International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1. Determinants Contributing to Relapse in Alcohol Dependence – A Single Centric Comparative Study
Puli Santhosh Reddy
Abstract
Introduction: Alcoholism is a psychiatric disorder combined with mental, physical and social difficulties and tends to have relapsing course. Relapse is a challenging clinical concern in alcohol dependence due to its high magnitude of conditions and limited availability of treatment. The present study was designed to assess the risk factors for relapse among cases with alcohol dependence. Materials and Methods: Seventy six participants of alcohol dependence above 18 years of age who attaining the criteria for alcohol dependence were recruited.  Participants were randomly divided into two groups. Group 1 has 38 participants relapsed with alcohol dependence after proper treatment, group 2 has 38 participants with alcohol dependence who consumed before 12 months diagnosed as per ICD 10. The stressful events of participants were assessed by presumptive stressful life event scale. Personality disorders were assessed by ICD-10 International personality disorder examination. Results: The difference of marital status, educational status, occupation, onset of alcohol consumption and family history was significant between study groups (P<0.05). In group 1, 82.20% of participants were reported stressful events that influence alcohol relapse, whereas in group 2, 7.09% of subjects reported stressful events. Stressful events related to financial conflicts (26.32%), unemployment (23.68%), marital conflicts (18.42%), familial negligence (13.16%), craving of alcohol (13.16%) and workplace conflicts (5.26%) were most common cause of dependence relapse. Discussion and Conclusion: The results were concluded that participants with unemployment, poor educational status, family history of alcohol abuse and early onset of alcohol were significant predictors among participants of relapsed group. It is necessary to counsel the victims and family to improve self-efficacy and social support.

2. Neutrophil to Lymphocyte Ratio as the Predictor of Severity of Dengue Viral Fever: A Cross Sectional Study at a Tertiary Care Centre in Central Rajasthan
Mohammed Riyaz Bhati, Hardayal Meena, Anil Kumar Sharma
Abstract
Introduction: Dengue is a viral febrile illness, which present with a wide spectrum of disease including haemorrhagic disorders and shock. Neutrophil to lymphocyte ratio, proved to be a good predictor of stress and morbidity in various clinical scenarios. Our study aims at finding out the correlation between NLR and thrombocytopenia and complications in patients suffering from dengue viral fever. Method: This is a prospective cross-sectional study at a tertiary care center. We included a total of 100 cases in this study with the history of fever of more than 38.5 degree Celsius and positive for NS1 antigen or Dengue IgM positive. All the patients were investigated with all routine investigations (CBC, NS1 antigens, IgM dengue, LFT, KFT) and followed from day 1 of admission till the time of recovery or discharge according to WHO discharge criteria whichever is earlier. Clinically patients are monitored, and CBC was repeated daily. For the purpose of this study the patients were categorised according to signs and occurrence of haemorrhage and shock into 3 groups I – without any haemorrhage, II – with haemorrhage and III – suffered with shock. Results: Out of 100, 58 patients were males and 42 were females with male to female ratio of 1.4: 1. The mean age was 29.84±6.4 years. Maximum patients were in age group of 26 – 35 years. Most patients were diagnosed as Dengue Fever with 65% patients, 21% suffered from Dengue Haemorrhagic Fever (DHF) grade I, 15% patients suffered from DHF grade II, and 8% patients suffered from DHF grade III and IV. The mean platelet count of the study group was 140,000 (92000 to 3,60,000) on day 1 and 89540 (15000 – 306000) on day 7. The mean neutrophil count was 5531.2 (2700 to 8,200) on day 1 and 3416.8 (1800 – 7120). The mean values of lymphocyte were 48.9 (12 to 82) and 41.6 (10 to 80) respectively on day 1 and day 7. The mean N:L ratio of the study group was 2.12 (0.1 to 8.2) on day 1 and 0.95 (0.23 to 2.20) on day 7. Out of 100 patients, 26 patients had bleeding manifestations and in them 8 had signs of shock. NLR does not show statistically significant reduction with the reduction of platelet counts on day 7 of the patients. Statistically highly significant relation between occurrence of bleeding and shock with reduction in NLR in patients with dengue. (P < 0.001). Conclusion: In our study it is evident that there is haematological disturbance with the progression of dengue fever in the form of decrease in platelets and NLR from day 1 to day 7 of illness. NLR may prove to be a good predictor of occurrence of complications like haemorrhage and shock however it’s not significantly associated with decrease in platelet count.

3. An Evaluation of Complications and Outcome of Endoscopic Dacryocystorhinostomy without Stenting
Ritesh Surana, Amit Modwal
Abstract
Introduction: The lacrimal system is composed of fluid channels and canalicular system. There are several diseases that occurs in these fluid channels and canalicular system and one of the most common is chronic dacryocystitis which occurs due to the blockage of nasolacrimal duct which in turn occurs due to the infection of the lacrimal sac. Trauma and iatrogenic causes are the most frequent mechanism of injury to the nasolacrimal duct. In this cases, endoscopic dacryocystorhinostomy (DCR) is performed. In this, usually, stent is used which later, in some cases, proved to bring complications like scarring and granulation and retaining the clinical features of chronic dacryocystitis. Aims and Objectives: This study is intended to evaluate whether DCR is possible without using stent and its clinical significance as compared to the DCR by using stent. Methods: This is a prospective study which has included the patients who underwent DCR due to chronic dacryocystitis. In some cases, stent is used as usual (control) and in some cases, stent is not used which is the objective of this study (intervention). DCR is performed and the clinical improvements and complications are evaluated. Results: The study found that the clinical features improved as observed during the follow up after the surgery but it is not significantly higher in intervention group than control group. The study has also found that the complications of the patients in Intervention group was significantly lower than the control group (p<0.05). Conclusion: The study has statistically shown that the endonasal DCR can be done effectively without using stent for epiphora and nasolacrimal duct obstruction. Operating without stents improves the clinical features but it is not significant from that of using stent. However, the complications in DCR without stent is significantly lower than DCR with stent. Therefore, it is better to choose DCR without stent although, more studies are advised.

4. Impact of Single Dose versus Multidose Prophylactic Antibiotics in Elective Hernia Surgeries
Ashokkumar G. Jiladia, Hardik Maheshbhai Patel, Het Yogesh Soni, Chintan Nayak
Abstract
Background and Aim: Prophylactic antibiotics are regularly utilized in all surgical cases. The presence of plastic biomaterial increases the occurrence of difficulties relating to the mesh itself, as well to other known complications of the hernia repair. Materials and Methods: A total of 320 subjects who were admitted for the elective hernia surgery were incorporated in the research. The incorporated subjects were divided into two groups with equivalent number of subjects in each group: Group A: Subjects in this group were given Amoxycillin-Clavulanic acid (2 gm) intravenously at the time of induction of anaesthesia Group B: Subjects in this group were given Amoxycillin-Clavulanic acid (2 gm) intravenously at the time of induction of anaesthesia followed by Amoxycillin Clavulanic acid (1 gm) intravenously two times a day for two days post-operatively. Results: A total of 320 subjects undergoing the process were incorporated and separated into two groups. In group A and group B there were 160 subjects evenly divided. Out of 160 subjects of Group A, eight subjects developed surgical site infection as compared to none in Group B. There is no statistically significant dissimilarity in occurrence of SSI in both groups (p=0.45). Conclusion: Prophylactic utilization of antibiotics in clean elective cases is still a subject of many debates. This research of antibiotic prophylaxis for hernioplasty incorporated two classes of antibiotic prophylaxis. The most efficient antibiotics were utilized in single doses in one group and in other group same antibiotics were utilized. Single dose prophylactic antibiotic will be efficient in dipping postoperative infection.

5. Spectrum of Semen Parameters of Male Partners of Infertile Couples Attending Infertility Clinic
Deepti Gupta, Jagmohan Singh Dhakar, Devesh Kumar
Abstract
Introduction: Infertility is a common problem affecting 8-12% of general population. Contrary to popular belief, male factor contributes alone or in association with female factor to 30-50% cases of infertility. Semen analysis is a valuable, cheap, easily accessible diagnostic test which can provide valuable information and pointers towards likely underlying cause of infertility. Aims and objectives: This study aims to analyse the spectrum of semen parameters of male partners of the infertile couples attending infertility clinic in Jabalpur, Madhya Pradesh. Materials and methods: Semen parameters of male partner of 285 couples were inserted in master chart and descriptive analysis done. Results: Male factor alone was responsible in 27.4% couples. Both male female factor was present in 14.5% couples. Mean age of male partner was 35.8± 6.3 yrs. In Isolated male factor couples, 89.29% presented with primary infertility and 10.71% as secondary. In both male/ female factor, 75% presented with primary infertility and 25% as secondary. Normal parameters in 58.1% males. Oligozoospermia in 23.3%, Asthenozoospermia in 34.4% (commonest), Teratozoopermia in 25.3%, oats in 23.3%, Cryptozoopermia in 9.8% and, Azoospermia in 8.8%. Conclusion: Semen analysis is a useful, cheap, easily accessible test which can identify male factor abnormalities and help prognosticate and decide the best management options for optimal outcomes. Isolated oligospermia is seldom observed, azoopermia needs to be critically checked after centrifuging the sample.

6. To Study and Evaluate the Effect of 0.5 % Dilution of Propofol MCT/LCT and Propofol LCT on Pain during Injection of Propofol for Induction of GA in Paediatric Patients
Sameera, Balasubramanya Halsanadu, Bala bhaskar, Adil Farooq
Abstract
Introduction: Propofol  with  its  attractive  kinetic  properties  like  titratable  level  of  anaesthesia, absence of cumulation, rapid and clear headed recovery and minimal  side  effects  is  an  ideal  agent  for  induction  of  anaesthesia. Materials and Methods: This prospective, randomized controlled study was conducted on 100 children in the age group of 6 to 12 years undergoing elective surgery under GA at VIMS hospital, Ballari during November 2015-November 2016. Results: Age of children was 8.66±2.26 and 8.68±1.9 years in group LCT and group MCT/LCT respectively. Mean weight of children was 21.58±4.74 and  21.56±4.53 kgs in group LCT and group MCT/LCT respectively. Both the groups were comparable demographically. There was no statistically significant difference between the two groups with respect to age and weight. Conclusion: Intravenous injection of 0.5% dilution of propofol MCT/LCT is associated with significantly less pain  than  0.5% dilution of propofol LCT in paediatric patients aged 6-12 years.

7. Prevalence and Risk Factors of Urinary Incontinence in Females of Tribal Area in Rajasthan, India
Vishwas Baheti, Pradeep Sharma, Smita Baheti, Pankaj Trivedi
Abstract
Background: Urinary incontinence (UI) has considerable social and economic implication. It is a common and distressing medical condition severely affecting quality of life. Thus, it is very importance to define prevalence and possible etiological factors with a view to subsequent prevention. Objectives: To know the prevalence and risk factors of urinary incontinence in females of tribal area in Rajasthan, India. Materials & Methods: This hospital based cross sectional study was conducted over a period of one year (April 2019 to March 2020)  included women attending urology and gynecology OPD during which 2920 women of various age group were asked complains about incontinence and  questionnaire was given to them which assessed  their demographic features and risk factors for incontinence. Results: Prevalence of incontinence was 19.93% (582/2920). Among  all  the  women having incontinence highest numbers found to have urge incontinence  46.7% (272/582) followed by  mixed urinary incontinence 42.9% (250/582) and isolated stress was least prevalent accounting for 10.3% (60/582). There was significant association between incontinence and risk factors like age, body mass index (BMI), parity, mode of delivery, post hysterectomy, associated medical conditions like chronic cough, diabetes, constipation and depression. Conclusion: This study concluded that simple measures like controlling BMI, pelvic floor exercise, reducing intake of caffeine and tobacco, treating chronic cough, constipation and diabetes mellitus  and restricting hysterectomy to only those  patients who have absolute indications; can reduce incontinence problems and its intensity.

8. Monopolar versus Bipolar Transuretheral Resection of Prostate in Terms of Surgical Outcomes and Efficacy
Rathee V, Ramole Y, Koshariya M
Abstract
Background: Endoscopic procedures like Trans urethral resection of prostate are scarless surgeries for benign prostatic hyperplasia, and unlike any other surgery, it has its ups and downs. Monopolar-TURP has been the standard of treatment for BPH but over time there has been a shift towards Bipolar-TURP. Methods: The present study is undertaken to study and compare postoperative outcomes after monopolar and bipolar transurethral prostate resection. An ambispectrive observational study was conducted on 68 patients who underwent transurethral resection of prostate From October 2017 to November 2021. Patients were placed in either M-TURP group (n=34) or B-TURP group (n=34), on the basis of surgical unit performing the procedure. Patients were followed for a period of three months after surgery and its outcomes (complications: hematuria, dysuria, incontinence, retrograde ejaculation and erectile dysfunction) were assessed and compared using Statistical Package for the Social Sciences (SPSS) v 20.0 (IBM Corp.) and Medcalc 19.5. Results: The age distribution shows the predominant age group to be of 71-75 years in both groups i.e. M-TURP (32.4%) and B-TURP (32.4%) respectively patients were comparable with age, prostate size and IPSS score and other complications. The mean hospital stay days was varied from 4.29±1.54 to 3.64±0.73 for Monopolar and Bipolar group respectively. Conclusions: Our study indicates that Bipolar and Monopolar Transurethral Resection of Prostate are comparable in terms of surgical outcomes and post operative complications. Bipolar TURP with better outcomes is the procedure of choice for benign prostatic hyperplasia.

9. The Value of Fine Needle Aspiration Cytology in the Assessment of Thyroid Swellings with Histologic Correlation
Tekam V, Roy N, Singh P, Rathee V
Abstract
Introduction: Thyroid gland diseases are common and after diabetes mellitus, it is the most common gland to cause endocrine disorder. FNAC is most accepted, accurate diagnostic procedure which is easy, quick, cost effective, cosmetically good and used regularly for diagnosis of any thyroid swelling. In this study, much importance is given on the correlation between FNAC and histopathology. Methods: The study соmрrised оf 50 раtients whо рresented with the histоry оf swelling оf thyrоid whiсh were referred frоm аnywhere. The рresent study wаs undertаken tо аnаlyze the rоle оf FNАС in the сytоmоrрhоlоgiсаl feаtures оf vаriоus thyrоid lesiоns with histораthоlоgiсаl соrrelаtiоn wherever the surgery wаs dоne аnd tо determine its diаgnоstiс ассurасy. Results: In this study it was observed that FNAC and histopathology have most correlation in detecting colloid goitre in 17 cases and least in detecting hyperplastic nodular goitre. Conclusions: The рresent study suggests thаt FNАС gives gооd роsitive соrrelаtiоn with histораthоlоgy with high sensitivity аnd sрeсifiсity. The use оf FNАС helрs in eаrly deteсtiоn аnd рrорer mаnаgements оf thyrоid neорlаsm. Fаlse negаtive аnd fаlse роsitivity саn be reduсed by reрeаt аsрirаtiоn, соrreсt sаmрling frоm the lesiоns with metiсulоus exаminаtiоn аnd reроrting. Henсe FNАС is а well estаblished first line diаgnоstiс test аnd effeсtive sсreening tооl whiсh аid in the diаgnоsis аnd mаnаgement оf раtients with thyrоid lesiоns.

10. Evaluate the Effectiveness of I-Gel for Ventilation, Nasogastric Tube Placement, and Blind Tracheal Intubation
Syed Farhan, Nishant Trivedi, Anurag Jain, Dinesh Chand Sharma
Abstract
Background: A revolutionary supraglottic airway device with a soft, non-inflatable cuff is called the i-gel. Through the use of a standard polyvinyl chloride tracheal tube and stomach tube insertion, we sought to assess the effectiveness of the i-gel ventilatory device in our research. Materials and Procedures: The research comprised 100 patients with American Society of Anesthesiologists (ASA) physical status I or II having elective surgery under general anaesthesia. I-gel was introduced when anaesthesia was induced, and the following measurements were made: The length of time needed for successful i-gel insertion, airway leak pressures, the simplicity of inserting a stomach tube, and a fiberscope image of the larynx. After that, an effort at blind tracheal intubation was made. Blind tracheal intubation and stomach tube insertion success rates on the first try and overall were assessed, and the length of the procedure was timed. Additionally, the existence of any adverse effects or complications after removal was noted. Results: In 71 out of 100 patients, i-gel was successfully implanted on the first try, giving us a success rate of 100%. Additionally, we were able to install stomach tubes successfully in 78.33% of patients using blind endotracheal intubation and i-gel, and in 92.22% of cases overall. We also reached a leak pressure of 25.52 (2.33) cm of water in our testing. Conclusion: I-gel may be used safely and with acceptable airway sealing pressures for ventilation, nasogastric tube placement, and as a route to blind endotracheal intubation.

11. Study of Enhanced Recovery after Surgery Protocol in Open Radical Cystectomy
Kumar G, Ramole Y, Jain A, Chaudhary A
Abstract
Introduction: Bladder carcinoma is one of the most common carcinomas of urinary system. However, in India, it is the 17th leading cause of cancer and 19th leading cause of mortality. Surgical treatment i.e. Open radical cystectomy is the mainstay of treatment for invasive urothelial carcinoma. As the bladder cancer is associated with poor clinical outcome, there is clearly a need to improve the treatment outcome of patients with invasive bladder cancer. Enhanced recovery after surgery (ERAS) protocol is a multimodal- multidisciplinary approach which aims at improving the outcome of the patient’s following surgery. Method: Study design: Prospective comparative study population-Patients scheduled for open radical cystectomy at study area during the study period. Inclusion criteria: All patients of Carcinoma Bladder undergoing open Radical cystectomy. Exclusion criteria: Patients not giving consent for the study. Detailed history regarding socio-demographic variables such as age, gender, residence, socioeconomic status and marital history was obtained and entered in questionnaire.  All the patients were subjected to 2 groups using random number tables- Group A- ERAS, Group B- Control. Result: Median (IQR) of first intake of clear fluids, ambulation, anal exhaust, and first defecation was significantly early in ERAS group as compared to control group. Vomiting was the most common complication in ERAS group (33.3%) followed by intestinal obstruction and pneumonia. Conclusion: The protocol helps in avoiding mechanical stress and improving the postoperative recovery by promoting early mobilization after surgery, early return of bowel functions and reducing length of stay.

12. Adrenaline Plus 3% NaCl vs. 3% NaCl by Nebulisation in Bronchiolitis in Children: A Prospective Randomized Study
Adithya Nikhileshwar B, Mamta Suthar, Jayendra Gohil, Pranav Punasanvala
Abstract
Background: Lower respiratory tract infection (LRTI) (inflammation of the airways/ pulmonary tissue) in younger children needing hospitalization, due to viral or bacterial infection presents with fast breathing, chest retractions, and wheezing. Acute bronchiolitis is responsible for half of LRTI in children less than 2 years. Various bronchodilators have been used in the treatment. None have been found to be efficacious. Aims and Objectives: To compare nebulized 3% NaCl alone, with, nebulised adrenaline plus 3% NaCl, in the treatment of LRTI with special reference to bronchiolitis in terms of improvement in SpO2, decrease in Heart rate, Respiratory rate, Respiratory Distress Assessment Instrument (RDAI)score [0-17 min-max] and duration of hospital stay in patients aged 1-24 months. Methods: Children in the age group of 1-24 months with LRTI, and/ or bronchiolitis with RDAI score from 0 to 15, admitted in the Pediatric ward, Sir T G Hospital, Bhavnagar from October 2018 to August 2019. Results: Out of 114 children enrolled, 57 received Adrenaline plus 3% NaCl nebulisation; 57 received 3% NaCl nebulisation. There was improvement in both the Groups in Heart Rate, Respiratory Rate, SPO2, Respiratory distress Assessment Instrument score and duration of stay. There was no significant difference in these parameters between the two groups except improvement in SpO2 in Adrenaline plus 3% NaCl nebulisation group. Conclusion: In the LRTI, including Bronchiolitis; nebulised adrenaline plus 3% NaCl, is not superior to 3% NaCl nebulisation alone, in the clinical improvement. The trial was registered at (CTRI) ctri.nic.in (CTRI/2018/10/016093).

13. Evaluation of Antimicrobial Susceptibility of Ceftazidime/ Avibactam and Ceftolozane/Tazobactam against Clinical Isolate of MDR Pseudomonas Aeruginosa
Sarita Kumari Nayak, Swetalona Pattanaik, Amruta Kar
Abstract
Introduction: To investigate the in vitro activity of ceftazidime/avibactam and ceftolozane/tazobactam against clinical isolates of MDR Pseudomonas aeruginosa. Materials and Methods: MDR P. aeruginosa isolated between Oct 2021 to Aug 2022 from Dept of microbiology, Hi tech medical college and hospital, Bhubaneswar ,were used for evaluation of ceftazidime/avibactam and ceftolozane/tazobactam susceptibility. Results: Pseudomonas aeruginosa isolates (n=1,909) were isolated from various clinical samples and their susceptibilities were tested using the broth microdilution method. Ceftazidime-avibactam (MIC50/MIC90, 2/8 mg/liter) and ceftolozane-tazobactam (MIC50/MIC90,0.5/2mg/liter) were the most active (i.e., had the highest susceptibility rates) compounds after colistin, with national susceptibility rates of96.9% and 97.5%, respectively. Conclusions: MDR P. aeruginosa susceptibility rates to ceftazidime/avibactam and ceftolozane/tazobactam were higher than those to all existing anti pseudomonal agents, except colistin, but were less than 50% in extremely resistant isolates. Non-susceptibility to ceftazidime/avibactam and ceftolozane/tazobactam was largely due to the production of ESBL and VIM enzymes. Ceftazidime/avibactam and ceftolozane/tazobactam are possible options  for some patients with MDR P. aeruginosa.

14. A Clinical Study of Dequervains Thyroiditis with Special Emphasis on its Relation with Novel Covid-19 Infection- Ourexperience in a Teaching Hospital in North India
Rakesh Kumar, Anoop M., G.P.S. Gill, Sachin Agarwal, Nishant Godara, Adeep Kirdatt
Abstract
Background: Among different types of clinical thyroiditis, Dequervain’s thyroiditis is a specific entity. It is triggered by viral infection in genetically susceptible individuals. There is a relative increase in the incidence of COVID – 19 related Dequirevains’s thyroiditis in the current running pandemic. Materials & Methods: This present study is a prospective  observational study of 14 patients. The study period was 18 months i.e. from January 2020 to August 2021. It was conducted in ENT department of our teaching hospital in northern India. All patients with painful thyroid swelling and associated systemic features like fever, myalgia, breathlessness were evaluated. Results: On analysing the data, it was found that 78.6 % were female patients and 21.4 % were males. Female: Male ratio was 3:6:1. Mean age was 35.7 Years. Urban: rural ratio was 2:5:1. Conclusion: From the present study, we conclude Dequirevain’s thyroiditis is not an uncommon entity causing painful thyroiditis. Multiple viruses including COVID – 19 is known for it causation. Now a days, more urban population is affected than rural. Data is lacking with regard to relation between other forms of clinical throiditis and novel covid-19. Further research is needed in this aspect.

15. A Comparative Study of Intrathecal Tramadol with Intravenous Tramadol, as an Adjuvant to Intrathecal Bupivacaine for Post Operative Pain Relief in Gynaecological Procedures
Mohamed Hussain Sait, Neena Thomas
Abstract
Background: In this study, we wanted to compare the efficacy of intrathecal bupivacaine and intrathecal tramadol with intrathecal bupivacaine and intravenous tramadol in patients undergoing gynaecological procedures. The parameters studied include onset of sensory block, change in vital signs, adverse effects, and duration of post operative analgesia. Materials and Methods: This prospective randomized double-blind study was conducted among 60 patients who were allocated randomly into two groups of 30 each. Group I received 3.5 ml of 0.5 % bupivacaine (heavy) and 0.5 mg/kg (preservative free) tramadol intrathecally. Group II received 3.5 ml of 0.5 % bupivacaine (heavy) and 0.5 ml saline intrathecally and 0.5 mg/kg tramadol (preservative free) intravenously. After obtaining written informed consent, Institutional Ethical Committee approval was taken. Results: The most common study is that of postoperative pain which is unique by its transitory nature. Bupivacaine is the most widely used local anaesthetics for spinal anaesthesia. Whereas tramadol is a centrally acting analgesic with weak opioid agonistic properties. A combination of intrathecal tramadol with bupivacaine could be used for better postoperative analgesia with no major side effects like respiratory depression. From the present study, it can be concluded that intrathecal tramadol 0.5 mg/kg in combination with bupivacaine offers a simple, inexpensive and effective means of good quality post-operative analgesia. Conclusion: A combination of intrathecal tramadol with bupivacaine could be used for better post operative analgesia with no major side effects like respiratory depression. Present study can be concluded that intrathecal tramadol 0.5 mg/kg in combination with bupivacaine offers a simple, inexpensive and effective means of good quality post operative analgesia.

16. Retrospective Analysis of CSR Patient in Pre and Post COVID Era
Sachala Bhoi, Sabita Devi, Sujata Padhy, Mohit Sharma
Abstract
Background: A retrospective analysis of CSCR patient to ascertain the link between noble corona virus and CSCR disorder. Explosion of covid 19 cases inflated the use of steroid as well as stress in the patients leading to increase CSCR cases in post covid era. Aim: To determine the risk factors in covid 19 patients leading to the development of CSR. Materials and Methods: A Retrospective Observational study was done in a tertiary care center from February 2019- January 2021 including all CSR cases and categorizing them into two groups. One pre covid CSR group with patients of CSR diagnosed between February 2019-January 2020 and Post covid CSR group with newly diagnosed CSR cases between February 2020- January 2021. Results: The pre-covid group had 194 patients with 132 males and 62 females ageing between 24-40 years. Post covid group had 290 patients with 170 males and 120 females ageing between 21-48 years. B/L disease increased from 2 cases to 13 cases after covid. OCT thickness ranged 290-370 m in the pre covid group in comparison post covid group ranged 319-450 m. Mean steroid intake in post covid group was 41%. Conclusion: The outbreak of covid 19 with an increase in stress and irrational use of corticosteroid are major causes of increment in cases of CSR in post covid patients.

