patients. Aims & Objectives: The aim of this study was to evaluate and compare the serum Lipid Profile  (TG, Cholesterol, HDL, LDL, VLDL) in CKD patients both hemodialyzed and conservatively treated and comparable control group. Methods: This study was a cross sectional study in which clinically diagnosed cases of Chronic renal failure from OPD of department of Nephrology, S.M.S. Medical College and Hospital, Jaipur were taken as cases. Results: 30 cases of chronic renal disease and matched controls between age group of 30-70 years were analyzed in this study. The mean age of cases was 46.63 years and controls were 44.45 years. TG was found to be higher in case group (179.77±69.53) as compared to control group (100.43±35.69). Similarly, Cholesterol was high in case group (182.77±37.07) as compared to control group (159.87±25.66), the mean of LDL-Cholesterol was high in case group (118.52±32.15) as compared to control group (100.60±20.44) and the mean level of VLDL was high in case group (35.94±13.86) as compared to control group (20.05±7.18). However, the mean level of HDL-Cholesterol was found to be low in case group(28.57±5.68) as compared to control group(39.23±4.60). All These values were statistically significant. However, TG and Cholesterol were significantly lower in patients on hemodialysis as compared to patients treated by conservative line. Conclusion: In this study, we concluded that there is significant dyslipidemia, raised in chronic renal failure patients as compared to healthy controls. We conclude that, the importance of this study lies in the early detection and treatment of lipid abnormalities in CRF, which in turn can decelerate / arrest the progression of the renal failure and predisposition to atherosclerosis.

25. Diphallia: A Rare congenital anomaly
Prem Prakash
Abstract
Diphallia is a hereditary disorder in which a baby is born with two penises. This uncommon congenital anomaly was originally documented in a report filed by Swiss doctor Johannes Jacob Wecker in 1609 when he came upon a cadaver with the condition. Diphallia affects roughly one in every five to six million infant boys. Only approximately 100 cases have been documented in the 400 years since it was first recognised medically.

26. Lower Back Pain due to Lumbar PIVD Evaluation by MRI: A Cross- Sectional Study
Khumanthem Shailendra Singh, Okram Pusparani Devi, Ruma Sarkar, Pheiroijam Robindro
Abstract
Background: Lower back pain due to lumber PIVD is prevalent most commonly among the age group over 50 years. The main symptom of disc degeneration after low back pain is sciatica. There are many risk factors associated with lumbar degenerative disc disease like advancing age, smoking, obesity, trauma, heavy weightlifting, height and genetic factors. Methodology: A cross sectional study was conducted among 210 patients of lower back pain referred from Department of Orthopedics, JNIMS. They were then evaluated by MRI (3 Tesla Phillips) in the Radiology and Imaging Department, JNIMS. Multiple level disc involvement is common as compared to single level disc involvement in this study. Results:  L4-L5 and L5-S1 Disc degeneration changes was seen mostly at L4-L5 and L5-S1. X Ray LS spine with AP and Lateral views reveal gross anatomic changes in the intervertebral discs. Conclusions:  MRI Lumbo-sacral spine is the standard imaging modality for detecting Lumber PIVD due to lower backache.

27. Detection of Cognitive Impairment in Type 2 Diabetes Mellitus by Choice Auditory and Visual Reaction Times During Acute Mental Stress: A Case–Control Study
Mahendra Kumar, Benazir Bano, Ashok Kumar Deo
Abstract
Aim: Detection of cognitive impairment in Type 2 diabetes mellitus by choice auditory and visual reaction times during acute mental stress. Methods: This prospective observational study was carried out in the Department of Physiology, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India for 6 months. 80 subjects within the age group of 33–53 years were included in the study. Informed consent was taken by each subject. They were cleaved into two groups. Group 1 comprised of randomly chosen 40 diagnosed cases of Type 2 DM at least 2 years of duration. Group 2 comprised of 40 age and gender-matched controls. MMSE was performed to assess the global cognitive function in these groups. Simple and choice auditory and VRTs were measured at rest and acute mental stress in these groups to assess cognitive function. The reliability of the reaction timer was tested by standard deviation obtained during the pilot study. Results: The mean age of Type 2 DM group was 45.7 years, and the control group was 43.6 years. There was a significant statistical difference between weight and BMI. Tables 2 and 3 show a significant difference in ART and VRT, both simple and choice in Type 2 DM and controls. These RTs further increased during mental stress in diabetes. Table 4 shows that there was significant difference ART and VRT, both simple and choice during resting and during mental stress and these RTs were more prolonged in Type 2 DM when compared to controls. Conclusion: we can conclude that mental stress in Type 2 DM does affect cognition, where grades of deterioration may be related to the difficulty of the given task (mental stress) and prevalence of central nerve deficits and peripheral nerve deficits seen as side-manifestation of Type 2 DM.

28. Staging of Plasma Cell Myeloma and its Correlation with Clinico Pathological Profile in a Tertiary Hospital (JNIMS)- A 3 Year Study
Khuraijam Asha Devi, Rajkumari Jayshree Devi, Urmila Thiyam, Rajkumari Banashree Devi, Irom Anil Singh, Kshetrimayum Achouba Singh
Abstract
Background: Plasma cell myeloma (PCM) is a neoplastic proliferation of plasma cells, confined in bone marrow usually associated with an M protein in serum and/or urine and evidence of organ damage related to the disease. Various staging systems and risk stratification are being proposed to prognosticate the cases. Aims and objectives: To categorize the newly diagnosed or treatment naïve PCM cases attending JNIMS into stages and to correlate the different stages with the clinicopathological features. Method: This is a retrospective cross-sectional study. All the information were obtained from bone marrow registers maintained in the Pathology Department and Hematology unit, Medicine Department, JNIMS Imphal. Newly diagnosed and untreated patients of PCM coming to JNIMS over a period of 3 years from July 2018 to July 2021 were included. Results: 20 PCM patients were included in the study. Majority of the cases were in the age group of 5th to 6th decades (range: 38 to 79 years) and a mean age of 58 years. 9(47%) patients were male, and 11(53%) patients were female with male-to-female ratio of 1:1.2. 11(55%) were presented with backache and other bone pains, 8(40%) had generalized weakness and easy fatigability,1(5%) had symptoms of spinal cord compression. 8 patients (40%) were in stage I,10 patients (50%) were in stage II and 2 patients (10%) were in stage III. Stage I patients had equal proportion of IgA and IgG PCM. Regarding distribution of light chain restriction 3(37.5%) cases had kappa and 5(62.5%) had lambda light chain restriction. Stage II patients had predominantly IgG PCM (60%) and lambda light chain restriction. One case of plasma cell leukemia presenting in stage III with intermediate risk molecular profile (t 4;14) was also included. All the different stages had significantly variable beta-2 microglobulin level. Conclusion: We concluded that though most patients were in 6th decade, however we got significant involvement in young age group. Bone pain mostly low backache was the most common presenting symptom along with weakness and fatigue. The majority of the patient had IgG PCM.  As staging of the disease has prognostic implication, this finding needs to be explored further.

29. Clinical Profile of Acute Poisoning Cases and their Outcomes
Prerna Tejaswi, Kumar Devashish, Sushma Shikha, Asha Kumari, V.K. Mishra
Abstract
Introduction: The present study was done to describe the incidence, nature, severity, and treatment outcome trends associated with acute poisoning cases presenting to our hospital. Methodology: This prospective observational study was conducted by including patients who were admitted to the emergency department, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India with a clinical diagnosis of acute poisoning from January 2021 till June 2021. Their socio-demographic variables and poison comsumed was noted. Results: In the present study, 172 patients were included. Mean age of the patients was 27.45 years, ranging from 12 to 71 years. The sample consisted of 68% males and 61% were had an urban residence. Among all cases, 64% were suicidal cases and rest were accidental poisonings. Recovery and discharge were observed in 73%, 19% died (N=32) and 8% left against medical advice. The most common poison consumed was organophosphate (n=36). Next most common was methanol poisoning (n=27) and aluminium phosphide (n=22). Forty percent arrived at the hospital within 2 hours of poison consumption. It was observed that patients from older age group (p value < 0.05) and those presenting to the hospital after 4 to 6hours (p value < 0.05) were found to be associated with poor outcomes. Conclusions: Our study found that patients of older age group and those arriving late to the hospital were found to have significantly poor outcomes. Also, we observed high case fatality in poisonings with aluminium phosphide, organophosphate, phenyl and insecticides.

30. Morphometric Assessment of the Variation in Insertion of Extensor Hallucis Longus in Human Cadavers
Khushnuda Perween, Umesh Prasad Sinha, Arun Kumar Gupta
Abstract
Aim: Anatomical study of variation in insertion of extensor hallucis longus in human cadavers. Methods:  The material for this study comprised of 50 lower limbs of 25 embalmed adult human cadavers obtained from the Department of Anatomy, GMC, Bettiah, Bihar, India. Muscles of anterior compartment of leg were dissected and the extensor hallucis longus was explored and studied. Results: In the present study, out of 50 total limbs in the study, 46 (92%) belonged to male cadavers while 4 (8%) belonged to female cadavers. Variation was encountered in three male cadavers. In 4 female limbs, no variation was encountered. In the present study, in 6 (12%) limbs double tendons were present. The muscle was observed to divides into two tendons, lateral and medial at the level of ankle joint. The lateral tendon was inserted normally on the dorsum of base of distal phalanx of hallux, but the medial tendon was variable in its insertion. In 2 (4%) limbs, the medial tendon was inserted on the dorsal aspect of head of 1st metatarsal however in 4 (8%) cases, the insertion of medial tendon was on the dorsal aspect of base of proximal phalanx of hallux. Origin of extensor hallucis longus muscle was exactly in consonance with standard textbook pattern in all the 50 limbs. Table 2 summarizes that in 4 (8 %) cases insertion was on dorsal aspect of base of proximal phalanx of hallux and in 2 (4 %) cases insertion was on dorsal aspect of head of first metatarsal. The average length of this muscle was longer (28.6 cm) as compared to its tendinous part (13.6 cm). Deep peroneal nerve supplied this muscle in all the limbs of the present study. Conclusion: The evidence of supernumerary tendons in the extensor hallucis longus have been well documented many years ago. However, our value is not significantly higher than that described recently by other authors.

31. An Observational Assessment of Anticataract Activity of Pioglitazone: In-Vitro Goat Lens Model
Archana Kumari, Rohit Kumar Singh
Abstract
Aim: Anticataract activity of pioglitazone by using in-Vitro goat lens model. Methods: This cross-sectional observational study was carried out in the Department of pharmacology, A. N. Magadh Medical College and Hospital, Gaya, Bihar, India, from September 2017 to October 2019. The homogenate is prepared by 72 hours incubation, homogenate of lenses was prepared by using Tris buffer (0.23 M, pH-7.8) containing 0.25 X10−3 sub M EDTA and homogenate makeup up to 10 % w/v. The prepared homogenate was centrifuged at 9,000 G at 4C for 1 hour and the supernatant for the final solution was isolated from the centrifuge tube which is used for estimation of biochemical parameters. For estimation of water-soluble proteins, homogenate was prepared in sodium phosphate buffer (pH-7.4). The electrolyte Sodium and Potassium (Na+ and K+) was estimated by using flame photometry. Results: There was a formation of blur layer on the goat eyeball occurs after 10-12 hours and this process complete after 72 hours. The cataract inducing lenses showing higher level of Na+, MDA (P<0.001) along with the decreases in sodium-potassium ATPase activity and water-soluble protein content. The goat lenses treated with Ascorbic acid 40µg/ml and Pioglitazone in concentrations of 15, 30, and 60 µg/ml showed increased protein content and prevent the formation of cataract. The 55 mM Glucose treated lenses (Group-II) showed significantly low concentrations of proteins (total and water- soluble proteins) in the lens homogenate (P<0.01) compared with normal lenses (Group-I). Ascorbic acid treated lenses (Group-III) and Lenses treated with Pioglitazone (Group- IV, V, VI) showed higher concentrations of proteins (total and water-soluble proteins) (P<0.01) compared with 55 mM Glucose treated lenses (Group-II). Conclusion: In the present work, Pioglitazone treated group shows the increase in protein content (water-soluble) by prevention of cataractogenesis. This cataract is due to the higher glucose concentration. Pioglitazone shows anticataract activity due to presence of antioxidant activity and prevention of the cataract forming factors.

32. A Prospective Hospital Based Assessment of the Association Between Iron Deficiency Anemia and Febrile Seizure
Hemant Kumar Thakur, Nishant
Abstract
Aim: Iron deficiency anemia as a risk factor for the first episode of febrile seizure. Methods:  Cases (n=100) were patients with typical febrile convulsions between 1 year to 5 years (AAP clinical practice guidelines). A control group (n=100) was selected from age and sexmatched children admitted with febrile illness but without a seizure. Results: 86% (n=86) children had Hb <11 gm/dl from the case group as compared to 25% (n=25) in control group with significant p-value (p <0.01). The proportion of cases with anemia was significantly higher as compared to that of controls (p=0.015). Mean hemoglobin level and MCV in cases were significantly lower as compared to that in controls (p <0.03). RDW value is significantly higher in cases as compared to control (p <0.03). No significant difference between the two groups was observed with respect to mean MCH levels (p>0.03). serum ferritin and serum iron levels in cases were significantly lower as compared to that in controls (p <0.01). TIBC value is significantly higher in cases as compared to control (p <0.01).Conclusion: The findings suggest that a considerable percentage of children having febrile seizures suffer from iron-deficiency anemia and low serum iron. This means the low serum iron and the presence of anemia can serve as a reinforcing factor for febrile seizures in children.

33. A Retrospective Observational Research on the Clinical Profile and Outcome of Patients in the PICU (Paediatric Intensive Care Unit) At General Hospital
Hiralal Ram, Mounish Nizampatnam, Soumyabrata Panda
Abstract
Aim: The aim of the present study was to identify the clinical profile and outcome of children admitted in PICU. Materials and methods: A retrospective, descriptive study was conducted in the Department of Paediatrics, Bokaro General Hospital, Jharkhand, India for 1 year. 100 children less than 15 years admitted to PICU with complete patient information along with the investigation reports in the medical records were included in the study. Outcome was noted as expired/ discharge (Survived)/leave against medical advice/referred. History, examination details, investigations done was noted. Results: Maximum numbers of patients were in the age group of more than 28 days to 1 year which constituted 56 (56%) cases. This was followed by 1 year to less than 5 years age group which constituted 24 (24%) cases. Central nervous system was the commonest system involved (33%). Next system commonly involved was respiratory system (19%). Other common causes were infections (15%), cardiovascular (10%), gastrointestinal (4%), haematological (5%) and renal (3%) system causes. This was followed by metabolic causes (2%), down syndrome (1%) and poisoning in 1 (1%) case. Out of the 100 patients admitted to PICU, 27 (27%) patients died. 56 (56%) cases improved and were shifted to general ward and later discharged. 36 (18%) cases constituted of those who were shifted to higher centre or another department or were taken against medical advice. Conclusion: Children under 5 years of age constituted the major load of the patients in our PICU. There was male preponderance of PICU admission. Central nervous system disorders were the commonest cause of admission in the PICU, followed by respiratory, infectious and cardiovascular causes.

34. Effect of Aqueous Extract of Terminalia Bellirica Fruit Pulp: An Animal Experimental Study
Krishna Kant Nirala, Rohit Kumar Singh
Abstract
Aim: Effect of aqueous Extract of Terminalia bellirica fruit pulp on Alcohol affected learning in swiss albino mice. Methods: This study was conducted in the Department of Pharmacology, ANMMCH Gaya, Bihar, India for 1 year. 64 Swiss albino mice of either sex weighing 20-30 grams bred and maintained under standard conditions in the central animal house in AJIMS and RC were used. The standard drug Piracetam was obtained from micro labs. The dried fruit of Terminalia bellirica was obtained by Ayurvedic Dispensary, BIHAR. Aqueous Extract of Terminalia bellirica fruit pulp [AETB] -Investigational product AETB (dose1) – 9mg/kg orally. AETB (dose2) – 18mg/kg orally. AETB (dose 3) – 36mg/kg orally. Results: Piracetam (200mg/kg) and AETB (36mg/kg) significantly reduced the time taken to reach the reward chamber (p < 0.001), while Ethanol (1.5g/kg) significantly increased the latency when compared to vehicle treated groups (p< 0.001). Animals pre-treated with Piracetam (200mg/kg) and AETB (9mg/kg) significantly reduced the enhanced latency induced by Ethanol when compared to Ethanol alone treated group (p< 0.001). Conclusion: Our study indicates that the test drug enhances the learning process and is comparable to the standard drug Piracetam at higher doses (36mg/kg). Also, it can oppose the alcohol induced learning impairment at lower doses (9mg/kg).

35. To Determine the Comparative Radiological & Functional Outcome & Complications of the Acute Open Tibial Fractures Treated with Primary Ilizarov External Fixator and AO External Fixator
Niraj Narain Singh, Diksha Chaudhary
Abstract
Aim: Comparative study of functional and radiological outcome in management of type IIIB tibial fractures by AO and ilizarov external fixator. Methods: This Randomized, comparative study conducted in the Department of Orthopedics, ESIC Medical College, Bihta, Patna, Bihar, India. 50 patients satisfying the inclusion criteria have been treated by Ilizarov technique and 50 patients treated by AO external fixator. Results: In our study ASAMI bone results & functional results was Excellent (24%), Good (72%) & Poor (4%) in AO group, whereas in Ilizarov group Excellent (64%), Good (32%) & Poor (4%). Conclusion: Ilizarov external fixator being minimally invasive procedure interferes less with the blood supply. The construct is ring fixator, safe, stable (three-dimensional stability) and enable the patient early Weight bearing after surgery and high union rates, even in highly comminuted fractures.

36. Descriptive Observational Study to Determine the Clinico-Pathological Profile of Paediatric Patients with Thalassemia Major
Nishant, Hemant Kumar Thakur
Abstract
Aim: Clinico-pathological profile of paediatric patients with thalassemia major. Methods: This Descriptive observational study conducted in the Department of Paediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 1 year. This study was conducted on 100 children with β-Thalassemia major patients aged between 1-15 year being regularly transfused. A preformed and pre-checked proforma was used for data collection that included personal information, data regarding the number of transfusions and pre-transfusion. haemoglobin and serum ferritin, at what dose of chelators they were with clinical examination finding and laboratory investigation reports. Results: β– Thalassemia major affects both male and female equally but gender status in the present study shows male predominance with 65 male (65%) and 35(35%) female. In 1-3 years, cases, 14 had low, 05 had high and 03 had a normal level of serum phosphorus. In 4-11years, 24 cases had low, 26 cases had high, and 13 cases had normal serum phosphorus levels. In 12-15 years, the only 2 cases had hypophosphatemia, 4 cases had high, and 8 cases had a normal level of Serum Phosphorus. In the present study, there were 27 (27%) patients who have been found short stature on the growth chart, out of which 18 cases were boys and 9 cases were girls who showed that, short stature was more in boys as compared to girls. Conclusion: There is a direct adverse impact of increasing serum ferritin values and transfusion index on anthropometric, clinical parameters and the biochemical parameters.

