International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Comparison of Isobaric and Hyperbaric Bupivacaine for Subarachnoid Block
Vibha Mishra, Rakesh Singh Baghel, Radhika Pathak, Anju Verma
Objective: Aiming to compare the onset and duration of sensory block. Onset and duration of motor block. Quality of block. Post operative analgesia. Side effects and adverse effects of hyperbaric and isobaric bupivacaine in subarachnoid block. Duration of postoperative analgesia obtained with test drugs. Methods: The patients included in the present study were scheduled for orthopaedic, general surgery and gynaecology requiring analgesia for below the level of umblicus. The patients were divided into two groups of 30 patients each .In group A patients hyperbaric bupivacaine and in group B patients isobaric bupivacaine 4ml 0.5% was injected. Vital parameters such as pulse, BP, pulse oximetry, RR, ECG where recorded throughout the procedure and in the post operative period. The onset and duration of sensory and motor block were recorded further the post operative analgesia, height of dermatomal level, muscle relaxation, complications and side effects were recorded in a predecided case proforma. Results: The onset, duration, segmental spread  of sensory and motor block is rapid with hyperbaric bupivacaine. Muscle relaxation was adequate in both the groups. The incidence of hypotension and bradycardia was seen more after hyperbaric bupivacaine whereas in isobaric bupivacaine, vomiting and shivering was seen. The analgesia produced with hyperbaric solution of bupivacaine is effective and satisfactory. The observations recorded where subjective to statistical analysis to discuss the finding with the available literature reviewed. On the basis of discussion, conclusions were drawn. Relevant bibliography of the articles reviewed is annexed. Conclusion: The onset, duration, segmental spread  of sensory and motor block is rapid with hyperbaric bupivacaine. Muscle relaxation was adequate in both the groups. The spinal subarachnoid block produced by hyperbaric bupivacaine is significantly better than by giving isobaric bupivacaine.

2. Hypothyroidism in Pregnancy and its Maternal Outcome
Sajini B, Leena A Joseph, Rani Lakshmi S
Introduction: Hypothyroidism in pregnancy is associated with various adverse maternal outcomes such as increased foetal mortality, miscarriage, premature birth and preeclampsia. In an about 2850 deliveries conducted from Jan 2021 December 2021 at Kottayam medical college, 290 patients were diagnosed with Hypothyroidism. Thus, this study has been necessitated as 10.17% of the pregnant women is affected by hypothyroidism.  In this study, we have tried to analyse the maternal out comes associated with hypothyroidism. Aim and Objective: To determine the maternal outcomes observed in hypothyroid mothers presenting at the Obstetric clinic in Government Medical College, Kottayam from Jan-Dec 2021. Method: Hospital based retrospective study was conducted among 290 patients admitted from Jan to Dec 2021, in the department of Obstetrics and Gynecology, Government Medical College, Kottayam, Kerala. Result: In our study 10.17% of pregnant woman had hypothyroidism. Out of the 290 cases with hypothyroidism, the mean age of the population was found to be 27.84 years with a standard deviation of +-5.084. 14% of the deliveries were preterm 16% had Complication. About 69.31% had presence of some or the other form of risk factors. Conclusion: Hypothyroidism in pregnancy is associated with increased risk of adverse maternal and foetal outcome. It is worth noting that more than 95% of the Prevalence were in patients below 35 years of age. However, a majority of them had one or other complication, associated with it. Screening of patients for hypothyroidism is necessary especially when the patient is having other complications.

3. Estimation of Serum Zinc Levels in Children Admitted with Pneumonia
Chinthireddy Sandeep Reddy, Durgesh Kannam
Background: Pneumonia, particularly in poor nations, is a major cause of illness and mortality in children under 5 years old. The goal of the study is to determine whether zinc deficiency and other dietary components are associated with pneumonia in kids between the ages of 6 months and 5 years old. Methods: n=40 children between the ages of 6 months and 5 years old who met the World Health Organization’s definition of pneumonia were among the cases. The control group also comprised n=40 siblings of admitted children in the same age group. To uncover several potential risk factors, a thorough case history was acquired and a physical examination was carried out using a predetermined proforma. The serum zinc levels were determined using colorimetric techniques and a semi-automatic analyzer with 5-Bromo-PAS. Results: Mean serum zinc level in children with Pneumonia (cases) is compared with that of a control group. There is a significant difference between children with pneumonia and controls in serum zinc levels. The distribution of the zinc levels in children has been depicted in graph 1. The mean serum zinc level in children with pneumonia is 59.86 ± 8.54 µg/dl. The mean serum zinc level in age, sex, and nutrition-matched controls is 80.12 ± 7.65 µg/dl. The mean serum zinc level is significantly lower in children with pneumonia than their matched controls p-value was <0.001. Conclusion: This study suggests that linked variables like malnutrition, and low serum zinc levels contribute to the mortality and morbidity of the illness in a developing nation like India where the prevalence of pneumonia is alarmingly high. Addressing these issues will assist to decrease the prevalence of pneumonia and the financial burden on the nation because they are deficient states.

4. Presentation and Severity of Community Acquired Pneumonia at Emergency Department of Tertiary Care Hospital – A Cross Sectional Study
Nikul K Patel, Maharshi B Pandya, Jay C Patel, Himanshukumar Nayak
Introduction: Pneumonia remains a major cause of death in developed countries. Pneumonia severity index (PSI), developed in the USA after pneumonia outcome research trial (PORT), and the BTS rule, which has recently been modified to the CURB-65 rule- “confusion, elevated blood urea nitrogen, elevated respiratory rate, low systolic or diastolic blood pressure (BP), and age over 65 years (CURB-65)” rule. The two scoring approaches are viewed as being complementary, as each has different strengths and weakness. Objective: To compare severity of pneumonia cases with CURB -65 & PSI score criteria. Material Methods: This was single centre cross sectional study conducted at emergency department of V.S. Hospital, Ahmedabad for 1 year from November 2015 to October 2016. 200 patients presenting to the emergency department of VS Hospital with breathlessness, at any time of the day, during the study period were included. Requirement for ICU admission was studied as a marker for “severe pneumonia”. Result: The load of pneumonia cases presenting to our ED is 12.4%. Mortality was high in patients who developed cyanosis (71.42%), in patients with SPO2<92%, in smoker group (17.50%) and in non-adverse habit group 9.17%. Means score of CURB-65 for E-WARD disposition of patient is 2.8182± 1.23, to MICU is 2.5102±-1.27 and to GENERAL WARD is 0.8729±0.88. Mean PSI score for disposition of patient to E-WARD is 130.48±33.95,MICU 120.81±35.05,GENERAL-WARD 78.97±31.14 (p value 0). Conclusion: ED physician has an important role to play in management of such cases. Old age and male sex has higher incidence and higher morbidity and mortality attached to it. Patients with higher CURB-65 & PSI have higher chances of admission to ICU and higher mortality.

5. To Analyse Macular Thickness by Age and Gender in Age Group 18-30 Years
Uma Thakur, Pooja Mishra, Priyanka Gupta, Hemlata Chourasia
Background & Method: The aim of this study is to analyse macular thickness by age and gender in age group 18-30 years. Patients who presented to our department with various complaints was examined thoroughly and those found relevant are to be included in our study. After routine registration of the selected cases the examination was done keeping following points in to the consideration. Result: In table male and female macular thickness has been depicted in age group 18-30 years. The male macular thickness is 244.32 (±19.22) compared to the female macular thickness of 233.64 (115.20) which is supported by the p value of 0.03 and t test of 2.17. Conclusion: These demographic variation may be important parameters when comparing macular thickness measurements and diagnosing ocular disease. With increasing use of SD- OCT in clinical practice, it is critical to measure macular thickness in healthy eye as well as compare these values with the current commercially available OCT system.