17. Role of Bronchial Artery Embolization in the Management of Massive Haemoptysis
Niranjan N., Anudeep Reddy
Abstract
Background: In this study, we wanted to evaluate the effectiveness and safety of embolization therapy as a lifesaving procedure in haemoptysis patients. Demographic profile and the amount of haemoptysis were noted. Various investigations were done to diagnose the underlying aetiology. Cortical blindness has been reported and it represents as an extremely rare neurological complication. Bronchial artery embolization (BAE) is an effective and safe procedure for the management of haemoptysis. Materials and Methods: This hospital based prospective study conducted among thirty patients with varying degrees of haemoptysis (excluding cardiac cause of haemoptysis) was done to evaluate the effectiveness and safety of embolization therapy in patients with haemoptysis, admitted in the Department of Pulmonary Medicine, Medicine and Cardiology, Indira Gandhi Medical College, Shimla from July 2013 to June 2014. Results: Total number of bronchial arteries embolized was 32 (46 %). Out of which, right bronchial arteries were 18 (56.25 %) and left bronchial arteries were 14 (43.75 %). Following embolization materials were used: Polyvinyl alcohol (PVA) in 18 arteries, coils in 9 arteries and gel foam in 3 arteries. Total number of non-bronchial systemic arteries embolized was 38 (54 %). The embolized systemic arteries included: Branches of subclavian artery (n = 18), internal mammary artery (n = 3), intercostal artery (n = 9), subclavian plus internal mammary arteries (n = 3), subclavian plus intercostals arteries (n = 4), internal mammary plus intercostal arteries (n = 1). Following embolization materials were used: PVA in 26 arteries, coils in 6 arteries and gel foam in 3 arteries. Conclusion: Embolization therapy is useful to control acute, chronic and recurrent haemoptysis. It is important to embolize non-bronchial systemic arteries at the same sitting, as more than 50 % of culprit arteries are of non-bronchial origin. It is also important to treat the underlying primary pulmonary condition in order to reduce future risk of haemoptysis. Embolization therapy with appropriate technique is a safe and well-tolerated procedure with minor complications and has got better outcomes than medical, surgical, or bronchoscopic techniques alone. In view of our results, we continue to favour the simplest and the quickest procedure, the embolization therapy in controlling haemoptysis.

18. Comparison of the Diagnostic Yield of Rigid and Semi Rigid Thoracoscopy in Undiagnosed Pleural Effusions
Bushna Bavumon, Anand. M, Shone P. James, Paulo Varghese Akkara, Suraj K. P., Rajagopal T. P.
Abstract
Background: Pleural diseases sometimes may present as a diagnostic challenge to the pulmonologist. The British Thoracic Society recommends thoracoscopy (diagnostic yield ≥ 90%) as the investigation of choice for an inconclusive pleural effusion after thoracentesis and pleural biopsy. Thoracoscopy can be performed using a rigid thoracoscope which requires more expertise or a semi-rigid thoracoscope which is more operators friendly but yield a smaller biopsy size. In this study, we are comparing the efficacy and safety of two procedures. Aim and Objective: To compare the diagnostic yield and safety of rigid versus semi-rigid thoracoscopy in undiagnosed exudative pleural effusions. Materials and Methods: Subjects with undiagnosed pleural effusions were allocated for either rigid or semi-rigid thoracoscopy randomly. The primary outcome measured was the diagnostic yield. The secondary outcomes measured were the requirement of sedative / analgesic, biopsy size, pain score, the operator’s view of the procedure and complications. Results: 70 patients with undiagnosed, exudative, low ADA (24.31±14.24) pleural effusions were enrolled in the study, 35 in each group with almost similar baseline characteristics. The diagnostic yield of rigid and semi-rigid thoracoscopy were almost comparable (88% v/s 82% p=0.49). The pain score, requirements of sedatives and analgesics were greater in rigid group, but biopsy sample size was distinctly larger (1.13 ± 0.26 cm v/s 0.57 ± 0.13, p=0.00). The number of complications were greater in rigid arm (2% v/s 7%, p=0.07). Conclusion: Though the biopsy size seems significantly larger in rigid arm, patient comfort and lesser rate of complications were found in semi-rigid arm with a comparable diagnostic yield.

19. A Comparative Study between Extra Oral and Transoral Approaches for Madibular Fracture
Ashish Shivendra Singhal, Aravind Lakshman Rao
Abstract
Introduction: Mandibular fractures are known to represent 70 percent of all maxillofacial fractures and out of these, 26- 35 percent are mandibular angle fractures. Most of the confusion and debate exists about the right approach for fractures of the mandibular angle. There are certain prerequisites for choosing approach: Type of fracture, amount of displacement of fractured segments, number of fractured segments, ease of accessibility and visibility, perfect anatomic reduction of the segments, perpendicular application of drilling device for fixation and approach related complications. Aim: To evaluate ease of accessibility, time taken for the procedure, ease of anatomic reduction and complications among madibular fracture patients with extra oral and transoral approached used. Method: In this retrospective cohort study, a total of 63 patients were included. Out of which 36 patients underwent transoral approach and 27 patients underwent extraoral approach for management of mandibular angle fractures. Results: Out of the total patients studied 61.9% had isolated mandibular angle fractures and rest of the patients had other associated facial bone fractures. Intermaxillary fixation was required in only 9.5% of the patients, as manual occlusion was difficult. Out of all the patients, a scar was seen only in patients operated by extraoral approach. Conclusion: Transoral approach was found to be much better for there is no risk of damage to the facial nerve and no visible external scar.

20. Prospective Comparative Study to Determine Analgesic Efficacy of Intrathecal 1% 2- Chloroprocaine with or without Fentanyl during Caesarean Section
Rekha Agarwal, Anshul Agarwal
Abstract
Background: Preservative free 1% 2-chlorprocaine is a short acting local anaesthetic agent appropriate for day care surgical techniques. Potentiation of analgesic accomplishment of intrathecal local anesthetics by the addition of opioids is well recognized. Objectives: To investigate the effect of intrathecal fentanyl as an adjuvant to 1% 2-chloroprocaine (2-CP) in parturients undergoing elective lower segment caesarean section (LSCS). Methods: A prospective randomized double blind study was performed on 120 healthy, term parturients planned for elective LSCS, divided into two equal groups. The group C1 received 1% preservative-free 2-CP 3 ml (30 mg) + 0.5 ml normal saline and group C2 received 1% preservative-free 2-CP 3 ml (30 mg) + 0.5 ml fentanyl (25 μg) with a total volume of 3.5 ml intrathecally in both groups. The duration of sensory blockade, duration of motor blockade, maximum height of sensory block, haemodynamic parameters, quality of block, neonatal outcome, patient satisfaction and any side effects were recorded. Results: There were no significant differences in demographic characteristics, haemodynamic parameters, onset of sensory block, and onset of motor block and duration of motor block between the groups. The duration of sensory block and duration of analgesia was statistically prolonged in group C2 than group C1 (P value= 0.01). There was no statistical difference in the Apgar score of newborns in both groups. Conclusion: The addition of fentanyl to 1% 2-chloroprocaine intrathecally prolonged the duration of sensory block and postoperative analgesia in patients undergoing LSCS.

21. A Prospective Observational Study of Use of High Flow Nasal Cannula for Airway Assessment Cases
Amer Sajed, Yogita Patil
Abstract
Aims: To study the number of cases maintaining saturation (SpO2) more than 90% during airway assessment. The median duration of saturation maintained > 90% during each case. Number of episodes of desaturation < 90% in each cases and  any adverse events noted. Methods: This study was Prospective observational study conducted in the ENT operation theatre in a tertiary care hospital over a period of one year. All the patients had received 30 Litres/minutes of oxygen with Airvo2 as high flow nasal oxygenanation method (Fisher and Paykel Company). After attaching monitors and premedication fraction of inspired oxygen (Fio2) was gradually increased to 100%. Anesthesia was maintained with propofol (2.0 – 4 mg /kg /min) and ketamine (0.1 – 0.5 mg/min) IV continues infusion. In our study single dose of Inj. Succunylcholine was given in all the patients. Parameters like pulse, NIBP, ECG and SpO2 were monitored throughout the procedure. The total duration of SPO2 maintained above 90% was noted in all the patients.Number of times SpO2 going below 90% was noted in each patient. Results: The 45 Patients were included in this study with fulfilling the criteria. In our study total duration of surgery was between 10-15 minutes in 25(55.56%) patient followed by 16-20 minutes in 20 (44.44%) patients. The mean duration of surgery was 15.31±1.20 minutes. In our study, duration of anesthesia was between 16-20 minutes in 25(55.56%) patients followed by 21 to 26 minutes in 20 (44.44%) patients. The mean duration of anesthesia was 22+-2.5 minutes. In our study the Majority 35(77.78%) had apnea time between 10-15 minutes followed by 10(22.22%) cases with apnea time between16-20 minutes. Mean apnea time was 14.64±1.51 minutes. The confidence interval of apnea time in study subjects ranged between 14.199 – 15.081 minutes. Inter Quartile range (IQR) of apnea time IQR = (15 -14 minutes).The confidence interval of the total duration of Sp02 >90% in study subjects ranged between 14.199 – 15.081 minutes. Our results are consistent with studies showing the benefits of HFNC in maintaining saturation above 90% in various other clinical scenarios. Conclusion: So we conclude that HFNC provides optimal working space to the surgeons and avoids desaturation and interferences with bag and mask ventilation without any adverse event up to apnea time of 14.64±1.51minutes and short-duration laryngeal and tracheal surgeries are possible without the need of endotracheal tube for oxygenation with use of HFNC.

22. Patterns of oral Hygiene Practices, Knowledge on Dental Caries Prevention and its Association with Dental Health Status Among School Children Between 12-15 Years of Age
Mini Rani Mary Beth, Jogindra Vati
Abstract
Introduction: Dental caries and gum disease are a major public health problem and predominantly affecting children worldwide. Materials & Methods: A quantitative non- experimental descriptive study was conducted among 125 school children between 12-15 years from selected private schools in Kanyakumari district, Tamil Nadu. Purposive sampling technique was used to select the samples.  A self-constructed and pre-tested online survey questionnaire was used to collect data. The association between demographic profiles of children with oral hygiene practice, knowledge and dental health status were analysed and interpreted by χ2 (Chi-square) test. The correlation was done by using Pearson correlation coefficient test (r). The IBM Statistics-20 was used for analysis and interpretations. The P-values < or equal to 0.05 (P≤0.05) was considered as statistically significant. Results: The assessment of the oral hygiene practices showed that 32% of them had excellent practice, 66.4% had good practice and 1.6% had poor oral hygiene practice. Assessment of knowledge on dental carries prevention showed that 52% of them had excellent knowledge, 29.6% had good knowledge, 16% had moderate knowledge and 2.4% had poor knowledge. Assessment of dental health status among the school children showed that 6.4% had excellent, 91.2% had good and 2.4% had poor dental health status respectively. The association scores shows that there is a significant association between the mothers’ education and oral hygiene practices among children (P<0.05). There is a significant association between fathers’ education and knowledge on dental caries prevention among children (P<0.001). There is a weak positive significant relationship between oral hygiene practices and dental health status of children(r-0.297). Conclusion: The researcher believes that oral hygiene practices and assessment of dental health of school children can help to improve dental health and prevent oral health problems that will benefit the children lifelong.

23. Mannheim’s Peritonitis Indexes as a Prognostic Tool in Perforative Peritonitis
Sushanth PT, Suhas BS, Murali SV, Sunil Kumar V
Abstract
Introduction: Peritonitis due to gastrointestinal tract perforation is the most common surgical emergency all over the world.Thus early prognosis of the severity of the disease is necessary for reducing the mortality. Hence the need for a scoring system for exact recognition of seriousness of disease. Objectives of the Study: This study is done to evaluate Mannheim’s peritonitis index score and its role in predicting mortality in patients of perforation peritonitis.In this study co-morbidities and their effect in outcome of perforation peritonitis patients is also analysed. Methods: This is a one and a  half  year study,done from January 2021 to June 2022.  A total of 35 cases suffering from peritonitis were included in the study.Patients are evaluated  using a prestructured proforma to study the variables. The MPI score was calculated for each patient. The Patients were grouped into three categories based on disease severity: those with MPI less than 21, between 21 and 29, and greater than 29. Results: In our study with the two mortality the MPI variables of adverse outcome namely, presence of organ failure; time elapsed > 24hrs; presence of malignancy; age>50 years, generalized extension of peritonitis, type of exudateand the non colonic origin of sepsis in peritonitis behaved as expected. Conclusion: The Mannheim’s peritonitis index was a very useful tool for prognosis of the morbidity and mortality of patients with peritonitis.MPI score allows the clinician to counsel the patient’s attendant with greater perspective.

24. Assessment of Knowledge on Cardiovascular Disease Risk Factors and Healthy Lifestyle Practices in High School Children
Pradeep Bagavatham, Arun Bapurao Bansode, Vundi Krishna Kumari
Abstract
Background: Cardiovascular disease (CVD) is the major cause of deaths in India. Risk factors like high blood pressure, tobacco use, high sedentary activities, obesity and positive family history are linked to CVDs. Improving the knowledge and adopting healthy lifestyle since childhood may decrease the risk of CVDs. The present study was conducted to assess the knowledge and healthy lifestyle practices linked to cardiovascular risk factors among middle age school children. Material and Methods:  A total of 484 middle age group school children of 6th to 8th class were considered. A semistructured self-administered questionnaire that comprises the questions about knowledge on cardiovascular complications and physical activity assessment questions was distributed and all subjects were undergone physical examination. Results: The level of knowledge on CVD was adequate in 23.22% (95% CI: 20.46%-25.98%), moderate in 64.14% (95% CI: 59.78%-68.50%) and poor in 12.64% (95% CI: 10.24%-15.04%) participants. There was a significant association between lifestyle routines i.e. tobacco use and physical activity with BMI, blood pressure and cardio respiratory reserve (p<0.05). Conclusion: The level of knowledge and healthy life style practices linked to cardiovascular risk factors among middle age school students was not adequate. General screening for conventional risk factors and implementation of intervention session at school level is important to improve health lifestyle practices and knowledge of CVD at young age.

25. Early Echocardiography in Acute Myocardial Infarction in a Tertiary Care Hospital in Tripura
Harish, Rajesh Kishore Debbarma, Swapan Sarkar, Bibhu Debbarma
Abstract
Introduction: Myocardial Infarction (STEMI), it continues to be a major public health problem in the industrialized world as well as in developing countries like India. It has been estimated that the number of years of life lost because of an AMI is 15 years. The burden of Myocardial Infarction in developing countries is approaching those now afflicting developed countries. The scarcity of available resources to treat ST Elevation Myocardial Infarction (STEMI) in developing countries mandate major efforts on an international level to strengthen primary prevention programs. This study is designed to observe the early echo changes following myocardial infarction using two-dimensional echocardiography among the myocardial infarction patients attending AGMC and GBP Hospital. Materials and Methodology: This is a prospective type of study done in 100 patients admitted with acute myocardial infarction in the department of medicine between Jan 2020 to Jan 2021. Patients with pre-existing heart disease was excluded from the study. Echocardiography was carried out within 24 hours and patient was checked for LV systolic and diastolic function, RWMA, valvular dysfunctions thereby to identify high risk patients. Results: Out of 100 patients 34(61.8%) were male and 21(38.2%) were female. Most of the patients were 51-60 years old. The mean age of patients was 62.2600 yrs. 26 (26.0%) patients had anterior wall, 30 (30.0%) patients had anteroseptal, 31 (31.0%) patients had inferior wall and 13 (13.0%) patients had lateral wall.  43 (43.0%) patients had mild EF, 31 (31.0%) patients had moderate EF and26 (26.0%) patients had normal EF.32 (32.0%) patients had grade 1 LVDD, 14(14.0%) patients had grade 2 LVDD, and 54 (54.0%) patients had Normal LVDD.RWMA was found in 95% of patients.28 28.0%) patients had MR in valvular dysfunction, 5 (5.0%) patients had MR/AR in valvular dysfunction and 16 (16.0%) patients had MR/TR in valvular dysfunction. Conclusion: The incidence of high risk RWMA and valvular dysfunctions were higher post-acute myocardial infarction and hence the early identification of patients with high-risk complications is needed and echo within 24 hrs of admission is helps in the identification of such patients and guide in the proper management of such patients.

26. Evaluation of Ischemic Heart Disease in Patients of Chronic Obstructive Pulmonary Disease in aTertiary Care Hospital
Kushal Kalvit, Rajesh Kishore Debbarma, Samson Debbarma, Gopinath Barman
Abstract
Introduction: Patients with COPD are at increased risk of an array of acute cardiovascular events, including myocardial infarction and have increased short-term and long-term mortality compared with their non-COPD counterparts. In fact, up to one-third of deaths in patients with COPD may be described to cardiovascular disease. Hence the study is taken up to evaluate the prevalence of IHD in patients of COPD in a tertiary care hospital. Methodology: A cross sectional study was conducted in the Dept. of General Medicine and Respiratory Medicine of AGMC & GBP Hospital from January 2016 to July 2017 among 135 COPD patients who were selected consecutively. Data were collected in a case record form and analysed using Microsoft excel. Result: The mean age of the participants was 65 ± 7 years ranges from 50 to 85 years where male was more (93.3%). Among 135 participants, 84 (64%) were current smoker and 65% of them were of stage II & III COPD gold stage. Only 28% of echocardiography shown regional wall motion abnormalities (RWMA) suggestive of Ischemic heart disease (IHD) out of all COPD patients. Advance age, smoker and reactive to CRP were strongly associated with presence of IHD. Conclusion: One third of COPD patients are having ischemic heart diseases. Advance age, smoker, and reactive to CRP were strongly associated with presence of IHD among COPD patients. Hence, screening for cardiovascular diseases is recommended among COPD patients in hospitals.

27. To Evaluate the Prevalence of Fatty Liver and Liver Stiffness in Persons with Metabolic Syndrome in a North-Eastern State of India
Debaditya Bhusan, Koushik Chakma, Avik Chakraborty
Abstract
Introduction: The significance of metabolic syndrome and its implications in cardiovascular and cerebrovascular diseases has been proved beyond doubt. Particularly in India and more specifically in Eastern part of our country where carbohydrate constitutes major part of the meal, the problem seems to be even graver. The present cross sectional study was done to assess the relationship between metabolic syndrome with its hepatic manifestation namely fatty liver and liver stiffness. Aim and Objective: Of the study is to find out the prevalence of fatty liver and grades of liver stiffness/fibrosis in patients with metabolic syndrome and also to evaluate the association of various cumulative risk factors in this cohort of patients. Materials and Methods: After fulfilling inclusion and exclusion and as per sample size one hundred haemodynamically stable diagnosed cases of metabolic syndrome (MetS) as defined by International Diabetes Federation (IDF) and Consensus definition for Asian Indians, were recruited in the study. Ultrasonography to assess fatty liver and transient elastography for liver stiffness were done in fasting state. Results: The mean liver stiffness measurement (LSM) was 8.3 kilopascal (kPa). 54% of study cohort had 4 risk factors, 27% had 3 risk factors and 19% had all 5 risk factors of metabolic syndrome. 46% had Grade II fatty liver, 22% had Grade I and 17% had Grade III fatty liver. Most of the study population (31%) were in Stage F2 fibrosis while the least number of study population (8%) were in stage F4 fibrosis. Liver stiffness was significantly higher in persons having 5 risk factors compared to 3 or 4 risk factors. There was significant positive correlation with fasting plasma glucose, waist circumference (WC), Aspartate Aminotransferase-to-Platelet-Ratio Index (APRI) and fibrosis – 4 (FIB-4) values with liver stiffness. Conclusion: It is evident that persons with metabolic syndrome are at higher risk of development of fatty liver and liver fibrosis which if unchecked can lead to cirrhosis. Therefore it is imperative to evaluate these high risk individuals at regular intervals for fatty liver and liver fibrosis as this disease is a dynamic process.

28. Assessment of Atherosclerosis Risk in South Asian Type 2 Diabetes Mellitus Patients
Chethana M.S, Rajesh Kishore Debbarma, Rajen Saha Bhowmik, Gopinath Barman
Abstract
Introduction: Cardiovascular diseases are the leading cause of mortality and morbidity in diabetes mellitus patients. Identifying asymptomatic high-risk patients at the earliest and treating them to reduce the risk is the priority. Carotid artery intima-media thickness (CIMT) would give better risk stratification than traditional ASCVD risk calculator in South Asian type 2 diabetes mellitus population. Methods: Based on history, examination and laboratory reports, data is used in ASCVD calculator to estimate risk and categorize into low, borderline, intermediate, and high risk. CIMT measured by B mode ultrasonography of both left and right side common carotid artery is averaged to get AvCIMT which is categorised into high risk if it is more than 75th percentile for the age and sex. Results: When categorized based on ASCVD calculator, 226(67.3%) belonged to low risk, 40(11.9%) borderline, 55(16.4%) intermediate, 15(4.5%) to high risk. When AvCIMT was categorized, among 336, 125 participants (37.2%) were normal, 211 participants (62.8%) had high CVD risk. Among the high-risk category, 61 of them, that is 18% of total population had Plaque. Conclusion: ASCVD risk calculator underestimates CVD risk in South Asian type 2 diabetes mellitus population. Integrating CIMT measurement would help in better stratification.

29. The Study of Independent Mortality Indicators in Patients of Diabetic Ketoacidosis
Madhurya M., Deepak Raj Sakhnani, Champa Kumari Saini, Mahima Makhija, Chetanya Kumar Sharma
Abstract
Background: Diabetic ketoacidosis (DKA) is an acute complication of uncontrolled diabetes  mellitus that is associated with increased morbidity and mortality. Objective: To identify independent mortality indicators in patients of DKA so as to stratify them according to risk for emergent intensive care. Material and Method: The study sample consisted of 110 patients diagnosed of DKA admitted to SMS hospital. All the patients were treated according to standard protocol. Detailed history, type of diabetes, presence of coexisting diseases, level of consciousness, vitals, capillary blood glucose, units of regular insulin administered to decrease blood glucose to less than 250 mg/dl , liters of normal saline administered and urine output were monitored. WBC count, blood urea, serum creatinine, serum electrolytes, arterial blood pH and bicarbonate, liver function tests, HbA1c, ECG and chest X ray were done. The above parameters and relevant investigations were monitored till the patient was cured and discharged or lost to death. The data was analyzed. Results: Ketonuria more than 3+, glucosuria more than 4+, presence of circulatory shock, fever and/or depressed mental status in the first 24 hours, requirement of more than 6 liters of fluids in first 24 hours; pH <7.1 and HCO3 < 11meq/l at presentation, time taken to become ketone free more than 96 hours or less than 48 hours had significant association with higher rates of mortality, while patients who were normotensive or hypertensive at presentation and those who took 48-95 hours to become ketone free had significantly lower rates of mortality. Age, sex, whether diagnosed newly or established case of diabetes, type of diabetes, presence of comorbidity, number of units of insulin required to bring the blood sugar levels to less than 250mg/dl in the first 24 hours, level of blood sugar at the time of presentation did not have a significant association with mortality. Conclusion: Mortality was higher among those who had ketonuria >3+, glucosuria >4+, lower respiratory tract infections, presence of circulatory shock, depressed mental status, fever in the first 24 hours, pH <7.1, HCO3-<11 meq/l at presentation, duration taken to become ketone free either too early (24-48 hours) or too late(>96 hours), requirement of >6L fluid on admission. Hence the high mortality rate in this study (38.18%) was due to multi- factorial reasons. It could have been confounded by the fact that the study was conducted during the ongoing covid pandemic. Risk stratification of patients with DKA is possible from simple clinical and laboratory variables available during the first day of hospitalization and prompt recognition of the above risk factors either at admission or during the course of management in the ward has to be followed by emergent ICU care to reduce the mortality.

30. Study of Risk Factors for Surgical Site Infection following Caesarean Section in a Tertiary Care Hospital
Nidhi Shankar, Usha Brindhini Mathialagan, Seema Mehrotra
Abstract
Introduction: Caesarean section is the most common major abdominal operation performed among women. Surgical site infection (SSI) is the second most common infectious complication following caesarean section. The knowledge of incidence and associated risk factors of SSI after caesarean section will help to increase awareness among health care professionals for prevention of this problem in the hospital. Aim and Objectives: To assess the frequency of surgical site infection following caesarean section and to assess the risk factors associated with surgical site infection following caesarean section. Results: The incidence of surgical site infection was found to be 7.2% in our hospital. Most of the SSI were superficial (76.6%), followed by 16.8% of deep and 6.6% of cases were organ space infections. Majority of the patients (84.98%) were unbooked who developed SSI. Higher BMI was associated with an increased risk of development of SSI. Proportion of women with rupture of membranes> 12 hrs and above was more in cases (41.44%) than in controls which was statistically significant. Regarding the microbiologic assessment, 230 cases had positive culture specimen and the most common gram negative isolate found was Escherichia coli (27.5%). Conclusion: SSI represents a substantial burden of disease both for patients and health care services in terms of morbidity, mortality and economic costs. The identification of risk factors can lead to potential review of practice and subsequent reduction of SSI.