37. A Prospective Observational Assessment of the Thyroid Profile Among the First Trimester Pregnant Women
Priti Singh, Priyanka Kumari, Anupama Sinha
Abstract
Aim: Study of thyroid profile among the first trimester pregnant women attending tertiary care hospital. Methods: 100 first trimester pregnant women were included in this study.  A detailed history was taken regarding the symptoms, and signs of thyroid disorders. Menstrual history, obstetric history, past history, medical history, family history, personal history. A thorough general physical examination with reference to Pulse, blood pressure, temperature, respiratory rate was noted followed by cardiovascular system, Central nervous system, Respiratory system, Local Thyroid examination and abdominal examination was done. Women are sent for thyroid hormone profile testing FT3, FT4 & TSH by ELISA reader method. The normal range of TSH in first trimester is 0.1 -2.5 μu/dl values outside this range was considered abnormal. All such women were asked to undergo Thyroid Peroxidase antibody testing. Results: Maximum number of cases 56(56%) were belongs to in the age group of 21-25 years and minimum no. of cases were 6(6%) belong to the age group of ≥ 31. The mean and SD of age was 25.4 ± 2.57. Maximum number of cases were multigravida 60(60.0%). Out of which G2 were 38(38%), G3, G4 and G5 cases were 16(16%), 5(5%) and 1(1%) respectively. There were 40 (40.0%) of primi case. Maximum number of cases 51 (51%) were belongs to in the gestational age group of 9-11 weeks and minimum no. of cases (9%) belonged to the gestational age group of ≥ 12 weeks. The mean and SD of gestational age was 10.20 ± 1.43. there   were   20 (20%) of   thyroid dysfunction cases in the study. The hospital incidence rate of thyroid dysfunction in first trimester pregnant women was 20% Study reveals that, there was no statistical significance difference of normal and thyroid dysfunction cases in relation with age (P>0.05). there were statistically very highly significance association normal and thyroid dysfunction cases in relation with period of gestation (P< 0.001). Higher the period of gestation age has significantly more number of thyroid dysfunction cases as compare to lower gestation age in relation with normal cases. Study observed that, there were 19 (95%) of thyroid dysfunction cases in which TPO was done and found out to be negative. Only one case 1(5%) had positive TPO among thyroid dysfunction in the study. In the study hospital TPO rate was 5%. Conclusion: A high proportion of hypothyroid was observed in first trimester of pregnancy, and hence a routine antenatal screening is suggested to diagnose the thyroid dysfunction at the earliest gestation.

38. A Prospective Questionnaire Based Assessment of the Efficacy and Satisfaction Rate in Postpartum Intrauterine Contraceptive Device Insertion
Priyanka Kumari, Priti Singh, Anupama Sinha
Abstract
Aim: Efficacy and satisfaction rate in postpartum intrauterine contraceptive device insertion. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, JLNMCH, Bhagalpur, Bihar, India for 15 months. IUCD was inserted immediately postpartum regardless of the mode ofdelivery either intra-cesarean section (CS) or spontaneous vaginal delivery (SVD). Some patients took longer to make the decision, and IUCD was inserted after vaginal delivery within 48 hours. All patients were asked to fill in a questionnaire based upon likerts scale to judge the satisfaction level. And there was one direct question at the end which asked aboutsatisfaction. All the patients were followed up immediately, after a week, after a month, after 3 months and after 6 months. Results: There were some complications and as accepted the satisfaction levels were good in the cases that did not haveany complications. Conclusion: The satisfaction level is good except in the patients who suffer from initial complications. Steps are necessary to counsel the patients and take appropriate steps so as to reduce the complications.

39. Prospective, Randomized, Controlled, Double Blinded Comparative Assessment of Ropivacaine with Dexmedetomidine, Clonidine and Magnesium Sulphate as Adjuvant in Caudal Epidural Block
Shatrughan Kumar, Narendra Kumar
Abstract
Aim: Controlled comparison of ropivacaine with dexmedetomidine, clonidine and magnesium sulphate as adjuvant in caudal epidural block in paediatric population for infra-umbilical surgeries. Material and methods: This prospective, randomized, controlled, double blinded study was carried out in the Department of Anaesthesiology, Sri Krishna medical college& hospital, Muzaffarpur, Bihar, India for 1 year.100 children belonging to age group of 2-8 years, weighing 8-20 kilograms(kgs), falling into American Society of Anesthesiologists’ (ASA) physical status I- II and undergoing elective below umbilical surgeries, were enrolled for the study. Results: The mean duration of analgesia in group R, D, C and M were 260.75±10.94, 388.6±10.90, 440±10.8 and 330.75±13.1 minutes(mins) respectively and the difference was statistically significant in all four groups (F=855.4778 and P<0.0001). The inter group differences were highly significant. The mean duration of analgesia was highest in group D followed by C, M and finally least in group R (Table 2). The time to onset of blockade in group D, C, M and R were 10.80±0.82, 10.10±0.70, 7.35±0.85 and 7.20±0.86 mins respectively and the difference was statistically not significant. No significant difference was seen in all four groups regarding haemodynamic parameters intraoperatively and postoperatively till 180 mins. The comparison of HR between four Groups showed highly significant difference at 240 mins, 300 mins and 360 mins, whereas of MAP showed similar findings at 240 mins, 300 mins and 360 mins. Conclusion: It can be concluded there is a definitive increase in post-operative analgesia when any of three adjuvants namely dexmedetomidine, clonidine or magnesium are added to Ropivacaine for caudal epidural block than control group.

40. A Prospective Randomized Controlled Research to Assess the Outcome of Oxiport Laryngoscope Blade Versus Miller Laryngoscope Blade for Intubation in Neonates and Infants During General Anesthesia
Sukesh Kumar, Jitesh Kumar, Ravi Ranjan Kumar, B.K. Kashyap
Abstract
Aim: Comparative study of oxiport laryngoscope blade versus miller laryngoscope blade for intubation in neonates and infants during general anesthesia. Methods: This prospective, randomised, controlled interventional single-blind study conducted in the Department of Anesthesiology & Critical Care Patna Medical College & Hospital, Patna, Bihar, India for 1 year. 80 neonates/infants in groups of 40 each posted for surgery in paediatric operation theatre (OT) over a period of 6 months were included in the study. Full-term neonates and infants up to 6 months of age of either sex requiring general anaesthesia with endotracheal intubation for elective as well as emergency surgery were included in the study. Results: Out of the 80 patients 40 patients in Miller group and 40 patients in Oxiport group were included. Both groups were comparable with respect to age, sex, weight, mean time to intubation (P = 0.57) and anaesthesiologist performing the laryngoscopy (P = 0.72). Mean lowest SpO2 recorded was 96.1% ± 4.75% in Miller group and 98.15% ± 2.83% in Oxiport group. This difference was statistically significant (P = 0.041). The incidence of mild desaturation (SpO2 up to 90%) was 87.5% in Miller group and 95% in Oxiport group. The incidence of moderate desaturation (SpO2 between 85% and 92.5%) was 2.5% in Miller group and 5% in Oxiport group. Incidence of severe desaturation (SpO2 <85%) was 15% in Miller group and 0 in Oxiport group (Chi-square test P = 0.04). Correlation between time to intubation and SpO2 in Miller group (Pearson’s R2 = −0.12) was statistically not significant at P = 0.41. Correlation between time to intubation and SpO2 in Oxiport group (Pearson’s R2 = −0.42) was statistically significant at P = 0.001. Both    groups    were     comparable     with respect to the type of surgery (abdominal, thoracic, miscellaneous) (P = 0.71). Abdominal surgeries were associated with a higher number of severe desaturations (70%) compared to thoracic (15%) and miscellaneous (15%) surgeries. Conclusion: In this study, apnoeic laryngeal oxygen insufflation with Oxiport laryngoscope blade decreased the incidence of severe desaturation while intubating neonates and infants.

41. To Compare Basketball Players’ and Sprinters’ Physical Fitness Measures Such as Body Composition, Strength and Endurance
Vijay Kumar Singh, Bharat Kumar, Sheela Kumari
Abstract
Aim: A comparative study of physical fitness parameters between basketball players and sprinters. Methods: This study was done the Department of physiology, Darbhanga Medical College, Darbhanga, Bihar, India for 6 months. 50 basketball players and 50 sprinters aged between 15 and 20 years and playing at various levels in Darbhanga bihar were selected for our study. Various physical fitness parameters were assessed in Exercise and Sports Physiology Lab. Physical and physiological parameters such as height, weight, upper segment, lower segment, arm span, body-composition, strength, and endurance were assessed. Results: The highly significant difference between two groups for height and weight. Arm span and upper body segments were statistically significant between two groups, whereas the difference in lower segments was not significant. Only lean body mass was a statistically significant when compared between basketball players and sprinters. Bench press, bench squat, and leg dynamometry were statistically significant between two groups, whereas there was no substantial difference in back dynamometry. Endurance was highly significant for the lower body while significant in the upper body between these two groups. Conclusion: Our study observed significant variances in the anthropometric features of sprinters and basketball players. Here in, basketball players were taller, heavier with more lean body mass than sprinters, but the experimental group was far-off behind the international standards. Equally important is the fact that the weight of a player has to be more attributing to more lean body mass and not just fat mass or fat percent.

42. Comparative Assessment of the Outcome in Patients with Knee Osteoarthritis Treated Using of TENS Therapy and Ultrasound-Guided Genicular Nerve Block
Vikas Kumar
Abstract
Aim: Comparison of the Therapeutic Efficacy of TENS vs Ultrasound-guided Genicular Nerve Block in Patients with Knee Osteoarthritis. Methods: Total 50 patients were included in this study, 25 each in the TENS group and GNB group, respectively. Primary OA knee, Radiologic K/L (Kellgren-Lawrence Grading Scale) score: 3 and 4, Age: 40–80 years, poorly responding to initial treatments, Patients unwilling or contraindicated for surgical management and Visual acuity scale (VAS) >5 were included in this study. All the subjects recruited in our study underwent some baseline routine blood investigation. The total study population (n = 50) was divided into two groups (25 in each group) randomly. Before starting treatment, basic information like age, sex, and duration of disease were noted and baseline VAS and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were calculated. A short course of acetaminophen tablet, lifestyle modification, and therapeutic exercise regimen was prescribed and followed. Results:  All numerical variables were found to be normally distributed by Kolmogorov–Smirnoff goodness-of-fit. The mean age of patients in TENS group (n = 25) was around 54.26 (±7.68) years and in GNB group (n = 25) was 55.63 (±6.97) years. a comparison of the numerical variable VAS for pain between both the groups by Student’s unpaired “t” test shows, after continuous 3 weeks of daily TENS therapy, knee pain improved from a mean VAS of 7.35 (±0.81) at baseline to 3.66 (±1.14) at the end of 1 month. Whereas, with a single sitting of GNB, the mean VAS improved from a baseline value of 7.41 (±0.86) to 2.87 (±0.92) at the end of 1 month. Thus, GNB shows a significantly better result (p < 0.05) in improving knee pain than TENS therapy at 1 month. Although at the end of 3 months, the VAS in both the groups again becomes comparable (p = 0.21). In the TENS group, WOMAC improved from a mean of 47.23 (±6.10) at baseline to 27.44 (±5.87) at the end of 1 month. In the GNB group (group II), the mean WOMAC improved from a baseline value of 46.69 (±5.85) to 24.44 (±4.81) at the end of 1 month. Thus, similar to pain, GNB shows significant better result (p < 0.05) in improving knee stiffness and function than TENS therapy at 1 month. At the end of 3 months, the WOMAC in both the groups again becomes comparable (p = 0.82.). Conclusion: We concluded that GNB is a better choice than TENS in the short-term and comparable in the long term and both add to the OA knee rehabilitation program significantly.

43. An Observational Assessment of the Incidence of Various of Cutaneous Granulomatous Lesions: Histopathological Study
Kannu Priya, Vandana, N.K. Bariar
Abstract
Aim: Histopathological study of cutaneous granulomatous lesions. Methods: The present Observational study was conducted in the Department of Pathology, Patna medical college and Hospital, Patna, Bihar, India for 1 year. We include 100 cases of skin biopsies after histopathological confirmation of granulomatous lesions. Results: Among 100 cases were studied in which male predominance was noted with 65(65%) cases and females constituted 35(35%) case providing M: F ratio of 1:1.86. Most of the patients were noted in age group of 20 to 30 years i.e 35(35%) cases followed by 22(22%) case in 30 to 40 years. 82% of cases were seen below 50 years of age in our study. Infectious granulomatous dermatoses were very common, only 1 cases of sarcoidosis were found.  Most cases of infectious dermatoses were noted in 20 to 30 years comprising 35(35%) cases. Leprosy remained the significant causative reason for infectious granulomatous dermatoses succeeded by tuberculosis of skin. Borderline tuberculoid leprosy was found to be predominant, constituting 30 (30%) cases followed by indeterminate and lepromatous leprosy both had 21(21%) cases, tuberculoid leprosy 17(17%) case and 7(7%) of borderline lepromatous. Lupus vulgaris constituted 2 cases (2%) and only 1 (1%) case of sarcoidosis was found. Conclusion: The granulomatous lesion is common in third decade of life with male predominance. Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction.

44. Prospective Comparative Study to Assess the Impact of Single Dose Versus Multidose Prophylactic Antibiotics in Elective Hernia Repair
Raj Kishor Roshan, U.S. Singh
Abstract
Aim: Impact of single dose versus multidose prophylactic antibiotics in elective hernia repair. Methods: This prospective, comparative study was done the Department of General Surgery, Patna Medical College & Hospital, Patna, India, for 12 months. 120 suitable patients who were admitted for elective groin surgery were included in this study were randomly assigned two groups (n=60) single-dose pre-operative (SD) group and multiple- dose (MD) in each group. SD group was given amoxycillin-clavulanic acid (2 gm) intravenously at the time of induction of anesthesia. MD group was given amoxycillin-clavulanic acid (2 gm) parentally at the time of induction of anesthesia and following it up with the same antibiotic (1 gm) intravenously twice a day for two days post-operatively. Results: Out of 60 patients of group SD, only 8.33% of patients developed surgical site infection compared to none in group MD Statistically, there was no appreciable difference in the incidence of SSI in both SD and MD groups with a p value of 0.31. Main complaints by many patients in the post-operative period were pain and headache managed well with intravenous fluids for spinal headache and analgesics. Seroma was found in the 3rd postoperative day in 3 patients in group I, fluid aspirated, and culture turned out to be negative. 5 of the SD group developed an infection, which subsided with the continuation of antibiotics. Expenditure incurred by the patient only for antibiotic analyzed of antibiotic (amoxicillin and clavulanic acid) and found the average cost of antibiotic per patient in SD group was Rs. 150 while the cost of antibiotic per patient in group II was Rs. 1500. P value is 0.0001 (p value <0.05) found to be significant. Conclusion: We concluded that the rate of infections is quite similar in SD and MD antibiotics thereby making single-dose antibiotics prophylaxis as effective as multiple doses of antibiotics prophylaxis. We also conclude that single-dose antibiotic prophylaxis is economical in uncomplicated elective surgery.

45. Prospective, Randomized, Controlled, Double Blinded Assessment of the Effect of Intravenous Dexmedetomidine Infusion on Subarachnoid Block with Bupivacaine in Inguinal Herniorrhaphies
Om Prakash, Anil Kumar Sinha, Moti Lal Das
Abstract
Aim: The Effect of Intravenous Dexmedetomidine Infusion on Subarachnoid Block with Bupivacaine in Inguinal Herniorrhaphies. Material and methods: This prospective, randomized, controlled, double blinded study was carried out in the Department of Anaesthesiology, NMCH, Patna, Bihar, India for 1 year. All the patients were dived in two groups. GroupA: received Spinal Bupivacaine 0.5% (Heavy) and intravenous Dexmedetomidine 1µg/kg bolus infusion in 20 mL (syringe) over a period of 10 minutes followed by 0.5µg/kg over a period of one hour in 50 mL (syringe). Group B: Received Spinal Bupivacaine 0.5% (Heavy) and normal saline Infusion. The volume of intravenous bolus dose for groups A and B was made same (20 mL). For loading dose in group, A, Dexmedetomidine 1µg/kg taken, made to 20 ml with distilled water & for group B 20ml of normal saline was taken. The volume of intravenous maintenance dose for group A and B was made the same (50 mL). Results: Mean time of onset of sensory blockade in group A is 3.58 mt and in group B is 3.58. It is not statistically significant with p value >0.05. Mean time to achieve maximum sensory blockade in group A is 12.06 mt and in group B is 11.62mts. It is not statistically significant with p value >0.05. Mean Time of first Analgesia is compared in two groups. Time of first analgesia in group A is 353.4 mts and for group B IS 185.28mts. It is statistically significant with p value<0.001. Whereas mean pain score at 60mt, 2hr, 3hr, 4hr, 5hr in group A is 3.3, 17.3, 26.5, 32.18, 39.10 and for group B is 10.10, 38.5, 48.67, 50.10. At 60 minutes the mean pain score for group A was 3.3 and for group B was 10.10 which was again showed significant difference between two groups. All the patients in group B showed a pain score of >50 before 4hr and received rescue analgesia. At 4hr the mean pain score in group A was only 32.18. At 60mt, 2hr, 3hr, 4hr, 5hr, 6hr, 7hr, 8hr mean pain score in group A is increased from 3.4, 17.4, 26.7, 32.19, 39.29, 45.20, 48.77, 50.20 is observed difference among the groups were statistically significant and that of group A continues to be a superior drug when mean pain scores were compared, then the other group. Conclusion: Intravenous infusion of dexmedetomidine added to subarachnoid block with bupivacaine shows prolonged analgesia in adult patients, without increasing the incidence of unwanted effects.

46. Randomized, Placebo-Controlled Study to Investigate the Effects of Eplerenone in Patients with Heart Failure of Different Etiologies
Vinayanand Jha, Chackappen D Aymanom, Shivendra Tiwari
Abstract
Aim: To investigate the effects of eplerenone in patients with heart failure of different etiologies. Methodology: This is a type of randomized, placebo-controlled study. 500 patients with age more than 55 years old and diagnosed with heart failure were enrolled in this study visiting Department of General medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Patients were divided into two sub-groups, which are group A and group B. Group A included 250 patients who were randomly assigned to receive placebo in addition to recommended therapy. Group B included 250 patients to whom eplerenone (up to 50 mg daily) was prescribed with recommended therapy. The number of hospitalizations per person were recorded, separately, for all-cause and heart failure hospitalizations.th number of deaths of patients and their causes were also recorded and further analyzed. Results: Out of 500 enrolled patients, 120 patients were died in total. Out of group A (placebo), total number of deaths reported were 68 (27.2%), out of which 44 (17.6%) deaths were due to cardiovascular reasons. Out of group B (eplerenone), total number of deaths reported were 53 (20.8%), out of which 32 (12.8%) deaths were due to cardiovascular reasons. Out of 500, 382 (76.4%) patients got admitted to hospitals for any cause during follow-up. The number of patients admitted for heart failure was 116 (23.2%). Conclusion: In patients with heart failure, eplerenone added to recommended therapy is found to be associated with a reduction in the rate of death from a cardiovascular cause or hospitalization for heart failure as well as hospitalization from other causes also.

47. Hypertension and Beyond in Indian Clinical Practice Study: A Nationwide Survey Assessing Knowledge, Attitude and Practices of Physicians
Krishna Kumar Jha, Jagritee, Komal Kumari
Abstract
Aim: Hypertension and beyond in Indian clinical practice study: a nationwide survey assessing knowledge, attitude and practices of physicians. Methods: This cross-sectional study was done the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 1 year. 100 individuals were included in this study. A pre-coded, clarified and pre-tested questionnaire was formulated to collect information from the selected respondent. Results: Out of 100, 32%, 30%, 28% and 11% of the respondents were 30 to 45 years, 45-60 years, below 30 years and more than 60 years old respectively. 56% were male and 44% were female. 38% of the respondents were housewives followed by 22% farmers, 16% retired, 7% students and private-job holders, 7%-day laborer, 5% businessman and 5% unemployed. More than 50% (average 56%) of the respondents had proper knowledge on hypertension. more than 80% (average 86%) had positive attitude about hypertension. 68% of the respondents never checked their BP, 66% of the respondents visited doctor last month. 77% and 76% of the respondents never checked their Urine and Blood Sugar and 95% of the respondents could not recall when they exercised. Conclusion: This survey revealed specific lapses in knowledge, attitude, and practice behaviors in regard to hypertension. Individuals were less proficient in knowledge, attitude and practices about hypertension. Majority of the respondents had higher knowledge and positive attitude toward hypertension but low level of practices.