6. A Comparative Evaluation of the Use and Non-Use of Preventive Antibiotics for Severe Acute Pancreatitis
Punj Prakash Mishra, Babulal Kannaujia, Pankaj Verma
Background: Acute pancreatitis is a common condition with a 10-30% fatality rate. The administration of prophylactic antibiotics has been a component of the treatment of severe acute pancreatitis in the hopes of preventing infectious complications and lowering mortality. Objective: to determine whether or not prophylactic antibiotics have any effect on complications, the need for an ICU bed, or mortality in cases of severe acute pancreatitis. Methods: A simple randomized randomized clinical trial was carried out; this was a preliminary report containing 53% of the entire estimated sample. Between August 2021 to May 2022, the medicine department team evaluated and treated patients with SAP. The sample size is 150 patients per group with a power of 80% and a 95% statistical significance level. In the trial, 150 patients were put into two randomized groups: group 1 (antibiotic prophylaxis use) had 75 patients, while group 2 (antibiotic prophylaxis use) had 75 patients. Results: The average age of the entire group (N=150) was 59.218 years; in groups 1 and 2, it was 58 years and 60 years, respectively (p=0.11). Gender distribution revealed that women made up 64% (N=123) of the entire group, with group 1 having 64% (N=48) and group 2 having 63% (N=47) (p=0.27). With lithiasis/stones accounting for 84% of the overall group and a similar distribution in the two groups (84% and 81%, respectively), this was the primary cause but it was not statistically significant. 10 patients from the group receiving no antibiotics and 12 patients from the group receiving antibiotics each required a bed in the ICU (16%) (p=0.11). All patients spent an average of 11–15.4 days in the ICU. Conclusions: It has not been demonstrated that using preventive antibiotics for severe acute pancreatitis reduces complications, the requirement for an intensive care unit bed, or mortality.

7. Oral Health Status of Pregnant and Nursing Women Reported to a Tertiary Care Medical Research Institute in Western Odisha: A Cross-Sectional Study
Prasanta Kumar Swain, Santosh Kumar Dora, Prasanta Kumar Swain
Aim: The major objective of this study was to raise awareness of oral hygiene among expectant mothers in order to prevent dental and oral illnesses, and the secondary objective was to develop a government-level policy to address the issues. Method: A cross-sectional study was carried out in the Department of Dentistry and Department of Obstetrics & Gynaecology, Veer Surendra Sai Institute of Medical and Research Institute (VSSIMSAR), Burla, Sambalpur, Odisha, India. The study was based on oral examinations of the pregnant women as population, for 6 months, based on different inclusion and exclusion area. Result: Statistical analysis revealed that Age (β = 0.02, p <0.002), maternal characteristics (β = 0.11, p <0.002), education (β = 0.05, p = 013), subjective health status (β = 0.26, p <0.002), sleep duration (β = 0.06, p = 0.002), breakfast frequency (β= 0.15, p <0.002), unmet dental care needs (β = 0.34, p <0.002), and depression (β= 0.01, p= 0.002), which are the main variables responsible for maternal oral care. Conclusion: The following conclusion can be used to wrap up the study. When a woman is pregnant, oral hygiene is normally ignored. There is a possibility that more periodontal issues will develop as a result.

8. Ivabradine in Patients with Ischemic Heart Disease – A Prospective, Longitudinal, Comparative Study to Metoprolol
Khushbu Agrawal, Ayan Roy, Sashi Bhushan Biswal, Bhabagrahi Rath, Nayan Kumar Patel
Background: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in developing countries with stable angina being the most common symptom. Heart rate is a key etiological factor in the pathophysiology of CAD as tachycardia induces myocardial ischemia by increasing oxygen demand and decreasing perfusion. So reduction in heart rate is the cornerstone of CAD management. Reducing heart rate with conventional drugs like ß-blocker is associated with drug interaction and adverse effects. Ivabradine is a novel heart rate lowering agent which is a selective inhibitor of the pacemaker I(f) current in the SA node. Objectives: To compare the efficacy and safety of ivabradine to metoprolol in patients with CAD. Methods: A prospective, longitudinal, comparative study was carried out in the Department of Cardiology of our hospital. 60 patients diagnosed with CAD were divided in to 2 treatment groups: Group 1 and 2 received Ivabradine(5mg/day) and Metoprolol(50mg/day) respectively. Patients were assessed for HR, Ejection fraction (EF), Canadian cardiovascular society (CCS) class of angina, QOL scores. Two follow ups were done at 90, 180 days. Long term QOL (EQVAS) evaluated compared statistically. Results: Ivabradine reduced HR from 89.07±1.99 to 75.17±0.40 bpm and metoprolol from 90.47±1.75 to 77.53±0.86bpm, EF from 42.67± 1.09% to 52.37± 0.33%. Both groups showed significant but comparable improvement in CCS class of angina and EQ-5D-3L dimensions at 6 months. Over longer term (18 months) statistically superior significance in Ivabradine group in EQVAS (p.02). Also there was significant decrease in episodes of angina attack and also the requirement of nitroglycerine tablets. Conclusion: Ivabradine was found to be safer and more effective in preventing and treating angina attacks in patients with CAD.

9. A Hospital-Based Assessment of the Profile of Pathological Vaginal Discharge among Pregnant Women
Shashi Prabha Sinha, Amit Kumar Ambasta, Seema, Alka Mishra
Aim: The purpose of this study was to determine the prevalence of vaginal discharge, pattern, common infectious causes, risk factors associated with pathological discharge and its complications. Methods: The present study was conducted in the Department of obstetrics and gynaecology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. 200 patients included in the study. The study included all pregnant women with vaginal discharge. Results: Out of 200 pregnant women 45 were </= 20 years of age, 75 were between 21 to 25 years of age, 50 were between 26 to 30 years of age and 30 were between 31 to 35 years of age. Out of 200 pregnant women who developed Vaginal discharge, 120 (60%) were primigravida and 80 (40%) were multigravida. Total of 200 women attending antenatal clinic with vaginal discharge were studied. Out of them150 were asymptomatic and 50 were symptomatic patient. Out of 200 patients there were 120 from low socioeconomic status risk group, 35 were from anaemia risk group 25 were from urinary tract infection risk group, 10 were from vaginal discharge in previous pregnancy and 10 were from diabetes risk group. Out of 50(25%) symptomatic patients there were 30(60%) Vaginal Candidiasis, 15 (30%) Bacterial Vaginosis and 5 (10%) Trichomoniasis. Conclusion: Pathological vaginal discharge was highly prevalent in younger women of low socioeconomic condition with a history of several morbid conditions during pregnancy. Pathological vaginal discharge strongly associated with threatened preterm, PROM and prematurity. These results stress a need for proper diagnosis and management of vaginal discharge and pregnant women should be educated on good hygiene habits.

10. Study of Etiopathogenesis and Management of Incisional Hernia
Sumit Raj, Roshani Prasad, Ashok Rai
Aim: The purpose of the present study was to analyze various etiological factors and to compare various surgical modalities based on size of incisional hernia. Methods: The present study was conducted in the Department of Surgery, JLNMCH, Bhagalpur, Bihar, India for the period of eight months. Out of 200 cases of various types of hernias operated a total of 60 cases of incisional hernias were studied and followed for a period varied from 6 months to 8 months. Results: During the period of our study, a total of 200 patients have been operated for various types of hernia, out of these 60 cases were incisional hernia. Inguinal hernia was most common type accounting for 45%, next common hernia was incisional hernia (30%) remaining rare type of hernias constituting 25% of total cases studied. Maximum number of cases in middle age group (30-60 yrs.) constituting 71.66 %. Conclusion: Hence the incidence of the incisional hernia can be decreased by preventing these factors. Incidence of incisional hernia is more common in the age groups 30-50 years. Incidence of incisional hernia is more common in females especially due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries.

11. An Observational Study to Assess the Association of Microalbuminuria and Glycosylated Hemoglobin in Type 2 Diabetes Mellitus
Shishir Kumar Suman, Amarendra Kumar Amar
Aim: The present study was planned to assess the association of microalbuminuria with glycosylated hemoglobin in type 2 DM patients. Methods: The present study was conducted in the Department of Biochemistry, JNKTMCH, Madhepura, Bihar, India for the period of one year. Hundred patients were selected in the present study. Results: Results of all biochemical analytes from patients with type 2 DM were compared with standard normal values of respective analytes using Z analysis. There was a highly significant difference (p<0.000) between values of all the analytes of the two groups. Microalbumin levels (g/day) were found to be highest i.e., 0.449 ± 0.160 g/ day in diabetic subjects with duration of diabetes more than four years, statistically significant (P < 0.001). Conclusion: Hyperglycemia in type 2 diabetes is leading to lethal effects by damaging the kidney. Early detection and prevention of nephropathy in patients with type 2 DM will be possible by frequent and timely screening the patients for HbA1c, microalbuminuria, urinary creatinine and ACR.