31. Comparative Study of Postoperative Analgesia in Major Abdominal Oncosurgeries: Epidural Drug Combinations of Ropivacaine and Nalbuphine with Levobupivacaine and Tramadol
Kawade D. B, Damani K., Chirde A.
Abstract
Objective: To combat postoperative morbidity because of pain following major abdominal oncosurgeries, a prospective, double-blind, randomized study done in tertiary care hospital to compare the efficacy of postoperative analgesia by epidurally administered Levobupivacaine (0.1%) with Tramadol (50mg) and Ropivacaine (0.1%) with Nalbuphine (10mg). Material and Methods: Study groups include patients of either sex, age 30 to 70 years, ASA I-II category planned for major abdominal oncosurgery. Randomization done into two equal groups as Levobupivacaine with Tramadol(Group LT) and Ropivacaine with Nalbuphine (Group RN). Preinduction lumbar epidural catheter was placed and then general anaesthesia was administered to all patients. Post operatively 10 ml solution made, containing 0.1% Levobupivacaine + 50mg Tramadol given in group LT and 0.1%Ropivacaine+ 10mg Nalbuphine given in group RN epidurally. Analgesic efficacy was evaluated using Visual Analogue Scale (VAS) at intervals of 15 min, 30 min, 1hr, 6hr, 12hr and 24 hr postoperatively. Results: In group LT Visual Analogue Scale scores (VAS) were significantly higher after 6hrs than group RN. Also incidence of nausea and vomiting was less in group RN than in groups LT. Conclusion: Epidurally administered Ropivacaine with Nalbuphine is more effective as compared to Levobupivacaine with Tramadol for managing postoperative pain in major abdominal oncosurgical procedures.

32. Evaluate the Progress of Labour in Primigravida using WHO Simplified Partogram
Deepica Tirkey, Archana Singh
Abstract
Objective: To prospectively evaluate the progress of labour in primigravida and study the labour characteristics using WHO simplified partogram in terms of augmentation requirement, duration of labour, mode of delivery and neonatal outcome. Methods: Partogram used in our study was WHO Simplified Partogram which included cervicograph, maternal and fetal parameters. The simplified partograph is colour coded. The area to the left of alert line in cervicograph is colored green, representing normal progress. The area to the right of action line is colored red, indicating dangerously slow progress in labour. The area in between the alert and action line is crossed amber, indicating the need for greater vigilance. Results: In our study most of the patients were found left to alert line 258 (86.00%), 38 patients (12.67%) were found in between alert and action line and 4 patients (1.33%) were found right to action line. In between alert and action line there were 21 normal delivered and 17 were taken for lscs.A significant difference was found on comparing group 1 and group 2 between duration of first, second stage and total duration of labour, lscs rate and nicu admission rate. Conclusion: In our setting, the partograph serves a simple and inexpensive tool to monitor labour in a cost-effective way. So the early recognition of any deviation from “normal” progression of labour will help to prevent or reduce undesirous maternal and fetal outcome, which brings in the importance of partogram.

33. Comparative Assessment of the Efficacy and Safety of Olopatadine 0.1% Ophthalmic Solution and Bepotastine 1.5% Ophthalmic Solution in Patients with Vernal Keratoconjunctivitis
Krishna Kant Nirala, Rohit Kumar Singh
Abstract
Aim: The purpose of the present study was intended to compare the effectiveness and safety of olopatadine 0.1% ophthalmic drops and bepotastinebesilate 1.5% ophthalmic drops with BD administration to relieve the symptoms of VKC in a tertiary care hospital in Bihar region. Methods: The study was done in the Department of Pharmacology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for duration of 12 months. Institutional ethics committee approved the study. By simple randomization (odd/even number) method, registered patients were grouped into A and B. Group A and Group B were given olopatadine 0.1% ophthalmic drops and bepotastinebesilate 1.5% ophthalmic drops, respectively, administered one drop in the affected eye twice daily for 6 weeks. Results: The itching scores among the treatment groups with all follow-ups compared with baseline are not statistically significant. The mean ocular discomfort scores during each visit. At the 1st, 2nd, and 3rd follow-up, there is statistical significance in ocular discomfort scores with Group B.The mean watering scores during each visit. In Group B, during the 2nd, 3rd, and 4th follow-ups, there is statistical significance in watering scores (P < 0.05). Conclusion: In this study, based on the evaluation of therapeutic performance, bepotastine eye drops proved quicker relief of symptoms and signs compared to olopatadine eye drops but was not statistically significant which would prove beneficial for the patients.

34. Association of Cell Phone Dependence with Cognitive Impairment in Persons with Bipolar Disorder
Kalpesh Suryavanshi, Lokesh S Shekhawat, Arvind Kumar, Kapil Singh, Ajay Kumar
Abstract
Background: Bipolar disorder is a mood disorder, also known as manic-depressive disorder. Manic episodes are characterized by an abnormally persistent elevated, expansive or irritable mood with abnormally increased goal-directed activity. Depressive episodes present with depressed mood, anhedonia, easy fatiguability, and suicidal ideation. commonly affected cognitive functions include attention, processing speed, set-shifting, executive function, and verbal memory performance. These cognitive impairments persist in bipolar disorder even after the remission of mood symptoms. Material and Methods:  the design of the study was a cross-sectional observational study. 92 subjects with bipolar disorder seeking treatment from the department of psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital were recruited, Young Mania rating scale and Hamilton depression scale were applied and YMRS 6 or less, HAM-D 7 or less was recruited. The Cell phone dependence scale was applied to assess the severity of dependence. Trail making test, Stroop test, verbal memory n back test, and Global assessment of functioning scale were applied to see the association of cell phone dependence with cognitive impairment a in person with bipolar disorder. Results: Significant correlation was observed between severe cell phone dependence and trail making test, Stroop color and word test, verbal memory n back test, and global assessment of functioning in persons with bipolar disorder. Conclusion: The study findings suggest an association between cell phone dependence and cognitive impairment in a person with bipolar disorder.

35. A Prospective Assessment of the Role of Diffusion-Weighted MRI in the Evaluation of Perianal Fistulae
Nain Kumar Ram, Uday Kumar, Sushant Agarwal
Abstract
Aim: The present study was conducted to evaluate the role of diffusion-weighted MRI in the evaluation of perianal fistulae. Methods: This prospective study was conducted in the Department of Radiology, IGIMS, Patna, Bihar, India and included 40 patients with a total of 50 cryptogenic perianal fistulas and abscesses. These patients presented to the surgery clinic during the time period of one year. These patients were then referred for MRI evaluation if a perianal fistula was suspected. Results: The study included 40 patients, 33 were males and 7 were females. Mean age was 36 ± 8.8 years old with a range of 24–60 years of age. The total number of cryptogenic perianal fistulas and abscess was 50. These included 40 fistulas and 10 abscesses. Eight patients had more than 1 fistula or fistula and abscess. The sites of these fistulas/abscesses were inter-sphincteric (n = 30, 60 %), trans-sphincteric (n = 10, 20 %), and extra-sphincteric (n = 10, 20 %). Conclusion: DWI alone is not superior to the T2W regarding the visibility of perianal fistula in our study. However, the best performance was observed for combined DWI-T2W image evaluation, although it was not statistically significant than DWI or T2W alone.

36. Evaluation of Forced Vital Capacity (Fvc) and Slow Vital Capacity (Svc) in Suspected Patients of Obstructive Airway Disease Visiting Tertiary Care Hospital In Southern Bihar
Patel Devangiben Dilipbhai, Tausif Anwar, Abhilasha Singh, Abhishek Kamendu
Abstract
Background: Forced expiratory volume in 1 second (FEV1) to forced vital capacity ratio (FVC) is being used to diagnose the obstructive lung diseases. Forced manoeuvre (FVC) or relaxed/slow manoeuvre (SVC) can be used to determine vital capacity (VC). In healthy individuals the difference between SVC and FVC (SVC-FVC) is minimal whereas in the presence of airway obstruction this difference will become significant. The present study was done with the objective to detect and compare the airway obstruction by determining the FEV1/FVC and FEV1/ SVC ratios. Methods: This was a prospective cross-sectional study done at Narayan medical college and hospital Sasaram Bihar during the period from January 2022 to June 2022 among the patients presenting with symptoms of obstructive airway disease. The sample comprised of 350 patients who underwent spirometry according to standard of ATS/ERS guidelines. As per the criteria, the patients are classified into four groups, by spirometry. Results: The analysis of FEV1/FVC revealed the presence of airway obstruction in 130 (37%) individuals compared to 165 (46%) individuals by the analysis of Fev1/SVC ratio. In the obstruction and mixed groups, the difference in vital capacity SVC – FVC is statistically superior (p<0.05) when compared to normal and restriction groups. Conclusions: The FEV1/SVC ratio detected the presence of airway obstruction in more individuals than did FEV1/FVC ratio and hence FEV1/SVC considered as more reliable factor in the detection of obstructive airway diseases.

37. Distal Tibia Fractures Managed with Locking Compression Plate Osteosynthesis: A Prospective Study of 28 Patients
Raj Kumar, Praveen, Lal Bahadur Manjhi
Abstract
Background: Distal tibia fractures are complex injuries having high complication rate. The conventional implants are unsuitable for managing such fractures successfully. The aim of this study was to evaluate clinical, functional and radiological outcomes after open reduction and internal fixation using distal tibial locking compression plate (LCP). Materials and Methods: A total of 28 patients with distal tibia fracture were treated by using distal tibia LCP. All the patients were followed up for a minimum of 12 months in orthopaedic department, R.I.M.S. Ranchi. Functional and radiological results were evaluated at the end of study. Results: There were 19 males and 9 females with mean age of 37.7 years. Majority of fractures were extra-articular (60.71%), while 32.14% were partial articular fractures and 7.14% were complete articular fractures. Out of 28 patients, 20 patients had closed fracture and 8 had open fracture. The mean fracture healing time was 22 weeks (range 16-36 weeks). Postoperatively, 5 patients developed superficial skin infection, 3 developed deep infection and 4 developed ankle stiffness, 6 had hardware problem like irritation in skin, 4 patients had delayed union and 2 patients had non-union. Functional outcome according to the Olerud and Molander score showed that 14 (50%) patients had an excellent outcome while 9 (32.14%) had good outcome and 5 (17.86%) patients had a fair outcome. Conclusions: Locking plate for distal tibia fractures is an excellent option for managing such fractures and gives consistent and reproducible clinical results.

38. A Retrospective Assessment of the Seroprevalence and Changing Trend of Dengue in a Tertiary Care Hospital
Sujeet Kumar, Priti Ranjana
Abstract
Aim: The present study was undertaken to find out the seroprevalence of dengue in a tertiary care hospital in Bihar region over the past 2 years and to analyze the changing trends of this infection – essential for planning necessary control and preventive measures in the forthcoming years. Methods: The retrospective hospital-based study conducted in the Department of Medicine, Vims, Pawapuri, Nalanda, Bihar, India over 2 years. All suspected case of dengue fever, which were either admitted or had visited OPD of Department of Medicine, Vims, Pawapuri, Nalanda, Bihar, India.  A total of 1500 cases, with a clinical suspicion of dengue infection, 400 cases (26.66%) were found to be positive for either current or past Dengue infection. Results: 1500 samples were tested in 2018 and 300 (350%) samples were seropositive for dengue; number of dengue cases detected by NS1 ELISA was 100 (16.66%) and by IgM ELISA were 200 (33.34%). 230 (46%) samples out of the 500 tested in 2019 were seropositive for dengue; 120 (24%) cases were detected as positive by NS1 ELISA and 200 (40%) by IgM ELISA. Of the 400 samples tested during 2020, 170 (42.5%) turned out to be positive for dengue; NS1 ELISA detected 80 (20%) and IgM ELISA detected 150 (37.5%). Conclusion: Dengue is an emerging public health problem in India. High degree of suspicion, screening for Dengue in suspect cases and preventive measures during monsoon and water stagnation periods may help us in the fight against spread of dengue infection.

39. Prospective Observational Assessment of the Factors Associated with Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy
Hemant kumar Das, Amit Anand
Abstract
Aim: To determine factors of conversion of laparoscopic to open cholecystectomy in tertiary care center. Material & Methods: This is a prospective observational study conducted on 120 admitted patients in Department of Surgery, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, over a period of one year. All patients exhibited symptomatic gallbladder disease and scheduled for laparoscopic cholecystectomy. Results: Out of 120 participants, 66 were males and 54 were females. Max no. of patients (N=82) between 30 to 60 years. A total of 11 conversions were obtained. Gender wise distribution showed increased incidence of conversion in male 62% patients compare to female 38% patients. Patients having age group of 30-60 years had more conversion rate 74%. the most common reason for conversion was intraoperative adhesions which was found in 9 patients. CBD injury and bleeding from cystic artery was found in 2 patients each. Conclusion: Laparoscopic cholecystectomy is a safe and minimally invasive technique, with only low conversion rate and the commonest cause of conversion in this study was the presence of dense adhesions at Calot’s triangle.

40. To Determine the Most Common Causes of Acute Abdominal Condition in Pregnancy: An Observational Study
Sanghmitra Kumari, Seema Singh, Lalan kumar, Prem Sagar Chaudhary
Abstract
Aim: The aim of the present study is to determine the common causes of acute abdominal condition in pregnancy. Methods: The study included 100 pregnant female in different trimesters whose presented to the department of Obstetrics and Gynecology, BMIMS, Pawapuri, Nalanda, Bihar, India with acute abdominal pain of obstetric and non-obstetric causes which included 50 obstetric cases and 50 non-obstetric cases. Results: In the age group (21-30 years); ectopic pregnancy was present in about 13 patients (13%) followed by abruption placenta which was seen in about 5 patient (5%). In  the age group (31-40 years) ectopic pregnancy was revealed in about 15 patient (15%), followed by acute appendicitis (10%). While the age group (41-50 years) revealed that the most common cause was  ectopic pregnancy which revealed about 7 patient (7%), followed by abruption placentae and acute appendicitis with 5 patients each .This study also showed that ectopic pregnancy was the most common cause of acute abdomen in all trimesters which was present in about 35 patients (35%). Conclusion: The most common cause of acute abdomen in pregnancy is ectopic pregnancy followed by acute appendicitis.

41. Comparative assessment of two techniques in terms of analgesia and sensory blockade in patients treated for modified radical mastectomy (MRM)
Rabindra Kumar, Hari Damodar Singh
Abstract
Aim: We aimed to compare the techniques in terms of analgesia and sensory blockade in patients undergoing modified radical mastectomy (MRM). Methods: The present study was conducted in the department of anesthesia DMCH Laheriasarai Darbhanga, Bihar, India for 1 year The study adheres to CONSORT guidelines. 100 American Society of Anesthesiologists (ASA) I/II patients between the age group 20 and 60 years, who were scheduled to undergo unilateral MRM under general anaesthesia, were screened. Out of these, 50 patients were allocated in one of the two groups. Results: Morphine consumption within 24 h postoperative period in group I was 6.50 ±1.30 mg and in group II was 8.65 ±0.75mg. The difference was highly significant between the two groups (P < 0.001). The intraoperative fentanyl consumption (μg/kg) was more in group II (1.56 ±0.480), compared to the other group: 1.5 ±0.570. Conclusion: Injection of drugs deep to erector spinae muscle provides more cranio-caudal blockade of posterior and lateral chest wall than superficial group.

42. Randomized Clinical Assessment of Synbiotic or Zinc Supplementation in the Treatment of Children with Bacterial Pneumonia
Md Khalil Ahmad, Krishna Murari, Rajeev Ranjan
Abstract
Aim: The aim of this study was to evaluate the interventional effects of synbiotic and zinc sulphate on reducing clinical symptoms and the average duration of treatment in children with bacterial pneumonia. Methods: The randomized clinical trial with a parallel-group in which infants and children with emergency or elective hospitalization in Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India were diagnosed with pneumonia. A total of 200 people were randomly assigned to the two study groups. Results: The mean ± SE age in the zinc group was 22 ± 2.4 months compared to 17 ± 2.6 months in the placebo group (p = 0.08). The children in the placebo group had a lower weight and height compared to the zinc group (9.6 ± 0.5 vs. 11.19 ± 0.7, p = 0.01, and 70.5 ± 2.2 vs. 80.4 ± 2.4, p = 0.04, respectively), and there were more males in the placebo group compared to the zinc group (65 vs. 40%, p = 0.04, respectively). The baseline clinical symptoms were comparable (according to the WHO pneumonia classification)—pneumonia (65 vs. 60%), severe pneumonia (30 vs. 35%, p = 0.93), oxygen saturation (84 ± 0.6 vs. 84 ± 0.8, p = 0.36), and respiratory rate (mean ± SE, 45 ± 1.5   vs. 46 ± 1.4, p = 0.55)—between the zinc and the placebo group, respectively. The predominant radiographic pattern was interstitial (84 vs. 70%), followed by alveolar (8 vs. 15%) and mixed (2 vs. 10%) (p = 0.25), in the zinc and the placebo group. Also comparable was the percentage of children with rales, fever, cough, respiratory distress, rhinorrhea, vomit, nasal flare, and costal retraction by group. Conclusion: The results of this study could not show any clinical benefit for prescribing zinc or synbiotics in combination with standard antibiotic therapy in the treatment of children and infants, and they could not reduce the side effects of this treatment.

43. A Hospital Based Assessment of the Prescription Pattern of Antiepileptic Drugs: An Observational Study
Krishna Kant Nirala, Rohit Kumar Singh
Abstract
Aim: The objective was to evaluate the prescription pattern of Antiepileptic drugs in Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India and to evaluate how rational is the prescription for various epilepsies. Methods: The present study was conducted in the Department of Pharmacology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. Adult outpatients who have been diagnosed to have epilepsy were identified and prescribing pattern was studied. Totally 120 prescriptions were collected randomly over a period of 9 months. Patients demographic details, clinical diagnosis, type of epilepsy, type of AED used, drug dose and frequency were recorded. Average number of drugs per prescriptions was calculated. Prescription of all patients was entered in a preformed proforma and was analyzed using descriptive statistics. Results: In the present study, out of 120 patients 70 patients were male and 50 patients were females. Epilepsy was more commonly seen in the patients of age group of 20-40 years.The analysis of the type of seizure showed that the most common type was partial seizures (60%) and the least common type was absence seizures (3.34%). Conclusion: Older antiepileptic agents like carbamazepine, valproate, phenytoin are still the most commonly agents as monotherapy whereas newer ones like levetiracetam are mostly used as add on drug in cases of treatment failure with older drugs. Antiepileptic prescribing in this study population is in accordance to the standard treatment guidelines for epilepsy.

44. Prospective Observational Assessment of Alvarado Score in Diagnosis of Acute Appendicitis
Amit Anand, Hemant kumar Das
Abstract
Background: Acute appendicitis is a common cause of abdominal pain for which a prompt diagnosis is rewarded by a decrease in morbidity and mortality. Delay in the diagnosis will lead to an increased morbidity and mortality rate, on another hand overzealous diagnosis may lead to increased negative appendectomy rates. Notwithstanding advances in modern radiographic imaging and diagnostic laboratory investigations, the diagnosis of appendicitis remains essentially clinical. Material & Methods: A prospective observational study was planned in which a total of 120 operated cases of appendicectomy were studied in the Department of Surgery, Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, over a period of one year. All patients who underwent an appendectomy at the hospital were identified. Results: 47 out of 100 patients had scored an Alvarado score of less than 7, suggesting a clinically very low probability of having acute appendicitis. In spite of scoring less than 7, 34 patients had been diagnosed with acute appendicitis on histopathological examination, 6 patients had been diagnosed with acute perforated appendicitis while only 21 patients had sub acute appendicitis. Conclusion: In this study, we concluded that the Alvarado score has a very high positive predictive value i.e.; diagnostic accuracy. Also with the help of the Alvarado score, we can reduce the number of negative appendicectomies.

45. Comparative Assessment of Two Different Methods of Management of Ruptured Ectopic Pregnancy
Sanghmitra Kumari, Seema Singh, Manoj Kumar Shaw, Prem Sagar Chaudhary
Abstract
Aim: The purpose of this study is to know the description and comparison of a few variables towards laparotomy and laparoscopy surgery for the management of ruptured ectopic pregnancy. Methods: The present study was conducted in the Department of Obstetrics and Gynecology, BMIMS, Pawapuri, Nalanda, Bihar, India, for the period of 1 year. Medical records of all the patients who underwent surgery for ectopic pregnancy at the study center were reviewed. During this period 100 cases of histopathology confirmed ectopic pregnancy were surgically managed. Results: It was observed that the demographic variables (mean age group) were well matched in both the groups. The most common age group of presentation in our study was 18-25 years. Very few patients were in the age group > 31 years. Age differences in the two groups were not significant. Conclusion: From this study, we conclude that laparotomy is still the preferred method of surgery for managing ruptured ectopic pregnancy. This might be caused by a lack of equipment or operator skills in managing ruptured ectopic pregnancy with laparoscopy.

46. To Analyze Predictors of Poor Outcome in Septic Shock: A Hospital Based Cross Sectional Study
Md Khalil Ahmad, Rajeev Ranjan, Krishna Murari
Abstract
Background: Skin diseases are the major contributors of disease burden in society. It affects individuals of all ages, neonates to elderly. Owing to its chronic nature, it causes serious impact on quality of life and financial status of the sufferer and his family. This study aims to determine the drug utilization pattern and assess the economic burden of the patient with skin disease. Methods: This prospective, cross-sectional, observational study was conducted in Dermatology outpatient department of Maharana Bhopal Hospital Udaipur, a tertiary care teaching hospital in southern Rajasthan. The study was conducted over a period of 11 months (May2020 – March2021) in Dermatology outpatient department, MB Hospital, Udaipur, a tertiary care teaching health center in southern Rajasthan. All the Patients (Male & Female) who were visiting the outdoor unit of Dermatology department were included. Sample size of 400 prescriptions was taken into consideration. Result: Antihistaminic drugs were maximally utilised drugs in our study followed by antifungal drugs. Among antihistaminics, Tab. Levocetrizine was maximally utilised drug while vitamin E, Terbinafine, Cotrimoxazole and calcium+vitaminD3 were the minimum utilized drugs. The costliest drug prescribed was Cap.Itraconazole while minimum costliest drug was Tab. Methotrexate. Average cost per encounter was Rs. 64.27/-. 100% of drugs were prescribed with generic name, which was similar to WHO standard (100%). 86.96% of drugs were prescribed from essential drug list (EDL), which was according to WHO standard (80-100%). Conclusion: We concluded that maximum patients who attended dermatology OPD were of fungal infections followed by dermatitis. Maximum number of patients received three drugs per prescription for various dermatological disorders which was within the WHO standard (2-3).

47. A Prospective Assessment of the Analgesic Efficacy of Intrathecal 1% 2-Chloroprocaine with or Without Fentanyl in Elective Caesarean Section: A Comparative Study
Rabindra Kumar, Hari Damodar Singh
Abstract
Aim: The present study aimed to compare the analgesic efficacy and safety of intrathecal fentanyl (25 μg) as an adjuvant to low dose 1% 2-CP (30 mg) in parturient undergoing caesarean section. Methods: The prospective comparative study was conducted in the Department of Anaesthesia, DMCH Laheriasarai Darbhanga, Bihar, India.The clinical research was done following the ethical principles for medical research involving human subjects in accordance with the Helsinki. Declaration 2013. 100 parturients with term pregnancy (≥36 weeks), belonging to the American Society of Anesthesiologists (ASA) physical status II, aged between 18 and 35 years, scheduled to undergo low-risk elective caesarean section under SAB for one year were enrolled in the study. Results: There were no significant differences in demographic characteristics, haemodynamic parameters, onset of sensory block, onset of motor block and duration of motor block between the groups. The duration of sensory block and duration of analgesia was statistically prolonged in group B than group A (P value < 0.0001). Conclusion: Our study concluded that intrathecal preservative-free 1% 2-chloroprocaine (30 mg) with fentanyl (25 μg) as an adjuvant result in a prolonged duration of sensory blockade and postoperative analgesia, with similar duration of motor blockade and incidence of complications when compared to preservative-free 1% 2-chloroprocaine (30 mg) without an adjuvant, in patients undergoing elective lower segment caesarean section.

48. Randomized Double-Blind Comparative Assessment of Analgesic Efficacy of Intrathecal 1% 2-Chloroprocaine with or Without Fentanyl in Elective Caesarean Section
Niranjan Kumar, Nagina Choudhary, Venu Gopal
Abstract
Aim: To investigate the effect of intrathecal fentanyl as an adjuvant to 1% 2-chloroprocaine (2-CP) in parturients undergoing elective lower segment caesarean section (LSCS). Material & Methods: This prospective, double-blind, randomized, comparative study was conducted in Department of Anesthesiology, Jan Nayak Karpoori  Medical College and Hospital, Madhepura, Bihar, India for 1 year. 120 parturients with term pregnancy (≥36 weeks) aged between 18 and 35 years, scheduled to undergo low-risk elective caesarean section under SAB, over a period of one year were enrolled in the study. Results: The difference in HR, BP and SpO2 was not statistically significant in both the groups throughout the perioperative period. The mean duration of sensory block was prolonged in group CF in comparison to group CS, with the difference being statistically significant (101.2±14.50 min versus 72.24±10.63 min, P < 0.0001). There was no statistical difference in the Apgar score of newborns in both the groups. Conclusion: The addition of fentanyl to 1% 2-chloroprocaine intrathecally prolonged the duration of sensory block and postoperative analgesia in patients undergoing LSCS.