48. A Hospital Based Descriptive Cross-Sectional Study to Evaluate the Level of Serum Uric Acid in Type 2 Diabetes Mellitus Patients
Krishna Kumar Jha, Komal Kumari, Jagritee
Abstract
Aim: To evaluate the level of serum uric acid in type 2 Diabetes mellitus patients in tertiary care hospital in Bihar region. Methodology: This is a descriptive cross-sectional study included 100 subjects diagnosed with type 2 Diabetes mellitus, conducted in Department of medicine DMCH, Bihar. Venous blood sample was collected (fasting and postprandial samples).  The test methodology for glucose levels was by colorimetric method of glucose oxidase-peroxidase. Serum sample was used to estimate serum uric acid by uricase trinder endpoint method. Results: Case group had a mean age of 48.7 ± 12.45 years; of which, 28 (56%) were men and 22 (44%) were women. The control group had mean age of 45.6 ± 14.2 years with 26 men (52%) and 24 women (48%). The mean fasting plasma glucose level was higher in cases (185.74 ± 71.74 mg/dl) than in controls (90.34 ± 13.65 mg/dl). The mean postprandial plasma glucose level was also higher in cases (273.65 ± 92.63 mg/dl) than controls (127.54 ± 24.76 mg/dl). The mean uric acid level in cases was found to be 7.85 ± 2.82 mg/dl, whereas in controls, it was found to be 4.62 ± 1.45 mg/dl. Conclusion: It can be concluded that Type-2 diabetes mellitus is related to rise in serum uric acid level. Further, more studies should be done to see whether lowering serum uric acid level decreases the glycemic level the diabetes mellitus patients which can help in improving the health of hyperuricemic subjects of Type 2 diabetes mellitus.

49. A Hospital Based Cross Sectional Assessment of Hyperuricemia A Prognostic Marker in Chronic Kidney Disease (CKD)
Vinayanand Jha, Shivendra Tiwari, Chackappen D Aymanom
Abstract
Aim: Study of hyperuricemia a prognostic marker in chronic kidney disease. Methods: This cross-sectional study was carried out in the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Results: 100 patients were included in this study. The prevalence of hyperuricemia amongst our study participants was 65% (95% CI: 58.3–75.7%). On bivariate analysis, patient’s age (β: 0.54, 95% CI: 0.25–0.84), eGFR (β: -0.67, 95% CI: -0.91 – -0.43), CKD stage 4 (β: 20.55, 95% CI: 10.32–30.76) or CKD stage 5 (β: 20.82, 95% CI: 9.55–32.09), spot urine PCR (β: 3.76, 95% CI: 1.12–6.40), severe proteinuria (β: 16.51, 95% CI: 6.56–26.46), no hypertension (β: -17.83, 95% CI: -27.17 – -8.48), systolic (β: 0.25, 95% CI: 0.09–0.40) and diastolic (β: 0.58, 95% CI: 0.14–1.01) blood pressures, diabetes (β: 9.01, 95% CI: 0.87–17.14), low protein diet (β: -8.31, 95% CI: -16.07 – -0.55), low-Carb diet (β: 8.36, 95% CI: 0.64– 16.07), ULT (β: 22.71, 95% CI: 16.00–29-42), loop diuretics (β: 11.94, 95% CI: 3.75–20.13), body mass index (β: 1.06, 95% CI: 0.07–2.05) and no anaemia (β: -27.42, 95% CI: (− 39.02 – -15.82) were significantly associated with serum uric acid. Mean serum uric acid significantly differed across CKD stages (F: 7.91, p value < 0.001) severity of proteinuria (F: 5.46, p value = 0.006) Also, on bivariate logistic regression, patient’s age (OR: 1.05, 95% CI: 1.02–1.09), eGFR (OR: 0.93, 95% CI: 0.89– 0.96), CKD stage 4 (OR: 9.11, 95% CI: 2.01–33.21) or CKD stage 5 (OR: 6.67, 95% CI: 1.63–27.27), spot urine PCR (OR: 1.52, 95% CI: 1.01–2.30), severe proteinuria (OR: 4.71, 95% CI: 1.59–13.99), no hypertension (OR: 0.06, 95% CI: 0.01–0.30), systolic (OR: 1.03, 95% CI: 1.01–1.06) and diastolic (OR: 1.05, 95% CI: 1.00–1.11) blood pressures, low protein diet (OR: 0.42, 95% CI: 0.18–0.98), low fat diet (OR: 3.09, 95% CI: 1.06–9.02), ULT (OR: 6.71, 95% CI: 2.32–19.37), loop diuretics (OR: 3.73, 95% CI: 1.29–10.82), obesity (OR: 6.65, 95% CI:1.36–32.61) and no anaemia (OR: 0.04, 95% CI: 0.00– 0.29) were significantly associated with hyperuricemia. On multivariate analysis, after adjusting for patient’s age, eGFR, spot urine PCR, systolic blood pressure, ULT, loop diuretics and haemoglobin level, patient’s age (β: 0.49, 95% CI: 0.24–0.74), eGFR (β: -0.36, 95% CI: -0.57 -0.16), CKD stage 4 (β: 17.49, 95% CI: 9.52–25.45) or CKD stage 5 (β: 13.28, 95% CI: 4.41–22.16), spot urine PCR (β: 3.06, 95% CI: 1.09–5.04), severe proteinuria (β: 13.94, 95% CI: 4.92– 22.95), no hypertension (β: -18.37, 95% CI: -28.67 -8.06), systolic (β: 0.14, 95% CI: 0.02–0.25) and diastolic (β: 0.35, 95% CI: 0.03–0.66) blood pressures, ULT (β: 18.84, 95% CI: 12.98–24.71), loop diuretics (β: 6.62, 95% CI: 0.25–12.99) and no anaemia (β: -18.08, 95% CI: (− 27.55 -8.61) were significantly associated with serum uric acid. Conclusions: Hyperuricemia was independently associated with patient’s age, eGFR, spot urine PCR, hypertension, ULT, loop diuretics, obesity and anaemia.

50. Retrospective Study to Determine the Prevalence of Dengue and its Complications
Shreyas Rajeev Pikle, Sudhir Chandra Jha, Syed Yousuf Faisal
Abstract
Aim: To estimate the prevalence of dengue and its complications. Methodology: This is a type of retrospective study carried out at Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India during the monsoon.130 patients diagnosed with Dengue were included in the study. Details of the age and gender distribution, signs and symptoms were recorded. Laboratory investigation reports of the patients at the time of admission were obtained. Details of treatment, hospital stay, organ involvement, complications and the outcomes were also recorded and analyzed. Results: Out of 130 patients, 82 (63.08%) were males and 48 (36.92%) were females. Majority of the patients i.e., 89 (68.46%) belonged to the age group between 18-40 years while 41 (31.54%) were more than 40 years of age. All the patients (100%) had fever on the day of admission. The other predominant symptoms were headache in 74 (56.92%), myalgia in 65 (50%), nausea in 47 (36.15%) and vomiting in 33 (25.38%), and abdominal pain in 28 (21.54%) patients. The laboratory parameters of the patients on admission had been recorded. The 21 (16.15%) patients had >16 gm/dl of hemoglobin. The 43 (33.08%) patients had leukopenia (4000/microliter) on admission. About 95 (73.08%) patients had thrombocytopenia (<100000/microliter) on admission. Among these, 24 (18.46%) of patients had <20000/microliter of platelets. About 58 (44.62%) patients had >45% of hematocrit on admission. Conclusion: In patients with dengue, fever, headache and myalgia are the most common clinical findings. The most common laboratory findings are thrombocytopenia and leucopenia. Dengue infections are usually at peak during the monsoon season due to collection of standing water. The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for dengue as well as for other diseases that Aedes mosquito transmit, that is why it is more prevalent in the rural regions.

51. To Evaluate the Role of Ultrasonography in Pelvic Congestion Syndrome
Archana Sinha, Swet Nisha, Sushant Kumar Sharma, Umakant
Abstract
Background: Pelvic congestion syndrome (PCS) is defined as chronic pelvic pain (CPP) due to either dilated or refluxing pelvic veins. Aims and objectives: 1) To evaluate the role of ultrasonography with doppler in diagnosing PCS. 2) To compare the findings with healthy volunteers. Materials & Methods: This observational cross-sectional study was carried out at Obstetrics and Gynaecology department IGIMS, Patna including 100 multiparous premenopausal women, 50 with chronic pelvic pain and 50 healthy women, over a period of 1 year (2019-2020), after clearance from institutional ethics committee. Inclusion criteria: CPP, Multiparous premenopausal women. Exclusion Criteria: Pregnancy, Fibroid, Endometriosis, PID, Prolapse uterus. Informed consents were taken. All underwent transvaginal and transabdominal sonography to assess the pelvic vein diameter, the ovarian veins diameter, flow direction, presence of pelvic varicocele, volume of uterus and presence of polycystic ovaries. The findings were statistically analysed. Statistical Analysis: SPSS v23 (IBM Corp.) was used for data analysis. Statistical significance was kept at p < 0.05. Results:  The mean ± SD diameter of the right Ovarian Vein Diameter, left ovarian vein diameter, right pelvic vein diameter and left pelvic vein diameter in the PCS group were significantly different when compared with control group.(p = <0.001). Reversed caudal flow in the ovarian veins were present in all of the patients with PCS group and in six patients of the control group. Pelvic varicoceles were present in all patients with PCS group and in five patients of the control group. Polycystic ovaries were present in 26 patients with PCS group (52%) and eight patients of the control group (16%).  Mean uterine volume was 113.632±0.537 cm 3 in the PCS group and 111.437±0.754 cm3 in the control group (p>0.05). Conclusion: Sonography was found to be potentially useful non-invasive tool for diagnosing patients with CPP.

52. Spectrum of Bacterial Pathogens and their Antibiogram from Cases of Urinary Tract Infection at a Tertiary Care Centre of Nashik, Maharashtra
Sneha Gupta, Geetika Patil, Nita M Gangurde, Aparna Lohar, Jeetendra Singh
Abstract
Background: Urinary tract infection and asymptomatic bacteriuria are one of the most common infections encountered in a routine clinical setting. These also forms one of the most common indications of antimicrobial therapy even before the laboratory results of the cultures becomes available. This mainly accelerates the rate of antibiotic resistance among these routinely isolated uropathogens. Aims and Objectives: The study was designed with two main aims and objectives: 1. To study the prevalence of different organisms isolated from urine samples of urinary tract infection (UTI) suspected patients. 2. To study the antibiotic sensitivity patterns of the bacterial isolates under study. Materials and Methods: This prospective observational study was conducted on 100 urine samples. A structured information of the patient was collected. The samples was examined microscopically and then cultures were inoculated according to the standard laboratory precautions on appropriate media. The cultures were later analysed for antibiotic sensitivity by Kirby Bauer Disk Diffusion Technique. Appropriate statistical method was used to analyse the data. Results: The overall culture positivity in clinically suspected cases of UTI was 60%. The most common organism isolated was Escherichia coli (28.16%) followed by Klebsiella pneumonia (22.53%).All the gram negative organisms were found to be sensitive to Colistin. Sensitivity to carbapenems, beta lactam inhibitors, aminoglycosides and nitrofurantoin was also good. Among gram positive organisms sensitivity to glycopeptides, linezolid, nitrofurantoin, rifampicin and fluoroquinolones was found to be fairly good. Conclusion: Regular monitoring is required to establish reliable information about susceptibility pattern of urinary pathogens for optimal empirical therapy of patients with UTI.

53. Incidence of Lung Cancer in North‑Western India Over 5 Years & Future Trend
Khatri Naresh Kumar, Arora Vansh, Gupta Piyush kumar
Abstract
Background: Lung cancer is the most frequently diagnosed cancer worldwide. Lung cancer occurs more frequently in males worldwide and India. There are few studies on the incidence of Lung cancer in Rajasthan state. The present study evaluates its temporal variation and area‑wise distribution. Materials and Methods: Five‑year retrospective data on Lung cancer incidence were obtained from Hospital‑Based Cancer Registry (HBCR) of Regional Cancer Centre (RCC), Bikaner, from January 2016 to December 2020. Linear regression was applied to determine the trend of Lung cancer incidence over these 5 years. District and tehsil-wise distribution of patients was also analyzed. Results: Total 4672 cases of Lung cancer were registered at RCC, Bikaner, from January 2016 to December 2020, which accounting for about 13% of total cases, among them 4082 males and 590 females (ratio 6.9:1). The diagnosis of Lung cancer was most commonly at 6th-7th decade of life in both genders. Median age at diagnosis of lung cancer was 62 years and 58 years, in males and females, respectively. 5 years data and linear regression analysis showed that an increasing trend of Lung cancer incidence over 5 years. The highest incidence rate was found in the districts of Bikaner, Churu and Nagaur, with most patients coming from Bikaner tehsil of Bikaner district. Conclusion: Lung cancer cases have shown an increasing trend in the past 5 years in Rajasthan with a higher incidence in the North‑Western districts. It is required to strict implement of rules and regulations of tobacco consumption and also required early diagnosis and effective management for improve survival of these patients.

54. Comparison of Efficacy of Labetalol with Nifedipine in Patients of Severe Preeclampsia
Meher Afshan Mehdi, Ayesha Ahmad, Amrita Singh, Saba Khan, Shilpa Singh, Kumkum Srivastava
Abstract
Background: In severe pre-eclampsia marked by blood pressure >160/110 mmHg, administration of antihypertensive agents become mandatory. The desired antihypertensive should have a quick action and should not have any maternal or perinatal side effect. Nifedipine and Labetalol are two first-line alternatives recommended for management of severe pre-eclampsia. The present prospective comparative study was conducted in Department of Obstetrics and Gynaecology, to compare the efficacy and safety of intravenous labetalol and oral nifedipine in management of severe pre-eclampsia. Methodology: A total of 50 pregnant women meeting the inclusion criteria were enrolled in the study after taking detailed history, examination and routine investigations. Thereafter these women were randomized into two groups; Groups A in which i.v Labetalol was given & Group B where oral nifedipine was given. Outcome was noted on the basis of time taken to achieve target BP, number of doses and crossover need. Results: Group A has all the patients who achieved targeted BP without crossover, however in Group B, two patients required cross-over to other group to achieve the targeted BP. Mean time taken to achieve targeted BP was slightly lower in Group A (33.60±14.97 min) as compared to that in Group B (39.57±20.99 min).In Group A, maximum patients achieved targeted BP with one dose only (48%) but in Group B after excluding 2 cases who required cross-over, maximum required two doses (47.9%).However these differences were not significant statistically. Conclusion: The finding of present study showed both labetalol as well as nifedipine to be equivalent as far as number of doses required and time taken to achieve the targeted BP is concerned however, given the safety profile and increased crossover need, labetalol is found to have better safety profile.

55. To Study the Correlation of Duration of Tobacco Intake with Occurrence of Oral Cancer – A Two Year Hospital Based Study in Bihar
Dilip Kumar, Tripurari, Dr. Sujeet Kumar
Abstract
Objectives: A hospital based study, we conducted to correlate the occurrence of oral cancer with duration of tobacco intake as tobacco consumption practice is widespread throughout the world specially in India leads to oral malignancies. Methods: Total of 109 patients with oral cancer attending various specialties of Patna Medical College and Hospital, Patna fulfilling the inclusion criteria recruited during two-year period from November 2017 to October, 2019 after obtaining written informed consent. Procedure like FNAC and biopsy from suspected lesions and enlarged lymph nodes were processed in department of pathology. Results: In our study among 109 cancer patients’ average duration of intake of tobacco and occurrence of oral cancer is 30.3±13.1 years with median age of 30 years. Chewing tobacco is most common mode of consumption and buccal mucosa and tongue with 31.2% each are most common sites of cancer, presenting with ulcer (60.55%). More than half of patients have cervical lymph nodes metastasis at the time of diagnosis. Males are more commonly affected than females with M: F ratio 4:1. Conclusion: we observed that tobacco in any form is carcinogenic and is a leading cause of morbidity and mortality in Indian population. Strict cessation of all forms of tobacco use and follow-up should be implemented to reduce the incidence of oral cancer.

56. Prospective Observational Clinical Assessment of the Outcome of Locking Plate Fixation in Cases of Comminuted Proximal Ulna Fractures
Kumar Satyam, Shankar Niwas, Shashi Kant Kr Singh
Abstract
Aim: Outcome of locking plate fixation in cases of comminuted proximal ulna fractures. Material and methods: This prospective observational study was carried out in the Department of orthopaedics, Sheikh Bhikhari Medical College And Hospital, Hazaribagh, Jharkhand, India for 1 year.  For this study we recruited 50 patients of comminuted fracture proximal ulna including fracture olecranon and Monteggia fracture. Patients were enrolled based on inclusion and exclusion criteria. Patients of more than 18 years of age with comminuted proximal one third ulna fracture of less than one month old were included in the study. Results:  More than two third (n=28) of total 50 patients of olecranon fractures were male and left side was more common to involved than right side. Fall on the ground and road traffic accident were the major cause of injury, almost equally contributed to these fractures. Out of twenty-one patients of olecranon fractures, thirteen patients belonged to Mayo type II A, four each of Mayo Type II B and Mayo type IIIA olecranon fracture. All 50 patients achieved fracture union in 6 months follow up period. Out of 50 patients, 36 (72%) had fracture union by 16 weeks. 12 patients (24%) achieved fracture union by 20 weeks while 2 patient (4%) took 22 weeks. Mean duration of fracture union of olecranon fractures was 16 weeks. No patient had any implant related complication like implant failure, implant breakage or loosening.  Assessment of range of motion at elbow joint on follow ups yielded progressively improving results with time. At 6 months follow up Mean Mayo elbow performance score was 90. Out of 22 patients, almost half (n=12) were male and rest were female. Left and right side affected almost equally. Two third of the patients were of type I while rest one third were type II of Bado classification. All 22 patients had fracture union by 16 weeks. Mean duration of fracture union was 14 weeks. No complication reported in any case. In cases of Monteggia fracture also range of motion at elbow joint on follow ups yielded progressively improving results with time. Mean Mayo elbow performance score at 6 months follow up was 94 all articular congruent extra articular fractures (Monteggia fractures) showed better arc of motion and Mayo elbow performance score than articular congruent intrarticular fractures. Conclusion: The good radiological outcomes highlight the usefulness of locking plate osteosynthesis in cases of proximal ulna fractures, provided optimal plate positioning achieved.

57. Prospective, Randomized Assessment of the Effect of Single Dose Dexmedetomidine on Extubation, drug Given Prior to Extubation
Anil Kumar Sinha, Om Prakash, Moti Lal Das
Abstract
Aim: Effect of single dose dexmedetomidine on extubation, drug given prior to extubation in adult patients following general anaesthesia. Material and methods: This Prospective, Randomized, Study was carried out in the Department of Anaesthesiology, NMCH, Patna, Bihar, India for 1 year. After obtaining informed written consent for participation in the study, 50 adult patients aged 18-70 years belonging to American Society of Anaesthesiologists physical status (ASA PS) class I-II of both genders undergoing elective surgeries were enrolled. Results: Incidence of cough at extubation was comparable in both groups (66% vs. 64%, p 1.10). Baseline mean arterial pressure was comparable in both groups, but at 3min after extubation it was significantly lower in Group A. Heart rate, postoperative nausea, vomiting, shivering and sedation scores did not show any significant difference between the two groups (p>0.05). Conclusion: An infusion of dexmedetomidine at 0.75mcg/kg prior to extubation did not affect the severity of cough but resulted in improved hemodynamics at predefined time points after extubation.