12. Study the Comperative Outcome of Postoperative Analgesic Effect of Intraperitoneal Bupivacaine with Fentanyl and Bupivacaine with Nalbuphine in Laparoscopy Cholecystectomy
Shudha Singh, Akhileshwar, Anantu Kumar, Pankaj Kumar
Aim: The aim of the study was to compare the effectiveness of intraperitoneal bupivacaine with fentanyl and intraperitoneal bupivacaine with nalbuphine for postoperative pain relief after laparoscopic cholecystectomy. Methods: The randomized, prospective, double-blinded, intervational clinical study was carried out in an IGIMS Patna hospital, over 1 year time after obtaining the necessary approval from the Institutional ethical committee. 80 patients were included in the present study. Selected patients were allocated to two groups, each containing 40 patients – Group BF (n = 40) were given 18 mL of 0.5% bupivacaine combined with 1 μg/kg fentanyl diluted with normal saline making total volume 20 ml and Group BN (n = 40) were given 18 mL of 0.5% bupivacaine combined with 2mg nalbuphine making total volume 20 ml through trocars i.e the total volume were 20 ml. Results: Eighty patients, scheduled for laparoscopic cholecystectomy, were entered into the study. Demographic data of patients and duration of surgery showed no considerable difference (p-value >0.05). The number of female patients was more in both the groups, but it was statistically insignificant. The two groups were comparable in terms of duration of surgery as well but not significant (p-value >0.05). VAS score at rest showed significant difference (favourable score in nalbuphine group) at one hour postextubation. At all the other time frames, the difference in VAS score was insignificant. Conclusion: Intraperitoneal instillation of bupivacaine in combination with nalbuphine significantly reduces postoperative pain scores in comparison to bupivacaine with fentanyl, in patients undergoing ambulatory laparoscopic cholecystectomy.

13. Intrathecal Dexmedetomidine and Fentanyl as an Adjuvant to Isobaric Levobupivacaine for Lower Limb Orthopaedic Surgery: A Comparative Study
Vishal Vaibhaw, Niraj Narain Singh, Kumar Rohit, Niraj Kumar
Aim: The aim of the present study was to compare the efficacy and safety of 25 mcg of fentanyl vs 5 mcg dexmedetomidine as an adjuvant in 0.5% of 3ml of isobaric levobupivacaine in lower limb orthopaedic surgery. Methods: The present study was conducted in the Department of Anesthesiology, ESIC Medical College Bihta, Patna, Bihar, India for the period of one year . The study participants were randomly divided into three groups. The study population consisted of 90 adult patients who were classified as American Society of Anesthesiologists (ASA) physical status I or II, undergoing elective lower limb orthopaedic surgery under spinal anesthesia. 90 patients with age between 20 to 60 yrs of either sex, ASA 1 and 2and Patient posted for elective lower limb orthopaedic surgeries were include in this study. Results: In the present study, male dominated in all the three groups as compared to females. The patients were more in ASA I as compared to ASA II. The mean time for onset of sensory block was 11.04 ±4.21 min in the saline group and 8.76±2.99 min in the dexmedetomidine group and 2.28±1.42 min in the fentanyl group. The mean time taken to achieve maximum sensory block in group A was 16.18±4.83 min, in group D was 14.16±3.42 min and in group F it was 5.52±1.67 min so maximum sensory block was achieved earlier in group. Peak level of sensory block attained in the fentanyl group was T4 and the peak level of sensory block in dexmedetomidine group was T6 and in the saline group peak level was T8. Conclusion: Dexmedetomidine group has longer onset of and duration of sensory block and effective postoperative analgesia and fewer side effect as compared to fentanyl group.

14. Cytopathological Pattern of Tubercular Lymphadenopathy on Fine Needle Aspiration Cytology (FNAC) in a Tertiary Care Hospital
Manjari, Anshu Anand, Md. Wakeel Ahmad, Kumari Seema
Aim: The aim of the present study was to evaluate the cytopathological patterns of tubercular lymphadenopathy on Fine Needle Aspiration Cytology in a tertiary care hospital. Methods: The Retrospective Study was conducted in the Department of Pathology of Narayan Medical College & Hospital, Jamuhar, district Rohtas, Bihar. 130 patients were included in the study. All the patients referred to the cytopathology lab for FNAC of lymph nodes between December 2020 to September 2021 were included. Results: Out of 130 patients, 61 (46.92%) were males and 69 (53.08%) were females. The age of the patients ranged from 1-71 years with mean age being 28.97±14.4 years. There was slight female preponderance with male to female ratio of 1:1.13. The disease was more commonly seen in the age group of 21-30 years (42%). Most commonly involved lymph node was cervical (74%) followed by supraclavicular lymph node (13.1%). The most common anatomical region of Tuberculous Lymphadenitis was 73.8% followed by supraclavicular 13.1%. The most common pattern observed was epithelioid granuloma with caseous necrosis (70 cases, 53.85%). ZN stain for AFB showed AFB positivity in 48 cases. Thus, overall AFB positivity was 36.9%. Conclusion: FNAC is useful for the diagnosis of tuberculous lymphadenitis. In developing countries with high prevalence of tuberculosis, FNAC with ZN stain should be the first line of investigation in patients presenting with superficial lymphadenopathy.

15. A Hospital-Based Assessment of the Proportion of Thyroid Dysfunction in Patients with Type 2 Diabetes
Rashmi Kumari, Ganesh Prasad Singh, Kumar Amar Dip Narayan
Aim: The aim of the present study was to study the proportion of Thyroid dysfunction in patients with type 2 Diabetes. Methods: The present study was conducted in the Department of Medicine, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for the period of one year. 400 patients were included in the study. Out of the 400 subjects, 200 were cases (Type 2 diabetes Mellitus) and the remaining 200 were controls. Results: The mean age of subjects in cases was 55.95 ± 11.19 years and it was 54.56 ± 10.09 years in controls. The difference in the age between the two groups was statistically not significant (P-Value 0.120). The difference in the proportion of gender between study groups was statistically not significant (P-value 0.510). The mean height in cases was 161.02 ± 8.3 cm, it was 161.01± 7.79 in controls. The mean weight in cases was 69.2 ± 12.64 kg, it was 65.47 ± 10.86 in controls. The difference in weight between the two groups was statistically significant. (P-value <0.001). The mean BMI in cases was 26.21 ± 4.7, it was 24.8 ± 4.15 in controls. The difference in BMI between the two groups was statistically significant. (P-value <0.001). Conclusion: The present study showed a high prevalence of thyroid dysfunctions in patients of type 2 DM. Hence, screening for thyroid dysfunction in diabetic patients should be performed routinely, so as to recognize these dysfunctions early, thus helping in improving the quality of life and reducing the morbidity rate in them.

16. An Analytical Assessment of the Salivary Calcium Level and Ph in Patients with Chronic Periodontitis and Healthy Individuals
Pratyush Anshuman
Aim: The present study was conducted to compare the salivary calcium level and pH in patients with chronic periodontitis and healthy individuals. Methods: A total of 120 subjects of both sexes (age range 25-55 years) were selected from the Outpatient department (OPD) of Department of Dentistry of Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India. Out of 120 selected patients 40 subjects having healthy gingiva were selected and included in Group I as a control group, 40 patients who were having chronic periodontitis who were non- smokers were included in Group II and 40 patients who were smokers having chronic periodontitis were selected and included in Group III. Results: The demographic profile of study subjects included in all the three groups. Majority of the subjects (70%) were in the age group of 25-35 years. The mean age of the study population was found to be 30.40 ± 4.10 years. Mean plaque index values in Group I was 0, in Group II mean PI was 1.36 ± 0.50 and in Group  III mean PI was 1.90 ± 0.25 (Table 2). Mean gingival scores were highest in Group II patients (1.78 ± 0.32) and Group III patients (1.12 ± 0.40) respectively. Conclusion: The present study concluded that a group with smokers having chronic periodontitis showed higher salivary calcium levels and salivary pH; this suggests that trend towards increased mineralizing potential in the saliva of smokers.

17. A Hospital-Based Prospective Evaluation of the Correlation between Glycemic Control, Lipid Profile and C-Reactive Protein in Adults with Type 2 Diabetes Mellitus
Rashmi Kumari, Ganesh Prasad Singh, Kumar Amar Dip Narayan
Aim: The purpose of this study was to determine the relation between HbA1C, Lipid profile and CRP in individuals with type 2 diabetes mellitus. Methods: This was a hospital-based prospective study comprised of 60 patients with type 2 diabetes mellitus reporting to Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for the period of one year. Results: In this study of 60 patients, 40 patients were males, and 20 were females with mean CRP levels of 1.19±1.25 and 1.12±0.99, respectively. There was no significant difference between male and female patients (p>0.05). In this study of 60 patients, HbA1C and CRP were correlated with age. Patients between age 30-40 years were 5 with mean HbA1C and CRP of 10.43 and 1.2, respectively. Patients between age 40-50 years were 15 with mean HbA1C and CRP of 10.59 and 1.8, respectively. Patients between age 50-60 years were 25 with mean HbA1C and CRP of 9.22 and 1.2, respectively. Patients between 60-70 years were 12 with mean HbA1C and CRP of 9.2 and 0.6, respectively. Patients above 70 were 3 with mean HbA1C and CRP of 8.0 and 0, respectively. Conclusion: It was found that CRP is significantly correlated with HbA1C level. A positive correlation was found between serum CRP and HbA1C in the initial group and in the follow-up patients, showing that CRP levels lowers with better glycemic control and correlates with dyslipidaemia profile.