49. Evaluation of the Effects of Torsemideon Quality of Life in Patients of CHF
Sanjeevani M. Chawre, Shraddha M. Pore
Abstract
Aim: The present study to evaluate the efficacy and tolerability of 8 weeks of torsemide therapy in patients with New York Heart Association (NYHA) Class II (slight limitation of activity; comfortable at rest or with mild exertion) to Class III (marked limitation of activity; comfortable only at rest) CHF whose condition had been stabilized with digitalis or ACE inhibitor treatment. Methods: Men and women aged 30 to 70 years with NYHA Class II to III CHF stabilized with digitalis or ACE inhibitors were eligible to enter the study. Results: A total of 120 patients (70 men and 50 women> with a mean age of 61.8* 8.6 years (range, 30 to 70 years) were enrolled in 10 centers. Of these patients, 20 were excluded from the efficacy analysis, 17 having violated protocol (use of prohibited concomitant treatments, poor compliance, NYHA Class IV [any physical activity brings on discomfort, and symptoms also occur at rest; confined to bed or chair]) and 3 having dropped out before the a-month treatment period ended (lost to follow-up [ll, adverse events. Conclusion: The present study demonstrates that torsemide is well tolerated, effective in treating moderate CHF, and useful when administered with digoxin or ACE inhibitors to reduce the signs and symptoms of CHF.

50. ICH Score as a Predictor of Mortality in Patients Presented with Intracerebral Haemorrhage in Tertiary Care Hospital
Dharak Modi, Anisha Anshu, Mehul Gajjar, Rajvi Dave, Bhavesh Jarwani, Ayush Srivastahava
Abstract
Background: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all stroke patients. It is a simple tool for outcome prediction (mortality rate) for intracerebral haemorrhage patients. This score is of prognostic significance in non-traumatic bleed and calculated in non-traumatic bleed. It consists of 5 characteristics including age>80 years, Glasgow coma scale, infratentorial location, ICH volume and presence of IVH. The study aimed to validate the prediction of mortality in intracerebral haemorrhage patients in tertiary care hospitals. Methodology: A retrospective observational study of 150 patients admitted with intracerebral haemorrhage in tertiary care hospital from August 2020 to July 2021. Descriptive analysis was done. Statistics were analyzed using SPSS version 15.0. Result: The volume of bleed was calculated in 150 patients by the ABC/2 method.  125 patients presented with a volume of bleed less than 30 cc. 25 patients presented with a volume of bleed more than 30 cc and out of which 10 patients (40%) were expired. Conclusion: ICH score is a simple grading scale. Each increase in the ICH score is associated with a progressive increase in mortality. In this study, no patient with scores 0 died, whereas all patients with scores 5 and 6 died. This study findings showed that increase in the ICH score is associated with a progressive increase in mortality.

51. Evaluation of Drug Utilization of Antiretroviral Therapy among HIV Patients in a Tertiary Care Hospital
Alak Kumar Das, Shreyoshree Mandal, Manab Nandy, Jinia Ghosh
Abstract
Introduction: Development of acquired immunodeficiency syndrome (AIDS) following infection with human immunodeficiency virus (HIV) continues to be a major global public health concern. Guidelines and protocols have been evolved over a period of time. Drug utilization studies help to evaluate changing pattern of drug usage, adherence with treatment guidelines and rational use of medicines. We aimed to evaluate the drug use indicators and utilization of anti-retroviral drugs among adult HIV patients. Materials and Methods: An observational, descriptive study was carried out on adult HIV patients visiting at Out Patient Department (OPD) of anti-retroviral therapy (ART) center of Medical College, Kolkata over a period of four months. The detailed data from case file was collected and recorded in a pre-designed proforma. Simple descriptive statistics was used to evaluate drug use indicators and utilization pattern of anti-retroviral drugs. Results: A total of 548 encounters were obtained from 122 patients. Majority of them were male (53.28%), belonged to the age group of 18 to 30 years, education below primary level (62.55%), married (72.06%),  non-smokers (70.49%) and did not drink alcohol (51.25%). Heterosexuality was the most common mode of acquiring the infection (90.16%). Efavirenz was most commonly prescribed (6.57%) single drug ART regimen whereas the commonest combined ART regimen was combination of zidovudine+lamivudine+nevirapine (37.6%). Lamivudine was the most commonly prescribed nucleoside reverse transcriptase inhibitor (NRTI) [87.22%]. Among the concomitant medicines prescribed, anti-tubercular drugs were the most frequent (14.23%). The commonest adverse drug reaction was anemia (5.7%). Folliculitis was the most common opportunistic infection (11.47%) followed by tuberculosis (9.84%). Average number of drugs per encounter was 3.08. Drugs were prescribed mostly in generic name (99.65%) and in oral forms (97%). Conclusion: The results of our study suggested that the prescribing pattern was in accordance with national guidelines and reflected the changing patterns of drug usage in HIV patients. Drug use indicators reflected rational approach towards prescribing pattern.

52. In-Vitro Bioequivalence Studies of Commercialized Vildagliptin Tablets in India
Revathi S, Hariprasath L, Mohana Priyan M, Muthu Bala Sanjay N, Seenivasan S, Soundarraja D, Yadesh J.K.
Abstract
The objective of this work is to evaluate the in-vitro behavior of marketed vildagliptin tablets. Six marketed Vildagliptin tablets and the innovator were evaluated. Physicochemical parameters such as percentage weight deviation, hardness, friability, drug content, disintegration, dissolution, similarity factor and difference factors were analyzed as per IP.  Dissolution profiles were evaluated using USP apparatus type 2 at 50 rpm and 900 ml of phosphate buffer in pH 6.8.  All the marketed products under study were bioequivalent to the innovator.  B-2 & B4 showed least similarity values and highest difference factor values but lies within the acceptable range.  B-6 showed the highest similarity value and least difference factor value with that of the innovator product. The results indicate that at pH 6.8 all marketed vildagliptin tablets included in this study seem to have good overall quality with good dissolution rate when compared to that of innovator product.

53. Examination Stress and its Correlation with Cardiovascular Parameters and Lipid Profile
Shafali Singh, Soumitra Chakravarty, Rajajeyakumar Manivel
Abstract
Introduction and Aim: Examination stress can be among the numerous factors that may bring about cardiovascular and lipoprotein changes in Indian subjects. The study was planned to examine the cardiovascular and lipid profile changes among first-year medical students undergoing their academic examinations. Materials and Methods: Blood pressure, pulse and lipid profile were assessed among 60 students, two months prior to final examinations and on the day of examination. Results: The systolic blood pressure, diastolic blood pressure & pulse rate, during exam period versus non-exam period showed statistically significant increase and positive correlation; except diastolic blood pressure where though the correlation was positive but it was not statistically significant. Total Cholesterol and LDL values during exam period versus non-exam period were raised significantly, whereas HDL values showed a significant decrease; triglycerides values increased during examination, but it was not statistically significant. There was significant positive correlation among (total Cholesterol, HDL, and LDL) during non-exam and exam period; except Triglycerides values, where though the correlation was positive, it was not significant. Conclusion: These findings suggest that during the examination period, the stress the students undergo leads to significant changes in cardiovascular and lipid parameters. In the long run these effects can accumulate with subsequent examinations and it can predispose the students to cardiovascular and metabolic diseases.

54. Diagnostic Method and Correlation of Fine Needle Aspiration Cytology (FNAC), Ultrasonography (USG), and Thyroid Nodule Histopathology
Parul Joshi, Neha Ahuja, Amrita Sinha
Abstract
Background: The thyroid gland is unique amongst endocrine organs because it is the largest endocrine gland in the body and the first to develop in fetal life. Objectives: To evaluate the correlation of Ultrasonogram (USG), Fine Needle Aspiration cytology (FNAC) with Histopathology in the diagnosis of thyroid nodules and to find the diagnostic criteria of USG and FNAC in detecting the thyroid nodules. Methods: It is a prospective study carried out on 70 cases of thyroid nodules attending the Department of Surgery and Pathology for Specimen during the period of May 2021 to May 2022. All patients were examined clinically after taking detailed history and status of thyroid function test (TFT), they were investigated with USG and FNAC of the thyroid nodule. SPSS (Version 22.0) was used for analysis. Results: Eighty-nine percent of the 70 patients were female, compared to 11% of male patients. Out of 71 patients, FNAC found that 21 patients (30%) had follicular hyperplasia, 33 patients (46%), had follicular neoplasia, 11 patients (15%) had papillary carcinoma, and 6 patients (8%), had thyroiditis. Ten of the eleven malignant FNAC interpretations were identified as Papillary carcinoma by HPE, with one instance showing up as a hypertrophic nodule. FNAC’s sensitivity and specificity (98%, 71.6%, respectively) are higher than USG’s (85%, 62.8%). Conclusion: When assessing and identifying thyroid gland masses or suspected tumours, USG and FNAC are useful techniques. Instead of using a single diagnostic modality, a combination of different diagnostic modalities will produce the best findings and help many patients avoid unnecessary surgery without overlooking any malignancies.

55. Comparison of Efficacy between Baska Mask and I-GEL (Supraglottic Airway Devices) in Patients Undergoing Elective Surgery
Abhisek Kumar, Rohit Kumar, Raja Avinash
Abstract
Background: Two fresh varieties of second-generation supraglottic airway devices are the Baska mask and i-gel. The purpose of this study was to examine the insertion, ventilation, and post-insertion problems of these two devices. Methods: Eighty adult patients scheduled for elective surgery under general anaesthesia were divided into two groups at random: Group IG: i-gel (n = 40) and Group BM: Baska mask (n = 40). Oropharyngeal leak pressure, tidal volume, peak airway pressure (PAP), post-insertion problems, ease of insertion, number of attempts, insertion time, number of corrective manoeuvres, and ease of insertion were all evaluated. Results: In comparison to Group BM, Group IG demonstrated significantly shorter median insertion times (13.3 [interquartile range, IQR 7.8] vs. 17.0 [IQR 9.6] s; a higher percentage in the “very easy” ease of insertion category (62.5% vs. 10.0%; P <0.001; a higher percentage in the no corrective manoeuvre category (92.5% vs. 72.5%; P = 0.003); and a higher When compared to Group IG, Group BM generated PAP that was considerably greater (12.7 [1.8] and 11.5 [2.2] cm H2O, respectively; P = 0.010). Other parameters showed no appreciable variations. Conclusions: The i-gel performed faster, easier, required fewer correction manoeuvres, and caused less throat pain after surgery than the Baska mask. However, a higher produced PAP indicated that the Baska mask had a superior cuff seal.

56. Study of Histopathological Pattern of Endometrial Lesion in Abnormal Uterine Bleeding
Nivedita Singh, O. P. Dwivedi
Abstract
Background: One of the most frequent presenting symptoms in the gynaecology out-patient department is abnormal uterine bleeding (AUB). When there is aberrant uterine bleeding without a known reason, it is referred to as dysfunctional uterine haemorrhage. For the patient with abnormal uterine bleeding to be managed effectively, an assessment of the endometrium’s histological pattern is necessary. Endometrial biopsy may be utilised successfully as the initial step in DUB diagnosis. Methods: In order to determine the endometrial aetiology of DUB, this study examined the endometrium’s histology. This prospective study is being conducted by the pathology department. This study used 150 cases of endometrial scrapings and hysterectomy specimens that were received at the pathology lab of the Nalanda Medical College and Hospital in Patna, Bihar. The trial lasted a full year, from March 2020 to February 2021. For the final analysis, 150 endometrial lesions with histopathological diagnoses were chosen. Results: The age range of 40 to 49 years represented the majority of DUB cases (49.3%). Proliferative endometrium (29.3%), secretory endometrium (14%) and simple cystic hyperplasia (9.3%) were the most prevalent patterns in these patients. Endometrial polyp, complex hyperplasia without atypia, endometrial cancer, pill endometrium, complicated hyperplasia with atypia, endometritis, atrophic endometrium, and adenomatous hyperplasia were some of the other patterns found. Age pattern and endometrial causes of DUB were statistically significant with a P value <0.05. In order to rule out cancer, a thorough histopathological examination of the endometrium should be performed on women who report with abnormal uterine bleeding, especially after the age of 40. Conclusion: In situations of dysfunctional uterine haemorrhage, it is helpful for diagnosis, to evaluate therapeutic response, and to understand the pathological incidence of organic lesions before surgery.

57. An In-Vitro Study to Compare the Shear Bond Strength of Orthodontic Metal Brackets on Bleached Enamel with and without Antioxidant Treatment
Pramod Kumar, Namrata Rastogi, Pragati Navit, Sulabh Grover, Devendra Singh
Abstract
Background: Vital tooth bleaching is a safe and well accepted procedure for the treatment of surface and intrinsic staining of teeth. At times, bleaching alone may not be sufficient to achieve required esthetics, need for other procedures such as composite veneers, laminates, etc. may be required. The purpose of this in vitro study was an attempt to regain the lost bond strength, for which, the comparison of shear bond strength of composite resin to bleached enamel was carried out using various antioxidants: 10% sodium ascorbate, rosemary extracts, pedicularis extracts. Material and Methods: The present study was conducted in the Department of Orthodontics, Chandra Dental College & Hospital Safedabad, Barabanki, Uttar Pradesh from 2017 to 2020 to compare the shear bond strength of orthodontic metal brackets on bleached enamel with and without antioxidant treatment. Results: 100 recently extracted maxillary first premolars were divided into four groups each having 25 premolar teeth. First group was considered to be the control group and the remaining 75 teeth were bleached and considered as experimental group. Antioxidant (10% sodium ascorbate solution was applied on 25 teeth after bleaching and 25 were stored in artificial saliva for 7 days after bleaching. All the teeth were etched and bonded and then stored in deionised water at room temperature. All the 100 samples were tested for shear bond strength with the help of Instron Universal testing machine. The breaking load at which the bond failure occurred was recorded in kilograms and the bond strength was derived from it using the formula as mentioned previously. Descriptive statistics such as mean, standard deviation and range were determined. The obtained results were then subjected to statistical analysis with one way analysis of variance (ANOVA), Post hoc Tukey HSD test, Mann Whitney test, Kruskal Wallis test, Statistical 2 Sigma technique using SPSS 21 version for windows. Conclusion: The present study concluded that the brackets bonded to recently bleached teeth have an increased chance of Bond failure. Exposed to an antioxidant prior to bonding does improve the bond strength, although further studies are needed involving the use of antioxidants. In cases where antioxidants are not applied, bonding procedure should be delayed for a week post bleaching.

58. Comparative Study of Intrathecal Isobaric and Hyperbaric Ropivacaine in Elective Caesarean Section
Rohit Kumar, Abhisek Kumar, Vishal Vaibhaw
Abstract
Background: For patients undergoing lower abdomen surgery, spinal anaesthesia is a common, safe, affordable, simple-to-use, and successful approach that provides quick and dependable anaesthesia with muscle relaxation. Aim: To evaluate the effects of isobaric versus hyperbaric ropivacaine in patients having caesarean section. Methods: Patients admitted for elective caesarean deliveries participated in this prospective observational clinical study. The study period lasts for a full calendar year, from September 2021 to August 2022. 80 patients in total, ages 21 to 30, ASA physical status 1 and 2, were scheduled for elective Caesarean birth under spinal anaesthesia. Two groups of 40 patients each are created from these patients. Patients in Group H received 2 ml of 0.75% hyperbaric Ropivacaine in dextrose 80 mg/ml, while those in Group I received 2 ml of 0.75% isobaric Ropivacaine (isobaric group). Results: The moment sensory block started to set in, there was no discernible difference. When compared to the hyperbaric group (Group-H), the time from injection to the height of the sensory block is much longer in the isobaric group (Group-I). In the isobaric group, modified bromage grade 3 takes longer to manifest than in the hyperbaric group. Because the rate of motor regression is quicker in the hyperbaric group than in the isobaric group, patients in the hyperbaric group can be mobilised earlier than those in the isobaric group. There was little difference between the two groups’ in respect to intraoperative hemodynamic variables and side effects. Conclusion: In comparison to isobaric ropivacaine, which is needed for day care surgery where prolonged immobilisation is desired, hyperbaric ropivacaine produced a more consistent, dependable, and good quality of motor block with quicker onset, early mobilisation, and rehabilitation.

59. Association of Serum Lactate Level with Severity of Pre-Eclampsia and Maternal Complications: An Observational Study
Shweta Shalini, Abhinav Mehrotra, Pallawi Singh
Abstract
Background: Pregnancy-related hypertensive problems are the most prevalent medical conditions. It increases mortality and morbidity rates for pregnant women and newborns. Incidence ranges from 5 to 10%. Complications can be minimised by identifying high risk patients and closely monitoring them. A helpful biochemical marker called lactate dehydrogenase can be used to assess maternal complications like disseminated intravascular coagulation (DIC), HELLP syndrome (haemolysis, elevated liver enzymes, and lowered platelets), pulmonary edema, renal failure, and foetal complications like foetal growth restriction (FGR) with an APGAR score ≤7 at five minutes and NICU admissions. Estimating serum Lactate dehydrogenase (LDH) levels in pre-eclampsia patients and examining the relationship between elevated LDH levels and maternal and foetal outcomes were the two main goals of this study. Methods: It was a prospective study from March 2022 to August 2022 at Sri Krishna Medical College and Hospitals, Muzaffarpur, Bihar. Results: Higher serum LDH concentrations were associated with an increased risk of maternal and foetal problems. The incidence of HELLP syndrome, DIC, and pulmonary edema was statistically significant when serum LDH was more than 600 IU/l. It also showed a p value of <0.001 correlation between lower platelets and higher creatinine levels. Apgar scores below 7 at 5 minutes and FGR NICU hospitalisation were considered statistically severe foetal problems. LDH levels rose in correlation with serum creatinine and liver enzymes. Conclusions: Raised LDH levels increase maternal and foetal problems, and it can be utilised as a biochemical marker to improve outcomes.

60. Study of Primary Caesarean Section in Multigravida Patients at SKMCH, Muzaffarpur, Bihar
Shweta Shalini, Abhinav Mehrotra, Pallawi Singh
Abstract
Background: The most often performed major surgery on women is a caesarean section. The purpose of this study was to determine the prevalence of primary Caesarean sections in multigravidas, their reasons and the outcomes for both the mother and the foetus in these patients. Methods: It was a six-month prospective study of primary caesarean sections performed on multigravida patients admitted to the obstetrics and gynaecology department of the SKMCH in Muzaffarpur, Bihar, between March 2022 and August 2022. Multigravida with a pregnancy of more than 28 weeks gestation (gravida 2 and above) and who had all previously delivered vaginally at least once at a gestation of more than 20 weeks were included. Women having prior abortions, prior sections and pregnancies accompanied by medical conditions were excluded. Results: A total of 8185 deliveries took place throughout the course of the study’s 6 month duration, of which 3061 (37.39%) required a caesarean section and 386 (12.61%) were multigravida primary caesarean sections. The majority (77.72%) of these multigravida individuals who underwent primary caesarean sections were unbooked. The majority of cases (61.13%) were admitted directly to the hospital. The majority of the patients (55.95%) were in the 25–30 age range. 69.44 percent of the patients could read and write. The majority of patients (49.72%) had Gravida 2. 95.85% of them (or all of them) had emergency caesarean sections. Malpresentation 115 (29.79%), Fetal distress 71 (18.39%), APH 71 (18.39%), Obstructed labour 33 (8.55%), Severe preeclampsia and Antepartum eclampsia 39 (10.1%) and Twin pregnancy 21 (5.44%) were the most frequent reasons for emergency LSCS in multigravida patients. Pyrexia was the most typical maternal morbidity at 40 (10.36%). Postoperative morbidity ranged from 21.24% for unbooked patients to 14.25% for referred patients to 23.58% for emergency patients, 12.43% for patients with poor socioeconomic level, and 3.88% for those with moderate to severe anaemia. 6.21% of infants were found to have birth asphyxia. The infant mortality rate was 2.33%. More newborn deaths (90.47%) occur in unbooked cases. Conclusions: Women who previously underwent a typical vaginal delivery can experience numerous unanticipated difficulties. It is advised that all prenatal patients schedule appointments and receive appropriate antenatal care on a regular basis. In order to lower maternal and perinatal morbidity and mortality, all deliveries in multigravida should take place in a hospital.

61. Study of Cytomorphological Patterns in Cervical Lymphadenopathies–A Hospital Based Cross Sectional Study
Bisen Varad V
Abstract
Background: Cervical Lymphadenopathy is common clinical presentation to inflammatory process to symptomatic or asymptomatic clinical conditions. The cause varies from mild infections to chronic diseases to Malignancies. Hence Cervical Lymphadenopathy needs to be investigated to find out the cause. Aim & Objective: To assess the various causes of Cervical Lymphadenopathy and to identify the most common cause of Lymphadenopathy with distribution of lesions in different age groups, gender and levels of cervical lymph nodes. Material and Methods: This study was conducted by over a period of 12 months. Total 380 Patients reported in Cytology section of Pathology Department with Cervical Lymphadenopathy. The stained smear was then studied for cytological features and to arrive in a Diagnosis. Results: Maximum number of cervical Lymphadenopathy patients were seen in second and third decade of life, Male to female ratio was 1.2: 1. Most common were Cases of Reactive Lymphadenitis with (N-163/380; 42.8%) overall, with most cases in first decade (0-10, N-62/163;38%) Followed by Tubercular /Chronic Granulomatous lesion (N-146/380; 38.4%) followed by Acute Suppurative Lymphadenitis with 41 cases. Least common was Malignant lesion (30/380; 7.9%), with increasing cases after 4th decade. Conclusion: FNAC is a Safe, Simple, Inexpensive alternative option to Diagnose Cervical Lymphadenopathy Cases. FNAC helps to classify the patients in reactive lymphadenitis, or to classify in infectious category or malignant diseases and refer the patients to further specialist. FNAC has great economical and psychological advantage to the patients.

62. The Study of Neck Shaft Angle of Dry Femur Bones in a Tertiary Care Teaching Institute
M Pranay Kumar, Yelpula Jyothi
Abstract
Background: Understanding the clinical significance of the biomechanics of the hip joint is made easier with the aid of femur neck shaft angle evaluation. It aids in the development of prosthetics as well as the improved treatment of various pathological hip and femur problems. The femoral neck-shaft angle is also crucial for communicating the subject’s racial identity. Therefore, the goal of the current study was to establish the neck shaft angle of the femur in humans. Methods: Adult dry femur bones totaling n=100 (n=50 left and n=50 right) were examined and analyzed. By drawing outlines of all of the femora’s contours, the neck-shaft angle of each femur was calculated. additional characteristics using a vernier caliper, osteometric board, and scale. Results: The neck shaft angle was measured and recorded in n=100 femur bones. Among n=100 femurs, n=70 bones were classified as male, and n=30 bones were female. The minimum angle measured was 118 degrees and maximum angle was 137 degrees and the mean angle was 128.92 degrees in male femur bones. In female femur bones, the minimum angle was 119 degrees and maximum angle was 139 degrees and the mean angle was 129.41 degrees. Conclusion: The Mean neck-shaft angles in the sample of the study was 129.16 degrees. Minor differences between the NSA of males and females were found although the differences remain insignificant. Similarly, the differences between the right and left femora were also found to be insignificant. These kinds of studies help us to determine the biomechanics of hip joints and the knowledge that could be utilized for hip replacement surgeries.

63. Spectrum of Cardiac Rhythm Disturbance after Acute Ischemic Stroke using 24 Hours Holter Monitoring
Santosh Kumar Kairi, Debaprasad Chakrabarti, Dulal Chakraborty
Abstract
Background: Acute stroke leads to imbalance of central autonomic control. It can cause over activity of sympathetic or parasympathetic control, myocardial injury, ECG abnormalities, cardiac arrhythmias and even sudden death. While evidence for cerebrally induced cardiac dysfunction is persuasive, predisposing factors, frequency and data on time course are limited and furthermore, various confounding factors hamper assessment. Methods: This Cross-Sectional Study was conducted in Tripura Medical College &Dr BRAM Teaching Hospital, over a period of One and half year duration from February 2019 to July 2020 and included subjects of acute ischemic stroke confirmed by brain imaging. After performing a 12 lead ECG in emergency ward, all eligible stroke patients were subjected to 24-hour Holter monitoring. Results: Out of 92 stroke patients, 35.28% had abnormal ECG. Changes included LVH in 10.87%, T-wave inversion in 9.78%, ST segment depression in 4.35% followed by QTc prolongation 3.26%. Holter monitoring for 24 hours revealed various cardiac rhythm disturbances viz ventricular ectopics (44.57%) supraventricular ectopics (30.43%), supraventricular tachycardia (11.96%), and atrial fibrillation (7.60%). Amongst brady-arrhythmias sinus pause was detected in 1.09%. Conclusions: ECG changes occur commonly in case of acute ischemic stroke, even in those having no history of heart disease as suggested clinically. Identification of paroxysmal atrial fibrilation episodes is important due to its relevance for planning of long-term treatment.

64. A Study to Record & Assess the Incidence of Adverse Drug Reactions in Pediatric Patients on Antiepileptic Drugs Reporting in a Tertiary Health Care Center of Central India
Verma Reena, Maheshwari Vatsala
Abstract
Objective: To record & assess the incidence of Adverse drug reactions(ADRs) in pediatric patients on antiepileptic drugs(AEDs) reporting in a tertiary health care center of central India. Method: A prospective observational study was undertaken for a period of 6 months between February 2019 to August 2019 to analyze adverse drug reactions due to antiepileptic drugs in pediatric department of a tertiary care hospital. Pediatric patients upto18years old were enrolled.  Other parameters like most common class of drug causing ADR, common types of ADRs, commonly involved systems, comparison of ADRs in patients on monotherapy versus polypharmacy were studied. Two patients were discontinued from therapy due to ADRs and in 2 patients, dose had to be reduced. Result: A total of 83patients were studied in the study duration where in a Total of 646 ADRs were reported. 6 various types of antiepileptic drugs were prescribed among which most frequently prescribed drugs were Midazolam (34.93%), Phenytoin (31.32%), Sodium Valproate (25.30%), Levetiracetam (7.22%). Patients on monotherapy were 34%,dual therapy 38%,triple therapy 21% and on polytherapy 7%. Most frequently reported ADRs with Monotherapy were fatigue & drowsiness. Central nervous system was most commonly affected followed by gastrointestinal system, skin &mucosa, urogenital system and miscellaneous ones like weight gain, rise in transaminase level and hematological changes. Incidence of Slow thinking and decreased concentration was reported less with levetiracetam than valproic acid.2 patients were Discontinued from therapy due to ADRs and in 2 patients, dose had to be reduced. Conclusion: AED-related adverse effects have high impact on the overall functioning and quality of life of children and affect their physical and psychosocial aspects of life. These factors need to be important considerations in selecting appropriate drug, dosage, dosage schedule, changes in dosages and schedules appropriately accordingly so that normal routine and quality of life is affected as minimal as possible. Also, If ADRs occur, appropriate actions are taken accordingly.