58. Prospective assessment of the role of Alvarado Score and Ultrasound in Diagnosing and Preventing Negative Laparotomies in Acute Appendicitis
Diwakar Yadav, O.P. Srivastava, Utkrist Kant
Abstract
Aim: To evaluate the role of Alvarado score and ultrasound in diagnosing and preventing negative laparotomies in acute appendicitis. Methodology: A prospective study was conducted on 50 consecutive patients who underwent appendicectomy in the department of general surgery at Sheikh Bhikhari Medical College and Hospital, Hazaribagh, Jharkhand,India, Depending on individual presentation of signs and symptoms, a score was calculated for each case of suspected appendicitis from 10 values (based on the Alvarado scoring system). All patients were clinically examined after taking a detailed history using a structured questionnaire. Then, they underwent blood examination, ultrasound abdomen, followed by surgery. The histopathological examination (HPE) of the specimen was obtained. Finally, the histopathology reports were correlated with the findings of ALVARADO Score and USG abdomen. Results: In our study of 80 patients, 31(62%) were male, and 19 (38%) were female. 23 (46%) patients were between 20-29 years of age followed by 14-20 years of age (32%). 50 (100%) of patients were admitted with pain in the abdomen. 39 (78%) complained of nausea or vomiting at admission, 33 (66%) had fever on admission and 41 (82%) of patients had anorexia at the time of admission. All patients (100%) had tenderness in the right iliac fossa. A shift to the left was seen in 40 (80%) of patients. Conclusion: According to our study the use of Alvarado Scoring System with USG is more effective and accurate than USG performing alone. It can be recommended to perform USG on each patient with suspected appendicitis and to operate on patients with a USG-supported appendicitis diagnosis and an Alvarado score of 7 and above.

59. A Cross-sectional Questionnaire based Study to Estimate Prevalence of Lower Back Pain and its Relation to Stress among Medical Students
Kumar Satyam, Shashi Kant Kr Singh, Shankar Niwas
Abstract
Aim: This study was undertaken to estimate the prevalence of LBP and its Relation to Stress Among medical Students. Methodology: A cross-sectional study among 200 medical students of SB Medical College & Hospital, Hazaribagh, Jharkhand, India was conducted. The questionnaires were distributed among the medical students during the period of 6 months. A questionnaire was designed by the researchers based upon a review of the literature. It included three parts: Sociodemographic characteristics (age, gender, year of study, weight, height, smoking, marital status, chronic diseases, and academic grade); A Standardized Nordic Questionnaire to assess musculoskeletal disorders and LBP; and A Kessler Psychological Distress Scale (K10) questionnaire to assess psychological stress. Results:  Our study included 200 students including 51% females and 49% males with a mean age of 22.53 ± 2.55 years. Most of participating students were single (93.4%) and non-smokers (88%) with normal body mass index (BMI) values (51.4%). Out of 200 students, 22.4% were 1st year, 27.2% were 2nd year, 24.6% were 3rd year, and 25.8% were final year students.  34.4% of the students had normal stress levels and 60% had not experienced LBP. Out of the 200 students with LBP, only 3% had been hospitalized. Overall, 18.5% of the students had LBP that interfered with their work activities and 27% had LBP within the last 7 days before answering the questionnaire. Conclusion: In this study, the prevalence of LBP was 40%. The prevalence of mild, moderate and severe stress was 26.6%, 20.4%, and 18.6% respectively. No significant association between LBP and psychological stress was found. Further, more studies on large scale should be done to evaluate the association between LBP and stress levels among medical students.

60. A Hospital Based Cross Sectional Study to Evaluate the Clinic-Demographic Profile of Pediatric Tuberculosis Detected by CBNAAT
Mani Shankar, Amit Kumar
Abstract
Aim: A cross sectional study of in-hospital cases of Pediatric Tuberculosis detected by CBNAAT at teaching hospital in Bihar region. Methods: This observational cross-sectional study was carried out in the Department of Pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 1 year, after taking the approval of the protocol review committee and institutional ethics committee. The study was carried out by analyzing the clinical & laboratory data of 100 patients treated with ATT. Results: Data of a total of 100 patients were analyzed. Male: female ratio was almost equal i.e., 1:1 (Male-50, Female 50). 90 patients were below the poverty line. 65% of the patients were from rural areas. 82% of patients had a tubercular contact history in the family and almost the same percentage (83%) households had a history of smoking in family members. 72% had a reactive tuberculin test. All the patients were non-reactive on HIV Screening.  In 26% of cases gastric aspirate was sampled and near about (11.53%) turned reactive for tuberculosis by CBNAAT. Out of 74 sputum samples from children more than five years of age. 40% of overall collected samples were reactive to CBNAAT testing for tuberculosis at this centre. None of the pediatric samples was positive for MDR TB. 57% of children completed treatment and 35% were declared cured. Conclusion: This study concludes with 40% positivity after CBNAAT testing for tuberculosis infection in collected samples of sputum and gastric aspirate where only 11.53% yield in GA samples. Because of the WHO End TB strategy, there is a need to implement standard procedures for sampling methods to increase yield in collected samples for diagnosis of Pediatric tuberculosis and improve contact tracing with the available diagnostic tools.

61. A Retrospective Assessment of the Incidence, Predisposing Factors & Associated Complications and Outcome of Emergency Peripartum Hysterectomy in Bihar Region
Neena Agrawal
Abstract
Aim: The aim of the study was to evaluate the incidence, predisposing factors & associated complications and outcome of emergency peripartum hysterectomy. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India, for 1 year. Age, parity, traumatic or atonic PPH, risk factors, complications were all studied in detail and analysed. Results: 50 underwent emergency peripartum hysterectomy, yielding to an incidence of 0.12%. 14 (28%) patients underwent emergency peripartum hysterectomy following vaginal delivery, among whom 3 (6%) patients had instrumental delivery and 33(66%) following caesarean section. The most common indications out of the incidence were atonic PPH, noted in 24 patients (48%), following vaginal delivery were 9 (18%), following caesarean section were 15 (30%). Indication for rupture uterus were 24 (48%), 12 (24%) following rupture of an unscarred uterus. 12 (24%) following rupture of scarred uterus. Due to secondary post- partum haemorrhage were 6(12%). Acute inversion of uterus was 1(2%).  Out of 50 patients, 16(32%) patients experienced intra-operative hypotension, 8(16%) developed febrile illness, 31(62%) required ICU care. The mean hospital stays of the patients <10days were 18 (36%), >10days were 26(52%) patients. None of the 50 patients required re-laparotomy, 19(38%) patients went into DIC, 5(10%) experienced bladder injury due to involvement of bladder along the rupture of uterus, repair done simultaneously during hysterectomy, 3(6%) patients developed vesicovaginal fistula post-operatively. 6(12%) patients who underwent emergency peripartum hysterectomy died during post-operative period. Maternal mortality was 12% in the study. Conclusions:Hysterectomy is a lifesaving procedure to control postpartum hemorrhage but is associated with significant maternal morbidity and mortality. Uterine atony, uterine ruptures, also due to prior caesarean delivery, placenta previa were identified as risk factors.

62. Retrospective Observational Research to Investigate the Variables that Increase the Risk of Severe Asthma in Adult Patients and the Sorts of Therapy that may Alleviate that Risk
Pawan Kumar Agrawal, Surendra Kumar
Abstract
Aim: Risk Factors and Treatment Types for Asthma Severity among Adult Patients. Material and methods: This retrospective study was done the Department of Tb and chest, Patna Medical College and Hospital, Patna, Bihar, India for 1 year. All asthmatic patients whose ages were greater than or equal to 20 years in chronic illness, medication and follow-up clinic for asthma treatment. Results: A total of 120 respondents, 100 were included in the final analysis. From total units in the study, 20 (20%) severe, 30 (30%) moderate, and 50(50%) were mild asthmatic patients, respectively. patients who were severely asthmatics 40% were female and 60% male. Those who were moderate asthmatic 30% were females and 70% were male. Percentage distributions of those who are mild asthmatic (60%, 40%) were female and male, respectively. The percentage distribution of asthma severity levels by different environmental factors. Out of total adult patients who were severely asthmatic 65%, 35% were registered in the dry season and rainy season, respectively. Of the total study unit who had asthma in childhood stage, 45%, 40%, 60% were severe, moderate, and mild asthmatic, respectively. Patients who had asthma in their family 35%, 40%, 58% were severe, moderate, and mild, respectively. The percentage distribution of asthma symptom seen in adult asthmatic patients are coughing (52%), wheezing (50%), dyspnea (44%), chest pain (25%), limited daily activity (10%), and rhinitis (6%). From 100 patients, who received oxygen (O2) and prednisolone were 70(70%) 30(30%) respectively. The percentage distributions of budesonide, beclomethasone puff was equal which is expressed by 5%. Of all treatments distributed to asthmatic patients in a study unit, Salbutamol puff has a minimum percentage (4%) value. Conclusion: The study showed that demographic, environmental, genetic, and health-related factors have a significant effect on asthma severity.

63. An Observational Study Assessment of Clinico-pathological and Lab Profile of Paediatric Patients with β-thalassemia Major
Umendra Kumar, Avinash Kumar
Abstract
Aim: To study the clinical profile and laboratory parameters of Thalassemia major in pediatric patients. Methodology: An observational study was conducted on 50 pediatric patients with β-thalassemia major in the Department of Paediatrics, SNMMCH, Dhanbad, Jharkhand, India for 8 months. Patients aged 1-14 year being regularly transfused were included in this study. A preformed proforma was used for data collection that included demographic details, transfusion details, and pre-transfusion haemoglobin and serum ferritin with clinical examination findings and laboratory investigation reports. The serum ferritin level was measured in all Thalassemic patients. Iron chelating agents were advised to all patients with serum ferritin level above 1000 ng/ml. Haemoglobin was measured before transfusion by Sahli’s method. Blood group cross-matching was done by blood typing. Standard references were used to analyze the laboratory parameters. Results: Out of 50 patients, 17 (34%) were male and 33 (66%) were females. 58% patients had normal stature. 12 patients belonged to 1-3 years age group, 31 belonged to 4-11years and 7 belonged to 12-14 years of age group. 19 out of 50 patients (38%) has serum ferritin level more than 2000 ng/ml out of which 15 patients (78.9%) had hepatomegaly followed by 10 out of 14 patients with serum ferritin level 1001-1500 units had hepatomegaly. In total 72% patients had hepatomegaly. Out of 50 patients, 3 (6%) had spleen size less than 2 cm, 26 (52%) had spleen size 2-7 cm, and 21 (42%) patients had spleen size more than 7 cm. Conclusion:Iron overload is the primary and major risk factor of mortality and morbidity in thalassemia major despite advances in chelation therapy. Early application of chelation therapy can prevent complications in beta-thalassemia major patients. There is a direct adverse impact of increasing serum ferritin values with the clinical parameters and the biochemical parameters.

64. Branching Pattern of Segmental Branches of Splenic Artery: Cadaveric Study
Vineeta Laxmi, Vijay Shekhar Kumar, Umesh Prasad Sinha, Bhavesh Kumar
Abstract
Aim: Study on branching pattern of segmental branches of splenic artery in human cadaveric spleens by dissection method. Material and methods: This prospective, randomized, study was carried out in the Department of Anatomy, Government Medical College, Bettiah (W.Champaran), Bihar,The present study is conducted on 100 Human cadaver spleens, irrespective of their age and sex, fixed in 10% formalin solution, collected from the department of Anatomy department. The gross dissection was done by following the guidelines of Cunningham’s Manual. Results: Two primary segmental branches were seen in 71 (71%) specimens, three primary segmental branches were seen in 24(24%) specimens and four primary segmental branches were seen in 5 (5%) specimens. The mean distance between the termination of splenic artery and the hilum of the spleen was 2.2 cm. The range was extending from 0.4 cm to 6.2 cm. Conclusion: The spleen is a highly vascular and friable organ. It is the largest of secondary lymphoid organ, which contains 25% of the body’s lymphoid tissue and has both haematological and immunological functions. Total splenectomy is commonly done after a splenic injury, which leads to decrease in the immunity and predisposes the normal host to overwhelming life-threatening infections and also creates an altered haematological picture. To overcome this, partial splenectomy can be done by ligating a particular segmental branch of splenic artery.

65. Prospective Observational Evaluation of the Emerging Role of a Newborn Screening Program for Congenital Hypothyroidism
Satish Kumar, Mithilesh Kumar, Pawan Kumar Yadav
Abstract
Aim: The emerging role of a newborn screening program for congenital hypothyroidism: a prospective study. Material and methods: This Prospective observational study was carried out in the Department of Paediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India for 1 year. A total of 120 babies were enrolled, but 100 were an eligible candidate for the study period. The blood sample was taken in a sterile container under aseptic precautions, between 3-5 days of life to minimize the false positive high TSH values due to the physiological neonatal surge that elevates TSH level and causes T4, T3 changes in 1-2 days. In cases with a healthy newborn baby, sampling was done between 3-5 days. Results: A total of 120 babies were enrolled, but 100 were an eligible candidate for the study period. Those, not eligible candidates received a blood transfusion, death within 3 days, left against medical advice (LAMA) or shifted to other hospitals and nonconsenting of parents for the study. Out of the delivered babies, 60 were born by lower section caesarian section and 40 were vaginally delivered and there were 36 mothers who were hypothyroid and were on medication. Numbers of term deliveries were 87 and preterm deliveries were 13, with 52 (52%) males and 48(48%) female babies. Of the total eligible neonates, 87 were term babies and 13 were preterm babies with more than 34 weeks (Table 1). Neonatal thyroid-stimulating hormone was estimated in all 90 neonates out of which 1 case were positive for CH, 9 cases had initially high values between 10-19 µIU/L which were later on repeat testing after two weeks were found to be in normal limits and rest all 1258 cases were normal (Table 2). From the 2positive cases of CH, one baby was of Downs’s syndrome on 12.5 mcg of Eltroxin and one baby was positive of elderly primi mother on 25 mcg of medication and on regular follow up since last 5 months. Conclusion: Timely diagnosis and treatment of CH are important in order to prevent psychomotor development disability &improve school progress. NBS is the need of the hour for early diagnosis of CH, which is simple, fast as well as cost-effective.

66. Prospective, Randomized Morphological Assessment of Variations in Shape of Coronoid Process of Adult Human Mandible
Vijay Shekhar Kumar, Vineeta Laxmi, Bhavesh Kumar
Abstract
Aim: Morphological study of variations in shape of coronoid process of adult human mandible. Material and methods: This prospective, randomized, study was carried out in the Department of Anatomy, Government Medical College, Bettiah (W.Champaran), Bihar,India Shape of the coronoid processes of 50(100 sides) dry adult human mandibles were studied out of which 30 (60 sides) were of males and 20(40 sides) were of females. Male and Female bones were differentiated by noting standard morphological features. Different shapes of coronoid process observed are triangular, rounded, and hooked. The different shapes of coronoid process were compared for sexual dimorphism and difference on either side. Results: In present study it is observed that Triangular shape of coronoid process was present in 50 mandibles out of which, in 70% cases it was bilateral while in 30% cases it was unilateral. Hence, observation leads to the interpretation that triangular shape of is more commonly bilateral. In case of unilateral, eight coronoid process of right sides were triangular (corresponding side have 2 rounded shaped & 5 hook shaped coronoid process). It was left side in 3 mandibles. It was of round shaped in 19 mandibles, out of which, in 47.37% cases it was bilateral mandibles and unilateral in 52.63% mandibles. In cases of unilateral side, it is present at three right and nine left side of mandible, The corresponding side of mandibles were two triangular shaped and one hooked shape in case of right side, while in cases of left side, five were triangular and four were hooked shape coronoid process. Conclusion: In present study it is found that hook shape of coronoid is most common in male mandibles followed by triangular and rounded shape. In case of female mandibles triangular shape is most common followed by hook and rounded shape.

66. Prospective, Randomized Morphological Assessment of Variations in Shape of Coronoid Process of Adult Human Mandible
Vijay Shekhar Kumar, Vineeta Laxmi, Bhavesh Kumar
Abstract
Aim: Morphological study of variations in shape of coronoid process of adult human mandible. Material and methods: This prospective, randomized, study was carried out in the Department of Anatomy, Government Medical College, Bettiah (W.Champaran), Bihar,India Shape of the coronoid processes of 50(100 sides) dry adult human mandibles were studied out of which 30 (60 sides) were of males and 20(40 sides) were of females. Male and Female bones were differentiated by noting standard morphological features. Different shapes of coronoid process observed are triangular, rounded, and hooked. The different shapes of coronoid process were compared for sexual dimorphism and difference on either side. Results: In present study it is observed that Triangular shape of coronoid process was present in 50 mandibles out of which, in 70% cases it was bilateral while in 30% cases it was unilateral. Hence, observation leads to the interpretation that triangular shape of is more commonly bilateral. In case of unilateral, eight coronoid process of right sides were triangular (corresponding side have 2 rounded shaped & 5 hook shaped coronoid process). It was left side in 3 mandibles. It was of round shaped in 19 mandibles, out of which, in 47.37% cases it was bilateral mandibles and unilateral in 52.63% mandibles. In cases of unilateral side, it is present at three right and nine left side of mandible, The corresponding side of mandibles were two triangular shaped and one hooked shape in case of right side, while in cases of left side, five were triangular and four were hooked shape coronoid process. Conclusion: In present study it is found that hook shape of coronoid is most common in male mandibles followed by triangular and rounded shape. In case of female mandibles triangular shape is most common followed by hook and rounded shape.

67. A Prospective Cohort Study to Evaluate the Early Indicator of Significant Hyperbilirubinemia in Healthy Full-term Infants at 72 hrs of Age
Amit Kumar, Mani Shankar
Abstract
Aim: This study aims to evaluate the early indicator of significant hyperbilirubinemia in healthy full-term infants at 72 hrs of age. Methods: This prospective observational study was conducted in the Department of Pediatrics, Darbhanga medical college, and Hospital, Laheriasarai, Darbhanga, Bihar, India, for 12 months. Full-term newborn delivered at our hospital of >36 weeks of gestation. Birth weight >2 kg was included in this study. Bilirubin level at or above high intermediate risk zone at 24 and 48 hrs of age was considered a cut-off value to find out the association with significant hyperbilirubinemia at 72 hrs of age. Results: Of 100, 54% of the newborn were male, and 46% were female. 91(91%) newborns included were between 37 to 40 weeks, and 9% were above 40 weeks of gestation. 85(85%) were appropriate for gestational age, 12 newborns (12%) were short, and three newborns were large. Five newborns (33.33%) developed hyperbilirubinemia; nine (30%) newborns developed subsequently developed hyperbilirubinemia at 72 hrs. In study groups, the median values for gestational age and birth weight were 38 weeks, 3.1 kg, respectively. Twelve newborns (12%) showed signs of dehydration, and out of these 12 newborns, 7 developed hyperbilirubinemia subsequently at 72 hrs of life. In addition, 31% received top feeding or mixed feedings, while 17% of newborns’ first feeding was delayed for more than 3 hrs due to inadequate lactation on the first few days. In our study, birth weight <2.5 kg, delayed first feeding, dehydration, and 48 Hr serum bilirubin >11.8 mg/dl were associated with significant hyperbilirubinemia(p<0.05).  Conclusion: The present study concluded that healthy full-term newborns with birth weight <2.5 kg, higher 24 and 48-hour serum bilirubin were more likely to experience significant hyperbilirubinemia who are often discharged from hospital early.