18. A Prospective Observational Study to Assess the Caesarean Section Complications in a Tertiary Care Hospital during the Second Stage of Labour
Shashi Prabha Sinha, Amit Kumar Ambasta, Seema, Alka Mishra
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 Gynaecology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for 15 months. 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 stays. 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.

19. Prospective Observational Assessment of the Profile of Pregnant Women Diagnosed with Pathological Vaginal Discharge
Anupam Kumar Chaurasia, Girija Kumari
Aim: The purpose of this study was to assess the profile of pathological vaginal discharge among pregnant women. Methods: The present study was conducted in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. 200 patients included in the study. From April 2019 to February 2022. The study included all pregnant women with vaginal discharge. Results: Out of 200 pregnant women 45 were </= 20 years of age, 75 were between 21 to 25 years of age, 50 were between 26 to 30 years of age and 30 were between 31 to 35 years of age. Out of 200 pregnant women who developed Vaginal discharge, 120 (60%) were primigravida and 80 (40%) were multigravida. Total of 200 women attending antenatal clinic with vaginal discharge were studied. Out of them150 were asymptomatic and 50 were symptomatic patient. Out of 200 patients there were 120 from low socioeconomic status risk group, 35 were from anaemia risk group 25 were from urinary tract infection risk group, 10 were from vaginal discharge in previous pregnancy and 10 were from diabetes risk group. Out of 50(25%) symptomatic patients there were 30(60%) Vaginal Candidiasis, 15 (30%) Bacterial Vaginosis and 5 (10%) Trichomoniasis. Conclusion: Pathological vaginal discharge was highly prevalent in younger women of low socioeconomic condition with a history of several morbid conditions during pregnancy. Pathological vaginal discharge strongly associated with threatened preterm, PROM and prematurity. These results stress a need for proper diagnosis and management of vaginal discharge and pregnant women should be educated on good hygiene habits.

20. Comparative Study on Adrenaline with 3% Hypertonic Solution and 3% Hypertonic Solution by Nebulization in Bronchiolitis in Children
Pratyush Roz, Priyank Kumar K Nisarta, Nikita Gohil, Jaimin M Kharadi
Background: Lower Respiratory Tract Infection (LRTI) is a respiratory disease affect the lung tissue in young children requiring hospitalization for viral or bacterial infections presenting with rapid breathing, chest contractions, and wheezing). Acute bronchiolitis is the cause of half of her LRTIs in children under 2 years of age. Various bronchodilators are used for treatment. Aim and Objectives: 3% Hypertonic alone versus nebulized epinephrine + 3% Hypertonic in the treatment of LRTI, with particular reference to bronchiolitis with respect to decreased SpO2, heart rate, respiratory rate, and improvement in Respiratory Distress Assessment Instrument Score (RDAI). to compare. [0-15 max] and patient hospital stays of patients age 1-24 months. Methods: Children aged 1-24 months with bronchiolitis with LRTI and/or RDAI scores of 0-15 were enrolled was hospitalized. Treatment were given and outcomes were measured. Results: 115 children enrolled, 57 received adrenaline with 3% Hypertonic 58 received 3% Hypertonic nebulization. Heart rate, respiratory rate, SpO2, dyspnea score, and length of stay improved in both groups. There were no significant differences in these variables between the two groups, except for her SpO2 improvement in the adrenaline and 3% NaCl nebulized group. Conclusion: In LRTIs including bronchiolitis, Adrenaline with 3% hypertonic solution nebulization is not superior to 3% hypertonic alone in clinical improvement.

21. Effect of Dexmedetomidine with Adjuvants (Fentanyl and Butorphanol) on Postoperative Analgesia and Cognitive Dysfunction Following Cardiac Surgery: A Prospective, Double- Blinded Randomized Controlled Trial
Kalpeshkumar Mistry, Aditya Sharma, Aradhaya Verma, Dhrupad Patel, Karan Patel
Background: Painafter cardiac surgery has various sites of origin and is caused by several factors. Postoperative analgesia improves patient satisfaction, reduces the incidence of postoperative complications and shortens the duration of hospital stay. Objectives: To evaluate and compare the effect of intravenous infusion of dexmedetomidine and fentanyl versus intravenous infusion of dexmedetomidine and butorphanol on postoperative analgesia and postoperative cognitive dysfunction in patients undergoing cardiac surgery. Materials and Methods: This study was conducted at tertiary care teaching hospital of Rajasthan from February 2019 to June 2020. Patients in the two groups received intravenous infusion of Dexmedetomidine 0.15μg/kg/h and Fentanyl 0.5μg/kg/h immediately postoperatively (Group DF) and intravenous infusion of Dexmedetomidine 0.15μg/kg/h and Butorphanol 2 μg/kg/h immediately postoperatively (Group DB) respectively. Both groups were compared for demographic data, postoperative hemodynamic data, Ramsay sedation scale, visual analogue scale (VAS) for pain and Montreal Cognitive assessment (MoCA) for cognitive function. Results: There was no statistical difference in the VAS score of the patients between the group DB and DF at post extubation intervals of 12, 18, 24 and 48 Hours (p>0.05) except at 4 hours and 8 hours post extubation (p<0.05). Time to first rescue analgesic was significantly earlier for DF as compared to DB group (p<0.05). There was no statistical significant difference found in the mean of MoCA score between both the groups for both 1 day prior to surgery and 24hrs Post extubation (p>0.05). Drowsiness had the highest incidence in both the groups among all the adverse effects. There was no significant difference in terms of adverse effects (p>0.05) except drowsiness which was significantly higher in group DB (p<0.05). Conclusion: The present study concluded that Dexmedetomidine in combination with Butorphanol is more effective as an analgesic than Dexmedetomidine with Fentanyl but no significant cognitive dysfunction was found among the patients in both groups.

22. A Study of Thyroid Dysfunction in Patients of Type 2 Diabetes Mellitus: A Case Control Study
Priyanka S Shah, Rajan Chaudhary, Gaurav J Desai, Dinkar N Goswami
Thyroid dysfunction and Diabetes Mellitus type 2 are two leading endocrinal issues faced by majority of population in a developing country like India. Hypothyroidism is more common in patients with type 2 Diabetes Mellitus. Type 2 Diabetes Mellitus often predisposes to changes in circulating thyroid hormone causing subclinical hypothyroidism and low fT3 levels. Patients with type 2 Diabetes Mellitus have a higher TSH levels and lower fT3 than those their non-diabetic counterparts. Patient with type 2 Diabetes Mellitus should undergo testing for complete thyroid profile at regular intervals. However, there are no specific guidelines for frequency of thyroid monitoring in patients with poor glycemic index.

23. Correlation of  Haematological Indices with Disease Severity in Patients of Chronic Plaque Psoriasis
Maheshwari K, Jain J, Gupta K, Saluja A, Menghani G, Vyas K
Introduction: Psoriasis vulgaris is a chronic inflammatory disorder and while exact pathogenesis of the disease has not been established, genetic and immunological mechanisms are presumed to play an important role. Platelets are known to play important roles in inflammatory reactions and immune responses and can be activated by various stimuli. Besides platelet count, one of the parameters that act as an important indicator of platelet activation is mean platelet volume [MPV]. The relationship between severity of psoriasis and MPV has been a subject of investigation in recent studies. Aim: To assess the relationship between hematological parameters for platelet activation like platelet count, MPV and red cell distribution width (RDW) with the disease severity indices of psoriasis vulgaris such as Psoriasis area severity index (PASI) and Nail psoriasis severity index (NAPSI). Materials and Methods: A case control study was conducted on 124 psoriatic patients and 124 healthy controls. The haematologic parameters (Haemoglobin, total leucocyte count, platelet count, MPV, RDW) were compared between patients and control subjects. These parameters were also correlated in patients with the PASI and NAPSI score. The data was statistically analysed using IBM SPSS software (Version 21). Spearman Rank Correlation was used to find the correlation between PASI/NAPSI and various haematological parameters. A receiver operating characteristic (ROC) curve was plotted to determine cutoff value of MPV. Results: PASI showed a negative correlation with MPV (p = 0.023) and when both genders were compared, a highly significant negative correlation was seen among the male patients (p = 0.007). A statistically significant negative correlation was noted with RDW and PASI (p = 0.042) whereas NAPSI and platelet count showed a significant positive correlation (p = 0.035). However, neither of these 2 parameters showed a significant difference when evaluated on basis of gender. ROC curve cut off value for MPV was ≥ 8 with a sensitivity of 87% and specificity of 62%. Conclusion: The MPV values and RDW showed negative correlation with the PASI score (highly significant with MPV in male patients). NAPSI showed a significant positive correlation with platelet count.  It can be concluded that decreasing MPV and decreasing RDW could be regarded as indicators of severe disease. Due to small sample size of our study and lack of previous research, further studies may be necessary before drawing conclusive evidence for the relationship of NAPSI with these parameters.