65. Johnsons Technique versus Hadlock – A Comparative Study to Estimate Foetus Weight
Aparna Chowdary Chaliki, Rajesh Nekkanti, Sunil Chowdary Chaliki, T Jaya Chandra
Abstract
Introduction: Birth weight is one of the most significant determinants of neonatal growth and development. The present study was conducted to find the accuracy clinical method to estimate foetal weight (FW) and comparison with ultrasound. Materials and Methods: This was a prospective, comparative study conducted for 2 years. Study protocol was approved by the ethical committee of institution. Women those submitted informed consent, with singleton pregnancy, without any maternal complications, known gestational age, cephalic presentation were included in this research. Johnson’s formula was used to estimate the FW. Then the participant was then sent to the Radio diagnostics for an obstetric ultrasound scan with the help of real time B mode scan equipment; biparietal diameter (BPD), femur length (FL), abdominal circumference (AC) were considered by Hadlock‘s reference table for FW. Baby was weighed within 2 hours of delivery using spring balance. The data was expressed in mean and standard deviation (SD) and association was estimated using one way ANOVA test, post hoc test; P<0.05 was considered statistically significant. Results: Total 100 antenatal women were included, majority were in 21 – 25 years (57%). The mean % error between Johnson and Hadlock techniques was not statistically significant. Statistically there was significant positive correlation between the actual birth weight with Johnsons (r = 0.730, P< 0.05) and Hadlock (r = 0.891, p = 0.000 < 0.05) techniques, respectively. Conclusion: In low and middle income countries such as India, do not require modern technology. An efficient clinician in predicting birth weight by Johnson’s formula is sufficient. This play an important role in labour management.

66. Online Teaching during Covid-19 Pandemic- Perceptions of Undergraduate Medical Students in Uttar Pradesh, India
Prerna Gupta, Shailendra Mishra, Deepak Chopra, Kauser Sayedda, Ankita Bist, Abdul Shaheer Umar, Mahboobul Haque, Quazi Shahir Ahmed
Abstract
Background: The suspension of regular face to face teaching during Covid Pandemic lead to emergence of e learning with full swing in every field of education including Medical Colleges. Students perceived this unplanned shift differently. So, this study was planned to explore the perceptions of medical students in a private medical university, UP, India. Methods: A questionnaire was designed on google form with close ended questions & likert scale questions. Link was shared with medical students who have attended online classes during Covid pandemic. Respondents were 140 medical undergraduates from 1st Professional, regular & supple batch. Responses were analyzed & results obtained. Results: Majority of students (76%) used smart phones to attend online classes & Google meet was the preferred platform (45.35%). Duration of online classes preferred by students was 30-45min (54.28%). Usefulness of online teaching by most of the students perceived as passable (Likert scale, LS- 2.84). Extent of understanding the topic was not equivalent to face to face (LS- 2.9) & internet connectivity posed problems (LS- 3.77) that is why most of the students demanded for reconduction of classes after resumption of regular offline classes (LS- 3.91) Most of them agreed that medical learning is suffering as practical classes cannot be conducted online (LS-3.98). Most of the students (45%) confessed that self-study was less at homes as compared to their hostels. Both students & their parents were worried about quality of studies & their future performance in exams (LS 4.02 &3.66). Students were not in favour of online teaching in future (LS-2.31). Conclusion: Online teaching was well received by medical students but they faced several challenges like sometimes internet connectivity issues, less student teacher interaction, methodology barriers, less development of practical skills. Despite all the hassles, chain of learning did not break due to online teaching. Efforts should be done to address the problems faced by students at individual faculty level as well as Institute level.

67. A Comparative Study of the Efficacy and Safety of Peribulbar Anaesthesia with that of Retrobulbar Anaesthesis in Patients Undergoing Cataract Surgeries
CKV Sirisha, K Satish, T Jaya Chandra
Abstract
Introduction: The history of anesthesia for Cataract surgery; dates back, to over 2500 years. A study was conducted to compare advantages, disadvantages and suitability of retro bulbar and peribulbar techniques of local anesthesia for cataract surgery. Materials and Methods: This was a prospective study, conducted in the department of anesthesiology and ophthalmology, Swatantra Multispeciality Hospitals, Rajahmundry. Study was conducted from June to June 2009 and the protocol was approved by the institutional ethics committee. Individuals of both gender, aged > 18 years, those submitted informed consent and who were selected for cataract extraction with or without intra-ocular lens implantation under regional block were included in this research. The study participants were randomly divided in to 3 groups. The first group were proceeded for retrobulbar (RB) anesthesia as per Atkinson. Peribulbar (PB) anesthesia was used for 2nd and 3rd groups, respectively. For the 2nd group, single quadrant PB anesthesia was given, named as PB 1 and double quadrant PB anesthesia was administered to the 3rd group, named as PB 2.  For PB 1, the facial block was not administered and the participants under this group received an infero temporal quadrant injection to provide PB block. Results: Total 75 members were included, 25 each respectively. Male female ratio was 0.78. Before anaethesia, statistically there was no significant difference in the mean IOP readings. But there was significant difference immediately after anaesthesia. Group wise, highest number of repetitions was observed in RB followed by PB 1. Group wise, highest eye lid movement and extra ocular movements were observed in PB 2 and sensation time was observed in RB. Conclusion: Safety of ocular anaesthesia for cataract surgery mainly depends on the preoperative preparation, proper selection of the drugs, size and length of the needle and type of block. The present prospective study confirms the fact.

68. Drug Utilization Pattern in Dermatology Out Patient Department in Tertiary Care Teaching Hospital in Southern Rajasthan
Vimlesh Kumar Meena, Rahul Meena, Sumitra Kumari Meena, Mohd Shakeel
Abstract
Introduction: The history of anesthesia for Cataract surgery; dates back, to over 2500 years. A study was conducted to compare advantages, disadvantages and suitability of retro bulbar and peribulbar techniques of local anesthesia for cataract surgery. Materials and Methods: This was a prospective study, conducted in the department of anesthesiology and ophthalmology, Swatantra Multispeciality Hospitals, Rajahmundry. Study was conducted from June to June 2009 and the protocol was approved by the institutional ethics committee. Individuals of both gender, aged > 18 years, those submitted informed consent and who were selected for cataract extraction with or without intra-ocular lens implantation under regional block were included in this research. The study participants were randomly divided in to 3 groups. The first group were proceeded for retrobulbar (RB) anesthesia as per Atkinson. Peribulbar (PB) anesthesia was used for 2nd and 3rd groups, respectively. For the 2nd group, single quadrant PB anesthesia was given, named as PB 1 and double quadrant PB anesthesia was administered to the 3rd group, named as PB 2.  For PB 1, the facial block was not administered and the participants under this group received an infero temporal quadrant injection to provide PB block. Results: Total 75 members were included, 25 each respectively. Male female ratio was 0.78. Before anaethesia, statistically there was no significant difference in the mean IOP readings. But there was significant difference immediately after anaesthesia. Group wise, highest number of repetitions was observed in RB followed by PB 1. Group wise, highest eye lid movement and extra ocular movements were observed in PB 2 and sensation time was observed in RB. Conclusion: Safety of ocular anaesthesia for cataract surgery mainly depends on the preoperative preparation, proper selection of the drugs, size and length of the needle and type of block. The present prospective study confirms the fact.

69. To Determine the Cause and Anatomical Distribution of Traumatic Gastrointestinal Perforation, and to Analyze Different Methods of Management of Traumatic Gastrointestinal Perforation and Their Outcomes
Kashinath Pandit, Sumit Mishra, Chandra Mohan Sinha
Abstract
Aim: The aim of the present study was to determine the cause and anatomical distribution of traumatic gastrointestinal perforation, and to analyze different methods of management of traumatic gastrointestinal perforation and their outcomes. Methods: The study was done in the Department of General Surgery, Jawaharlal Nehru medical College and hospital, Bhagalpur, Bihar, India for the period of nine months that has round the clock availability of all radiological investigations. In our study, a total of 120 patients with traumatic gastrointestinal perforation were included. Results: In our study, a total of 120 patients with traumatic gastrointestinal perforation were included. Out of 120 patients, 100 were males and 20 were females. Maximum patients (64) were found in the age group of 21-40 years of age. In our study, RTA was the most common mode of trauma with total of 50 patients followed by fall with 45 patients. Conclusion: Traumatic injury to gastrointestinal tract due blunt and penetrating abdominal trauma is on a rise due to road traffic accidents and more common in adulthood and males. Traumatic gastrointestinal perforation most commonly involves small intestine specifically jejunum and is usually managed by primary closure.

70. To Study the Effect of Low Dose Aspirin Therapy on Renal Function in Elderly Patients
Vibhash Kumar, Amit Kishor, Vikash Vashisth, Swati Singh
Abstract
Aim: The aim of this study to evaluate the low dose aspirin therapy and renal function in elderly patients. Methods: This prospective study was carried out in the Department of Medicine, NMCH, Sasaram, Bihar, India. This study employed a cohort of 50 elderly patients (age 60 years) and was comprised of 30 male and 20 female patients at the commencement of the study. The United Nations definition of an elderly person was used. Results: A total of 50 participated in this preliminary study. There were 20 (40%) females and 30 (60%) males with age range between 50–80 years and mean ages of 59.88 years (±7.16) and 65.77 years (±10.09) for males and females, respectively. 21 (42%) of the patients had more than one diagnosis. Systemic hypertension was the most common diagnosis, accounting for 31 (62%) of cases. Hypertension and diabetes mellitus coexisted in seven (24%) of the study participants. 88% exhibited their basal renal function in stages 1 and 2 based on CrCl. The P-value for all these weekly parameters did not show statistical significance except for the CrCl (P = 0.021). The CrCl reduced at week 2, and then increased at week 3, pleateauing before gradually returning to baseline at the sixth week. The mean hemoglobin was 12.7 ± 5.7 g/dL with a range of 7.7–15.7 g/Dl. Conclusion: This study did not show any deleterious effects of short-term, low dose aspirin (75 mg) use on the renal function of elderly patients. This 6-week study was cumbersome for most of the patients, and this precluded the participation of a lot of eligible geriatric patients.

71. A Retrospective Determination of a Fraction of Pap Cervical Smear Finding through LBC
Rakesh Raushan Chaudhary, Kumari Rashmi
Abstract
Aim: The objective of this study was to address this preventable cancer burden and also to determine a fraction of pap cervical smear finding through LBC in Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. Methods: From the period of nine months, a retrospective record assessment was performed for a total of 100 women who were referred from Department of Obstetrics and Gynaecology at Darbhanga medical college and Hospital, Darbhanga, Bihar, India for Pap cervical smear to the Department of Pathology. Results: It was observed that among women with abnormal cytology, majority of the cytology presented as ASC-US with 50% (50/100), LSIL 5% (5/100), ASC-H 25% (25/100), 15% (15/100) were High grade squamous intraepithelial lesion (HSIL), while 2.65% (3/113) were Squamous cell carcinoma and adenocarcinoma stood at 1% (1/100). Conclusion: The result from this retrospective analysis was to address the disease burden through representative data, highlight the need of effective screening programme and availability of HPV testing for uniformity of management and treatment according to the national recommendations. LBC can be a better alternative to conventional smear because of lower rate of unsatisfactory smears.

72. Assessment of Two Different Techniques in the Treatment of Diabetic Foot Ulcer
Roshani Prasad, Sumit Raj, Ashok Rai
Abstract
Aim: The aim of the present study was to evaluate the effect of the collagen dressing and conventional dressing on foot ulcer. Methods: The present study was carried out in the Department of  surgery, JLNMCH, BHAGALPUR, Bihar, India for the period of six months. Total one hundred patients with chronic foot ulcer were studied. Results: We found high number of male (75%) had chronic leg ulcer as compared to female (25%). However, the gender distribution was comparable same in both collagen and conventional dressing groups (p>0.05). There is a clear association between age and chronic leg ulceration. Data suggest that the prevalence of leg ulceration progressively increases with increasing age. In our study, overall, the chronic leg ulcer was found more in older age. Mean age [conventional dressing group (50.55 ± 10.90 years) and collagen dressing group (45.15±6.50 years)]. Conclusion: Diabetic foot ulcers treated with collagen dressing are efficacious in terms of reduction in wound area resulting in early wound healing.

73. An Observational Assessment of the Etiological Prevalence, Clinical Types and in Vitro Antifungal Drug Susceptibility Testing Against Dermatophytes in a Tertiary Care Setting
Shivani, Neha Kumari
Abstract
Aim: The aim of the study was to assess the etiological prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infections, and in vitro antifungal drug susceptibility testing against dermatophytes to understand the variation in minimum inhibitory concentrations (MICs) levels of antifungals among dermatophytes. Methods: The present study was conducted in the Department of Skin and VD, Patna medical College and hospital, Patna, Bihar, India. For 1 year. All patients with dermatophyte infections visiting the outpatient department during this period were screened. A total of 300 consecutive patients aged between 18 and 65 years with recurrent cases of tinea and other atypical presentations, receiving antifungal treatment, and willing to have minimum three days washout period before antifungal drug susceptibility testing of the clinical specimen (fungal isolate), were recruited. Results: In the present study, Itching (93.33%), scaling (88.33%), dryness (83.3%) and inflammation (45%) where the most common clinical presentations Antifungal susceptibility testing was done for all 150 (50%) culture-positive patients. Griseofulvin reported the least mean MIC values, followed by luliconazole, eberconazole, sertaconazole, amorolfine and itraconazole. The mean MIC value of terbinafine (0.05 [0.043] µg/mL) was above the reference range. However, it was noted only in 25 (16.66%) out of total culture-positive patients.  The individual high MIC values were reported up to 0.256 µg/ml [range: 0.001–0.03 µg/ml]. Conclusion: Dermatophytosis is a prevalent problem in the Indian scenario due to the hot and humid climate and low socio-economic status. Varied etiological agents, along with regional variations, make the management of this common cutaneous condition challenging. T. rubrum was found to be the most common, and T. mentagrophytes the emerging/codominant fungal isolate.

74. A Study to Characterize Dermoscopic Features of TSDF and to Correlate Them with Potency and Duration of Application of the TCS-A Cross-Sectional Study
Neha Kumari, Shivani 
Abstract
Aim: This study was undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: The present study was conducted in the Department of Skin and VD, JLNMCH, Bhagalpur, Bihar, India for 1 year.  Sample size of 100 cases was included in the study. Patients (18 years or above) with clinical symptoms and signs suggestive of TSDF (redness, itching, acne, burning, swelling, photosensitivity, pigmentation and atrophy). Results: In the present study, Females (80, 80%) constituted the majority as compared to males. Most of the patients belonged to the age group of 18–30 years (50, 50%) with a mean age of 32.8 ± 8.2 years. Seventy-Five (75%) patients had received some form of formal education, while 25 (25%) patients were illiterate. Presenting complaints of the patients were redness in 80 (80%), itching in 70 (70%), pigmentation in 60 (60%), burning in 64 (64%) and acne in 35 (35%) patients. Duration of TCS application ranged from one month to 25 years with 50 (50%) patients having applied TCS for over one year. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

75. Evaluation of the Risk Factors Affecting Elderly Patients’ Inability to Regain Pre-Fracture Mobility Following Hip Fracture Surgery
Niraj Narain Singh, Pawan Kumar
Abstract
Aim: To evaluate the functional recovery at six months postoperatively in elderly patients with hip fractures and to determine the risks of not regaining to the pre-fracture mobility level. Methods: The present study was conducted in the Department of Orthopaedics, ESIC Medical College, Bihta, Patna, Bihar, India. Total 330 consecutive patients over the age of 65 who were admitted to the hospital with hip fractures for 2 years were examined. Results: 120 (60%) of the patients were female and 80 (340%) were male, with a mean age of 78.8±9.4 years. There were 150 (75%) intertrochanteric fractures and 50 (25%) femoral neck fractures. 100 (50%) patients underwent proximal femoral nail (PFN), 80 (40%) patients underwent hemiarthroplasty, 12 (6%) patients underwent dynamic hip screw (DHS) and 8 (4%) patients underwent total hip arthroplasty. In the analysis performed to determine the level of mobility, it was found that 160 (80%) patients moved without the use of an aid and 40 (20%) patients moved with the use of an aid in the pre-fracture period. Conclusion: In the postoperative period, a high rate of worsening in activities of daily living and limitation of movement were detected in patients who were operated on for hip fractures. Patients who have intertrochanteric fractures, who use PFN as an implant type during surgery, and those with cardiovascular disease or dementia are more likely to be unable to return functionally to the pre-fracture stage.

76. Morphometric Assessment of the Insertion and Relation of Brachialis with the Neurovascular Structures of the Arm
Virwar Kumar Jha, Pramita Kumari, Kumari Ayushree
Abstract
Aim: The present study was done to observe the insertion of brachialis and course of the Median nerve and the Brachial artery related to it. Methods: The study was conducted on 18 upper limbs from embalmed cadavers from the department of anatomy, ESIC medical college and hospital, Bihta, Patna, for the period of 1 year. A longitudinal incision was made in the anterior surface of brachial fascia from the level of pectoralis major to the elbow. The limbs were routinely dissected for observing the insertion of Brachialis and its relation to the neurovascular structures in the arm. Results: In 16 specimens (88.9%), the Brachialis muscle is inserted into the anterior aspect of the coronoid process and the tuberosity of ulna, The Median nerve and the Brachial artery passes superficial to the brachialis muscles and the relationship was normal. In 2 specimen (11.1%) a tunnel was formed by brachialis muscles in the lower 1/3 of right upper limbs. The length of the tunnel was measured about 2.5 cm. Conclusion: Considerable difference in the morphology of the brachialis was found in the present study as compared to the classical picture found in standard textbooks. And hence, there is a requirement for revising its anatomy.

77. Autologous Platelet Rich Fibrin Matrix versus Zinc Oxide and Phenytoin Paste in Non-Healing Ulcers: A Comparative Assessment
Pawan Kumar, Shivani
Abstract
Aim: The aim of the present study was to compare the therapeutic efficacy of autologous PRFM versus triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in non-healing ulcers. Methods: The present clinical trial was conducted in the Department of Dermatology, Patna Medical College and Hospital, Patna, Bihar, India for one year.  A total of 20 patients were included in the study with the age range 20–70 years. Patients with non-healing ulcers were selected from the outpatient department of Skin and VD. Results: A total of 20 cases of non-healing ulcers of varying etiologies were treated using autologous platelet rich fibrin (PRF) at weekly intervals for maximum frequency of 6 sittings respectively. The mean age of the patients was 39.7 ± 13.02 years. Out of 20 ulcers, there were 7 (35%) venous ulcers, 3 (15%) traumatic ulcers, 6 (30%) diabetic ulcers and 4 (20%) trophic ulcers. Group A showed a mean reduction in the ulcer area by 8.26 mm2 (75.90%) which is highly significant (P-value = 0.0002). Group B showed a mean reduction in the ulcer area by 4.500 mm2 (45%) which is also significant (P-value = 0.015). Conclusion: This procedure is simple, patient-friendly, cost-effective, painless and can be performed as an outpatient procedure. We concluded that autologous platelet-rich fibrin matrix is much more effective than the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in the treatment of non-healing ulcers.

78. A Hospital-Based Study to Assess the Role of Serum Vitamin D Levels in Severity of Dengue Fever – A Cross Sectional Study
Rajeev Kumar, S.K. Astik, Subham Bhaskar, Narendra Kumar
Abstract
Aim: The aim of the present study was to compare the therapeutic efficacy of autologous PRFM versus triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in non-healing ulcers. Methods: The present clinical trial was conducted in the Department of Dermatology, Patna Medical College and Hospital, Patna, Bihar, India for one year.  A total of 20 patients were included in the study with the age range 20–70 years. Patients with non-healing ulcers were selected from the outpatient department of Skin and VD. Results: A total of 20 cases of non-healing ulcers of varying etiologies were treated using autologous platelet rich fibrin (PRF) at weekly intervals for maximum frequency of 6 sittings respectively. The mean age of the patients was 39.7 ± 13.02 years. Out of 20 ulcers, there were 7 (35%) venous ulcers, 3 (15%) traumatic ulcers, 6 (30%) diabetic ulcers and 4 (20%) trophic ulcers. Group A showed a mean reduction in the ulcer area by 8.26 mm2 (75.90%) which is highly significant (P-value = 0.0002). Group B showed a mean reduction in the ulcer area by 4.500 mm2 (45%) which is also significant (P-value = 0.015). Conclusion: This procedure is simple, patient-friendly, cost-effective, painless and can be performed as an outpatient procedure. We concluded that autologous platelet-rich fibrin matrix is much more effective than the triple combination paste (zinc oxide, phenytoin, and mupirocin ointment) in the treatment of non-healing ulcers.

79. Assessment of Caesarean Section Complications in a Tertiary Care Hospital during the Second Stage of Labour: A Prospective Observational Study
Veena Kumari
Abstract
Aim: To evaluate the maternal and neonatal outcome of caesarean section in second stage of labour. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, NSMCH, Amhara, Bihta,Patna, Bihar India .  Total 100 patients were included into the study. All caesarean sections performed at full cervical dilatation over this time period. Results: During the study period, a total of 2400 women delivered by caesarean section, 1700 emergency and 700 elective cases. Of these 100 (2.27%) were at full cervical dilatation, >37 weeks gestation with a singleton fetus in cephalic presentation.The commonest indications for doing caesarean section in the second stage of labour was cephalo pelvic disproportion, fetal distress and obstructed labour. Incidence of PPH was 12 out of 100 cases (12%).There were no cases of bowel or bladder injury reported. Post-operative wound infection was seen in 8(8%) and Post-operative fever was seen in 17(17%) out of 100 cases. There were no cases of maternal deaths reported. The mean operative time was 52.2 min .The mean length of hospital stays was 6.6 days. Mean weight of the babies of the second stage caesarean section was 3.5kg. 6(6%) babies were admitted  to the Neonatal Intensive  Care  Unit  and  12  (12%) to neonatal nursery for management of respiratory distress, sepsis, jaundice, and observation. 14(14%) babies had Neonatal jaundice and  There were 2 neonatal deaths reported. Conclusion: The women delivered by cesarean in second stage have a higher risk of post-partum hemorrhage, operative morbidity with visceral injury, sepsis and prolonged hospital stay. Hence it is recommended that second stage cesarean should ideally perform and supervised by an experienced obstetrician. Timely decision for cesarean section should be taken especially when risk factors for failure to progress are present and there should be good neonatology support.

80. Comparative Assessment of Manual and Automated Methods of Counting Reticulocytes and the Effect of Sample Storage on Reticulocyte Count: An Analytical Assessment
Kumari Rashmi, Rakesh Raushan Chaudhary
Abstract
Aim: The purpose of the study was to assess comparability between manual and automated methods of reticulocyte counting and to understand the variation of reticulocyte count over time. Methods: The cross-sectional study conducted in the Department of Pathology of a Darbhanga medical college and Hospital, Darbhanga, Bihar, India over a period of six months. In this study, comparison of RC by the manual and automated method was done in 100 patients with anemia and 100 control samples which were matched for age and sex. Results: Basic demography in study cases showed 46 females and 54 males. Out of 100 cases, 12 cases were infants (up to 1 year), 38 cases were children (>1 year to 14 years) and 60 cases were adults (>14 years). The mean automated RC for males was 4.76 ± 4.20 and it was 4.90 ± 4.36 by the manual method. In the case of females, the mean automated RC was 3.65 ± 3.44 and that by the manual method, it was 3.88 ± 3.66. No statistically significant difference was found between the automated and manual count among the male (P = 0.77) as well as female patients (P = 0.61) by z-test for the difference between the mean automated RC and mean manual RC. Conclusion: We conclude that there was no significant difference between automated and manual methods for reticulocyte counting in any gender for microcytic, normocytic, or macrocytic patients.

81. A Cross Sectional Study on Spacing Contraception among Religious Group of North Indian Population
Prabhu Dayal Gupta, Archana Mishra, Rakesh Kumar Shukla, Sanjay Pandey
Abstract
Aim: The objective of this original research article is to find Spacing Contraception among Religious Groups of the North Indian Population. Material & method: A cross-sectional study was conducted in the Department of Obs and Gyne, SSPG District Hospital (Female) Varanasi, Uttar Pradesh, India from January 2017- January 2019. The sample size for the study was calculated using the couple protection rate of Uttar Pradesh, which was around 38%. The estimated sample size determined for the study was 750 and the targeted sample group was 348. Women under the age group 15-50 years reported to the SSPG District Hospital female Varanasi were assessed by structured interview and data recorded. Result: Majority of the women 367 (49%) were in the age group of 21–30 years with a mean age of 25-26 years. Among the study group 645 (86%) were Hindu, 101 (13.5%) were Muslims and 04 (0.5%) were Christians. The number of children the couples had at the time of tubectomy. The maximum number of couples (47%) had 3 children before opting for tubectomy. The next predominant group was the couple who had 1-2 children (24%). Among all the religions spacing method of contraception was most preferred compared to tubectomy. It has been found that 41% of the Hindu population and only 5% of the Muslim population were using the spacing contraceptive. Among all the spacing contraceptive method Condom has been found as the most preferred method by all the communities and the folk method as the least preferred. Conclusion: The analysis shows rising contraceptive use rates and declining fertility rates in all the religious groups. Muslim women in India have considerably lower contraceptive use and higher fertility rates at each parity than Hindu women. Male Condoms are found as the most preferred choice among all religions.