68. To Study   the   Correlation of Duration of Tobacco Intake with Occurrence of Oral Cancer – A two Year Hospital Based Study in Bihar
Dilip Kumar, Tripurari, Sujeet Kumar
Abstract
Objectives: A hospital based study, we conducted to correlate the occurrence of oral cancer with duration of tobacco intake as tobacco consumption practice is widespread throughout the world specially in India leads to oral malignancies. Methods: Total of 109 patients with oral cancer attending various specialties of Patna Medical College and Hospital, Patna fulfilling the inclusion criteria recruited during two-year period from November 2017 to October 2019 after obtaining written informed consent. Procedure like FNAC and biopsy from suspected lesions and enlarged lymph nodes were processed in department of pathology. Results: In our study among 109 cancer patients average duration of intake of tobacco and occurrence of oral cancer is 30.3±13.1  years with median age of 30 years. Chewing tobacco is most common mode of consumption and buccal mucosa and tongue with 31.2% each are most common sites of cancer, presenting with ulcer (60.55%). More than half of patients have cervical lymph nodes metastasis at the time of diagnosis. Males are more commonly affected than females with M: F ratio 4:1. Conclusion: we observed that tobacco in any form is carcinogenic and is a leading cause of morbidity and mortality in Indian population. Strict cessation of all forms of tobacco use and follow-up should be implemented to reduce the incidence of oral cancer.

69. COVID-19 Awareness among Healthcare Students and Professionals at a Tertiary Care Institute in India
Dhruvi Shah, Jeetendra Singh, V. Hemanth Kumar, Sakshi Mishra
Abstract
Background: The rapid and extensive spread of the COVID-19 pandemic has taken a huge toll on the healthcare profession.  The healthcare workers on the frontlines are particularly vulnerable to this infection and are also at high risk of burden of extended work hours, physical and psychological stress, burnout and fatigue. Not only the doctors but also the medical and paramedical staff, medical students as well as people working and studying in allied health sciences are exposed to high risk of COVID-19 infection as they are surrounded by a high viral load. Lack of awareness may put themselves and their communities in danger of infection with COVID-19 . Materials and Methods: A questionnaire-based survey on the awareness, knowledge and infection control practices carried out in COVID-19 out of which a total of 246 responders completed the survey. Convenient sampling method was used for data collection which was represented as frequencies and percentages. The individuals correct responses were compared with the average number of correct responses and presented in a tabular form. Results: The highest percentage of response was from medical professionals with that of 90.00% and lowest percentage was among paramedical sciences with that of 81.82%. The highest correct response was observed in the age group of 18-30 years with 86.02%. Females had a slightly higher correct response rate with a difference of 2%. Participants who received hand hygiene training had a higher correct response rate with difference of 3%. Conclusion: There is a strong need for periodic intervention and education regarding COVID-19 infection control practices. There should be a conductance of periodic webinars and interventions across all healthcare professions including non-clinical and administrative staff, paramedical and nursing sub-groups to reduce the chances of infections amongst these groups.

70. Acceptance of COVID-19 Vaccination Across India: How Concerned are the Health Care Workers?
Ruchira Khasne, Hitendra Mahajan, Shreyas Bhor, Sahil Sankalecha, Kaivalya Atul Kulkarni, Atul Prabhakar Kulkarni
Abstract
Background and objectives: In COVID19 vaccination drive, Healthcare workers (HCWs) were first to receive the vaccine. But their concern about the safety of the vaccine prompted us to conducted this survey. Methods: A questionnaire-based online survey was conducted to know post-vaccination symptoms in vaccinated and reasons of refusal in non-vaccinated HCWs. Results: Among 2036 eligible respondents 1589 were vaccinated. In vaccinated group 665 experienced at least one post-vaccination symptom while remaining had no symptoms. Most commonly experienced post-vaccination symptom was pain at injection site (31.8%) and myalgia (31.7%) and were mild to moderate. Age showed inverse relationship with the post vaccination reactogenicity (p<0.001) whereas gender and brand of vaccine showed no significant association. Respondents with comorbidities experienced significantly less symptoms (p<0.001) whereas those with prior COVID19 infection showed significantly higher incidence of post-vaccination symptoms (p<0.046). Among non-vaccinated 447(22.0%) respondents, lack of availability was the major reason cited (29.7%). Interpretation and conclusion: Apart from few mild to moderate, transient, self-limiting symptoms, no HCW reported any major post-vaccination symptom, including elderly with comorbidities, assuring safety of vaccine. We can encourage and appeal general public to participate in vaccination drive without any apprehension, and strengthen the fight against COVID19 pandemic.

71. Non haematogenous Metastatic Deposits to the Bone Marrow: A Case Series During a 5 year Period from a Tertiary Teaching Hospital in Manipur, North-East India
Phirthangmoi Fimate, Narendra Laishram, Rajkumari Jayshree Devi, Rajkumari Banashree Devi, Irom Anil Singh, Kshetrimayum Achouba Singh
Abstract
The bone marrow is commonly involved in both primary and secondary malignancies. Detection of bone marrow metastasis has significant clinical implications with impact on therapeutic decisions and is associated with poor prognosis. In some cases, it may be detected incidentally providing a means to proper diagnosis & subsequent confirmation. Here, we present a case series of bone marrow metastasis by solid non-haematogenous malignancies over a period of 5 years. We emphasise the importance of bone marrow examination in providing an easy, cheap and quick yet effective way of detecting metastatic involvement in patients with malignancies that have a tendency to involve the bone marrow.

72. A Comparative Assessment of Clinical and Pathological Profile of Post-dated Pregnancy
Anjana, Rupesh Kumar, Binod Kumar
Abstract
Aim: The aim of this study was to find out clinicopathological study of post-dated pregnancy. Methods: This was a comparative study conducted in the Department of Pathology, Sheikh Bhikhari Medical College, Hazaribagh, Jharkhand, India for 10 months.  Total 200 patients in the antenatal ward and labour room were selected for the study and they were divided into two groups, Control group with Gestational age 37-40 weeks and Study group with Gestational age >40 weeks. The maternal outcome was noted in terms of need for cesarean section, postpartum haemorrhage and sepsis. Foetal outcome was noted in terms of intrapartam asphyxia, intrauterine foetal death, admission to neonatal intensive care unit etc. Results: Maximum number of patients belonged to the age group of 25-30 years both in cases (50%) and control group (51%). The maximum number of patients in the study group (78%) belonged to the gestational age of 40-41 weeks while all the controls belonged to 37-40 weeks gestational age. 66% of the patients in study group were primigravida and in the control group 56% were primigravida. In the study group the percentage of LSCS was 28% which was higher than in the control group where it was 12%. Incidence of instrumental delivery was also higher in the study group as compared to control group (12% as compared to 4%). The most common indication among the study group was acute foetal distress which includes meconium stained liquor (12%) followed by cephalopelvic disproportion (5%). In the control group, most common indication was non progress of labour (7%) followed by acute foetal distress (2%) and non reactive CTG (3%). 14% of infants in the study group had asphyxia as compared to only 7% in the control group. 16% infants of the study group had to be admitted to the NICU as compared to 10% in the control group. 2% was the percentage of intrauterine deaths in the study group as compared to none in the control group. Conclusions: Considering this, policy of early intervention should be undertaken in post-dated pregnancy to avoid maternal and perinatal complications.

73. Prospective Observational Assessment to Determine the Prevalence of Urinary Tract Abnormalities in Children Presented with first UTI
Ashish Kumar Basant, Ankur Gautam
Abstract
Aim: Prevalence of Urinary Tract Abnormalities in Children with First Urinary Tract Infection. Material and methods: This prospective observational study was carried out in the Department of Pediatrics, Rama Medical College and Hospital, Hapur, India from  May 2020 to July 2020 .Children with culture-proven first episode of UTI. During the study period, 100 children were diagnosed as culture proved first UTI. Children between 1 month and 12 years of age with the first episode of confirmed diagnosis of UTI during the study period and Children who are followed up for a minimum period of 6 months after diagnosis and starting the treatment were included in the study. Children with previously known urinary tract anomalies and Children with comorbid medical renal diseases were excluded from the study. Results: Majority were in the age group of >5 years. Majority presented with fever. Urinary symptoms were present in 20% of the cases. Out of 100 children with culture proved UTI, only 45% had significant pyuria in centrifuged urine sample. The most common pathogen isolated in urine culture was E. coli. About 20% had abnormal finding in USG abdomen. Structural Among them, majority (22%) had hydroureteronephrosis. DMSA scan was done in 60 children who showed abnormalities in 16. MCU was done in 45 children, which showed abnormalities in 15. The most common anomaly detected was VUR. Among 5 children with VUR, majority 40% had Grade I VUR. MCU was abnormal in 1 child who had normal USG findings. Conclusion: UTI is a common pediatric problem with the potential to produce long-term morbidity. In children below 5 years, symptoms and signs are non-specific and routine urine examination may not yield persistent findings. Hence, high index of suspicion is necessary. The presence of VUR is a risk for recurrence of UTI and renal scarring.

74. An Observational Descriptive Assessment of Lipid Profile of Diabetic Patients Visiting Tertiary Care Facility
U.C. Jha, Brajesh Kumar, Natwar Lal Das
Abstract
Aim: The aim of this study was the assessment of lipid profiles mainly triglycerides in diabetic patients from Bihar region. Methods: This was a cross-sectional study was done in the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. A total of 80 newly diagnosed type 2 diabetes mellitus within the last 3 months using the ADA (American Diabetes Association) criteria and both males and females were including in this study for determine the lipid profile levels. Results: According to ATP III classification 34(42.5%) participants had normal serum triglycerides levels which is <150 mg/dl whereas 56(57.5%) participants had an abnormal level of serum triglycerides. Among the 56(57.5) participants with abnormal triglycerides, 32.5% had borderline high levels (150-199mg/dl), 25% had high levels (200-499 mg/dl). In our study, 52.5% participants had low HDL and 47.5% participants had normal HDL. The Gender distribution showed that 16 male participants and 26 female participants had low HDL. In our study, among the 80 participants, 55(68.75%) participants   had   desirable total   Cholesterol levels of <200mg/dl, 20(25%) had borderline high levels of 200- 239mg/dl and 5 (6.25%) had high total cholesterol levels of ≥240mg/dl. 10(12.5%) had high levels of LDL of which 3 were males and 7 were females. 2 (2.5%) participants had very high levels of LDL of which 1 was male and 1 was female. Conclusions:Hyperlipidemia is the commonest complication of the diabetes mellitus, and it can predispose patients to premature atherosclerosis and microvascular complications. Good glycemic control can prevent the development and progression of common lipid abnormalities in diabetes like raised triglycerides, LDL, serum cholesterol and low HDL.

75. Prospective Assessment of the Clinical and Radiological Parameters for Predicting the Difficult Laparoscopic Cholecystectomy
Prabhakar Krishna, Anisha Kishore
Abstract
Aim: The aim of this study to Predicting difficult laparoscopic cholecystectomy. Material and methods: The prospective study was conducted in the Department of General Surgery, MGM Medical College Kishanganj, Bihar, India from May 2019 to April 2020. Results: In present study patients above 18 years only were included. Majority of patients in the study were in the age group of 30-40 years (30 out of 50). There were 40 females and 10 males. Only symptom duration of >1yr, history of hospitalization for acute cholecystitis and BMI >30 were statistically significant predictor of difficult laparoscopic cholecystectomy (Table 1). Analysis of risk factors as a group showed that only clinical risk factors achieved significant predictive value (p value 0.005). Radiological risk factors i.e., small, contracted gall bladder, gall bladder wall thickness >3mm and single large stone did not show significant effect either individually (p values – 0.955, 0.132, 0.088 respectively) or as a group (p value – 0.066). The only biochemical adverse factor taken into consideration, deranged LFT also did not show significant association with difficult laparoscopic cholecystectomy (p value – 0.182). Conclusion: Good clinical assessment is the most significant predictor of difficult laparoscopic cholecystectomy. Radiological predictors have inconsistent predictive value due to dependence on various factors beyond surgeon. So, it is important for surgeons working with infrastructural constraints to apply good clinical judgment and arrange specialized instruments, expertise, convert if necessary or refer to a specialized centre and counsel patients accordingly.

76. Management of Postpartum Hemorrhage-Carbetocin Versus Methergin: A Comparative Study
Ponnam Chandramathi, Ponnam Vaishnavi, K. Sudha Prabhakar Reddy, Puppala Vinayaka Vishnu Vardhan
Abstract
Background: Postpartum haemorrhage (PPH) kills one woman every minute around the world, and it is still the leading cause of maternal death and morbidity. To limit the burden of PPH, early identification of risk factors, as well as effective prevention and management of PPH, are crucial. Carbetocin is a synthetic analogue of oxytocin with a half-life of up to 4 to 10 times that of oxytocin, making it a new medication for the prevention of uterine atony. Unlike oxytocin, it is administered as a single-dose injection rather than an infusion and can be administered intravenously or intramuscularly. Aim: The aim of our study was to examine the efficacy of carebtocin and combination oxytocin and methergine in avoiding postpartum haemorrhage in high-risk individuals after a normal vaginal delivery. Materials and Methods: This study was conducted between 01 July 2021 to 01 December 2021. In this study, 150 patients were included between 37 and 40 weeks of gestation with risk factors for developing PPH. In this study, the patients were divided into 2 equal groups namely group I which consisted of 75 pregnant women. These patients received a single dose of carbetocin 100 mg I.M. Group 2 consisted of 75 pregnant women. These pregnant women received oxytocin 5 I.U. I.M. combined with methergine 0.2 I.M. Results: Carbetocin was significantly more successful in reducing the time of the third stage of labour, reducing the amount of blood loss, and lowering both HB percent and hematocrit levels, all while having a significantly lower incidence of side effects. Conclusion: A single 100 mg IM dose of carbetocin may be more effective than 5 IU IM oxytocin mixed with 1 mL, 0.2 mg IM methylergonovine maleate (Methergine®) in reducing postpartum blood loss with a smaller drop in haemoglobin levels.

77. Functional Outcome of Conservative Management of Displaced Midshaft Clavicle Fracture: It’s Significance During Covid- 19 Pandemic
Kanchana Laishram, L. Labango Singh, Ruma Sarkar, H. Shantikumar Singh
Abstract
Background: With increasing popularity of surgical interventions in the past few decades in the field of Orthopaedics, conservative treatment methods were challenged by surgical techniques of fracture fixation with various implants. However, due to the COVID-19 pandemic, the need for pragmatic management that balances optimum treatment of patients against clinically safe practice has brought conservative treatment methods back into focus. Methods: The functional outcome of displaced mid-shaft clavicle fracture in 20 patients (6 females, 14 males) managed conservatively with figure of eight bandage was studied prospectively over a period of 9 months from March- November 2020. The demographic and the clinical data including the Constant Murley Score, length of shortening of the fractured clavicle, non-union and cosmetic outcome of the patients were recorded over 3 follow up visits at 2 weeks, 6 weeks and 3 months. The correlation between the study variables and the functional and clinical outcome was then calculated. Results: The mean shortening of fractured clavicle was 15.65±2.94 mm and the mean Constant Murley Score was 76.90±3.27. On an average, the union was achieved at 3 months and there were no non-union cases. Out of the 20 patients, 18 patients were satisfied with the treatment and 2 were dissatisfied with the outcome. Dissatisfaction was more among the males as compared to the females. 2 out of14 males were not satisfied. There was no significant association between the satisfaction of treatment and shortening of the bone (P value >0.05). There was a linear correlation between the Constant Murley Score and bone shortening with the functional outcome being better with lesser bone shortening. Conclusion: During the treatment of displaced mid shaft clavicle fractures in adults, the conservative management with figure of eight bandage yielded a good functional outcome with fewer follow-up visits to the hospital. The conservative treatment still had a significant place in the armamentarium of fracture management during the COVID 19 pandemic.

78. Management of Idiopathic Congenital Talipes Equinovarus (CTEV) by Ponseti Technique- A Prospective Study
Labango Singh, H. Shantikumar Singh, Kishorchand Naorem, Lungsumpou Gonmei, Ph. Nickson Maku, Dinendra Chirom, O. Guneshwar Singh
Abstract
Congenital talipes equinovarus (CTEV), also known as clubfoot, is common congenital orthopedic foot deformity in children characterized by four components of foot deformities: midfoot cavus, hindfoot varus, equinus and forefoot adduction. Although a number of conservative and surgical methods have been proposed to correct the clubfoot deformity, the relapses of the clubfoot are very common. Therefore, a study was conducted to determine the effectiveness of Ponseti technique in the management of CTEV in children less than 2 years of age. 40 cases were studied out of which 25 of them were bilateral CTEV. The sequence of correction of deformity were cavus, adduction, varus and equinus. Serial manipulation and casting were done. Tenotomy done for equinus deformity difficult to correct with cast followed by bracing. Average of 6 cast were required per feet. Initial mean Pirani score was 4.7. Almost 95.38% (62 out of 65) achieved correction using this method. Hence, we concluded that Ponseti technique is simple, effective and economical technique which can be useful for treatment of idiopathic clubfoot.

79. Perspectives of Medical teachers on E learning of MBBS students in Covid 19 pandemic
Lata Gupta, Ashish R Jain, Charu Mishra, Suresh Singh
Abstract
The coronavirus disease 2019 (COVID-19) pandemic led to far-reaching restrictions of social and professional life, affecting societies all over the world. To contain the virus, medical colleges had to restructure their curriculum by switching to online learning. This study was conducted to find out the faculty’s perception about these live online classes conducted for 1st year MBBS students in lockdown period of COVID-19 pandemic in India. This is questionnaire-based study. Questions were prepared with help of Google forms. The google forms were sent to 90 faculties of different medical colleges. Faculties were involved in online teaching classes during COVID-19 pandemic lockdown period. Questions asked to the faculties regarding online teaching included various E learning tools and methods used, teachers perspective on advantages and disadvantages of E learning. Methods used for online classes were Zoom, Google classroom, Live webex, Whatsapp group, discussion, Telegram App, Microsoft Teams, Skype. Advantages of online classes were its best alternative for physical mode classes, Ability to stay at home in pandemic, Comfortable surroundings, Teacher centered teaching. Disadvantages of online classes were technical problems, Lack of Student –Teacher interaction, Lack of proper students assessment, Difficult to demonstrate practicals, Lack of Students Discipline. E-learning is a powerful tool for teaching medical students. However, successful implementation of online learning into the curriculum requires a well-thought-out strategy and a more active approach.

80. Prevalence of Autoantibodies in Underweight Diabetic Adult Subject in Southern Rajasthan
Salgiya Nirali, Hasan Akhlaq, Patira Nilesh Kumar, Goyal Suchi
Abstract
Introduction: This study aims to estimate the autoantibody profile of underweight, physically active diabetic subjects, to know the exact etiology of their diabetes because this will help the medical staff for proper management with less morbidity and mortality. Methodology: This study was conducted in the Biochemistry department, RNT medical college, Udaipur. Inclusion criteria: Underweight diabetic subjects on oral antidiabetic drugs or insulin, Age 18 years to 60 years and Both sex. Exclusion criteria: Obese or overweight diabetic individuals, Gestational diabetes mellitus, Secondary diabetes mellitus – pancreatitis, post pancreatectomy, steroid induce DM, lipodystrophy, congenital insulin resistance syndrome and Age less than 18 years and above 60 years. Results: Out 110 of which 95 patients tested positive for only GAD antibodies and 5 patients tested positive for both GAD antibodies and tTGIgA. 10 patients were sero negative for either antibodies. 17 seropositive patients were demonstrating good control of blood glucose as evident by HbA1c levels (6.5%-7.5%) while 83 patients were having HbA1c levels above 7.6% experiencing poor control of blood glucose. The mean value of fasting blood glucose was higher in sero positive patients (176±57.18) mg% when compared with sero negative patients (163.81±36.66) mg%. Conclusion: Antibodies can be present long before the clinical presentation of type 1 diabetes, and their detection can be useful in confirming a diagnosis of type 1 diabetes. AntiGAD Antibodies have the advantage because their titer remains relatively stable over a period of time.