24. Antibiotic Impregnated Intramedullary Nailing in Compound Fractures of Long Bones
Chetan Solanki, Praveen Khatri, Brajesh Meher, M. Gopala Rao, Vishal Nigwal, Ankit Prasad, Suneet Tandon
Objectives: To evaluate the prognostic value of compound femoral and tibial shaft fractures treated with  antibiotic  impregnated  cement  coated  nailing,  as  well  as  the  biological anmechanical upsides of primary antibiotic impregnated cement coated nailing in the management of compound femoral and tibial shaft fractures. Methods: At a tertiary facility in Bhopal, India, 23 individuals with Gustilo Type II and III compound tibial and femoral shaft fractures received antibiotic-impregnated IM nails between December 2019 and June 2021. Results: Infection was controlled (as indicated by a decrease in inflammatory markers like ESR and CRP, as well as clinical evaluations like any discharge from the lesion, signs of inflammation) and mechanical stability was achieved in 85 percent of cases, with really no restriction of movements across the adjacent joints, after an average follow-up of 6 weeks. After 6 weeks, 16 instances had their nails exchanged. Conclusion: An antibiotic-impregnated cement coated nail could be a reliable substitute for an external fixator in compound fractures of the tibia and femur, improving stability and limiting infection.

25. Outcome Analysis of Transforaminal Lumbar Interbody Fusion in Degenerative Spine Diseases
Manish Rajpoot, Praveen Khatri, Chetan Solanki, Kuldeep Dinkar, Vishal Nigwal, Brajesh Meher, Suneet Tandon
Prevalence of Low Back Pain (LBP) seeking medical treatment ranges from 59℅ to 84%. Lumbar degenerative diseases are among common aetiologies of lower back pain and significantly affect quality of life. Over 90 % of spine surgeries are performed because of degenerative disc diseases (DDD). Aim: To assess the outcome of open transforaminal lumbar interbody fusion (TLIF) performed in degenerative lumbar spine diseases having chronic low back pain. Study design: A prospective interventional study. Material and Methods: our study included 20 patients of degenerative lumbar spine diseases having chronic lower back pain, underwent open transforaminal lumbar interbody fusion (TLIF) were studied at tertiary care centre from January 2020 to June 2021 in the Department of Orthopaedics Gandhi Medical College and associated Hamidia Hospital, Bhopal, Madhya Pradesh. Outcome was assessed using Visual analogue scale (VAS score) for Pain relief at back and leg, Oswestry disability index (ODI) was used to assess quality of life pre-operatively and post-operatively at 1 month and 6-month follow-ups. Statistical analysis used: paired t test. Results: The Mean age of patients was 46.9 years , with 12 cases (60%) were males and most common pathology was spinal instability arising from prolapsed intervertebral disc ( PIVD) 65%. The preoperative mean VAS score was 7.9±0.85 which improved to 2.2±0.79 at final follow-up which is statistically significant improvement (p<0.0001). The preoperative mean ODI score was 64±8.1 which improved to 27.5±5.9 at final follow-up. The improvement in mean ODI score was statistically significant with p value of < 0.001). Conclusion: The present study demonstrates that TLIF is safe and effective procedures for management of degenerative spine diseases with clinical improvement in pain and disability.

26. Cutaneous Adverse Reactions after Administration of Covishield Vaccine in a Tertiary Care Hospital in Western Uttar Pradesh: A Series of Cases
Pihu Sethi, Kriti Maheshwari, Bhuvan Adhlakha, Shivani Kalhan, Rakesh Kumar Gupta
COVID-19 is a recently discovered highly communicable disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) and its variants. The sudden emergence of the COVID 19 pandemic and its impact on global health meant that the development of effective and safe vaccines was crucial for this new lethal disease as vaccination always plays an essential role in the advancement of global health. So far, there are three main types of COVID-19 vaccines in use around the world: mRNA-based vaccines, adenoviral vector vaccines, and inactivated whole-virus vaccines. Since the introduction of vaccines for the COVID-19 disease, various reports of a spectrum of mucocutaneous side effects have surfaced. With the aid of this case series we would like to highlight the different types of cutaneous adverse effects that were observed post vaccination with the COVISHIELDTM vaccine by the department of Dermatology at our institution.

27. Antibiotic Coated Intramedullary Interlocking Nailing for Compound Lower Extremity Fractures – Assessment of Clinico-Radiological and Functional Outcomes
Hari Kumar, Vikas Panditrao Kale
Introduction: Compound lower limb fractures are prone to infections that cause significant morbidity, increased health care cost, duration of hospital stays, and occupational loss. Antibiotic coated intramedullary nailing is one of the effective methods in preventing implant related infection. This study was designed to assess the clinico-radiological and functional outcome of compound lower limb fractures treated with antibiotic intramedullary interlocking nailing. Material and Methods: Thirty-two cases with compound lower limb fractures between age group 21 to 60 years belong to Gustilo grade I, grade II, grade IIIA and grade IIIB types were recruited. The antibiotic coated intramedullary nail was prepared by incorporating antibiotic bone cement, 4g vancomycin and 80mg gentamycin. Postoperative follow up was done till six months and parameter like status of infection, status of wound, and radiological assessment of fracture union were assessed. Results: Road traffic accidents (68.75%) were common cause of fractures. Postoperatively, 9.37% reported superficial and 3.15% showed deep infection. In regard to clinical outcome, 50% fair, 31.5% good and 15.62% excellent outcome recorded. The radiological outcome was good in 62.5%, and excellent in 25%. The functional outcome was good in 43.75%, excellent in 31.25% and fair in 18.75%.  Conclusion: Antibiotic coated intramedullary nail was safe, effective management option for compound tibial fractures with minimal deep infection rate.

28. Prevalence of Cardiovascular Morbidity among Hypothyroid Patients
Sangita Choudhury, Bijayaditya Datta, Arindam Datta
Background: There remains an association between thyroid disorders and cardiovascular problems. Hypothyroidism is one of the most prominent thyroid disorders which has a proven association with dyslipidemia an independent risk factor for cardiovascular morbidity. This present study is done to highlight the cardiovascular complications in thyroid disease. Material and Methods: This study is conducted as a Cross-sectional study from the period of January 2020 – June 2021 (1.5 years) in the Department of General Medicine, TMC & Dr. BRAM Teaching Hospital, Agartala, Tripura. Results: The study included 66 patients of hypothyroidism. The male subset experienced a statistically significant high level of serum cholesterol and serum low-density lipoprotein. Bradycardia was the commonest ECG finding seen in 44% of all patients in the study population. With respect to Echocardiography, only 66% of the study population had normal parameters in echocardiography. The commonest abnormal finding in the sample was Raised interventricular septal dimensions and left ventricular diastolic dysfunction. Conclusion: This study shows there are various cardiovascular morbidities which remains a concern in hypothyroidism cases. Early diagnosis and correction of hypothyroidism is necessary and along with that physicians should be vigilant about the detection of various cardiovascular morbidity as well so as to prevent future cardiac events.