82. Colony Variants of Pseudomonas aeruginosa-Rising MIC Value of Imipenem Posing Threat in Treating Pseudomonas Infections
Atiya Kausar, Prashanth H V, Imtiaz Ahmed, Anusuya Devi D
Abstract
Background: Pseudomonas aeruginosa has the ability to produce about seven types of colonies. Small colony variants have been isolated from critically ill patients and are known to possess high adherence capacity. Carbapenems play a major role in treating Pseudomonas infections. As a result of increased antibiotic use, the development of resistance to carbapenem is being reported nowadays. Objective: The objective of this study was to study the colony variants of pseudomonas aeruginosa isolated from various clinical specimens, correlate clinically with the patient presentation, and study the minimum inhibitory concentration of Imipenem of all these isolates in a tertiary care hospital. This study was conducted in Sri Siddhartha medical college and hospital. A prospective study was conducted for a duration of 18 months. Methods: All the isolates presumptively identified as pseudomonas aeruginosa from various clinical samples received at the department of microbiology were included in the study. Variation in the type of colony morphology was noted and the MIC value of imipenem was tested on Muller-Hinton agar using E-test strips. Results: The study revealed that small colony variants and mucoid variants isolated showed an increased resistance pattern to an anti-pseudomonal group of antibiotics. They also showed a high MIC value of imipenem. Conclusion: Characterization of pseudomonas aeruginosa isolates showed that small colony and mucoid variants showed increased resistance patterns to antibiotics. Studies have also shown that there is an association between biofilm formation and colony morphology. Virulence factors are likely to contribute to biofilm formation and also contribute to antibiotic resistance.

83. Effect of Pre-Treatment with Intravenous Midazolam on Propofol Infusion for Induction of General Anaesthesia: An Observational Study Conducted in Upper Assam, India
Rajib Hazarika, Vikramjit Baruah, Subhadeep Sarkar
Abstract
Background: Propofol has drawback of causing cardiovascular and respiratory depression. Midazolam has synergistic effect with propofol. Target controlled infusion of propofol for induction appears to be safer than bolus dose given at random rate. Methods: One hundred and eight consecutive patients, aged 18-60 years of either sex belonging to ASA status I or II undergoing elective surgery under general anaesthesia and meeting the inclusion criteria were selected. These patients were divided into two groups – Group I and Group II alternatively, each having 54 patients. Group I received injection midazolam 0.03 mg/kg five minutes prior to induction with propofol infusion and group II did not receive midazolam. In both the groups, propofol (10mg/ml) was infused intravenously using syringe pump at the rate of 200 ml/hr for induction of anaesthesia. Hemodynamic parameters were recorded for statistical analysis at baseline, pre-induction, induction, laryngoscopy & intubation and at two minutes interval post laryngoscopy & intubation till 10 minutes. Results: The mean duration in Group I to achieve the end point of induction was 2.63 ± 0.39 minutes and in Group II was 3.48 ± 0.49 minutes. Average dose of propofol infusion required before loss of verbal response in Group I was 1.35 ± 0.03 mg/kg & in Group II was 1.73 ± 0.02 mg/kg. Conclusions: Using midazolam premedication, reduces the total dose of propofol infusion and induction time by 21.97 percent and 24.43 percent respectively compared to propofol infusion only. Dosage of propofol infusion, even without midazolam premedication, was seen to be lower by 13.5 percent than that of IV bolus dose of 2 mg/kg body weight. Myocardial depression and vasodilatation are dose dependant phenomena of propofol. Therefore, reduction in the total dose of propofol would be safe and ensure lesser chances of circulatory collapse during induction of general anaesthesia.

84. An Observational Study on Prognostic Implication of Post-Operative Blood Lactate Level for Complications and Predicting Length of ICU Stay after Major Abdominal Surgery
Udayanath Behera, Amiya Kumar Nayak, Sabyasachi Das, Nirlipta Kumar Behera, Ramachandra Sahoo
Abstract
Background: In this study, we wanted to evaluate the association of blood lactate levels during the first 24 hours after surgery with post-operative morbidity and mortality, correlate the lactate values at various time points with different post-operative complications (POC), observe the correlation between lactate levels and length of intensive care unit (ICU) stay, detect any abnormal lactate level and treat this to improve tissue perfusion. Materials and Methods: This was a hospital based observational study conducted among 60 patients who were posted for major abdominal surgery under general anaesthesia in the Department of Anaesthesiology and Critical Care of S.C.B. Medical College & Hospital, Cuttack, over a period of 12 months from September 2020 to August 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: There was statistically significant difference with regard to lactate level, urine output, duration of surgery, duration of ICU stays and duration of intubation measured at the point of time (0, 6, 12 and 24) in cases with shock as compared to cases without shock (p < 0.05), in cases with death as compared to cases without fatal outcome (p < 0.05), in cases with acute kidney injury (AKI) as compared to cases without AKI (p < 0.05), in patients who required extended respiratory support as compared to cases who did not require extended respiratory support (p < 0.05), and in cases with wound dehiscence as compared to cases without wound dehiscence (p < 0.05). Conclusion: Increased serum lactate levels were significantly associated with post-operative complications, mortality and length of ICU stay in patients undergoing major abdominal surgery. Serial lactate measurements in early post-operative period were able to discriminate between patients with and without post-operative complications. This result warrants a “golden hour and silver day” perspective of early resuscitation in this patient. Further studies are needed to establish a lactate-directed treatment protocol within 12 – 24 hours of surgery.

85. Association of Glycosylated Haemoglobin, Non-High-Density Lipoprotein and Uric Acid in Diabetic Patients Presenting with Acute Coronary Syndrome
Uday B. Nayak, Aswathi Kamal
Abstract
Background: In this study, we wanted to evaluate the association between glycosylated haemoglobin, non-high-density lipoprotein and uric acid in diabetic patients presenting with acute coronary syndrome and study the clinical profile of diabetic patients with acute coronary syndrome. Materials and Methods: This was a hospital based single centric, observational, cross-sectional study conducted among 105 diabetic patients who presented with acute coronary syndrome to the Department of General Medicine of a tertiary care hospital over a period of 12 months from December 2018 to December 2019 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: The average serum fasting blood sugar level (BSL) among enrolled patients was 215.01 ± 67.00 mg/dl. The average serum post prandial BSL among enrolled patients was 292.85 ± 85.38 mg/dl. The average serum HbA1c among enrolled patients was 8.13 ± 2.22 %. The average uric acid among enrolled patients was 8.5 ± 2.55 mg/dl. The average serum total cholesterol among enrolled patients was 188.37 ± 25.57 mg/dl. The average serum HDL among enrolled patients was 40.77 ± 8.96 mg/dl. The average serum non-HDL among enrolled patients was 147.6 ± 25.90 mg/dl. The average serum LDL among enrolled patients was 109.55 ± 25.65 mg/dl. The average serum triglyceride among enrolled patients was 190.75 ± 29.09 mg/dl. Uric acid was directly correlated with HbA1c, total cholesterol, non-HDL, LDL and triglyceride. Uric acid was inversely correlated with HDL. Conclusion: Serum uric acid level was increased in diabetic patients with acute coronary syndrome. Serum uric acid directly correlated with HbA1c, total cholesterol, non-HDL, LDL and triglyceride. Serum uric acid was inversely correlated with HDL.

86. SARS Cov-2 Immune Response in Health Care Workers – is There Need for Antibody Titer Testing in Post Vaccinated Individuals
Leelambika C., Prithvi Shankar, Shravan Kumar, Mohana Kumari Chidananda, Shilpa H.D.
Abstract
Background: Studying the immune response among health care workers in different areas is crucial for understanding the risk and vaccine deployment. Our study was designed to measure the immune response in post vaccinated health care workers and evaluate the immune response with type of vaccination. So that it can help in better management of the disease. Methodology: SARS CoV-2 IgG-II levels were measured in health care workers post vaccinated with covishield and covaxin, also the effect of covid positivity on antibody response. Results: Compared to males females had significant increase in reactivity (p=0.0227) with Median value of reactivity among males was 9.96 AU/mL[ 7.31-12.31] and of females was 5.4 AU/mL[0.53-14.77]. Median value of 12.035 AU/mL[6.11-74.9] in vaccinated was significantly increased  (p=0.0008) compared to median value of 1.28 AU/mL[0.52-6.43] in non-vaccinated health care workers. Significant difference [p= <0.0001] as observed covid positive health care workers as compared to covid negative with median values of 59.4 Au/mL[47.56-167] and 6.11 Au/mL[0.54-11.96]. Vaccinated and non-vaccinated health care workers tested positive for covid are had median reactivity of 231.7 AU/mL[49.03-168.56] and 9.98 AU/mL [5.27-14.69] respectively. covid negative health care workers, vaccinated had median value of reactivity of 7.37 AU/mL[5.34-18.28] as compared to 1.27 Au/mL[0.45-4.03] in non-vaccinated [p=0.0131]. Conclusion: Seroprevalence among the health care workers has a varied response. State of covid positivity, vaccination, type of vaccination and infection along with vaccination affect the Antibody response. Thus measuring the immune response will guide us in taking precautions and better management of the disease.

87. Seroprevalence of Transfusion Transmitted Infections in Blood Donors – A 6 Year Experience in Tertiary Care Hospital
Priya, Velayutham Sumathi
Abstract
Blood transfusion is a lifesaving tool for millions of patients. However, there is always a risk of transfusion transmissible infections (TTI) in the blood and its products if not properly screened. There is increasing incidence of transfusion transmitted infections (TTI including Hepatitis B virus (HBV), Hepatitis C virus (HCV), Human immunodeficiency virus (HIV), Syphilis and malaria in developing countries. Hence, it is essential to monitor safety of blood transfusion. Aim: The aim of this study is to determine the Seroprevalence of transfusion transmitted infections in healthy blood donors in a tertiary care blood bank. Materials and Methods: A retrospective study was based on records of voluntary blood donors over a period of 6 years from January 2016 to December 2021 in a tertiary care blood bank. The serum samples were screened for Hepatitis B surface antigen (HbsAg), antibodies to Human Immunodeficiency Virus (HIV) type 1 and 2, Hepatitis C virus (HCV) and syphilis using Enzyme Linked Immunosorbent assay and rapid plasma reagin screening test. Results: Total of 57,777 donors were screened and their data were analysed. Majority of the donors were male (94.6%). The overall seroprevalence of HIV, HbsAg, HCV and Syphilis were 0.045%, 4.5%, 0.015%, 0.006%. The most common TTI prevalence was that of Hepatitis B followed by HIV. Conclusion: In our study we found a low prevalence of TTIs among voluntary blood donors. This may be due to better selection of donors. There should be public awareness regarding voluntary blood donation. Careful donor screening and selection and the use of highly sensitive tests help to reduce the TTIs.

88. A Comparison Study Evaluating the Incidence of Post-Operative Hoarseness and Sore Throat when the Endotracheal Cuff is Inflated with Alkalinized Lignocaine during Laproscopic Procedures
Rekha Agarwal, Anshul Agarwal
Abstract
Introduction: Cuffed endotracheal tubes are used to maintain the airway during general anaesthesia, which is a crucial aspect of the anaesthesiologist’s role in patient care. A consequence of using cuffed endotracheal tubes is localised airway irritation and inflammation brought on by prolonged cuff inflation, which can lead to post-extubation morbidities like a sore throat, hoarse voice, and cough. Objectives: To compare the incidence of post-operative, sore throat has any relation with age, sex and post-operative nausea and vomiting. Methods: In the months of August 2021 and July 2022, the anaesthesia department at Rama Medical College and Hospital carried out a prospective one-year cross-sectional study. The study population consisted of people having laparoscopic procedures in the areas of urology, gynaecology, and surgery while under general anaesthetic at Hospital. There were two groups of patients. Calculations were made for the postoperative painful throat and hoarseness at 0, 6, and 24 hours. Analysis was performed using IBM 22.0 SPSS. Results: A standard deviation of 6.801 was used to obtain the mean age of 32.1. Similar calculations were made for the control group, which had a mean age of 32.3 and a standard deviation of 6.990. Among the 100 patients enrolled in the study’s test group, 57 (or 57% of the total) were women and 43 (or 43% of the total). When compared to air in the cuff, alkalinized lignocaine is substantially more effective at reducing the occurrence of sore throat (p<0.001). 82 patients in the test group AL’s 100 patients did not experience post-operative nausea and vomiting, while 18 of them did. Out of 100 patients in the control group A, 34 suffered post-operative nausea and vomiting while 66 did not. Conclusion: When examined over the course of 24 hours, the intervention of employing alkalinized lignocaine in the endotracheal cuff instead of air in the endotracheal cuff during laparoscopic procedures significantly reduces sore throat and hoarseness.

89. Seasonal Trend of Neonatal Dehydration in Hot Climatic Conditions of Southern Rajasthan, India
Malvia S, Rajwaniya D, Jakhar SK
Abstract
Objective: Dehydration in neonates is a potentially serious condition. The healthy neonates on exclusively breast feed were found to be dehydrated, especially in summers. The objective is to determine the incidence of dehydration and biochemical changes which occur in these neonates in summer, rainy and winter months of the year. Methodology: Hospital based prospective study on term neonates (>37 week gestation and >2 kg birth weight) admitted with dehydration (signs/symptoms of dehydration/ >10% weight loss after birth in neonatal period) during the study period of 1 year in a tertiary care centre located in Udaipur, India. Informed consent was taken. Neonates with sepsis/asphyxia/anomalies were excluded. Result: A total of three hundred and eighty four term neonates with dehydration were enrolled during study period of 1 year. Number of cases during winter months were 51(13.2%). in summer months were 249 (64.9%) and rainy months were 84(21.9%). The number of neonates with hypernatremic dehydration in summer, winter and rainy months was 172(69.1%), 18(35.3%) and 48(57.1%) respectively. Mean weight loss, mean blood urea, mean serum creatinine, mean serum sodium were significantly elevated in neonates admitted during summer months in comparison to winter and rainy months. 5 neonates admitted during summer months expired due to various complications. All neonates admitted during winter and summers were successfully discharged. Conclusion: The number of neonates getting admitted due to dehydration in summers increases rapidly with most neonates among them having serious renal parameters derangement. Countries with hot climatic conditions must emphasize on problem of neonatal dehydration. Proper maternal counselling regarding breastfeeding adequacy must be given. Daily weight monitoring and frequent follow up in first few weeks of birth will help in early diagnosis of dehydration and thus will help in preventing the morbidities and mortalities associated with it.

90. Incidence, Etiology and Outcome of Retinopathy of Prematurity in NICU Graduates
Anil Prasad, Sourabh Agrawal
Abstract
Background: This condition, known as retinopathy of prematurity (ROP), affects the growing blood vessels in the retina of preterm infants. While improvements in neonatal care over the last several decades have allowed us to preserve preterm newborns, those without ready access to medical help often have permanent vision loss. Aims and Objectives: To determine the incidence of Retinopathy of prematurity (ROP) in high risk babies admitted to the neonatal unit, to study risk factors for its development and evaluate the effect of laser therapy. Methodology: This is a hospital based prospective cohort study conducted at Surya Children Hospital, Mumbai. The risk and severity of ROP, as well as the need for therapy, were examined in relation to perinatal and neonatal factors such as birth weight (BW), gestational age (GA), days on mechanical ventilation (DMV), days on oxygen (DOX), and the presence of proven sepsis. Results: Incidence of ROP according to birth weight in our study is 100% in ≤ 1000 gms. Out of 77 patients receiving oxygen, 81.9% developed ROP of varying stages. 100% of patients who had all 3 risk factors positive i.e. oxygen supplementation, mechanical ventilation and confirmed sepsis developed ROP. Conclusion: 100% of patients who had all 3 risk factors positive i.e. oxygen supplementation, mechanical ventilation and confirmed sepsis developed ROP. Our study concluded that the Incidence of ROP of various stages in our study is 66%.

91. A Clinical Study of Upper GI Endoscopy in Cases of Gastrointestinal Bleeding
M Anil, M. Ramu
Abstract
Background: Upper Gastrointestinal Hemorrhage (GI Bleeding) Is A Well-Known And Possibly Fatal Abdominal Emergency That Requires Quick Evaluation And Vigorous Emergency Care. Depending On The Position Of The Hospital In The Hierarchy And Its Location, The Range Of Upper GI Bleeding Varies From Region To Region. This Study Aimed To Determine The Common Etiological Factors Of Upper Gastrointestinal Bleeding Using Upper GI Endoscopy. Methods: This Cross-Sectional Study Was Conducted In The Department Of General Surgery, Prathima Institute Of Medical Sciences, Naganoor, Karimnagar. The History Of Drug Consumption Over The Previous 48 Hours And Frequent Drug Consumption Over The Prior Months Was Asked About, And The History Of Cardiovascular, Respiratory, Renal, And Liver Illnesses Was Carefully Assessed. The Patients Were Then Subjected To Upper GI Endoscopy Using A Fibreoptic Instrument. (Olympus GIF 290). Results: Out Of The Total N=50 Cases N=35 (70%) Were Males And N=15(30%) Were Females. The Male-To-Female Ratio Was Approximately 2.5: 1. Portal Hypertension (PTH) Varices Were The Most Commonly Found Cause For The Upper GI Bleeding In Both Male And Female Sexes, Consisting Of N=17 Cases And N=7 Cases Respectively. Other Causes, Duodenal Ulcers, Erosive Gastritis, And Esophagitis Were Commonly Seen In Males Whereas Mallory Weiss Syndrome Was Found In A Female Patient. Conclusion: Endoscopic Therapy Is A Tested Method For Treating GI Bleeding And May Be An Effective Treatment Option For Some Individuals. An Essential Part Of The Care Of Acute Variceal Bleeding And The Long-Term Treatment Of Patients After A Variceal Bleed Is Endoscopic Therapy With Either Band Ligation Or Injection Sclerotherapy. Overall, The Available Data Show That Band Ligation Has Distinct Advantages Over Sclerotherapy For Variceal Hemorrhage. This Study Emphasizes The Use Of Endoscopy In The Therapy Of All Upper GI Bleeding, Both As A Diagnostic And Therapeutic Tool.

92. Comparative Study of Epidural Bupivacaine with Buprenorphine, Pentazocine and Tramadol for Post Operative Pain Relief
Bharat Verma, Amrita Nidhi
Abstract
Introduction: Pain is also old as evolution of life. All the definition of pain seems to be incomplete it cannot be defined completely. It is subjective sensation which varies individual. To make whole world pain free, medical research is continuing. Objectives: To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine. Materials and Methods: A prospective, randomized controlled, double-blinded study was undertaken in 100 patients scheduled for major abdominal surgeries. Group B received epidural bupronorphine .3 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Results: Visual analog scale better with bupronorphine group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group. Conclusions: Epidural tramadol with antiemetic is better than buprenorphine and pentazocine for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients.

93. Comparison between the Effects of Ringer`s Lactate and Hydroxyethyl Starch on Pulse Rate and Systolic Blood Pressure after Spinal Anesthesia: A Randomized Clinical Trial
Bharat Verma, Amrita Nidhi
Abstract
Background: Hypotension during spinal anesthesia is common and can lead to severe injuries and even death. Administration of crystalloid fluids is advised to prevent occurrence of hypotension; however its effectiveness is still the matter of arguments. Objectives: This study was designed to compare the effects of Ringer`s lactate and hydroxyethyl starch 6% on hemodynamic parameters after spinal anesthesia in patients undergoing orthopedic surgeries on lower limbs. Methods: This randomized clinical trial was performed in MLB Medical College Jhansi. 75 patients undergoing elective obstetrics and orthopedics surgeries with spinal anesthesia were included in this study. Fitted patients were randomly divided into two equal groups. After entrance to the operation room and before spinal anesthesia, patients’ hemodynamic parameters including systolic blood pressure (SBP) were evaluated using monitoring electro-velocimetry set. Results: The baseline values of mentioned variables did not show a significant difference between two groups using t-test (P > 0.05). Also SBP after intervention was not significantly different between two groups using t-test (P > 0.05). Conclusion: The result of present study on patients undergoing femoral fracture surgeries who received Hetastarch or Ringer`s lactate solutions showed that Hetastarch was not significantly more effective in compensation of hypotension induced by spinal anesthesia.

94. An Evaluation of Variable-Angle Volar Locking Plate for Distal Radius Fractures
Sachin Gopalrao Saoji
Abstract
Introduction: This study is regarding the fracture of distal end of radius and its management. There are several treatment modalities available for fracture distal end radius. Complication rate with majority of modalities is very high. The prevalence of radius fracture at distal end was reported to be about 37 for every 10,000 person-years among female population while in male population it is about 9 for every 10,000 person-years over the age of 35 years. It was proposed that volar locking plate is better to improve patient’s outcome in terms of radiological parameters and also to increase the range of motion. Several volar and dorsal plates are available for managing the distal radius fractures in the India. This can be classified as fixed-angle locking plates, non-locking and recently available variable angle locking plates. Aims and Objectives: To evaluate the outcome of applying variable angle locking plates in comparison to existing treatment modalities in terms of improvement in radiological parameters and functional outcome. Materials and Methods: In this retrospective study, patients with distal radius fractures treated with variable angle locking plate were considered. The outcome parameters for analysis were determined at different follow up time i.e. immediate post op, at 8th week and 6 months after operation. Results: The study found that the improvement in radiological picture and functional movements were significantly better (p>0.05) and suggest to use volar variable angle locking plate as better alternative than ORIF and fixing with fixed angle locking plate. Gartland and Werley’s scores also came to be excellent with 73.52% of patients. Conclusion: The study has concluded that variable angle volar locking plate can be used with lower complication rate and should be considered in the guidelines to be used as better treatment modality to the existing treatment modalities.

95. Effects of either Sitagliptin or Pioglitazone Addition on Metformin in Patients with Uncontrolled Type 2 Diabetic Mellitus
Priyanka Bhagat, Nilam Nigam, Kriti Jalota, Syed Shadman Ahmad, Shrawan Kumar
Abstract
Objective: Compare and study the use of metformin and DPP-4 inhibitors in conjunction with currently used combination treatments. Materials and Methods: In this 16-week study, sitagliptin and pioglitazone were compared as add-on treatments for type 2 diabetes mellitus patients whose condition was not sufficiently controlled by metformin alone. In addition to metformin, 52 patients were randomly assigned to receive either sitagliptin 100 mg (group 1) or pioglitazone 30 mg (group 2). Change in HbA1c served as the main efficacy end objective. Changes in body weight, lipid profile, and fasting plasma glucose (FPG) were considered secondary end objectives. HbA1c significantly dropped in both groups. Results: In neither group did the mean FPG reductions differ significantly from one another. In group 1, the mean body weight and body mass index significantly decreased, while the same variables significantly increased in group 2. High density lipoprotein (HDL-C) and triglyceride levels significantly dropped in both therapy groups, according to the reports. Conclusion: The drug was well tolerated and did not cause any instances of hypoglycemia. It was determined that pioglitazone was not as effective or well tolerated as sitagliptin when added to metformin.

96. Study of Atretic and Ovulatory Dominant Follicle in Women undergoing Ovulation Induction in a Tertiary Care Center, Patna
Priyanka Singh, Huma Nishat, Ram Sagar, Rajiv Ranjan Sinha, Binod Kumar, Avanish Kumar
Abstract
Background: In a typical 28-day cycle, ovulation takes place on day 14, while follicle formation starts on day one when menstruation first starts. The developing antral follicle competes with other follicles for FSH and is dependent on it. The “dominant follicle or leading follicle” is the one that controls this process; all other follicles will atrophy. The “dominant” or antral follicles secrete oestrogen and inhibin, which have a negative feedback effect on FSH and “switch off” the antral follicles nearby. If the hypothalamic-pituitary-ovarian axis activity is properly regulated, the follicular release takes place in a cyclic manner about 14 days before menstruation. The purpose of the present study is to establish the average follicular size (measured in millimetres) on the trigger day most likely to result in ovulation, the day of the menstrual cycle on which hCG trigger was most frequently administered, the relationship between the average antral follicle count (AFC) and the age of the woman visiting the infertility centre, and the average growth rate of ovarian follicles. Methods: This study was conducted in the Department of Anatomy and Department of Reproductive Medicine, Indira Gandhi Institute of Medical Sciences, Patna from December, 2018 to May, 2020(18 months) and approved by the ethical committee of the institute. This was an observational and prospective study. 100 consecutive women undergoing ovulation induction between the ages of 19- 40 have been taken as subjects who attended the Reproductive Medicine at IGIMS for infertility treatment. Results: In a routine folliculometry we deducted the Leading mean follicular diameter has been found to be 17.56± 1.03 mm and 18.73± 1.38mm for the right and left ovaries respectively. Day 11th of the Menstrual Cycle was found to be the most common day for administering hCG trigger. A negative relationship has been established between AFC and Age in women and the Mean growth rate of Ovarian Follicles were 1.61±0.29 mm per day and 1.34±0.30 mm per day for right and left ovaries respectively. Conclusion: The hundred subjects of the reproductive age group 19 – 40 who visited our center in reproductive medicine, 40% were between the ages 28 – 31. Five patients were tested positive for Serum hCG indicating pregnancy. Hence, having a success rate of 5%.