81. A Cross Sectional Study to find out the Etiological Factors Associated with Acute and Chronic Renal Failure in a Government Hospital in Gujarat
Shikha Goyal, Ritu Bajpai, Bharat Agarwal, Manish Mewani, Amit Haritwal
Abstract
Introduction: Renal failure is a relatively uncommon condition. However, the exact incidence is difficult to define as it depends upon the referral patterns of the reporting renal unit and the proximity to, and expertise within, the related intensive care units (ICUs). Aim: to find out the common eitiological factors for acute and chronic renal failure. Method: This was a cross sectional study  done in the department of Pathology, M. P. Shah Medical College, Jamnagar in collaboration with biochemistry department and dialysis unit of G.G. Hospital, Jamnagar, Gujarat. Results: diabetes was the leading cause of CRF in the present study, with the incidence of 33% followed by unknown causes(30%),  obstructive uropathy (14%),  hypertension(12%). Other causes includes diabetes+hypertension (8%) , polycystic kidney disease (2%) and myeloma (1%). Conclusion: The commonest etiological factors for CRF are diabetes, hypertension and obstructive cause.

82. Comparative Analysis of Epidural Ropivacaine 0.75% Versus Ropivacaine 0.75% with Clonidine for Vaginal Hysterectomy – Randomised Controlled Trial
Abhas Chhabra, Sweta Bharadiya, Rekha Jadiya, Devendra Kumar Bohara
Abstract
Aim: Comparative analysis of epidural ropivacaine 0.75% versus ropivacaine 0.75% with clonidine for vaginal hysterectomy. Methodology: This prospective randomized study was conducted at department of anaesthesia, Jhalawar Medical College, Jhalawar in 80 ASA I and II patients scheduled to undergo Vaginal Hysterectomy. Patients were randomly divided in two groups with 40 patients in each group, group RS were given epidural 0.75% Ropivacaine 20ml and 1ml normal saline (total 21ml), group RC were given epidural 0.75% Ropivacaine 20ml and 1ml clonidine (75 mcg dissolved in NS upto1ml, total 21ml). Patients were observed for intraoperative and post operative duration of sensory block, motor block, regression of sensory and motor block, post operative analgesic requirement. Results: It was observed that epidural ropivacaine in combination with clonidine (Group RC) provides earlier and prolonged sensory and motor block, prolonged duration of analgesia as compared to ropivacaine (Group RS) alone. Incidence of hypotension and bradycardia were comparable in both the groups. Incidence of sedation and dry mouth were more with clonidine. None of our patients in both the study groups experienced respiratory depression. Conclusion: The findings of the study suggest that use of clonidine as adjuvant helps in achieving faster block onset, longer duration of block, and analgesia without any significant hemodynamic changes.

83. Correlation of Blood Markers Including CRP with Severity of COPD in Eastern Part of Rajasthan
Deepak Singh, Vatsana Kasana, Ravi Saini, Arun Kumar, Vineet Gupta, Kailash Sharma
Abstract
Background: Previous studies& scientific knowledge have indicated that Systemic inflammation, which is multifactorial, in COPD plays a major role in disease pathogenesis, severity, manifestations& in causation of its comorbidities. CRP being a sensitive and easily available biomarker even in resource limited health facilities can help detect this ongoing occult inflammation which turns COPD into a multisystem disease with mammoth implications which can be timely & properly managed by optimum control of the COPD pathology. Methods: 100 COPD patients aged >40 years visiting Chest department at RBM Hospital, GMC, Bharatpur were assessed clinically, by spirometry and laboratory tests. Patients were staged according to GOLD Criteria &according to MMRC scale. Results: Strong association of disease severity was observed with positive inflammatory titres of CRP (P value <0.05). High inflammatory CRP also correlated strongly with low SPO2, low BMI and dyspneic grades of MMRC, besides total smoking Pack years. Conclusion: Raised inflammatory titres of CRP were significantly associated with the Severity of COPD reflecting the ongoing systemic inflammation which should be tested as a routine to address COPD inflammatory syndrome timely & properly so as to decrease disease morbidity & mortality.

84. Comparison of Thyroid Hormones between Type 2 Diabetes Mellitus Patients & Matched healthy controls at SMS Medical College & Hospital, Jaipur
Arti Jain, Sangeeta Meena, Chitra Upadhyay, Mahesh Bairwa, Harjeet Singh, Balveer Singh
Abstract
Background: Thyroid diseases and diabetes mellitus are the two most common endocrine disorders encountered in clinical practice. Thyroid disease is a pathological state that can adversely affect glycaemic control in diabetics and has the potential to affect health. Aims & Objectives: The aim of this study was to assess the levels of Thyroid hormones (FT3, FT4, TSH) in Type 2 Diabetes Mellitus patients and comparable control groups and to find out the correlation between thyroid function and Type 2 Diabetes Mellitus. Methods: This study was a cross-sectional study in which clinically diagnosed cases of Type 2 diabetes mellitus in OPD of Department of Medicine SMS Medical College and Hospital, Jaipur were taken as cases. Results: 55 cases of Type 2 diabetes mellitus and matched controls in age group of 40-65 years were analyzed in this study. In this study the mean age in control group was 54.07 ± 7.28 years while in cases group it was 52.95 ± 6.86 years. The mean FBS for controls was 83.47 ± 12.78 mg/dl and for cases was 165.25+21.51 mg/dl, mean HbAlc % for controls was 5.12 ± 0.59 and for cases was 8.27 ± 0.92, mean FT3 for controls was 2.71 ± 0.50 pg/ml and for cases was 2.27 ± 0.54 pg/ml, mean FT4 for controls was 1.15 ± 0.18 ng/ml and for cases was 0.96 ± 0.09 ng/ml, mean TSH for controls was 3.30 ± 2.05 µIU/ml and for cases was 4.95 ± 3.07 µIU/ml which was statistically significant (p-value<0.001). Conclusion: Thyroid dysfunction exists in Type 2 DM and screening for the same is important because abnormal thyroid hormone levels in type 2 diabetics if unrecognized may be a primary cause of poor management of diabetes. This will also help in the early detection and treatment of thyroid dysfunction which in turn helps in better glycaemic control and associated cardiovascular risk measurement and its management.

85. Assessment of Epithelial Changes of Gall Bladder in the Gallstone Disease
Hemlata Sharma, Manogya Agarwal, Mayank Sarawag, Varun Saini
Abstract
Background: Gallstone disease is a common health problem worldwide forming about 95% of the biliary tract disorders. The estimated prevalence of gallstone disease in India has been reported between 2- 29%. In India, this disease is seven times more common in north (stone belt) than is south India. It is appeared to be increasing in incidence over past couple of decades in India. Material & Methods: This prospective study was conducted in the Departments of Anatomy and Pathology of R.N.T. Medical College and Attached Hospital (M.B. Govt. Hospital), Udaipur. The study was done in hundred patients of cholelithiasis which were admitted and operated in our hospital either open or laparoscopically, irrespective of age, sex, physique or parity. Results:  In the present study it was observed that maximum (46%) cases had mixed type gallstones. (30%) cases had pigmented type gallstones and (24%) cases had pure cholesterol type gallstones. In the present study it was observed that multiple gallstones present in 58% cases which is followed by single gallstones present in 30% cases. In the present study it was observed that maximum 32% cases had faceted gallstones which is followed by irregular gallstones present in 29% cases which is followed by round gallstones present in 22% cases. Ovoid gallstones present in 15% cases. Only 5% cases had normal mucosa. Rest of cases showed different types of epithelial alterations as above mentioned. The most common epithelial alterations observed was focally ulcerated which is followed by hyperplastic changes. Atrophic changes were observed in 9% cases. However, this difference was statistically non- significant. Conclusion:The type and number of gallstones were not significantly correlated with the various epithelial lesions of gallbladder. Histopathological examination is thus important in every case of cholecystectomy for identifying hyperplasia, metaplasia, dysplasia and carcinoma.

86. Correlation of Renal Failure in Birth Asphyxia with Hypoxic Ischemic Encephalopathy Among Term Neonates
T. V. Niharika, Vadnala Suman Chandar Rao
Abstract
Background: Most important organs commonly affected in the multiple organ dysfunction due to the perinatal asphyxia is kidney.  Perinatal asphyxia is the important reason for mortality and neurological morbidity in most of the cases. Regular assessing biochemical parameters like serum creatinine, urea with urine output helps in predicting severity of disease and for early management of disease and good outcome. Aim and Objectives: In the study we are correlating the severity of renal failure with hypoxic ischemic encephalopathy staging. Material and Methods: In the  prospective observational study, we have collected data of  100 term neonates (38-42weeks) with APGAR score of less than 7 at one minutes. Study conducted at Gandhi medical college, Secunderabad, Telangana, for the period of one year from June 2016– June 2017. All the neonate with clinical feature of HIE were staged by Sarnat and Sarnat staging. All asphyxiated [as per WHO definition] neonates were selected as cases. Gestational age, birth weight, relevant perinatal history and examination findings were recorded in predesigned, pretested proforma. The post asphyxiated neonates were managed as per the standard guidelines. In Descriptive statistical analysis Qualitative data were presented by frequency and proportion and quantitative data were presented by using mean and standard deviation.  Significance is assessed at 5% level of significance. ANOVA was conducted to observe mean difference in HIE staging for quantitative variables. Results: Male is to female ratio in the study was 13:12. We had 31 patients with HIE-I, 37 patients with HIE-II and 30 patients were with HIE-III. We observed there was significant increase in the serum creatinine level as the HIE progressed, also urine output was decreased as the HIE progressed. Oliguric patients were more in stage III of HIE compared to stage I and stage II. Conclusion: We concluded that renal dysfunction increases with the  severity of HIE. there was good correlation between the renal dysfunction and HIE, means renal dysfunction can be used as early predictor of severity of disease and for early management of disease.

87. A Study on Knowledge, Attitude and Practice of Self Medication for Diarrhoea Among Undergraduate Medical Students in A Tertiary Care Hospital in Bihar
Sara Sultana, Braj Nandan Kumar Sah, Jeetendra Kumar
Abstract
Objectives: This study was to evaluate the knowledge, attitude and practice of self-medication for the treatment of diarrhea among undergraduate medical students in a tertiary care hospital in Bihar, India. Methods: A random sampling method was used for the data collection. A face to face questionnaire based interview was held for collecting the data regarding self-medication practice. The predesigned pretested questionnaire consisted of thirty questions under four sections. The first section consisted of the demographic information of the participants, the second, third and fourth sections consisted of questions on knowledge, attitude and practice of self-medication for diarrhoea respectively. Results: A total of 100 undergraduate medical students were included in this study. Mean age of students were 23. Male and female ratio was 11:9. Most of the students 87(87%%) were responded self-medication. Most common cause were time saving36(36%). Most common source of self-medication was 50(50%) medical stores. Most common drugs used as a self-medication were ORS 49(49%), metronidazole 26(26%) and ofloxacin 20(20%). Only 20(20%) students were aware for the harmful effect of self-medication. Conclusions: Most of the common cause of self-medication for the treatment of diarrhoea in undergraduate medical is time saving. Common source of drugs for self-medication is medical stores. Oral rehydration solution (ORS), metronidazole and ofloxacin are the common drugs used as a self-medication for the treatment of diarrhoea. Hence, under graduate medical students have lack of knowledge on dose, frequency and adverse effects of drugs, they should be educated about merits and demerits of self-medication and ask them to acquire the knowledge about drugs before using them. So that, regulatory authorities need strict implementation of rules on distribution of drugs by pharmacists in medical stores.

88. COVID-19 in Rural Population: is Elevation of C-Reactive Protein Levels Reflecting Liver and Kidney Involvement
Kumari A, Singh SB, Mahajan S, Sharma V, Vohra P, Hasija S, Chatterji P, Singh N, Chawla H
Abstract
C-Reactive Protein (CRP) is one of the vital markers to assess COVID-19 severity. This study was planned to analyse the CRP levels of COVID-19 patients admitted in SHKM GMC, Nalhar, Nuh, Mewat, Haryana. 63 Covid-19 positive patients were included in the study. Data of CRP, blood Urea, Serum Creatinine, SGOT, SGPT, ALP and Bilirubin levels were collected retrospectively. Mean CRP level was 7.71 mg/dl with Standard Deviation (SD) 9.91 mg/dl. (Normal value <0.5mg/dl) Minimum and maximum CRP levels were 0.014 to 41.37 mg/dl. Percentage of subjects having CRP above normal level were 77.78%. There was no correlation of CRP with age, gender, liver function tests (SGOT, SGPT, ALP, S. Bilirubin) and kidney function tests (B. Urea, S. Creatinine). CRP levels were found to be significantly increased in COVID-19 patients before liver and kidney involvement. These results are different from many studies which were conducted in other populations.

89. Does Serum Magnesium Levels Correlates with Serum Ferritin Concentrations in COVID-19 Patients?
Kumari A, Sharma V, Singh SB, Mahajan S, Agrawal Y
Abstract
Introduction: Serum Ferritin has emerged as an important marker in Covid-19 pandemic. High Serum Ferritin concentrations independently predicts in-hospital mortality. Magnesium is a simple in-vestigation which can be easily done on fully automatic analyser. Few evidence has estimated correlation between Serum Ferritin and Magnesium concentrations. Material and Method: This study was retrospectively conducted in Department of Biochemistry, SHKM GMC, Nalhar, Nuh, Mewat, Haryana over a period of two months (Jan -Feb 2021). Data was collected from Covid-19 positive patient’s reports available in department. Serum Ferritin and Serum Magnesium levels were statistically analysed. Results: 85 Covid-19 patients (38 Females and 47 males) were included in the study. Mean age of patients was 42.54 +/- 15.31 (Mean +/-SD). Mean Ferritin level was 360.521ng/ml. Mean serum Magnesium level was 2.20 +/-0.43 mg/dl. Correlation coefficient between Serum Mg and Ferritin is 0.6694. p value is < .00001. Conclusion: A positive correlation between Serum Magnesium and Serum Ferritin was found in this study and hence Mg may be used as a supplementary test at Biochemistry labs or a substitute test during kit nonavailability of Serum Ferritin during Covid-19 pandemic.

90. Prevalence of Metabolic Syndrome and Identification of Cardiovascular Disease Risk Factors Among Medical Students
Swarnim Swarn, Indu Prasad, Satish Kumar, Binod Shankar Singh, Ganesh Prasad Singh
Abstract
Introduction: Metabolic syndrome (MS) refers to the co-occurrence of several known cardiovascular risk factors, including insulin resistance, obesity, atherogenic dyslipidemia and hypertension. Metabolic syndrome (MS) increases the risk of developing type 2 DM and cardiovascular diseases. The National cholesterol education program- adult treatment panel III (NCEP- ATP III) definition incorporates the key features of hyperglycemia/insulin resistance, visceral obesity, atherogenic dyslipidemia and hypertension. Objectives: The present study was aimed to estimate the prevalence of metabolic syndrome among medical students of VIMS, Pawapuri and to identify the important risk factors for cardiovascular disease. Material and methods: A cross‑sectional study was conducted among medical students at Vardhman Institute of Medical Sciences (VIMS), Pawapuri, Bihar from June 2021 to August 2021 after obtaining approval from the Institutional Ethics Committee. Two hundred sixty medical students of Vardhman Institute of Medical Sciences, Pawapuri, Bihar were included in this study. Participants were interviewed using a standardised questionnaire and height, weight, hip circumference and blood pressure were measured. A venous blood sample was taken for biochemical tests like plasma glucose, HDL, LDL and TG. Obtained data were statistically analysed using SPSS. Results: Out of 260 medical students included,169(65%) were male and 91(35%) females. The mean age of the male students’ group was 20.40 ±3.44 years and the female students’ group was 21.32± 3.27 years. Only 5.76% of students gave a history of smoking and 3.84% regular alcohol consumption. Family history of Diabetes, Hypertension or cardiovascular diseases was present among 44.23% of students. Mean BMI among females was 24.71±3.68 kg/m2 and 23.81±3.07kg/m2 in males. 25.76% of students were overweight and 33.84% were obese. Metabolic Syndrome was diagnosed in 23.46% of students. The prevalence of metabolic syndrome in females (28.6%) was higher than in males (20.7%). Conclusion: Obesity and dyslipidaemia are prevalent among medical students and must be considered as an important component of MS and potential risk factors for diabetes and CVD. Regular screening of these risk factors and awareness among medical students about these would help prevent diabetes and CVD in society.

91. A Prospective Study Assessing the Accuracy of Diagnostic Imaging in Evaluating Peripheral Nerve Pathologies: Comparative Study
Baidya Nath Singh, Ishan Tiwari
Abstract
Background: Magnetic resonance imaging (MRI) has been used extensively in revealing pathological changes in the central nervous system. However, to date, MRI is very much underutilized in evaluating the peripheral nervous system (PNS). This underutilization is generally due to two perceived weaknesses in MRI: first, the need for very high resolution to image the small structures within the peripheral nerves to visualize morphological changes; second, the lack of normative data in MRI of the PNS and this makes reliable interpretation of the data difficult. Materials and Methods: This prospective study was done Department of Radiology, SSIMS Medical College, Bhilai, Chhattisgarh, India for 12 months.  using HRUS with 14 MHz linear-transducer and 1.5T MR in cases referred for the assessment of peripheral nerve pathologies. Results: The overall accuracy of MRN was 89.3% (negative predictive value [NPV]: 57.1%, positive predictive value [PPV]: 95%) and that of HRUS was 82.9% (NPV: 42.8, PPV: 100). Conclusion: HRUS is a powerful tool that may be used as the first-line imaging modality for the evaluation of peripheral nerve pathologies, and a better means of evaluation of peripheral nerves with submillimeter caliber.

92. Morphometric Evaluation of the Variation of Spleen Morphology in Human Cadavers
Swami Nand Prasad, Nimisha Madhu, Rajendra Prasad
Abstract
Aim: Morphometric study of adult human spleen in a cadaver. Methods: This prospective observational study was carried out in the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India for 15 months. The present study was conducted on 60 adult human cadaveric spleens collected from department of Anatomy. All the spleens were observed for their morphometric features like shape, number of notches   on borders and measurements were taken for length, breadth and thickness using vernier calliper. Results: Out of 50 spleens studied, five different shapes of the spleen were observed. 20 spleens were wedge shaped (40%), 13 spleens were triangular shaped (26%), 10 spleens were tetrahedral (20%), 6 spleens were oval shaped (12%), 6 spleens were irregular shaped (12%). All the spleens were observed for the presence of notches. 30 spleens (60%) had notches on its superior border, 2 spleens (4%) had notches on its inferior border, and 13 spleens (26%) had notches both in their superior and inferior borders, 5 spleens (10%) were found with absence of notch on either of its borders. The number of notches varied from zero to six, but in most of the spleens there were one or two notches. The presence of splenic fissure on diaphragmatic surface was noted in 3 spleens. Conclusion: The knowledge of morphometric variations is helpful for clinicians, surgeons and radiologists during routine clinical examinations. These variations are to be considered during splenic transplantations, surgical procedures and differentiate it from splenic injuries.

93. To Determine the Link Between the Main Presenting Symptoms of Depressive Disorder and the Level of Stigma
Upendra Paswan
Abstract
Aim: To determine whether there is a link between the main presenting symptoms of depressive disorder and the level of stigma associated with them, taking into account the patient’s socioeconomic and demographic background. Material & Methods: Seventy-five adult patients with Major Depressive Disorder (MDD) who are attending psychiatry OPD for the first time have been chosen. The study used proforma for socio-demographic and clinical characteristics, as well as the Hamilton depression rating scale, distress questionnaire, and stigma scale from the Eplanatory Model Interview Catalogue (EMIC). Results: Pains or other somatic symptoms were identified as the most distressing symptom by nearly half of the patients, but sadness was mentioned by just 27% of the patients. When compared, somatic problems were perceived as less stigmatizing; the difference in mean stigma scores was statistically significant. The intensity of depression was found to be linked to stigma ratings. Unmarried status, as well as a family history of psychiatric illness, were perceived as more stigmatizing. Conclusion: The majority of patients with serious depression cited somatic issues as the most worrisome, which could make early detection more difficult. Because stigma is linked to the severity of depression, it may function as a deterrent to getting care. The presence of depression is unrelated to socio-demographic factors.