29. A Clinical Study of the Spectrum of Gastrointestinal Perforations
D Guruva Reddy, Akula Sanjeev
Background: One of the most frequent acute abdominal crises in surgical clinics is intestinal tract perforation. Gastrointestinal tract perforations manifest clinically in a variety of ways, ranging from the typical severe acute abdominal pain at one extreme to mild or no symptoms in hospitalized patients with unrelated illnesses. The current study aimed to evaluate causes, signs and symptoms, management, and possible complications which develop in gastrointestinal perforations. Methods: Based on the inclusion and exclusion criteria patients were selected and the demographic profile of the selected patients was collected based on pre-designed proforma which included the age, sex, and associated illnesses if any were recorded. The time interval between the admission and the time of intervention was also noted. Investigations were conducted, including those involving blood urea, blood sugar, serum creatinine, serum electrolytes, chest x-ray, blood grouping, x-ray abdomen, and another testing as needed. Results: The commonest complaint by the cases in the study was abdominal pain in 100% of cases followed by vomiting in 80% of cases and distension of the abdomen was reported in 48.89% of cases fever in 35.56% of cases and constipation in 31.11% of cases. Among the site of perforations identified intraoperatively 46.67% cases of duodenal ulcer perforations were present. Followed by Gastric perforation in 13.33% of cases. Ileal perforations were seen in 11.11% of cases appendicular perforations in 4.44% of cases. All duodenal perforations were repaired using an omental patch, ileal perforations were closed primarily in a plane perpendicular to the lumen, and perforation axis resection and anastomosis were performed in cases of large perforations. Conclusion: Duodenal ulcer perforation was the commonest cause of gastrointestinal perforation with a male preponderance. More common in the fourth and fifth decades of life. Alcohol and smoking were aggravating factors. The role of nonsteroidal anti-inflammatory drugs as the cause of perforation was little in this study group. Radiological evidence of pneumoperitoneum could not be established in nearly one-fourth of the patients. Simple closure with an omental patch with thorough peritoneal toileting was very much effective.

30. A Comparison of the Sealing Pressures and Post-Complication Rates for Adults Having Elective Laparoscopic Cholecystectomy Under General Anesthesia Using I-Gel and Proseal LMA
Bharat Verma, Amrita Nidhi
Background: Laryngeal mask airway (LMA) Proseal has an inflatable cuff while i-gel™ has a noninflatable cuff made of thermoplastic elastomer. Aims: To compare sealing pressure and post of complication while introducing I-gel and PLMA while conducting Lap-choly under GA. Subjects and Methods: This study was conducted as randomized observational study in a teaching hospital. Sixty American Society of Anesthesiologists I and II, patients posted for Lapcholycystectomy under general anesthesia were divided in two groups of thirty each. LMA Proseal™ and i-gel™. Sealing pressure and post of simplification were compared between the two. Results: According to our study we conclude that both I-gel and PLMA are comparable in maintaining a patent airway during controlled ventilation. Both PLMA and I-gel are emerging as an effective alternative for tracheal intubation. We also concluded that airway sealing pressures are found to be significantly higher in PLMA as compared to I-gel thought PLMA  provides a better orophrayngeal seal than i-gel in laparoscopic surgeries where the is pneumo-peritoneum and increased intra-abdominal pressures. Conclusions: We conclude that both the devices can be effectively used in laparoscopic surgeries though their frequent use and safety needs further evaluation.

31. A Study to Compare the Prolongation of the Corrected QT Interval of Rheumatoid Arthritis Patients on Hydroxychloroquine
Kushagra Tandon, Prakash Joshi, Ansh Rajput
Background: For rheumatoid arthritis (RA) patients, hydroxychloroquine (HCQ) is a staple treatment. Concerns about its cardiovascular safety have been raised after reports of its use and fatal arrhythmias in individuals with coronavirus illness 19. Aims and objectives: To examine the relationship between HCQ use and corrected QT (QTc) length in RA patients. Materials and Methods: Hundred subjects (age ≥ 18 years) were studied after dividing them in to Cases (n=50; patients with RA taking HCQ) and Control (n=50; patients without RA not taking HCQ) at the Department of General Medicine of a tertiary care center in Madhya Pradesh. Patient characteristics and laboratory measures, including rheumatoid factor hemoglobin, white blood cells count, platelets, erythrocyte sedimentation rate (ESR), random blood sugar, urea, Creatinine, SGOT, SGPT, serum electrolytes, calcium, and magnesium level, were assessed. QTc length was obtained with the help of 12-lead ECG. Results: Incidence of QTc prolongation in patients with RA was 11%. Odds for prolonged QTc interval for patients with age >50 years was 3.500 (95% CI = 0.865-14.155), serum calcium <8 was 2.400 (95% CI = 0.540-10.666), and ESR >20 was 0.756 (95% CI = 0.640-0.892). A significant positive correlation was obtained between prolonged QTc with age (r=0.283; p=0.046). Conclusion: There is a significant increase in risk of QTc prolongation with the use of HCQ in patients with RA.

32. Assess the Correlation between Baseline Perfusion Index and Incidence of Hypotension Following Spinal Anaesthesia
Mayank Karode, Chandra Shekhar Mishra, Sunil Kumar Rajpoot, Nishtha Sharma, Anil Bhati
Objective: This study is aimed to assess the correlation between baseline Perfusion index and incidence of hypotension following spinal anaesthesia. To observe if intra-operative changes in PI values correlate with degree of hypotension during spinal anaesthesia. Methods: Patients posted for elective surgery under spinal anaesthesia (21 to 60 years of age) were included for our study. Patients with a baseline perfusion index of less than 3.5 were included in Group A whereas group B was formed by patients with a baseline perfusion index of 3.5 or more. So, our study population group was different from our reference studies that were conducted in obstetric population. Results: Majority of the cases belonged to the age group of 41 to 50 years in both groups and were comparable to each other (p value=0.234). Male: female ratio was comparable in the two groups (p value=0.482).It was found that 25 incidences of hypotension (MAP<65mmHg) were recorded after subarachnoid block amongst 165 patients in group A (baseline PI<3.5), whereas other 165 patients in group B with a baseline PI more than or equal to 3.5 recorded 23 incidences of hypotension after spinal anaesthesia, evident from table 9. No significant difference was noted in the two groups with respect to number of incidences of hypotension (MAP<65mm Hg) following spinal anaesthesia (p value = 0.628). Conclusion: Baseline perfusion index cannot predict the incidence of profound hypotension following spinal anaesthesia. Trends of fall in perfusion index after spinal anaesthesia was observed with decreasing, systolic, diastolic and mean blood pressures but, perfusion index is not a reliable parameter to indicate changes in blood pressure.

33. Role of Sympathetic Denervation in Peripheral Occlusive Arterial Disease – A Critical Appraisal
A. K. Saxena, Ravi Baghel, Mirza Farah Beg
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 claudicants 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.

34. A Comparison of I-Gel and Proseal LMA’s Effects on Hemodynamics in Adult Patients Undergoing Laparoscopic Cholecystectomies under General Anesthesia
Bharat Verma, Amrita Nidhi
Introduction: Proseal  (LMA)™ has an inflatable cuff while i-gel™ has a noninflatable cuff made of thermoplastic elastomer. Objectives: To compare and evaluate the hemodynamic response and during device insertion and during maintenance of general anesthesia in patient undergoing lapcholecystectomy. Methods: This study was conducted as randomized observational study in a teaching hospital. One hundred American Society of Anesthesiologists I and II, patients posted for lapcholycystectomy under general anesthesia were divided in two groups of fifty each. LMA Proseal™ and i-gel™. Hemodynamic response, hemodynamic data, at 1, 3, 5, 10, 15, 20, 25 and 30 min of insertion. Descriptive analyses were expressed as a mean ± standard deviation. Independent t-test used for parametric data, Chi-square test for nonparametric data and hemodynamic data were analyzed using repeated measures ANOVA to find statistical difference within the groups. Results and Conclusions: Our study conclude that both devices I-gel and PLMA are equally good for maintenance of airway in Lapcholecystectomy under GA and can be effectively used for maintenance of  general anaesthesia without any significant hemodynamic changes.

35. Comparative Evaluation between Preoperative HRCT Temporal Bone findings and Intraoperative findings in Mastoid Surgeries.
Alpesh Patel, Nehal Patel, Dimpal Padavi, Riddhi Gohil, Arundhati Patel, Deepti Tulsiyani, Akash Desai
Objective: To study the correlation of intra operative findings of chronic suppurative otitis media (atticoantraltype) with high resolution computerized tomography. Materials and methods: This study was conducted in E.N.T Department of S.C.L. Hospital, Ahmedabad, NHL Municipal Medical College from July2018 to December 2020.Total  67cases with chronic suppurative otitis media (Atticoantral type) were included in this study. The HRCT images were studied in comparison with the intra operative findings. Results: Total 67 cases were included in this study. The age range was 5 to 60 years. As a result of the comparison between Preoperative HRCT temporal bone findings and Intra operative findings in mastoid surgeries, Incus appeared eroded on HRCT Scan in 60 cases & 62 cases intra operatively, malleus appeared eroded on HRCT scan in 54 cases & 60 cases intra operatively, stapes appeared eroded on HRCT scan in 50 cases & 55 cases intraoperatively. Conclusion: In this study, 67 patients on intraoperative findings revealed cholesteatoma while in HRCT temporal bone findings 60 patients revealed cholesteatoma. Thus, there was good correlation between preoperative HRCT temporal bone findings and intra operative findings in diagnosing cholesteatoma. HRCT temporal bone very successfully predicts the extent of disease and ossicular erosion.