97. A Case Series on Placenta Accreta Spectrum Disorder in DMCH, Bihar
Shikha Jha, Preeti Pushpam, Seema
Abstract
Following the trend of rising caesarean deliveries, the incidence of placenta accreta spectrum (PAS) is quickly rising globally. The diagnosis and treatment of PAS, a diverse illness with a high prevalence of maternal morbidity and mortality, present special difficulties. The biggest obstacles to gaining a thorough grasp of this syndrome up until now were its rarity, the dearth of high-caliber evidence, and the absence of a standardised method for reporting PAS cases for the ultrasonography, clinical, and pathologic diagnoses. The heterogeneity of the available epidemiological data on PAS has made it difficult to study the available management solutions for this ailment. This review’s objective is to offer a critical assessment of the current body of knowledge regarding PAS diseases’ screening, diagnosis, and treatment choices, with a particular emphasis on the difficulties we anticipate in the near future.

98. A Study of Changes in Keratometry Readings after Pterygium Excision Surgery
Madhavi K Malivad, Monali Sonawane, Nirav H. Zala, Hitesh Vyas
Abstract
Introduction: Pterygium is a very common degenerative condition of subconjunctival tissue that is associated with chronic ultraviolet rays (UV rays) exposure and its prevalence rates are higher in the tropics than in temperate climates with the equatorial countries having higher prevalence rates. It is also very common in India. Aims and Objectives: To study the changes in keratometry readings after pterygium excision surgery. Methods: Pre-operative measurement of pterygium extends over the cornea, which was measured on slit lamp. Pre-scrub peribulbar anaesthesia was given with 4cc 2% lignocaine, 2cc 0.5% bupivacaine and 250-unit hyaluronidase. Surgical excision of pterygium was carried out. And closure was done depending upon the size of the conjunctival defect either with bare sclera technique or conjunctival autograft with 10-0 ethilon suture technique. Complete post-operative follow up examination was done on 1st, 7th, 45th post-operative days. During this follow up, patient’s Visual Acuity, Best corrected visual acuity, Auto refraction and Auto keratometry readings was recorded. Surgery was done under expert supervision and in excellent infrastructure. Results: It was found that the maximum number of patients preoperatively has astigmatism ranging from 4.1 to 8 D (44%) and patients having astigmatism >12 D are 18%. The study also found that highest incidence of pterygium is seen in age group of 51-60 years while least incidence is found in age group of 71-80 years. Conclusion: The study concluded that pterygium leads to significant high corneal astigmatism and with increase of the size of pterygium encroaching on cornea, the extent of induced astigmatism increases.

99. Role of B-Scan Ultrasonography in Pre-Operative Mature and Hyper-Mature Cataracts
Madhavi K Malivad, Monali Sonawane, Saurabhkumar K Hirani, Hitesh Vyas
Abstract
Introduction: Ultrasonography is a crucial way of considering the posterior area in visions with unclear media and delivers a way for analyzing fundamental changes in the posterior part of the vision in people with transparent media. On B-scan ultrasonography, the most common observations of postsurgical lesions linked with perforating and blunt trauma, as well as absent trauma, were macular dislocation, retinal haemorrhage, intraocular parasitic organism, cancer, and vitreous isolation. In addition, ultrasound is a risk-free method that is also less expensive, more readily available and offers greater affordability (MRI). Its application has grown to include biometric measures, tissue characterisation, therapies for involved vitro-retinal diseases, and the importance of intraocular groups, among other things. Aims and Objectives: To evaluate the prevalence and nature of posterior segment pathologies detected by B-scan ultrasound in pre-operative mature and hypermature cataract patients and to study various patient risk factors that increase the likelihood of posterior segment pathology in predicting possible visual prognosis and to decide postoperative management. Methods: This study had been designed as cross-sectional observational study. Detailed ocular, systemic, family history will be taken. Preoperative evaluation were  recorded such as Visual acuity testing for distant vision using Snellen’s chart, anterior segment examination by using of slit lamp biomicroscopy, measurement of IOP with schiotz tonometer and Goldmann’s applanation tonometer after instilling paracaine eye drop and staining with fluorescein strip and B-scan examination. B-Scan results obtained according to the type of cataract, in various IOP status and ophthalmologic conditions. The required statistical analysis was carried out. Results: In this study shows that out of 120 patients studied 75 patients had normal B-scan findings followed by 15 patients with posterior vitreous detachment, 14 patients with vitreous degeneration, 9 patients with asteroid hyalosis, 4 patients with retinal detachment, 2 patients had posterior staphyloma and vitreous haemorrhage was noted in 1 patient. The chi-square statistic is 16.42. The p-value is .000051. The result is significant at p <0.05. The chi-square statistic is 16.5211. The p-value is .000048. The result is significant at p <0.05. Conclusion: The study concluded that B-scan is a reliable, safe, cheap, non-invasive and rapid investigation with no exposure to ionizing radiations. It is a quality diagnostic tool for real-time imaging and applicable in  evaluating the posterior segment in the presence of opaque ocular media in great detail and with great accuracy. It is the preferred screening modality in extraocular lesions also.

100. Does Left Ventricular Diastolic Dysfunction Predict Outcomes in Patients with Pre-Eclampsia
Sushmita Varshney, Seema Hakim, Raghav Bansal, Mohammad Azharuddin Malik, Preeti Yadav
Abstract
Background: Left ventricular diastolic dysfunction has been shown to be associated with pre-eclampsia. Whether presence of diastolic dysfunction acts as a prognostic marker for adverse maternal and fetal outcomes, remains unknown. Methods: This was a single centre prospective observational cohort study. 100 patients with pre-eclampsia presenting to the antenatal clinic were enrolled. Age and gestational age matched pregnant females were enrolled in the control group. All subjects received routine evaluation and standard of care in addition to transthoracic echocardiography for evaluation of diastolic dysfunction. Patients were followed up for outcomes of pregnancy and all the adverse events during follow-up were recorded. Results: 100 patients with mean age of 25.9 ± 4.0 years and mean gestational age of 36.2 ± 2.5 weeks were included in the study and control groups each. Left ventricular diastolic dysfunction was noted in 43 patients (43%) in the study group as compared to none in the control group. Severe pre-eclampsia was noted in 47 patients (47%). Adverse maternal and fetal outcomes were noted more frequently in the pre-eclampsia group as compared to the control group (44% vs 24%, p = 0.003; and 53% vs 25%, p < 0.001 respectively). Left ventricular diastolic dysfunction was not associated with any adverse maternal or fetal outcomes. However, features suggestive of pre-eclampsia predicted adverse maternal and fetal outcomes. Conclusion: In patients with pre-eclampsia, left ventricular diastolic dysfunction was found in 43% of the patients. Presence of left ventricular diastolic dysfunction did not predict adverse maternal or fetal outcomes.

101. Evaluation of Inhalational Procedures and the Most Frequent Mistakes Made by Patients with Bronchial Asthma who were Hospitalized in Tertiary Care Settings
Dimple Makhija, Anupama Arya, Shalabh Jauhari, Deen Dayal Verma
Abstract
Aim: The purpose of this study was to evaluate the proper use of inhalational procedures as well as the most frequent mistakes made by bronchial asthma patients. Methodology:This research was a cross-sectional examination, and it was carried out during the months of July 2021 and July 2022. Participants in the study were required to have a diagnosis of asthma and be receiving treatment with an inhaler. Those patients who attended the outpatient department of respiratory medicine and fulfilled the inclusion criteria were included. All of the participants were evaluated with the use of a pre-made questionnaire as well as a standardized check list, both of which were completed with the help of an interview-based methodology. Data were imported into Microsoft Excel 2010 before being analyzed using Epi Info 7.0 and SPSS 16.0 respectively. Calculations of appropriate frequencies, percentages, and proportions were carried out, in addition to any essential statistical examinations. The findings showed that there were 120 participants, 60 of whom were female, and 60 of whom were male. Additionally, 100 patients made use of dry powder inhalers (DPIs), and 20 patients, made use of metered-dose inhalers (MDIs). Of these, 80 patients exhibited improper technique, with 30 patients using DPI and 10 patients using MDI. The percentage of patients using DPI was 60 percent. In a group of 60 patients with poor clinical control, 50 patients with inappropriate technique had asthma that was either partly managed or not controlled at all. In spite of the fact that there are right recommendations available, improper inhaler technique continues to be the primary cause responsible for inadequate asthma control and low compliance rates.

102. Role of Chest Radiography as the Imaging Tool in COVID Pandemic Era
Jagrit Bansal, Boddeda Sarath Chandra, Prashant Sinha, Mohit Choudhary, Aakriti Hans, (Col) P.K Tiwari, Roopak Dubey
Abstract
Background: The present radiological COVID literature is mainly confined to the CT findings. Using High Resolution Computed tomography (HRCT) as a regular 1st line investigation put a large burden on radiology department and constitute a huge challenge for the infection control in CT suite. Materials and Methods: A prospective study of 700 consecutive COVID positive cases who underwent Chest Xray (CXR) and HRCT thorax were included in the study. Many of these CXR were repeated and followed up over a duration of time to see the progression of disease. Results: 392/700 (56%) were found to be negative for radiological thoracic involvement. 147/700 (21%) COVID positive patients showed lung consolidations, 115/700 (16.5%) presented with GGO, 40/700 (5.7%) with nodules and 42/700 (6%) with reticular–nodular opacities. 150/700 patients (21.4 %) had mild findings with total RALE severity score of 1-2. More extensive involvement was seen in 104/700 (14.8 %) and 43/700 (6.2%) patients, who had severity scores of 3-4 and 5-6 respectively. 11/700 patients had a severity score of >6 on their baseline CXR. Those with severity score of 5 or more than 5 (54/700, 7.7%) required aggressive treatment with mean duration of stay of 14 days, many of them died also (23/54, 42.5%). Conclusion: In cases of high clinical suspicion for COVID-19, a positive CXR may obviate the need for CT. Additionally, CXR utilization for early disease detection and followup may also play a vital role in areas around the world with limited access to CT and RT-PCR test.

103. Tailored Lateral Sphincterectomy versus Conventional Lateral Sphincterectomy in the Management of Chronic Anal Fissures – A Comparative Study
Shailendra, Bal Singh
Abstract
Background: Chronic fissure in ano is a distal anal mucosal tear that require surgical correction. Lateral internal sphincterectomy is considered as gold standard technique with high recovery rate and have transient incontinence and recurrence drawbacks. The present study was designed to assess the efficacy of tailored lateral sphincterectomy and conventional lateral sphincterectomy in the management of chronic anal fissures. Material and Methods: Fifty-two clinically diagnosed cases of chronic fissure in ano above 21 years of age were recruited. Cases were randomly divided into two groups. Group 1 treated with tailored sphincterectomy and group 2 with conventional lateral internal sphincterectomy. Cases were followed for two weeks and assessed the bleeding per-rectum, pain score, fecal incontinence, and flatus incontinence. Results: The mean pain score in tailored group was 5.3 on 1st day, 3.0 on 3rd day and 1.3 on 5th day, whereas in group 2, pain scores were 5.4, 3.1, 1.5 on 1st, 3rd, and 5th day respectively. Fecal incontinence (5 in conventional & none in tailored), flatus incontinence (1 in conventional & none in tailored), fecal soiling (1 in tailored & 2 in conventional), and recurrence (1 in tailored and 5 in conventional) was observed and the difference of fecal incontinence (p<0.001), flatus incontinence (p=0.0204) and recurrence (p=0.0368) was statistically significant. Conclusion: Tailored lateral sphincterectomy is an effective treatment choice for the chronic fissure in ano than conventional lateral sphincterectomy in terms of low fecal and flatus incontinence and recurrence rate.

104. A Retrospective Study on the Use of Colour Doppler Ultrasound in High-Risk Pregnancies
Poonam Mehrotra, Pankaj Mehrotra
Abstract
Background: High-risk pregnancy is linked to a number of negative perinatal outcomes. Doppler ultrasound is a non-invasive approach to examine foetal and mother blood flow and direct therapeutic treatment. Objective: The goal of this study is to better understand how Color Doppler Ultrasonography can be used to manage high-risk pregnancies. Methods: The Department of Radiology conducted a retrospective record-based study. In the study, records of antenatal women between the ages of 20 and 30 who had singleton pregnancies lasting from 26 weeks to term and had one or more high-risk characteristics were included. The risk factors taken into account include diabetes, anaemia, oligohydramnios, and pregnancy-induced hypertension (PIH). The umbilical artery underwent a Doppler investigation. The analytical programme utilised was Epi-info 7. Results: A total of 140 cases were examined. The age range of 20 to 25 years was the one in which high-risk pregnancies were most prevalent. With 50% of cases, PIH was the most prevalent high-risk factor in pregnancy. 40 cases out of 140 high-risk pregnancies had intrauterine growth restriction (IUGR). Umbilical artery results were abnormal in 43% of patients. In high-risk pregnancies, colour doppler can be the most useful tool for monitoring the foetus. The most significant benefit is that it directs early intervention and enhances foetal outcome.

105. To Evaluate the Modified Alvarado Score in Patients with Acute Appendicitis
Anil Kumar Sharma, Pranay Dixit, Manisha Singh, Rajesh Prajapati
Abstract
Background: Appendicitis has been one of the most widely studied and researched about topic since the early years. Even after elapse of more than 120 years since its first description this common surgical disease continues to remain a diagnostic problem and can baffle best of the clinician. There is nausea but vomiting more than twice is rare. A low grade pyrexia and constipation is usual. An alternative outcome is that the appendix becomes surrounded by a mass of omentum or adjacent viscera which walls off the inflammatory process and prevents inflammation spreading to the abdominal cavity yet resolution of the condition is delayed. Aim: To Evaluate the Modified Alvarado Score in patients with acute appendicitis in J.A. Group of Hospitals with respect to sensitivity, specificity, positive predictive value and negative predictive value and diagnostic accuracy. Methods: After approval from ethical committee this study was done on over 100 patients of acute appendicitis admitted in Surgery Department, J. A. Group of hospitals & G. R. Medical College Gwalior who have consented to participate in the study we enrolled the patients for this study from Dec. 2017 to Aug. 2019. With clinical suspicion of acute appendicitis, admitted from outpatient department and emergency in ward giving consent for participating in the study in Surgery Department, J.A. Group of Hospital during the study period. Results: For the study, there were 100 patients considered from different age groups. The study has involved the patients from the age of 7 to 79 years. Moreover, the study has involved both male and female patients for carrying the study. Here, the percentage of male patient was 70% and female was 30%. The maximum incidence was in age group of 21 to 30 years. According to analysis of the diagnostic test results positive results were found among the 72 patients and 16 patients were found to be true negative. Their appendices were subjected to histopathological examination and 80(85.1%) were confirmed having acute appendicitis. The sensitivity of system was calculated as 90% and specificity 80%, with a positive predictive value of 94.3% and negative predictive value of 66.6%. The Commonest presenting symptom was pain in right iliac fossa (96%), followed by nausea / vomiting (88%) and, fever (85%). Conclusion: The modified Alvarado scoring system is a good diagnostic indicator tool for acute appendicitis. It is highly sensitive in diagnosing acute appendicitis. A cut off point of 7 for diagnosis of acute appendicitis, it can be used to improve diagnostic accuracy of acute appendicitis and subsequently reduce the negative appendicectomy.  Modified Alvarado score >7 sensitivity is very high and score <7 sensitivity of Modified Alvarado score is decreased.

106. Obesity – A Pandemic in 21st Centuary
Sanket Kumar Mohanty, Bharati Misra, Sairindri Sahoo, Rajashree Sahoo
Abstract
Introduction: Obesity among fertile women is reaching epidemic proportions. Mothers who are overweight or obese during pregnancy and childbirth are known to be at risk of significant antenatal, intrapartum, postpartum and neonatal complications. So the aim of the current study was to evaluate the effect of obesity on the maternal and perinatal outcomes in pregnancies complicated by obesity. Material and Methods: It is a prospective observational study conducted over 100 cases in Department of O & G of MKCG MCH, Berhampur from October 2019 to September 2021.The mode and duration of delivery along with the antepartum, intrapartum and postpartum complications were recorded. Results: The mean BMI was 30±3.53 with a statistically significant association was observed with maternal weight gain in pregnancy, associated with preterm labour, induced labour, increased rates of caesarean section and prolonged hospital stay indicating that maternal obesity is a major risk factor for antepartum, intra-partum and postpartum complications. An increased risk of hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM), pre-eclampsia, induction of labour, caesarean section, postpartum complications like wound infection, atonic PPH (post-partum hemorrhage), the longer length of maternal stay in hospital and preterm birth were observed among obese subjects. Conclusion: Pregnancy complications related to maternal BMI is a growing problem. Maternal obesity is a risk factor for gestational diabetes, preeclampsia, labor induction, cesarean for fetal distress and wound infection.

107. Variation of Intraocular Pressure in Relation to Age and Gender: A Hospital Based Observational Study
Ajay Kumar, Ramakant Thakur, Rajiv Kumar
Abstract
Objectives: This present study was to evaluate the variation of intraocular pressure in relation to age and gender in Muzaffarpur district of Bihar. Methods: A total of 200 subjects with age group 20 to >60 years were enrolled in this study. IOP was measured in both the eyes using the Goldmann Applanation Tonometer. Results: A total of 100 males and 100 females with age group 20 to >60 years were enrolled in this study. Majorities of subjects 84(42%) were in age group of >50 years. when we compared the mean ± standard deviation of male and female in age group of 51-60 years and >60 years respectively. P-value was found to be less than 0.05, which is statistically significant. Similarly, when we performed the gender wise comparison of mean ± standard deviation of intraocular pressure, then p-value was found to be <0.0001, which is highly statistically significant. Conclusions: Mean of intraocular pressure is significantly greater in females than males. And intraocular pressure is significantly decreasing with increasing age but more decreasing in males as compared to females.

108. Feature Optimization and Breast Cancer Classification using Machine Learning Algorithms
Amit Tak, Puran Mal Parihar, Shikha Mathur, Pranshu Sharma
Abstract
Background: Breast cancer is the world’s most prevalent cancer in females. Statistical models and machine learning (ML) algorithms have been proposed to predict breast cancer. The present study used ML classifiers to classify breast tumors into ‘benign’ and ‘malignant.’ Materials and Methods: The study dataset consists of a random sample of medical records of 569 breast cancer patients. The dataset is publicly available on the Machine Learning Repository website of the University of California Irvine (UCI ML). Thirty features are extracted from a digitized image of cell nuclei obtained from fine needle aspiration cytology of breast tumor. The response variables were ‘benign’ or ‘malignant.’  Predictors differed significantly in biostatistical tests and contributed significantly to the logistic regression model were used to train ML classifiers on MATLAB classifier application. The performance metrics of the machine learning classifier were expressed as accuracy, the area under the receiver operator characteristic (AU-ROC) curve, sensitivity, and specificity. Results: The predictors that contributed significantly to the logistic model include perimeter worst, smoothness worst, texture worst, radius se, symmetry worst, compactness se, and concavity mean. These predictors were used to train various Machine learning classifiers. The logistic regression model showed the best performance. The accuracy, AU-ROC, sensitivity, and specificity were 97.2%, 99%, 98%, and 96%, respectively. Conclusion: There was a striking improvement in the accuracy of classification of breast cancer achieved with ML algorithms compared to the state-of-the-art model-based approaches.

109. Occurrence and Analysis of Needle Stick Injuries among Health-Care Workers in a Tertiary Care Hospital
Anusuya Devi D., Latha Roy S., Atiya Kausar, Sharadadevi Mannur Y.
Abstract
Background: Needle stick injuries (NSIs) are the major occupational hazards among health care workers (HCWs). Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV) are the most common blood borne viruses (BBVs) that are transmitted by NSIs. The present study was conducted to know the prevalence and factors responsible for the NSIs. Objectives: To know the occurrence of NSIs among Health care workers. To know the risk factors and analysis of NSIs. Materials and Methods: As a routine practice, we have needle stick injury reporting form to all self-reporting health care workers. The exposed HCWs were asked to fill up a questionnaire. The Infection control nurse then follows up with the HCW regarding the required blood investigations and post exposure prophylaxis to be given. Results: Between December 2019 and January 2021, 56 NSIs were reported. Staff nurses reported the maximum injuries 32 (57.1%) followed by doctors 11 (19.6%). Injuries were commonly seen from emergency and ICU. Almost 20 (35.7%) of the percutaneous injuries occurred during giving injections and during IV cannulation. Recapping and detachment of the needle after use were responsible for 08 injuries (14.2%) only. Conclusion: Our study showed that the overall incidence of NSIs were decreased. Improved training, greater use of safety devices, increased education and awareness may have led to decrease in NSIs incidence.

110. Evaluation of Histopathological Reports of Abnormal Uterine Bleeding in Women at Tertiary Care Centre
C. Rekha, Meera Rajagopal, Dheeravath Kanya Kumari
Abstract
Background: Abnormal uterine bleeding (AUB) which is a significant clinical entity and its subgroup, heavy menstrual bleeding (HMB), are common conditions having a significant impact on the physical, social, emotional and/or material quality of life of the affected 14–25% of women of reproductive age. Aim of the Study: To evaluate histopathological reports of abnormal uterine bleeding in women at tertiary care centres. Methodology: The retrospective cohort study was carried out from June 2020 to June 2022 in the Department of Obstetrics and Gynecology at a tertiary medical teaching hospital at Mediciti Institute of Medical Sciences, Medchal. Medical records of 100 cases of AUB were retrieved. A detailed history was taken and investigations were carried out. Results: The age group of 36-50 years was commonly associated with AUB. Maximum no. of women 45 cases were para 2 (45 %) while 4 cases (4 %) were nulliparous, 1 case (1 %) was para 1, other 37 women were para 3 and the remaining 10 women were para 4 or more. Management was done by medical and surgical approaches for these women. D and C alone or D and C followed by hysterectomy was the surgical approach. Majorly 82 cases (82 %) were associated with secretory endometrium on histopathology and 18 (18 %) cases were associated with the proliferative type of endometrium. Conclusion: The majority of endometrium was revealed by histopathology in the secretory phase and hysterectomy remained the commonest method of intervention.

111.  A Retrospective Study on Deliveries Complicated by Meconium-Stained Amniotic Fluid
Thanku Thomas Koshy, Lalithambica Karunakaran, Shijini T.
Abstract
Background: Meconium is a viscid olive-green substance formed in the fetal gastrointestinal tract that consists of denuded intestinal epithelium, fetal lanugo hair, ingested amniotic fluid, mucus, digestive enzymes, bile acid and water. The significance of meconium passage in utero ranges from being a sign of normal maturation of the fetal gastrointestinal tract to a sign of fetal distress, associated with adverse perinatal outcomes including poor APGAR (Appearance, Pulse rate, Grimace, Activity, and Respiratory rate) scores, increased NICU (Neonatal intensive care unit) admissions, and a high rate of perinatal mortality due to meconium aspiration syndrome (MAS). Objectives: To find out the proportion of deliveries complicated by MSAF (Meconium staining of amniotic fluid) in Government T.D. Medical College, Alappuzha during the period January 2018 to December 2019, and to find out the various fetal and maternal factors associated with deliveries complicated with MSAF during the same period. Methods: The study is a descriptive retrospective record-based study conducted in the Government T.D. Medical College, Alappuzha during the period January 2018 to December 2019. Approval from Institutional Research Committee and Ethical Review Board were taken before the study. Data was collected using a pretested structured proforma. The data were entered in Microsoft Excel sheet and analysed using SPSS 16 statistical software. Results: Out of a total of 4496 deliveries, 187(4.15%) mothers had meconium staining of amniotic fluid during the study. The mean gestational age was 37.8±1.6. 58.8% of the mothers had grade 2 meconium-stained liquor, 27.8% mothers had grade 1 meconium-stained liquor and 13.4% mothers had grade 3 meconium staining. Majority (60.4%) of the patients were primigravidas. Maximum patients (67.9%) belonged to 38 to 40 weeks of gestational age group. 44.4% of the patients had an overweight range of BMI. Thyroid disorders (13.9%) stood in the forefront of maternal medical disorders. 15 % of patients had gestational diabetes mellitus and 11.8% had gestational hypertension. Intrapartum maternal pyrexia was seen in 8.6% of patients. Among the fetal complications, majority of the babies (26.7%) had fetal growth restriction. 61.5% of mothers had a spontaneous onset of labour. Out of the induced patients, 86.1% had induction with prostaglandin E1. 65.8 % of mothers had a cesarean delivery. 8.6% of the patients had puerperal pyrexia and 8.6% had postpartum hemorrhage in the postpartum period. None of the babies with grade 1 meconium had an APGAR score less than 7 at 1`. 94.5% cases with grade 2 meconium and 88% cases with grade 3 meconium had an APGAR score more than 7 at 1’. All 4 cases of neonatal death had grade 3 meconium-stained liquor. Conclusion: Majority of cases in our study belonged to grade 2 meconium staining of amniotic fluid. Most of the patients belonged to the 38 – 40-week gestational age group. Among those induced, maximum number of patients were induced with prostaglandin E1 (86.1%). Among the fetal complications, fetal growth restriction was seen in majority of cases (26.7%). Thyroid disorders is the most common maternal medical disorder seen (13.9%). All the 4 cases of neonatal death were seen in the grade 3 meconium group.