94. An Observational Assessment of the Prevalence and Demographic Profile of Glaucoma in Pseudo Exfoliation Syndrome
Vikash Vaibhav, Nandani Priyadarshini, Uday Narayan Singh
Abstract
Aim: To assess the prevalence and characteristics of glaucoma in Pseudo exfoliation syndrome. Methodology: A total of 53 patients with pseudoexfoliation who came to the Department of Ophthalmology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India from Feb 2018 to Jan 2019. were investigated and followed up for one year. All patients were subjected to complete ocular examination including visual acuity. All patients diagnosed as pseudo exfoliation syndrome with age group of 40-80 years. Patients with previous history of uveitis or ocular trauma and known cases of POAG and angle closure glaucoma who were on medication were excluded from this study. Pseudo exfoliation glaucoma was diagnosed on the basis of pseudoexfoliative material on slit lamp examination, IOP >21 mm Hg, glaucomatous cupping on fundus examination, pigmentation of trabecular meshwork on gonioscopy, glaucomatous field defects on perimetry. Results: Out of 53 patients 29 patients (54.7%) were males and 42 patients (45.3%) were females. 9.4% (5 cases) patients belonged to 41-50 years of age group, 30.2% (16 cases) belonged to 51-60 years, 45.3% (24 cases) belonged to 61-70 years, and 15.1% (8 cases) belonged to more than 70 years of age group. 50% patients had glaucoma out of 8 patients with pseudoexfoliation of more than 70 years of age followed by 45.83% in 61-70 years of age (11 glaucoma patients out of 24 patients with pseudo exfoliation) and 18.75% in 51-60 years of age (3 glaucoma patients out of 16 patients with pseudo exfoliation. Prevalence of glaucoma in pseudo exfoliation was 37.93%in males (11 out of 29 patients) and 29.17% in females (7 out of 24 patients). Conclusion: Pseudoexfoliation syndrome (PXF) can lead to open angle glaucoma. All patients with pseudo exfoliation must undergo complete glaucoma evaluation for early detection and follow up. Patients with pseudo exfoliation alone without glaucoma must be followed every 6 months. In pseudo exfoliation patients with glaucoma the intraocular pressure must be checked after regular intervals.

95. Prospective Randomized Comparative Assessment of Efficacy of Amniotic Membrane in Preventing Failures in External Dacryocystorhinostomy
Nandani Priyadarshini, Vikash Vaibhav, Uday Narayan Singh
Abstract
Aim: To evaluate the efficacy of amniotic membrane in preventing failures in external dacryocystorhinostomy. Methodology: The study was a prospective randomized comparative study of external DCR and external DCR with AM conducted 1 year. The study included 50 cases that were diagnosed with primary nasolacrimal sac or duct obstruction or chronic dacryocystitis out of which 35 patients underwent external DCR and 35 patients underwent external DCR with AM. The surgeries were performed by the same surgeons. Patients above 20 years were included in the study. A detailed ocular and systemic history were taken. Patients were examined with particular reference to lacrimal apparatus. A detailed ocular examination and a thorough anterior rhinological examination were done to rule out any nasal pathology by otorhinolaryngologist. The patency of nasolacrimal duct was found by lacrimal sac syringing and by both primary and secondary Jones dye test. Routine blood investigations like complete hemogram, blood glucose level, serological tests to rule out HIV, Hepatitis B and C were done. Results: 50 patients were randomized into 2 groups of 25 each, group 1 patients underwent External DCR, group 2 patients underwent external DCR with AM. In group 1, 28%, 52%, and 20% patients belonged to 21-40, 41-60, and 61-80 years of age group respectively. Similarly in group 2, 24%, 52%, and 24% patients belonged to 21-40, 41-60, and 61-80 years of age group respectively. Group 1 includes 40% males and 60% females, while in group 2, 44% were males and 56% were females. Youngest patient studied was 21 years old and oldest was 78 years old. Out of 50 patients included in the study, 8 (16%) patients had mucocele (3 in Group 1 and 5 in Group 2), 42 patients (84%) had chronic dacryocystitis (22 in Group 1 and 20 in Group 2). 15 patients (30%) had DNS (8 patients in Group 1 and 7 in Group 2). There were 7 cases of bleeding in Group 1 and 5 in Group 2 (total 12 cases out of 50) intraoperatively. On 6 months follow-up, it was found that out of 50 cases, total of 6 patients had failure. Out of this 4 were in group 1 and 2 were in group 2. Conclusion: From this study, it can be concluded that there was more success rate in DCR with AM as compared to DCR only. There were less intraoperative as well as postoperative complications in DCR with AM as compared to DCR only but the difference was not statistically significant. More studies on large scale should be done to evaluate the results properly.

96. Study of Carrying Angle in Respect to Demographic Parameters of Medical Students
Mani R, Yadav P, Singh J, Geeta
Abstract
Introduction: An acute angle, at the elbow medially made by the long axis of the humerus and the long axis of the ulna in the anatomic position is known as carrying angle. The normal range of carrying angle is 5-10⁰ in males and 10-15⁰ in females. The aim of this study is to correlate the carrying angle with sex, height, length of forearm and dominant hand in North-west Indian medical students. Materials and Methods: The study comprised of a total of 200 healthy subjects without any deformity of upper limb, including 100 males and 100 females. Goniometer was used for measuring the carrying angle. Stadiometer and measuring tape were used for the measurement of height and length of forearm. Results: The mean carrying angle of right side was 11.88±1.32⁰ and 14.80±1.97⁰ in males and females, respectively. The mean carrying angle of left side was 11.53±1.20⁰ and 15.38±1.87⁰ in males and females, respectively. The carrying angle was significantly greater in females than males. Height and length of forearm were inversely related to carrying angle. It was found that non-dominant limb had a greater carrying angle. Conclusion:Findings of present study is useful in the management of clinical conditions, such as, elbow dislocation, elbow deformities, elbow fractures and elbow reconstruction.

97. Biomechanical Factors which Lead to Implant Failure in Proximal Femoral Fractures: A Retrospective Study
Amit Kumar, Alok kumar, Neha Kumari
Abstract
Aim: To evaluate biomechanical factors which lead to implant failure in proximal femoral fractures. Methodology: This is a retrospective study including 30 cases below 75 years of age in last 10 years with proximal femoral fracture [fracture Inter-trochanteric & Sub-trochanteric included] fixed with PFN in Department of Orthopedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 12 months. Cases with infection; poly-trauma and disability in other limb were excluded from study. Detailed history was taken from patient and close relatives regarding rehabilitation protocol, mode of failure. Information about surgical procedure, approach & implant details from patient records and if necessary, from hospital records. Results: In our study we registered total of 30 cases with mean age of registered cases was 65.72 + 9.45 years. 21 patients (70%) were male and 9 (30%) were females. Except 3, all cases of implant failure in our study were categorized as unstable type according to EVAN’s & A.O. classifications preoperatively. Out of 30 cases registered, pattern of implant failure in our study were 10 cases (33.3 %) had implant failure pattern of Z- effect, 8 cases (26.7%) had implant failure pattern of  reverse Z-effect; 4 (13.3%) had breakage of nails; 2 cases (6.7%) had both screw breakage with varus collapse; 3 (10%) had single upper proximal screw breakage; & 3 cases (10%) were associated with spiral fracture femur just distal to the tip of PFN. Conclusion: Surgeon’s experience & accuracy of procedure is of great importance in preventing implant failure. Various complicated forces are there that acts on hip joint in different direction. Each force [whether it is tractional, compression or rotational force] has its own direction. These biomechanical forces are due to bodyweight while standing and walking. To minimize damage to joint & implant [To prevent implant failure], these forces vectors have to be compensated by forces generated in opposite direction either by body itself [abductor muscle strength etc] or biomechanical properties of implant either due to its specific design or due to properties of material which is used. If not compensated implant failure may occur.

98.An Observational assessment of Clinical and Hematological Profile of Patients with Dengue Fever
Chandra Shekhar Das, Chirag Agrawal, Rajeshwer Kumar Ranjan
Abstract
Objectives: To study the clinical and hematological profile of dengue fever cases presenting to a hospital. Methods: A total of 450 patients were examined during a period of 6 months. Patients with fever and other signs of dengue with either positive NS1 antigen test or IgM or IgG antibody were included. Results: NS1 was positive in 109 patients (24.2%), IgM antibody test was positive in 302 patients (67.1%) while in 33 patients (7.3%) the IgM antibody was negative, but they showed positivity for IgG antibody. Mild dehydration was noted in 164 patients of DF (40%) who were treated with oral rehydration therapy, while 51 cases of DFWS (12.4%) required intravenous fluid therapy. Twelve patients (2.9%) had severe dehydration requiring IV fluid resuscitation. Conclusion: This study highlights the most common clinical and laboratory profiles of dengue viral infections that could alert physicians to the likelihood of dengue virus infections in the study area.

99.Prospective Observational Research to Determine Antimicrobial Susceptibility and Biofilm Production among Coagulase Negative Staphylococci
Pratulya Nandan, Swati Sharan
Abstract
Aim: To determine antimicrobial susceptibility and biofilm production among coagulase negative staphylococci at a tertiary care hospital. Materials and Methods: This prospective observational study was carried out in the Department of Microbiology, Patna Medical College, Patna, Bihar, India for 10 months.  Purely isolated CoNS from various clinical samples from both outpatients and inpatients included in this study. All the test strains were subjected to antimicrobial susceptibility testing. The ability to produce biofilm was detected by tube adherence method. Results: Most of the isolates were from pus swabs (40) followed by sputum samples (27). All the test strains were resistant to penicillin. Methicillin resistant was seen in 70% and mec A gene was present in 69% of the isolates. Majority of the strains were sensitive to ceftriaxone (77%), cefepime (69%), vancomycin (78%), cefaperazone – sulbactum (96%), piperacillin- tazobactum (99%). Only one CoNS strain isolated from blood sample showed resistant to piperacillin – tazobactum. Of the total 100 isolates of CoNS, 38% showed moderate biofilm formation by tube adherence method. 32% of isolates did not form biofilm. All the isolates from blood samples showed moderate (10/14) and strong (4/14) biofilm formation. Among non-biofilm producers 20% were MS CoNS isolates and 12% were MRCoNS. 60% of biofilm producers were MRCoNS and 8% were MSCoNS. Conclusion: As Coagulase negative Staphylococci are exhibiting multi drug resistance and are able to form biofilm, these organisms causing a major challenge for the physicians. Hence, such problems can be prevented by detection of biofilm producers and appropriate antibiotic doses modification.

100.Mucinous Carcinoma of Breast: Clinicopathological and Immunohistochemical Analysis
Rachna Kumari, N.K. Briar
Abstract
Introduction: Mucinous carcinoma (MC) is a rare form of breast cancer. It accounts for 1 to 7% of the cases and characterized by the presence of extracellular mucin (ECM). Mucinous breast carcinoma (MC) is a special type of breast cancer that presents with a large amount of extracellular mucin. MC comprises approximately 4% of all invasive breast cancers. This type of tumor has a better prognosis and higher incidence in peri- and postmenopausal patients. Pathologically, there are two main subtypes of MC: pure and mixed. Aims and Objectives: To study the Clinicopathological and Immunohistochemical features of Mucinous Carcinoma Breast. Materials and Methods: We present our 2-year study in the Department of Pathology, Patna Medical College & Hospital, Patna, Bihar, India on mucinous carcinoma of breast. Patients diagnosed with Pure MC and Mixed MC according to WHO classifications of tumors of breast 2012 were studied. Specimens were routinely processed and stained with Hematoxylin and eosin. Results: In the present study, we identified 40 patients 37 female and 03 male patient with mixed and pure mucinous breast carcinoma. The patient age ranged from 30 to 78 years with mean age at presentation was 55.9 years. Conclusion: Majority of the Pure MC did not show evidence of secondary deposit, whereas 50% cases of Mixed MC show secondary deposit. Most of cases of pure mucinous and mixed mucinous showed hormone receptor positivity.

101.A Case Control Study to Establish the Association Between Vitamin D Deficiency with Knee Osteoarthritis
Rajeev Kumar Rajak, Barun Kumar Golwara
Abstract
Aim: The study’s goal is to compare serum 25-hydroxy vitamin D levels in patients with knee osteoarthritis to age-matched healthy controls, as well as to look into the link between 25-OH vitamin and osteoarthritis. Materials and Methods: There are 360 patients in the trial, separated into two groups: Group 1 and Group 2. Group 1 consisted of 180 participants with clinical signs of knee osteoarthritis who served as controls, while Group 2 consisted of 180 patients with knee osteoarthritis who functioned as patients. Serum 25-OH vitamin D was measured in all the participants by the ELFA method and concentrations <10ng/ml was considered as deficient. Results: In Group 1, 81 (45.0%) were males and 99 (55.0%) females, while in Group 2, 74 (41.1%) were males and 106 (58.8%) females. Distribution of vitamin D status according to age, BMI and gender was also made and compared between the groups. Number of patients <60 years were 121 and 113 respectively in Group 1 and Group 2. Serum 25-OH vitamin D deficiency was observed in 104 (57.7%) patients in Group 2 versus 25 (13.8%) of Group 1 (P = 0.001). Further analysis of subgroups revealed that the mean serum 25-OH vitamin D level in Group 2 aged <60 years was significantly lower than Group 1. (P < 0.05). Conclusion: The results of this investigation revealed a link between serum 25-OH vitamin D insufficiency and knee osteoarthritis in persons over 60 years old. The measurement of blood 25-OH vitamin D in patients with symptoms suggestive of knee osteoarthritis is advised since it has been linked to the disease.

102.Analytical Cross Sectional Study to Evaluate the Pattern of Patients Attending Psychiatric OPD of A Tertiary Care Hospital
Shravan Kumar, Rakesh Kumar Gaur, Suhail Ahmed Azmi, Deoshree Akhouri, Hamza
Abstract
Aim: Pattern of patients attending psychiatric OPD of a tertiary health care centre. Material and methods: This cross-sectional study was carried out in the Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India, for 10 months, A total of 50 patients attending the psychiatric care facility of the institute during the period of lockdown amid concerns due to COVID-19 pandemic were included in the study after getting informed consent. Anxiety was evaluated with GAD-7 scale which is a short 7 item scale. Each item is scored on a four-point Likert scale (0–3) with total scores ranging from 0 to 21 with higher scores reflecting greater degree of anxiety. Results: The mean age of the patients was 35.85 years. More than half of the patients included in the study were male (60%). Of the total number of patients, 56% were employed, 72% belonged to nuclear families, 64% belonged to a lower middle socio- economic status and 58% were educated beyond secondary school. A total of 50 patients attended the psychiatric care facility of our institute. 28(56%) of these patients had come with a first episode of psychiatric illness whereas 23(46%) patients had previous episodes of psychiatric disease. Among the new patients approximately half of patients presented with anxiety symptoms 23(46%) whereas anxiety with predominant insomnia was seen in 5(10%) patients. 2(4%) patients presented acute transient psychotic disorder (ATPD). 1(2%) patient was diagnosed as depression and 3(6%) patients presented with dissociation. Conclusion:We concluded that the patients with both previous psychiatric illness or without any psychiatric are equally vulnerable for psychological reactions during this pandemic.

103.An Observational Assessment of the Clinico-Etiologic Profile of Abnormal Uterine Bleeding (AUB) mong Women in Peri-Menopausal Age Group: A Retrospective Study
Smita Kumari, Gunjan, Alka Pandey
Abstract
Aim: Clinico-etiologic profile of abnormal uterine bleeding (AUB) among women in peri-menopausal age group. Materials and Methods: This study included retrospective study of randomly selected 210 cases of abnormal uterine bleeding between 40–55 years of age during a period of 24 months, in the Dept. of Obstetrics & Gynecology, Patna Medical College & Hospital, Patna. Patients were evaluated with menstrual history, physical examination, laboratory tests, imaging studies and histological examinations. Results: Most common age group presenting with AUB was 40–45 years (65.2%). Most of the women were multiparous and menorrhagia was most common presentation. Among organic causes fibroid (30%) uterus was most common. Majority of patients had mild anemia. Conclusion: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient’s family, personal and social life. Perimenopausal women’s health and quality of life can be maintained and improved through preventive care, lifestyle modification, early diagnosis of risk factor or disease and appropriate treatment.

104.Prospective Observational Assessment of Hearing Impairment in Newborns Admitted to A Neonatal Intensive Care Unit (NICU) Study
Upendra Prasad Sahu, Buwan Kumar Singh, Kamal Narayan Prasad
Abstract
Introduction: Hearing is essential for humans to communicate with one another. Early diagnosis of hearing loss and intervention in neonates and infants can reduce developmental problems. The aim of the present study was to assess the prevalence of hearing impairment in newborns admitted to a neonatal intensive care unit (NICU) and analyze the associated risk factors. Methods: Prospective observational study was conducted among neonates with birth asphyxia admitted to the NICU at RIMS, Ranchi, Jharkhand, India, from November 2020 to October 2021. Auditory function was examined by Otoacoustic emission (OAE) followed by auditory brainstem response (ABR) test and distortion product OAE (DPOAE). Statistical analysis, Chi-square test was used, and testing data was analyzed using the SPSS software version 22. Results: Among the 100 neonates, most of the babies i.e., 14 (63.3%) had mild grade of hearing loss. Three babies (13.63%) had severe grade of hearing loss. The statistically significant risk factors for development of hearing impairment in babies with birth asphyxia were – Hypoxic ischemic encephalopathy (P=0.00817) and mechanical ventilation (P=0.0003). Conclusion:Auditory function in neonates who are admitted to a NICU, especially those treated with oxygen or antibiotics and those born prematurely, should be assessed during their stay in Hospital. The importance of early diagnosis of hearing loss and intervention in these neonates and avoidance of any unnecessary oxygen or antibiotic therapy needs to be further promoted.

105.Assessment of Vitamin B12 Deficiency in Chronic Metformin Treated type 2 Diabetic Patients
Ebrahim, Mitul Rudach, Jwalant Joshi, Brinda Mevada
Abstract
Background: Metformin is one of the most widely used oral hypoglycemic agents. Vitamin B12 deficiency due to metformin therapy may not be easily detected without close attention. Monitoring for vitamin B12 has been recommended for patients with type 2 diabetes, especially those on long-term metformin treatment. Peripheral neuropathy due to vitamin B12 deficiency may be confused with diabetic peripheral neuropathy or may contribute to the aggravation of diabetic peripheral neuropathy. Objectives: This study was conducted with the objective to assess the relation between metformin therapy duration, dose and vitamin B12 levels in chronic metformin treated type 2 diabetic patients. Materials and Methods: The study was conducted at the V.S. General Hospital, Smt. N.H.L. Municipal Medical College, Ahmedabad between January 2017- August 2018. Patients of Type 2 diabetes with metformin therapy for one or more than one year duration were taken as cases and those type 2 diabetes patients without metformin therapy were taken as controls. Laboratory investigations including FBS, PPBS, Hb1AC and Vitamin B12 levels were performed and comparison of these parameters between cases and control was done. Results: There was no statistically significant difference in mean FBS, PPBS and Hb1Ac% between cases and control groups. Among cases, 47% patients were taking metformin dose of ≤1000 mg/day while 28% patients were on higher dose of metformin i.e. >1500 mg/day. Mean year of metformin usage by case group was 5.6 years. Duration of metformin use 500mg or more varied from lowest 1 year to highest 12 years. Significantly lower mean S. vitamin B12 was observed in cases (333.15pg/ml) as compared to controls (467.78pg/ml). Conclusion:Metformin therapy is associated with vitamin B12 deficiency among diabetic patients.