36. Maternal and Foetal Outcome of Anaemia in Pregnancy: A Study in Tertiary Care Hospital in South India.
Jenan M., Anasooya P.S., Sapna S.
Introduction: Anaemia in pregnancy is a public health problem. It is the most common medical problem complicating pregnancy. Socio-demographic factors are known to be associated with anaemia. Anaemia increases the risk of inter-current infections, preeclampsia, postpartum haemorrhage, low birth weight, preterm birth, sepsis, neonatal morbidity. Most common cause of anaemia in pregnancy is iron deficiency. Objective: To find out the socio-demographic risk factors of anaemia in pregnancy and fetomaternal outcome in those pregnancies. Methods: This is a hospital based prospective observational study among 180 antenatal patients diagnosed with anaemia in a tertiary care centre in India. After obtaining informed written consent, proforma was used for obtaining data from the subjects. Detailed clinical examination was done, and the patient was followed up till delivery and discharge from hospital to check whether there were any maternal, foetal, or neonatal complications. Results: Parity, inter-pregnancy interval and socioeconomic status were found to be important risk factors. There was no correlation seen between BMI and anaemia, diet was not seen to be an influencing factor. 3.3% of subjects had not taken prophylactic oral iron which should be addressed. Antenatal anaemia is the most important risk factor for postpartum anaemia. 76% of subjects developed postpartum anaemia. Antenatal anaemia is a risk factor for preeclampsia, puerperal infections, PPH, blood transfusion requirement and increased NICU admission rates. Conclusion: Sociodemographic factors such as Parity, Education, and socioeconomic status are associated with anaemia in pregnancy. Preeclampsia, puerperal infections, PPH, blood transfusion requirement, birth weight of the baby and NICU admissions also show association.

37. Outcome of Placental Extract Dressing versus Collagen Sheet Dressing for Partial Thickness Burns: A Comparative Study.
Siva Mandadap, Sharanabasavaraj Javali
Introduction: Burns are major morbid health issues with complex pathophysiology. Topical management of burns is a challenging task for surgeon. Effective topical agent should have less duration of healing, less duration of hospitalization, pain reduction, better scar formation and less incidence of infection properties. The present study designed to assess placental extract dressing on collagen sheet dressing for partial thickness burns. Material and Methods: Seventy-six cases attended with partial thickness burns (<40%) under 55 years of age were recruited. Cases were randomly divided into two study groups i.e. group P treated with placental extract gel and group C treated with collagen dressing. Parameters like duration of wound healing, texture of healed area, contour of healed area and duration of hospital stay were assessed. Results: The duration of healing was 25.31 days and 20.28 days and duration of hospital stay was 18.22 days and 13.65 days in group C and Group P respectively. This difference between two study groups was statistically significant (p<0.05). Infection after treatment was observed more in cases of group C (71.05%) than cases of group P (31.57%). Conclusion: Placental gel extract has superior efficacy in terms of less duration of healing time, less duration of hospital stays and less incidence of infection.

38. Study to Assess the Performance and Safety of Exocool Pain Numbing Device on Pain Due to Vaccination and Intravenous Cannulation in Children.
Rahul Chopra, Baburao Vikram, Chaithanya KJ
ExocoolTM system is a Novel pain Numbing device used for providing a painless experience to sharp prick of injection needles using cryo-numbing mechanisms which numb the site of the application within 8-10 seconds without the use of any chemical or therapeutic agents. Exocool system finds a wide area of application from cosmetic procedures, paediatrics centres, vaccination centres, pathology labs, clinics, and at home. This study is a Randomized, controlled, two-arm, Parallel, sham-controlled trial to study the efficacy of pain-numbing devices and to measure the patients and caregiver satisfaction with the device during intravenous cannulation. Children aged 4-18 years were considered in the study. A total of 60 subjects participated in the study. A majority of study participants (80%) rated the cool device as satisfactory and which indicated that they liked the device. The results show that Exccool device has significant and satisfactory analgesia actions for intravenous cannulation among children (4-18yrs). This study revealed that Exocool Pain Numbing is an effective pain management intervention for children in vaccination and intravenous cannulation.

39. Effect of Maternal Body Mass Index on Pregnancy Outcome.
Somani S, Misra M, Tahilramani H, Kamlesh Kumari K
Introduction: Body weight is double edged sword, underweight as well as overweight are responsible for various medical illnesses, overweight pregnant women are more prone to gestational hypertension, preeclampsia, gestational diabetes mellitus, macrosomia, operative deliveries, wound infection, respiratory problems. Underweight pregnant women are more prone for anemia, preterm birth, intra uterine growth retardation, low birth weight babies. Objective: To determine maternal and perinatal risk in over weight as well as underweight pregnant women. Method: This is an observational study, conducted over a period of 4 months. Total 127 pregnant women admitted in hospital were included in the study as per inclusion criteria, their BMI was calculated and then all women grouped as per WHO guide lines, all patients were followed till delivery and again till the date of discharge and their obstetrics outcome was noted. Result: Most of the patients were from the age group of 21-30, In our study we found that women  with low BMI were associated with anemia, oligohydroamnios,  preterm delivery, low birth babies, while women with high BMI were associated with gestational diabetes mellitus(GDM), pregnancy induced hypertension(PIH), instrumental vaginal deliveries, cesarean deliveries(LSCS), high birth weight babies, wound complications, respiratory tract infections. Conclusion: It was concluded from our study that extremes of maternal BMI is related to adverse fetomaternal outcome, thus fetomaternal outcome can be improved significantly by prevention and treatment of overweight as well as underweight in pregnant women.

40. Milan System for Reporting Salivary Gland Cytopathology with the Implication for Risk of Malignancy: An Experience in a Tertiary Care Hospital.
Adhlakha B, Yadav P, Jigjini S, Swati
Introduction: Fine needle aspiration cytology (FNAC) of salivary gland lesions has diverse and overlapping cytological features making this a challenging work to give precise diagnosis. The Milan System for reporting salivary gland cytopathology (MSRSGC) helps standardize reporting systems across institutions, provides an intrinsic risk of malignancy (ROM) for each diagnostic category and guide the clinical management of patients. This study emphasises on validation of MSRSGC and evaluate its diagnostic utility. Material and Methods: This was a retrospective study in which FNAC of salivary gland lesions done over a period of 3.5 years were retrieved. All cases were categorized according to MSRSGC and correlated with histopathological follow-up, wherever available. ROM was calculated for each MSRSGC category. Results: A total of 90 cases were classified using the Milan system as non-diagnostic (0%), non-neoplastic (45.5%), atypia of undetermined significance (0%), benign neoplasm (38.8%), neoplasm of uncertain malignant potential (5.5%), suspicious for malignancy (2.2%), and malignancy (7.7%). Cytohistological correlation was done on 29 cases with discordance in 2/29 cases (6.8%). The risk of malignancy was zero for Category II, 5% for IVa, 33.5% for IVb, and 100% for both V and VI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were 71.4%, 100%, 100%, 91.6%, and 93.1%, respectively. Conclusion: MSRSGC provided a uniform system of reporting salivary gland cytomorphology, helps triage patients and thus facilitates individualized management. The present study confirms the validity and diagnostic utility of Milan system.

41. Cytological Spectrum of Lesions in Neck Swelling with Histopathological Correlation in RUHS Medical College and Hospital.
Chandra Prakash Kumawat, Yogesh Kumar Gupta, Archana Singh
Neck swellings are very frequently visited condition in surgery and ENT OPDs. The differential diagnosis in these cases is often extensive and vary with age, sex, and site. The swellings around neck range from enlarged lymph nodes, to salivary glands diseases, cysts, lipomas, and thyroid lesions. FNAC is a good tool to evaluate neck lesions. The use of FNAC in the investigation of head and neck masses has become an acceptable and widely practised minimally invasive technique with a larger acceptance by the patients. Method: All the FNAC and respective biopsies received at our department between Jan 2019 to Dec 2021, retrospective from Jan 2019 to Dec 2020 and prospective from Jan 2021 to Dec 2021 were included in our study as per inclusion and exclusion criteria. Results: We included 200 patients by simple random sampling. The age ranged from 10 to 78 years (median age = 48 years). Most common age group was 51-60 years with 48 (24%) cases followed by 41 – 50 years with 38 (19%) cases. There were 126 male patients 74 female patients with male: female ratio of 1.7: 1. Lymph nodes were the commonest involved in 96 (48%) cases, followed by thyroid and salivary glands lesions with 30 (15%) and 28 (14%) cases respectively. The sensitivity in cases of lymph node lesions was found to be 84.58%, whereas specificity of 97.62% with accuracy in diagnosis of 95.62%. In cases of aspirations of thyroid gland, the sensitivity was 100% and specificity of 77.9%. In salivary glands aspirates out of 28 cases, 18 cases showed infective and benign lesions and 10 cases of malignant lesions. In miscellaneous cases (n=76) it showed, 26 cases of cystic lesions, 20 cases of lipoma in different areas of neck region. Histopathological correlation was available in 76 cases. The overall sensitivity of diagnosing malignant lesions by FNAC in the present study was 83.33% and specificity was 91.29%. Conclusion: The sensitivity and specificity of FNAC is fair enough with lot of advantages. FNAC provides a reliable method of investigating neck swellings, the efficacy of which approaches that of other similar diagnostic procedures and in the present study.