112. Evaluation of PM-JAY Health Insurance Scheme Services Utilization by Eligible Families of Visnagar Taluka, Mehsana District, Gujarat
Vijay Pandya, Bhargav Dave, Billav Rojasara, Nikhilkumar J. Patel
Abstract
Introduction: Ayushman Bharat Yojana, also known as the Pradhan Mantri Jan Arogya Yojana (PMJAY), is a scheme that aims to help economically vulnerable Indians who are in need of health care facilities. Scheme was launched in 2018 and covers 50 crore citizens in India. It is claimed to be largest government funded health scheme globally. After its launch around 3 years has passed and not any concrete evaluation data of this scheme is available for Gujarat. So, Evaluation of this scheme from beneficiary perspective will help Government to make it more accessible to families, to know the hurdles faced by families to get benefits of scheme and for better implementation of scheme. Objectives of the study: 1. To know knowledge and awareness about components of PM-JAY scheme to its beneficiaries. 2. To know utilization rate of PM-JAY scheme by beneficiaries  3.To know Out of Pocket Expenditure (OOPE) of families who have utilized PM-JAY scheme 4. To know reasons/ hurdles for not utilizing benefits of the scheme. Basic procedures and methodology: A Cross sectional study was conducted with stratified random sampling and according to Probability Proportion to Size of Visnagar Taluka by this way 118 families from Visnagar Urban and 240 Families from Visnagar Rural were selected and total sample size covered was 358 families. Hospitalization data of last one year was inquired and questions were asked to beneficiary families. Important findings: Coverage rate of PM-JAY scheme was 82.6%. Families don’t know whether a particular medical condition was covered under PM-JAY scheme, was the commonest reason for Non-utilization of the scheme. Problems at registration/ Initial phase in healthcare facilities, financial expenditure on medicines, follow up related problems and wage loss related problems were the commonest problems faced by the PM-JAY Yojana beneficiaries. Principal conclusions: Out of Pocket Expenditure (OOPE) on outside medicines and other things purchase from patient side should be decreased.  Special attention should be provided on patients wedge loss.

113. Association of Serum Calcium and Serum Magnesium in Gestational Hypertension and Pre-Eclampsia: A Case-Control Study
Shashi Prabha Sinha, Amit Kumar Ambasta, Seema, Sangeeta Singh
Abstract
Aim: The aim of the present study was to evaluate the association of serum calcium and serum magnesium in gestational hypertension and pre-eclampsia. Methods: The study was conducted in the Department of Obstetrics and Gynecology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for 1 year. We conducted a prospective observational case control study. We enrolled 50 pregnant women in their third trimester in the age group of 18-35 years. 25 women were classified as cases based on the development of hypertension for the first-time during pregnancy and 25 were taken as normotensive controls. The serum calcium and magnesium level were estimated in each patient. Results: The mean serum calcium level in the cases was 8.32±0.58 mg/dl and 8.95±0.45 mg/dl in the controls. Comparison of the serum calcium (mg/dL) between the two groups shows that serum calcium (mg/dL) is higher in control group with a t value of 4.450and is statistically significant with a p value of <0.001. The mean serum magnesium level in the cases was 1.66±0.34 and in the controls was 1.80±0.20. Comparison of the serum magnesium(mg/dL) between the two groups shows that serum magnesium(mg/dL) is higher in Control group with a t value of 4.249 and is statistically significant with a p value of <0.001. The correlation between the systolic blood pressure (mmHg) & serum calcium (mg/dL) shows a negative correlation, and is not significant with a t value -0.350 and with a p value of 0.050. The correlation between the systolic blood pressure (mmHg) & serum magnesium (mg/dL) shows a strong negative correlation, and is significant with a p value of 0.015. Conclusion: Our study shows that both serum calcium and serum magnesium were significantly lower in pregnant women with hypertension when compared with normal pregnant women. Thus, intake of supplements of these trace elements may help in the reduction of incidence of hypertension in pregnancy especially in a population of the developing countries where the nutrition of the average woman is poor.

114. A Hospital-Based Assessment of the Anemia Profile: An Observational Assessment
Rashmi Kumari, Ganesh Prasad Singh, Kumar Amar Dip Narayan
Abstract
Aim: The aim of the present study was to determine the clinical and laboratory profile of anemia among patients admitted to the tertiary hospital in Bihar. Methods: This study was a hospital based prospective observational study undertaken in the Department of Medicine, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. Fifty patients with anemia were included in the study. Duration of the study was one year. Results: Easy fatiguability and generalized weakness were the most common symptoms of anemia in our study. Incidentally detected patients constituted 12% of patients and were the second most common in occurrence. This was followed by breathlessness seen in 20% of patients. On systemic examination haemic murmurs on CVS examination were detected among 12 patients. Bibasilar crepts not attributable to other diseases were found among 3 patients. Isolated hepatomegaly was found in 8, splenomegaly in 2 and hepatosplenomegaly was found in 3 patients. Conclusion: The most common aetiology of anemia in patients enrolled was iron deficiency, followed by anemia of chronic disease and malignancy, both hematological and non-hematological. The most commonly encountered complaints on presentation in general were subjective non-specific ones such as weakness, fatigue and lassitude whereas in females it was per vaginal bleeding.

115. Global Strategic Business Management on Healthcare Administration and Operations – A Comprehensive Framework for Decision Makers of the Healthcare Industry
Sunil K Adepu, Kevin T Cherian, Maqhawe Malinger, Ramya Surapaneni, Srikanth Sangoju, Vikram Aditya Boorla, Sandeep Kumar Yadav
Abstract
Healthcare is a system that is constantly evolving, with development moving relatively, quickly and new procedures being created almost constantly. The deployment of new management tactics, such as downsizing, fee-for-service, managed healthcare capitation system, etc., is a result of efforts to lower the cost of healthcare. Every institution is accountable for providing healthcare to ensure the well-being of its most valuable resources: the people. New medical techniques, medical equipment, medications, and diagnostic methods are all examples of advancements in the medical field. New standards of care, which are revised yearly to reflect changes in the healthcare system, have also been developed to match the enormous advancements in healthcare. A dynamic system is needed to govern the healthcare industry because it is a dynamic system that is always evolving. Most healthcare use is not intentional or impulsive. In fact, utilization is usually postponed until a pressing need arises. People don’t decide to get a bypass operation when they first wake up. The purpose of quality management is to ensure the delivery of high-quality services, reduce or eliminate avoidable negative consequences, maximize resource utilization, improve processes with the cooperation of all parties involved, and reduce waste related to improper usage of services. The strategy begins with the organizational leadership vision and values statement, then moves on to the establishment of goals and the creation of a strategy for putting these goals into action. In general, the corporate hospitals have adopted a strategic management system and organizing structure, which has resulted in a strategic plan with metrics. It has made it possible to establish formal and quantifiable connections across a wide range of internal business operations, including the yearly operational plan, choices about how to allocate resources, the balanced scorecard, and employee performance.
The Strategic- Management System- (SMS) aligns organizational- planning and- performance measurement and facilitates an- appropriate.

116. Drug Utilization Study in Type 2 Diabetic Patients Attending Clinic of Tertiary Care Hospital Rajasthan
Mayur Gandhi, Sunil Kumar Goyal, Dherendra Sharma, Archana Jain
Abstract
Background: Diabetes has gradually emerged as one of the most serious public health problems in our country. To focus and manage effectively, the illumination of current knowledge about the pattern of anti-diabetic drug utilization is important. As a result, it is necessary to evaluate the pattern of anti-diabetic medication use among diabetes patients determine if there is room for improvement in light of current knowledge. Aim: To evaluate the drug utilization pattern of oral anti-diabetic drugs in type 2 diabetic patients in a tertiary care hospital. Materials and Methods:  Observational cross sectional study conducted in Department of Pharmacology in association with Department of Endocrinology of Maharana Bhupal Hospital Udaipur, 300 patients were included. Patients with type 2 DM and age above 25 years were included in this study. Results: Maximum patients (116, 38.7%) received 3 antidiabetic drugs while 30.0% patients received 2. 70.42%% of patients who had more than 5 years of duration of diabetes have taken 3 or more different drugs while 57.59% of patients with less than 5 years of duration of diabetes taken 3 or more drugs. Among the antidiabetic, Biguanides were the most commonly prescribed drugs followed by Sulphonylureas. PDD: DDD ratio was ranged between 0.314-2.13 with Gliclazide having maximum ratio (2.13) followed by Glimepiride (1.695) Conclusion: Metformin was most commonly prescribed antidiabetic drug followed by Glimepiride, majority of patients had taken 3 antidiabetic drug combination.

117. A Study of Rives-Stoppa Retromuscular Mesh Repair for Incisional Hernia
Khalid Muqueem, Sushilkumar, Kasa Somasekhar
Abstract
Background: Incisional hernia is an important source of morbidity following abdominal surgery, more commonly in the middle-aged females. It is the only hernia which is truly iatrogenic. It can be repaired using anatomical, mesh or laparoscopic methods. Despite potential advantages of Rives-Stoppa retromuscular mesh repair when compared to other commonly done hernia repairs, not many systematic studies have been done in this part of country. Hence, this study analyses the various etiological factors of Incisional hernia and complications and outcome after hernia repair using Rives-Stoppa retromuscular mesh repair. Materials and Methods: This was a hospital based prospective study conducted among 30 patients with incisional hernia, who presented to Department of Surgery at Vijayanagar Institute of Medical Sciences, Ballari, from January 2020 to September 2021. Patients were subjected to mesh repair by using Rives-Stoppa retromuscular mesh repair technique. Clearance was obtained from Institutional Ethics Committee. Written informed consent was obtained from the study participants. Results: The incidence was more common in females, who underwent gynaecological procedures by lower and midline incisions. It was found to be more common in the age group of 50 – 60 years. Predominant risk factors were midline infra-umbilical incision multi-parity, obesity, occupation with strenuous work, chronic cough and smoking. Most common presenting complaint was swelling over the previous surgical scar. Majority of hernias have occurred within 2 years of previous surgery. The postoperative complications noted were mainly seroma formation. Patients had good compliance with Rives-Stoppa retromuscular mesh repair technique, with less incidence of post-operative pain complications, good recovery, and no recurrence in our study. Conclusion: Rives-Stoppa retromuscular mesh repair for incisional hernia provides good strength to the abdominal wall. Patient had good compliance, less post-operative pain, less complications, and no recurrence.

118. To Analyze the Patterns of Pelvic and Para-Aortic Lymph Node Involvement among Patients with Early Endometrial Cancers: An Observational Study
Amit Kumar
Abstract
Aim: The aim of the present study was to analyze the patterns of pelvic and para-aortic lymph node involvement among our patients with early endometrial cancers. Methods: All patients with stage I endometrial cancer (clinical and radiological) who had undergone surgical staging at Bihar cancer surgical Hospital, Malahi pakri chowk, Patna, Bihar, India were included in the study. A total of 100 patients were included in the study. Surgical and pathological data of these patients were collected and analysed retrospectively. Results: Mean age of the patients was 55 years (25–75 years). Endometrioid carcinoma was the commonest histological type (82 patients, 82%).  Majority of patients (55 pts, 55%) had low-grade disease (endometrioid carcinoma grades 1 and 2) and 45 (45%) had high-grade disease (included endometrioid carcinoma grade 3, clear cell carcinoma, uterine papillary serous carcinoma and adenosquamous carcinoma). Among the patients with > 50% myometrial invasion, lymph node involvement was noted in 10 (20%) and in patient with < 50% myometrial infiltration, lymph node involvement was 7.5% (3/40) (P value 0.001). Among 90 patients without peritoneal disease, 16.66% (15 patients) had lymph node metastasis, whereas among 10 patients with peritoneal disease, 50% (5/10) had lymph node metastasis (P value 0.05). Isolated para-aortic lymph nodal metastases were noted in 4. Conclusion: The result of STATEC (Selective Targeting of Adjuvant Therapy for Endometrial Cancer) may give a final answer regarding therapeutic benefit of lymphadenectomy in early endometrial cancer.

119. Assessment of the Risk Factors of Not Regaining to the Pre-Fracture Mobility Level after Hip Fracture Surgery in Elderly Patients
Pankaj Kumar
Abstract
Aim: To evaluate the functional recovery at six months postoperatively in elderly patients with hip fractures and to determine the risks of not regaining to the pre-fracture mobility level. Methods: The present study was conducted in the Department of Orthopaedics, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India, 240 consecutive patients over the age of 65 who were admitted to the hospital with hip fractures for six year were examined. Results: 120 (60%) of the patients were female and 80 (340%) were male, with a mean age of 78.8±9.4 years. There were 150 (75%) intertrochanteric fractures and 50 (25%) femoral neck fractures. 100 (50%) patients underwent proximal femoral nail (PFN), 80 (40%) patients underwent hemiarthroplasty, 12 (6%) patients underwent dynamic hip screw (DHS) and 8 (4%) patients underwent total hip arthroplasty. In the analysis performed to determine the level of mobility, it was found that 160 (80%) patients moved without the use of an aid and 40 (20%) patients moved with the use of an aid in the pre-fracture period. Conclusion: Advanced age, high ASA score, cardiovascular disease or malignancy among comorbidities, intertrochanteric fracture as fracture type, and use of PFN as implant type were the main risk factors for not regaining to pre-fracture mobility and ADL.

120. A Retrospective Assessment of the Complication Profile after Pterygium Excision, in Primary and Recurrent Pterygia
Rajesh Kumar Singh, Binod Kumar, Gopal Prasad Singh
Abstract
Aim: The aim of the present study was to analyze of complication profile after pterygium excision, in primary and recurrent pterygia. Methods: The present study was conducted in the Department of Ophthalmology,SKMCH, Muzaffarpur, Bihar, India. A total of 2200 eyes in 2000 patients were included in the study. Patients who had undergone (a) Conjunctival auto grafting for primary pterygium (CAG) (b) Conjunctival Limbal auto grafting for recurrent pterygium (CLAG), (c) Vertical split conjunctival auto grafting (VsCAG) for double head pterygium (primary) were included in the study. Results: Of 2200 cases, 2000 patients were included in the study, and these patients were retrospectively analyzed. 2000 patients had primary pterygium (1800 eyes had single head pterygium, 200 cases had double-head pterygium), 200 cases had recurrent pterygium. 1700 patients had unilateral pterygium; 300 patients had bilateral pterygium. Out of 2028 patients, 900 patients were male and 1100 patients were female. The follow-up period ranged from 6 months to 75 months, with an average of 17 months. Patients with less than 6 months of follow-up were excluded from the study. Conclusion: Various complications can occur post pterygium surgery. Selecting a proper procedure for a particular type of pterygium with a proper graft fixation technique will improve the outcome with minimal complications.

121. Analysis of Various Intraocular Lens Power Calculation Formulae to Achieve Emmetropia Following Cataract Surgery by Phacoemulsification: A Comparative Analysis
Saket Bihari Choudhary
Abstract
Aim: The aim of the present study was comparative analysis of various intraocular lens power calculation formulae to achieve emmetropia following Cataract surgery by phacoemulsification. Methods: After obtaining clearance from ethical committee of the institute, the study was conducted in the Department of Ophthalmology, Darbhanga Medical College and Hospital, Darbhanga, Bihar. All patients undergoing cataract surgery by PKE in this centre were taken and an IOL power calculation was done using Zeiss IOL master utilising parameters; AXL, anterior chamber depth, keratometry and lens thickness. 40 Patients were randomly assigned to 4 groups each were underwent PKE with IOL implantation by a single surgeon using one of the 4 formulae. Results: We found in our study a total of 160 eyes were studied and subdivided into 4 groups as per IOL Formulae were taken for the study. 40 Patients were randomly assigned to 4 groups each were underwent PKE with IOL implantation by a single surgeon using one of the 4 formulae. In our study distribution of mean AL in the groups was statistically significant (p=0.0099). Distribution of mean residual SRE with in the groups was statistically significant (p<0.0001). It was found that difference of mean small eye and normal eye with in groups was statistically significant but difference of mean large eye with in groups was not statistically significant. Conclusion: We found that aver all in all eyes Hoffers Q Formula is coming as most accurate. In Small eyes as well as in Normal eyes Hoffer Q IOL formula is most accurate followed by Holladay formula, SRK-T formula and Haigis formula and In case of Large eyes Holladay formula is coming better followed by Hoffer Q, Haigis and SRK-T formula.

122. 1-Year Hospital-Based Study to Assess the Effect of Visual Stimuli on Heart Rate Variability in Middle Aged Males
Sanjay Kumar
Abstract
Aim: The aim of the present study was to test the effect of visual stimuli on HRV in middle aged male. Methods: The present 1-year study was conducted in the Department of Physiology, Patna Medical College and Hospital, Patna, Bihar, India for one year. Healthy 100 males of middle age group of 40-60 years were included in the study. Results: This study signifies that closing eyes for a while might help heart by increasing the parasympathetic component of the cardiac autonomic activity and the parasympathetic component of the cardiac autonomic activity increased during the closed eye condition when compared to the open eye condition. The mean value of HF nu for under CEC was significantly greater (<0.05 level) when compared to OEC. The values of LF nu and LF/HF under CEC appear to be smaller than those OEC. Conclusion: When compared to the open eye condition, when the eyes are closed state of the eyes. Closing your eyes for a few moments could benefit your heart by enhancing the parasympathetic component of cardiac autonomic activity.

123. An Evaluation of the Various Factors Affecting Medication Adherence in Diabetes Mellitus Patients: Observational Study
Shatrughan Kumar, MD.Tarique Anwar
Abstract
Aim: The aim of the present study was to find out the modifiable risk factors which are responsible for the non- adherence among the diabetes population. Methods: The present study was conducted in the Department of Medicine, Sadar Hospital, Motihari, Bihar, India for the period of 5 months. 400 patients were included in the study. Responses were recorded using a detailed questionnaire consisting of 25 questions. Responses were recorded in terms of Yes or No along with the basic demographic details. Results: Of the 400 patients, majority were T2DM patients 380 (95%) followed by T1DM 10 (2.5%). Only 70 (17.5%) patients had family history of diabetes. Majority of the patients were illiterate 100 (25%) followed by 90 (22.5%) patients who were graduate. Majority of the patients were married 360 (90%), were businessman 110 (27.5%) and had monthly income between 5001 to15000 rupees 90 (22.5%). Majority of the patients were on oral antidiabetic medications 300 (75%) followed by Ayurvedic plus Oral Antidiabetic medication 80 (20%). Only, 20 (5%) patients were on insulins. Conclusion: For effective diabetes management medication adherence plays a very important role. Authors found a low level of medication adherence among the study population. This finding highlights the importance of improving the physician’s approach on the modifiable risk factors on individual basis. However, it is the patients and their family who play a vital role in the diabetes management.

124. Descriptive Assessment of the Clinic-Epidemiological Factors among Thyroid Dysfunction (TD) Patients Diagnosed with Metabolic Syndrome (Mets)
MD. Tarique Anwar, Shatrughan Kumar
Abstract
Aim: The aim of the present study was to assess the prevalence and clinical and epidemiological factors of thyroid dysfunction (TD) patients diagnosed with metabolic syndrome (MetS). Methods: The study was conducted in the Department of Medicine, Sadar Hospital, Motihari, Bihar, India for nine months In this study, we had enrolled 400 patients with MetS. The study was conducted in accordance with the principles of the Declaration of Helsinki, International Council on Harmonization Good Clinical Practice (ICH GCP) guidelines, and Indian regulatory guidelines (Indian Council of Medical Research and Indian GCP guidelines). Results: In this study, we had enrolled 400 patients with MetS. The baseline demographic characteristics of these patients are shown. Of all the enrolled patients, 120 (30%; 95% CI: 23.83-32.32) were diagnosed with TD (mean age (SD): 47.9 (10.96) years; mean BMI: 30 ± 4 94 kg/m2), with a higher prevalence among women compared to men (91 (75%) vs. 30 (25%)).  Of the 400 MetS patients, overt hypothyroidism was reported in 78 (19.5%) patients and overt hyperthyroidism in 8 (2%) patients. Conclusion: The prevalence of TD in patients with MetS was high, indicating a possible interplay between thyroid status and MetS.. The data generated from the present study will aid in establishing a correlation between TD and MetS in Indian patients. This early diagnosis of TD in MetS would help in modifying the disease course by early interventions with appropriate lifestyle modification regimens, as applicable.

125. A Randomized Comparative Assessment of the Efficacy of the TAP Block and II-IH Block in Controlling Post Caesarean Section Pain
Nikita, Madhukant, Sudama Prasad, B.K.Kashyap
Abstract
Aim: The aim of this study was to compare the efficacy of the TAP block and II-IH block in controlling post caesarean section pain. Methods: The present study was conducted in the Department of Anesthesiology, Patna medical College and Hospital, Patna, Bihar, India for 1 year. 105 pregnant mothers were assessed for eligibility and only three refused to give consent. 100 pregnant mothers scheduled for elective cesarean delivery were randomized to either ilioinguinal-iliohypogastric nerve block or transverses abdominis nerve block after skin closure at the end of surgery. Results: A total of 100 parturient were enrolled in the current study. Mean age was 27.33 ± 3.74 for group T and 27.23 ± 4.66 for group I. According to the 2018 modified ASA physical status classification all patients fall in the ASA II category. With regard to the number of previous C-sections majority of the participants were having their first C-section while 13.9% were having their second operative delivery and a single parturient was having third operative delivery in group T. Interval tramadol consumption was not statistically significant at 12 & 48 hours with U = 654.5, Z = 0.086, P = 0.920 & U = 700.5, Z = 0.838 & P = 0.400 respectively. However, median tramadol consumption at 24 hour was 0.0 mg for TAP & 50.0 mg for II/IH. This was found to be statistically significant with U = 832.0, Z = 2.310, & P = 0.020. Similarly at 36 hour median tramadol consumption was 25 & 50 mg for TAP & II/IH groups respectively. Conclusion:  In summary both ilioinguinal-iliohypogastric and transverses abdominis nerve block were equally effective in decreasing post-operative pain after cesarean section, total tramadol consumption within 24 hr. TAP block has achieved longer analgesic duration compared to Ilioinguinal-iliohypogastric nerve block.

126. Klestadt Cyst: Case Series and Review of Literature
Vikas Dhillon, Ajit singh, Aarushi Chaudhary
Abstract
Klestadt cysts are rare but easily identifiable when they do occur. They are thought to arise from the remnants of the nasolacrimal ducts. Klestadt investigated nasolabial cysts in depth, after which the lesion was named Klestadt’s Cyst. But it was Rao (1951) who first used the term nasolabial cyst. Thus, Klestadt and nasolabial cysts are synonymous with each other.  Most of the available information on these cysts is limited to isolated case reports. The purpose of our study was to examine the clinical and pathologic features of nasolabial cysts in order to provide a basis for their correct diagnosis and treatment. Eleven patients with nasolabial cysts were treated at Kalpana Chawla Government Medical College, Karnal, Haryana between 2017 and 2020.  All patients underwent surgery via the sublabial approach.  There was no recurrence, and there were no surgical complications on follow-up. The results of our study provide a basis for better diagnosis and management.

127. Clinical Presentation and Surgical Management of Koch’s Abdomen
Dipali Sadhu, Purvesh Bhatt, Jigar Aagja, Prabhuta Khare
Abstract
Background: Tuberculosis continues to be a global health concern. The principal forms of abdominal TB are intestinal, peritoneal and nodal. The clinical symptoms and signs of abdominal TB are non-specific and diagnosed late when presented with complications. Aim: To study the various clinical presentations and surgical management of abdominal tuberculosis. Material and methods: It was a retrospective observational study. The study period was from January 2022 to June 2022. 50 patients with abdominal tuberculosis from Civil Hospital, Ahmedabad were included in the study. Observation & Results: Of the 50 patients studied, mean age of presentation was 31 years with no gender predisposition. The presenting complaints in the patients were abdominal pain (100%), Nausea and vomiting (84%), abdominal distension (76%) and features of subacute intestinal obstruction (72%). ESR was noted to be elevated in all patients (mean = 54). Erect abdominal x-ray showed multiple air fluid levels in 37(74%) and free air under diaphragm in 6 (12%). CECT is the investigation of choice. 20 out of 50 underwent CECT with common findings being ascites (60%), lymph node enlargement (65%), ileal stricture (25%). 20 patients (40%) were successfully managed conservatively, started AKT and discharged with adequate weight gain at the end of 6months. 30 patients (60%) required operative intervention in the form of adhesiolysis, resection of bowel or stoma formation. Postoperative 3 patients (6%) developed fecal leak with an overall mortality in 6 patients.(12%). Conclusion: Abdominal tuberculosis continues to be widely prevalent in our society. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation.

128. Comparative Study of N-Butyl Cyanoacrylate Glue versus Prolene Suture Method of Mesh Fixation in Inguinal Hernia Repair. A Randomized Clinical Trial
Ravi Baghel, A.K. Saxena, Mirza Faraz Beg
Abstract
There are various methods for any hernia repair. They can be broadly classified in two main types (i) without prosthetic mesh or (ii) with prosthetic mesh. Prosthetic mesh repair gives better strengthand so less recurrence. There are many methods for fixing the prosthetic mesh. In this study the result of fixing mesh by N-Butyl Cynoacrylate Glue is compared with prolene suture method in inguinal hernia cases. 100 patients were randomised in two groups, 50 patients in each group for hernioplasty with glue or prolene sutures. Longer time required in surgery, lengthier duration of hospital stay and more analgesia needed in prolene group patients.

129. Role of Sympathetic Denervation in Peripheral Occlusive Arterial Disease – A Critical Appraisal
A.K.  Saxena, Ravi Baghel, Mirza Farah Beg
Abstract
The role of sympathectomy in improving the muscle blood flow in peripheral occlusive arterial diseases was objectively assessed in 20 limbs of 18 patients.82% of the patients were of Thromboangitis obliterans.2,5 and 13 limbs had claudication alone, rest pain without gangrene, and rest pain with gangrene respectively. Sympathectomy significantly improved the muscle blood flow as determined by arterio-venous differences of PO2,Glucose and Lactate levels. Clinically, following the operation the 2 Claud cants were cured. In 18 limbs with rest pain,12 had relief of pain to the patient’s satisfaction. Out of the 13 with rest pain and gangrene, ulcers healed spontaneously in 8 and the remaining 5 required amputation limited to forefoot only.

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