106.Management of Posterior Urethral Stricture in Children by Transpubic Urethroplasty
Manish Jain, Alpana Jain
Abstract
Background: Trauma is a major cause of morbidity and mortality in children. Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge. Controversy exists as to the correct acute treatment of posterior urethral injuries and delayed management of PFPUDDs. TPUP is one technique with which satisfactory results have been reported in experienced hands. Aims and Objective: To review the management of posterior urethral stricture in children by transpubic Urethroplasty. Material and Methods: This Prospective study conducted in in Surat during the period between Jan 2007 and Dec 2018 on 12 patients who were between 4-13 years of age and who underwent Transpubic urethroplasty. On admission to hospital, a detailed history and clinical examination was carried out. Operative technique to prevent complications is emphasized. Initial management whether in the form of suprapubic diversion, primary anastomosis or any other form was noted.  Management of some patients presented directly to us as pelvic fracture was noted. Results:  The present study conducted on 12 patients who underwent transpubic urethroplasty, ranging from 4 years to 13 years of age in which 9 patients were above seven years and 4 were below 7 years of age. Among all 10 patients were male and 2 were females. Data suggests that 10 patients came with vehicular accidents, one with fall while one case did not have any pelvis trauma but presented with congenital stricture of urethra. During the investigations, urine culture showed no growth in 6 cases while remaining six cases showed growth of gram-negative organisms. Urethroscopy was performed in all patients but antegrade scopy through SPC fistula was performed only in 3 patients and in one (No.12) scopy was tried from above and below but both way it was not possible due to the distortion and obliteration of normal anatomy. Conclusion:Transpubic urethroplasty for complex posterior urethral disruptions is still a viable alternative with excellent results and minimal morbidity.

107.Laparoscopic Appendectomy Versus Open Appendectomy: A Prospective Assessment
Ajay Kumar, Ashutosh Kumar Singh, Anupama Kumari
Abstract
Aim: To compare laparoscopic appendectomy versus open appendectomy. Methods: This study was carried out in Nalanda Medical College and Hospital, Patna, Bihar, India over a period of two years, with a sample size of 180cases of acute appendicitis above 16 years of age without co morbidities. The purpose of the study explained to patients. Informed written consents were taken prior to actual participation of patient into the study, patient information sheet and informed consent form includes all necessary information to conduct the study. Results: Mean age of study sample was 27.21 years with standard deviation of 8.17 years, with the highest 65 years and lowest 17 years. 36% samples were from 31-40 year age group followed by 49% subjects in years 21-30 age group. Abdominal pain was the most common complaint and was present in all 100 (100%) subjects followed by fever in 79 (43.8%) subjects, nausea and/or vomiting in 58 (32.2%) subjects. Other complaints like weight loss, constipation, abdominal distension, sleep disturbance, etc., were also noted among study samples. Conclusions: Laparoscopic appendectomy had advantages like better cosmesis, shorter duration of procedure and hospital stay, fewer post-operative complications and early return to work with disadvantage of steep learning curve, while open appendectomy, does not require special instruments, and is performed under direct three-dimensional vision.

108.To Record the Visual Evoked Potential in Smokers and Non-Smokers and Comparison Between Two Groups for Any Changes in P100
Anant Kumar, Rajiva Kumar singh, Priyanka
Abstract
Objectives: To record the visual evoked potential in smokers and non-smokers aged 20-40years and to compare between two groups for any changes in P100. Materials and Methods: Age matched 120 male smokers and 120 male non smokers in the age group of 20-40 years were studied for visual evoked potential. Smoking in terms of pack years was noted. Data was statistically analyzed. Results: Visual evoked potential was affected in smokers with prolongation of latency and decrease in amplitude of P100 in both the eyes than non smokers, with is statistically highly significant. There is a significant positive correlation between smoking history expressed in pack-years and latency of P100 in smokers group. Conclusion:Smoking causes degeneration in optic nerve shown by increased latency of P100 which increases as the number of pack-years increase.

109.Prospective Analytical Assessment of the Role of Hysteroscopy and Histopathology in Evaluation of Patients with Abnormal Uterine Bleeding
Anumeha Anand
Abstract
Aim: Role of hysteroscopy and histopathology in evaluating patients with abnormal uterine bleeding. Methods: This prospective analytical study was carried out in the Department of Obstetrics and Gynecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for 12 months. 100 consecutive cases of abnormal uterine bleeding were taken up for the study. All the patients in this study underwent Hysteroscopy followed by Hysteroscopic guided biopsy or Dilatation and Curettage and the biopsy specimen or curetting’s were sent for Histopathological analysis. Both Parous and nulliparous women with age between 25-60 years with Abnormal Uterine Bleeding who did not require any emergency management were included in the study. Results: In the present study, hysteroscopy was performed in 100 patients presenting with complaints of abnormal uterine bleeding followed by hysteroscopic biopsy or curettage. The commonest presenting complaint in this series was menorrhagia (53%) followed by polymenorrhea (17%) followed by Postmenopausal bleeding (15%). Conclusions: Hysteroscopy is a safe and reliable procedure in the diagnosis of cases with abnormal uterine bleeding with high sensitivity, specificity, positive predictive value and negative predictive value.

110.Prospective Study to Determine the Role of Abdominal Ultrasound and Alvarado Score in Diagnosing and Preventing Negative Laparotomies in Acute Appendicitis
Ashutosh Kumar Singh, Ajay Kumar, Anupama Kumari
Abstract
Aim: To evaluate the role of abdominal ultrasound and alvarado score in diagnosing and preventing negative laparotomies in acute appendicitis. Methods: This prospective study conducted in the Department of surgery, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for two years. 100 consecutive patients more than 15 years of age who had a provisional diagnosis of acute appendicitis and were willing for surgery and who gave consent for the study were included. Results: In our study, 82(82%) complained of nausea or vomiting at admission. 71(71%) had fever on admission. 81(81%) of patients had anorexia at the time of admission. 40(40%) of patients in our study had a pulse rate between 81-90 per minute. All patients in the study had tenderness in the right iliac fossa, and 71(71%) had rebound tenderness. The majority, 47(47%), of patients had complete blood count between 10000 and 15000. A shift to the left was seen in 81(81%) of patients. 60(60%) of patients in our study had conclusive evidence of appendicitis on ultra- sound. Alvarado score calculated for the 100 patients showed that 85(85%) had a score >=7. Taking histopathology as the gold standard and comparing it with the Alvarado score, the Alvarado score was >=7 in predicting appendicitis 90(90%) of patients with a sensitivity of 95, specificity of 84 and an accuracy of 94. Conclusion: Proper clinical assessment is the mainstay of diagnosis in acute appendicitis and ALVARADO score and USG abdomen help in clearing the diagnostic dilemma and preventing negative appendicectomies to a great extent.

111.A Prospective Study to Evaluate the Clinical, Biochemical and Serological Profile in Children Diagnosed with Celiac Disease
Binit Singh, Ved Prakash Gupta, Rizwan Haider
Abstract
Aim: The goal of this study was to look at the clinical symptoms and biochemical profile of celiac disease in children. Methods: All children diagnosed with CD in the previous 5 years, as well as newly diagnosed celiac patients who meet the inclusion criteria for the next year. This is a prospective and retrospective observational descriptive study. CD was diagnosed in children with chronic diarrhoea and other suggestive signs based on a positive tTGA and duodenal biopsies. For complete follow-up data, hospital records were reviewed. Results: In a study period of 12 months we diagnosed 42 children with Celiac Disease, who were studied prospectively, whereas 58 patients who were diagnosed within the last 3 years & were on regular follow up in OPD were studied retrospectively. In the total group of 100 patients in the age range of 1year to 15 years. The presenting clinical features of our group of patients were: chronic diarrhea (81 %), failure to thrive (78%), abdominal pain (41%), abdominal distention (37%), anorexia/vomiting (5%/ 2%), &weight loss (15%). Rare features were fever, fatigue, blood in stools & constipation. Conclusion: Chronic diarrhea was the most common presenting complaint in all age groups (92%) followed by failure to thrive, not gaining weight and abdominal pain. Constipation was least common. Anemia was the most common laboratory-confirmed finding and the most common type of anemia was iron deficiency anemia. Prevalence Anemia was most common in below 5 yrs.

112.A Cross-Sectional Observational Study to Evaluate the Lipid Profiles Mainly Triglycerides in Diabetic Patients from Bihar Region
Neeraj Kumar, K.K. Lohani
Abstract
Aim: The aim of this study was the assessment of lipid profiles mainly triglycerides in diabetic patients from Bihar region. Methods: This was a cross-sectional study was done in the Department of Medicine, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for 12 months. A total of 80 newly diagnosed type 2 diabetes mellitus within the last 3 months using the ADA (American Diabetes Association) criteria and both males and females were including in this study for determine the lipid profile levels. Results: According to ATP III classification 34(42.5%) participants had normal serum triglycerides levels which is <150 mg/dl whereas 56(57.5%) participants had an abnormal level of serum triglycerides. Among the 56(57.5) participants with abnormal triglycerides, 32.5% had borderline high levels (150-199mg/dl), 25% had high levels (200-499 mg/dl). In our study, 52.5% participants had low HDL and 47.5% participants had normal HDL. The Gender distribution showed that 16 male participants and 26 female participants had low HDL. In our study, among the 80 participants, 55(68.75%) participants   had   desirable total   Cholesterol levels of <200mg/dl, 20(25%) had borderline high levels of 200- 239mg/dl and 5 (6.25%) had high total cholesterol levels of ≥240mg/dl. 10(12.5%) had high levels of LDL of which 3 were males and 7 were females. 2 (2.5%) participants had very high levels of LDL of which 1 was male and 1 was female. Conclusions: Hyperlipidemia is the commonest complication of the diabetes mellitus, and it can predispose patients to premature atherosclerosis and microvascular complications. Good glycemic control can prevent the development and progression of common lipid abnormalities in diabetes like raised triglycerides, LDL, serum cholesterol and low HDL.

113.A Study to Address the Link Between the Main Presenting Symptoms of Depressive Disorder and the Level of Stigma Associated with Them
Rajeev Kumar, Amardeep Kumar, Vinay Kumar
Abstract
Aim: To determine whether there is a link between the main presenting symptoms of depressive disorder and the level of stigma associated with them, taking into account the patient’s socioeconomic and demographic background. Material & Methods: One hundred adult patients with Major Depressive Disorder (MDD) who are attending psychiatry OPD for the first time have been chosen. All subjects were rated with Hamilton depression rating scale to assess severity of their depression. Selected portion of EMIC Questionnaire (Distress questionnaire & Stigma scale) were used to assess the most troubling patient-specified symptoms with reference to four broad categories of symptoms (sadness, pain and other somatic, mental tension and others) and total perceived Stigma (illness experience) with reference to 13 items directly related to stigma. Results: The study population is made up of 33% men and 67% women. Table 1 shows basic sociodemographic details of the study participants. 48 percent of the participants in the study had a positive family history of psychiatric disease; 31 percent complained of sadness. The statistical significance of the difference in means is strong (one way ANOVA; df 3, F=15.92, p<0.001). There is no significant relationship between age and total stigma score, but there is a positive association between HDRS score and total stigma score, which is highly significant at the p<0.001 level. Conclusion: Stigma is linked to the severity of depression; it may function as a deterrent to getting care. The presence of depression is unrelated to socio-demographic factors.

114.A Randomized Comparative Assessment of the Effectiveness of Low Dose Versus High Dose Oxytocin Regimen for Induction of Labor
Rashmi Raginee
Abstract
Aim: To evaluate effectiveness of low dose versus high dose regimen for induction of labor. Material and Methods: A total of 160 antenatal patients who were admitted for induction of labor were enrolled in the study. All patients were randomized by block randomization into two groups i.e. Group I and Group II, each consisting of 100 patients. A detailed history, thorough clinical examination and relevant investigations were done for all the women. Per vaginal examination was done to know the cervical status and the bishop score. High dose regimen was started with 4mu/min with increment of 4mu/min up to a maximum of 32mu/min and low dose regimen was started with 2mu/min with increment of 2mu/min up to a maximum of 32mu/min. Results: Women induced with high dose oxytocin regimen had shorter induction delivery interval as compared to low dose oxytocin interval by 2 hours 9 minutes. The incidence of various maternal outcomes in the high dose and low dose oxytocin regimen were similar. The most common indications for LSCS in the two groups were fetal distress and failed induction. A special consideration is required for the incidence of tachysystole, which was more in high dose regimen as compared to low dose oxytocin regimen but the difference was not statistically significant. Conclusion: High dose oxytocin regimen can be considered for induction of labor as it has same effects as that of low dose regimen with lesser induction to delivery interval.

115.Efficacy And Safety of Intravenous FCM and Iron Sucrose (IS) in Post-partum Iron-Deficiency Anaemia: A Comparative Study
Varsha Sinha, Swetabh Verma
Abstract
Aim: A comparative study of efficacy, safety and compliance of intravenous ferric carboxymaltose versus iron sucrose in the treatment of iron deficiency anaemia of pregnancy. Methods: This comparative study was carried out in the Department of Obstetrics and Gynaecology, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India.  Women less than 10 days after delivery with hemoglobin between ≥6 g/dl and ≤11 gm/dl requiring iron supplementation were enrolled. Total 200 women were categorized into two groups 100 each. Detailed history and clinical examination were done. Diagnosis was confirmed by peripheral blood smear, CBC and serum ferritin. All women were dewormed. Results: Mean pre-treatment Hb was 8.1±0.77 and 8.11±0.61 in iron sucrose and ferric carboxy maltose group respectively. There was statistically significant rise (P <0.001) of Hb in FCM group 4.88 g/dl compared to iron sucrose group 3.82 g/dl. Mean rise of serum ferritin was 72.07±26.23 and 96.39±44.84 in iron sucrose and ferric carboxy maltose group. No serious adverse events were reported in either the FCM group or iron sucrose group. However, minor adverse effects like urticaria, injection site reactions, nausea hypotension occurred in 7 (7%) iron sucrose group and chest discomfort was noted in 2, nausea in 1, (3%) of FCM group. Conclusion: Properties like ultra-short duration of treatment, fewer adverse reactions and better compliance makes FCM the first-line drug in the management of postpartum iron deficiency anemia.

116.A Hospital-Based Cross-Sectional Assessment & Correlation of Gestational Age in Newborns with Head Circumference
Ved Prakash Gupta, Binit Singh, Rizwan Haider
Abstract
Objectives: This study aimed to evaluate the relationship between gestational age (GA) and neonatal anthropometric parameters, namely head circumference and crown heel length. Method: A cross-sectional study in Darbhanga Medical College and Hospital Darbhanga, Bihar, India for 14 months. with 300 consecutively live-born newborns. Their birth weight, mid-arm circumference, length and head circumference were measured and compared with gestational age assessed by New Ballard score. We summarized the variables using descriptive statistics, and the strength of association was determined through correlation analysis. Result: Amongst 300 newborns, 71% were term and 29% were preterm. Pearson’s correlation coefficient between gestational age as assessed by New Ballard score and head circumference, birth weight, mid-arm circumference and length all showed a significant positive correlation in the decreasing order [maximum with head circumference (r = 0.526)]. Linear regression analysis was done to develop predictive equations. Conclusion: Head circumference measurement can be a surrogate marker to predict prematurity as a significant correlation is seen between it and gestational age assessed by the New Ballard score. Further studies are needed to cross-validate our result.

117.Prospective Study to Access the Most Feasible Method for the Management of Facial Injuries in Children without Hampering the Facial Growth
Ahtashtam Anwar, Shagufta Syreen, S. Kokay
Abstract
Aim: To access the most feasible method for the management of facial injuries in children without hampering the facial growth. Materials and Methods: The present study was conducted on 100 child patients with facial injuries attending the outpatient department of dentistry in JNKTMCH, Madhepura, Bihar, India for 1 year.  Detailed information consisting of age, sex, socioeconomic status, chief complaint, history of present illness, past medical history, dental history, duration of injury, etiological factors and associated injuries were recorded. After recording the history, a thorough clinical examination as well as radiological interpretation was done for every patient for establishing the diagnosis. Results: In our study fall was the predominant cause for most of the facial injuries in children. A total of 100 children were afflicted by facial injuries, the incidence being 2.81%. The incidence of mandibular fracture was found to be 51%, midface and mandible to be 5%, midface 5%, dentoalveolar 34% and laceration 8%. Conclusion: Most of the mandibular fractures were found in the parasymphysis region. Simple fracture seems to be commonest in the mandible. Most of the mandibular and midface fractures in children were amenable to conservative therapies except a few which required surgical intervention.

118.Prospective, Randomized Controlled Study to Evaluate Bipolar Cautery and Diode Laser, Versus Conventional Cold Steel Dissection Tonsillectomy
Pramod Kumar, Anshu Kumar, Rana Pratap Thakur
Abstract
Aim: To compare the mean operative time, mean blood loss, post-operative pain and complications in tonsillectomy using bipolar cautery and diode laser, versus conventional cold steel dissection tonsillectomy. Materials and Methods: This was a prospective, randomized controlled study of 180 patients in the age range of 3 to 56 years undergoing tonsillectomy or adenotonsillectomy, performed to compare three tonsillectomy techniques: diode laser, bipolar cautery and classical cold dissection (which served as the control) conducted in the Department of ENT, ANMMCH, Gaya, Bihar, India, over a period of 2 years. Results: The operative time, blood loss and pain were significantly lower with tonsillectomy using bipolar cautery and diode laser tonsillectomy than with cold dissection tonsillectomy. Bipolar dissection took the shortest time on an average, whereas blood loss was the least with Diode Laser tonsillectomy. Post-operative pain increased in the Laser group by the 5th day. Conclusion: Both bipolar and diode laser tonsillectomy are associated with significantly reduced blood loss, shorter operative times and less post-operative pain compared with cold dissection tonsillectomy. But there was no significant difference seen regarding the postoperative pain when comparing both the surgical methods, by the end of one week.

119.A Prospective Study to Evaluate the Effectiveness of Budesonide Nasal Irrigations Comparison with Saline Irrigations During Postoperative Care of Patients with Rhinosinusitis
Anshu Kumar, Pramod Kumar, Rana Pratap Thakur
Abstract
Aim: This study aimed to evaluate the effectiveness of budesonide nasal irrigations compared with saline irrigations during postoperative care of patients with rhinosinusitis. Materials and Methods: A total of 200 patients who underwent functional Endoscopic Sinus Surgery (ESS) were randomly divided into two groups (A and B) of 100 participants each (normal saline [NS] + budesonide irrigation and NS irrigation alone, respectively). Pre- and post-operative evaluation was done with a 22-item sinonasal outcomes test (SNOT-22), and Lund Kennedy endoscopic (LKE scores) in second and sixth week. Results: The condition of the patients significantly improved in both intervention arms related to SNOT-22 and LKE score at each postoperative visit (Group A: p<0.001, Group B: p<0.001). A Repeated measures ANOVA F- test shows that mean SNOT-22 score difference is statistically significant between Preoperative, Postoperative (6th week), (p≤0.001). The significant P value of ≤ 0.001 “between groups” comparison shows that the two groups are statistically significantly different concerning the LKE score. It indicates that, in general, the LKE score of category A had been different from category B. Conclusion: Steroid nasal irrigation is a good option in postoperative EES patients. The difference of reduction of both SNOT 22 score and LKE score was statistically significant (p <0.05 and p<0.01 respectively) by repeated contrast test. This study is one of the few comparative studies evaluating budesonide and saline nasal irrigations in post-ESS patients.

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