42. Omphalocele: A Rare Case Report.
Lipika Behera, Deepika Mishra, Swetambari Acharya, Chaitali Pattnaik, Shushruta Mohanty
Gastroschisis and omphalocele are commonly described anterior abdominal wall defects. Omphalocele is a midline anterior abdominal wall defect with extrusion of abdominal viscera, covered by a membranous sac, into the base of the umbilical cord. Omphaloceles occur in 1 in 3,000 to 10,000 live births. Contents of omphalocele are usually bowel, liver, or both of these. A male foetus of 21wks gestational age was delivered by MTP after being detected of having omphalocele on USG. The diagnosis was confirmed later by autopsy.

43. A Study of Hematological and Lipid Profile Status of Apparently Healthy Donors in Blood Bank at a Tertiary Care Centre in North India: A 2 Year Experience.
Deeksha Singh, Sayeedul Hasan Arif, Suhail Ur Rehman, Bhuvan Adhlakha, Shivani Kalhan, Samridhi Allhabadi
Introduction: Blood donation is a nobel act and it save the life of four patient, as one whole blood is divided into four components. Blood donation is noble act for survival of the sick and needy patients during emergency. Numerous studies conducted and they have reported, the mean haemoglobin level, serum iron, serum ferritin and cholesterol level were significantly low in repeat donors compared to first time donors. Iron deficiency was more common in high frequent donors compared to low frequent donors [4].  There is strong evidence of the role of red cell indices as early indicators of iron diminution in frequent blood donors by measuring serum ferritin or soluble transferrin receptor levels. Methods: This two year prospective study was done in the blood bank of J.N. Medical College and Hospital, AMU, Aligarh from 2018 to 2020. This study was conducted on first time donor, repeat donor and repeat donor on subsequent donation. Statistical analysis of Haematological parameters, Iron Profile and Lipid Profile was done. Results: In present study, there was decrease in value of haemoglobin in repeat donors (13.4g/dL) which further decreases on subsequent donation (13.36g/dL). Mean iron in first time donor was 92.67µg/dL which reduces on repeat donation and on subsequent donation. The value of mean iron reduces from 90.9µg/dL in repeat donors to 83.3µg/dL in repeat donors on subsequent donation. Mean ferritin value in first time donor was 59.47 ng/mL and in repeat donors it was 51.17 ng/mL which further reduces to 43.08 ng/mL on subsequent donation. LDL cholesterol in first time donor was 74.77 mg/dL and it decreases in repeat donors and in repeat donor on subsequent donation to 70.7 mg/dL and 65.5 mg/dL respectively. LDL/HDL ratio in first time donor was 2.19 and it reduces to 2.15 in repeat donors and on further donation it falls to 2.11. Conclusion: Blood donation is beneficial as it reduces LDL cholesterol and increases HDL cholesterol.

44. Correlation of Cytomorphological Pattern and Thyroid Hormone Profile: Role of Fine Needle Aspiration Cytology (FNAC) in Reducing the Surgical Intervention of Thyroid Lesions.
Gummalla Swetha, G Santhoshi, Vijayalakshmi Koduri, Byram Bheeshma
Background: Fine needle aspiration cytology (FNAC) of the Thyroid is over half a century old and has been shown to be superior to clinical, radionucleotide or thyroid ultrasound assessment alone. It is the most accurate, cost-effective, and simplest screening test for rapid diagnosis of thyroid nodules. Evaluation of both cytomorphological pattern and thyroid hormone profile aids in early detection of various thyroid diseases there by reducing surgical intervention. Aims and Objectives: To correlate role of thyroid hormone profile (T3, T4 and TSH) with cytology results, in various thyroid disorders like diffuse nontoxic goiter, diagnosis of solitary/dominant thyroid nodule and thyroid malignancy. To evaluate the clinical correlation with Euthyroid, Hypo and Hyperthyroid picture in various disorders. To calculate the percentage of surgical intervention for various thyroid disorders in view of FNAC findings in correlation with thyroid profile. Material and Methods: All patients who underwent thyroid FNAC from July 2020 to July 2022 have been included in the study only if Thyroid profile has been done. The various lesions have been categorised as Euthyroid, Hypothyroid and Hyperthyroid as per the hormone analysis results. The FNAC findings have been reported as per the Bethesda System and classified as per the latest WHO guidelines. Results: Predominantly affected gender was females (91.25%), most common affected age group was 41-50 years (30%), 88.75% were euthyroid patients, most common benign lesion on FNAC was nodular goiter (33.75%), malignant lesion was papillary thyroid carcinoma (18.75%), thyroid profile in various thyroid lesions were euthyroid. Conclusion: FNAC along with thyroid hormone profiles helps clinician in early detection and accurate diagnosis of various thyroid lesions and to determine course of therapy in the management of thyroid nodules and possibility to reduce surgical intervention.

45. Efficacy of Fine Needle Aspiration Cytology in the Analysis of Thyroid Swellings with Histologic Correlation in Tertiary Care Hospital of Central Rajasthan.
Saumya Katiyar, Chandrika Gupta, Radha Sharma, Hema Udawat, Nitin Gupta, Chandraprakash Kumawat, Virendra Vikram Singh Patel
Introduction: In the human body, the thyroid is frequently the source of illness. In these situations, fine needle aspiration cytology is a quick, effective, affordable, and secure diagnostic technique. It makes it possible to make surgical decisions with greater precision than any other way. It enables the doctor to make a diagnosis in the majority of cases with the least amount of time and money spent, and frequently without the need for unneeded surgery. It is an important tool in the diagnosis and treatment of patients with thyroid lesions because it has high rates of sensitivity and positive predictive value in identifying thyroid lesions. Methodology: (1) In the current investigation, 704 thyroid FNA cases were analysed, and wherever possible, cyto-histopathological connection was interpreted. (2) Where histopathological correlation was available, all thyroid lesions that were conventionally diagnosed by FNA were classified according to TBSRTC and assessed for the risk of malignancy. Results: A total of 704 thyroid swelling cases were examined for this investigation. Out of these 704 cases, FNAC determined that 626 cases were non-neoplastic lesions, 6 cases were suspect of malignancy, and 72 cases were neoplastic lesions. 125 of the 704 patients underwent follow-up biopsies and histological analysis. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the FNAC in the current investigation were 72.2%, 99.06%, 92.86%, 95.49%, and 95.2% respectively.

46. Prevalence of Hypothyroidism among Anal Fissure Cases – A Single-Center, Retrospective and Observational Study.
Gokila M., G. Vinayagam
Background: Fissure in ano is common proctologic condition. Fissure in ano is common condition which affects young and middle-aged people with an equal incidence in males and females. The effect of hypothyroidism on gastrointestinal system seems to be multifactorial with alterations of the hormone receptors, neuro-muscular disorders and myopathy by infiltrating the intestinal wall. Aim of the study was to look for prevalence of Hypothyroidism among Fissure in Ano patients. Objective: The present study aimed to analyse the association between Hypothyroid state and occurrence of Fissure in ano among consecutive 52 patients who were diagnosed and admitted with fissure in ano. Materials and Methods: Inclusion criteria was composed of all the patients diagnosed and admitted with fissure in ano during the study period July 2021 to July 2021. Whereas, exclusion criteria were composed of 1) patient age less than 12 years, 2) any patients with history of Crohn’s disease, Haemorrhoidectomy, Ulcerative colitis and Abdominal tuberculosis and 3) those patients who are on medications and conditions that affect T3, T4 and TSH values like Pregnancy, treated thyroid abnormalities, total thyroidectomy patients, sepsis, lithium, phenytoin, metaclopromide. Medical records of all the patients admitted with fissure in ano whom underwent Thyroid Function Test during admission were retrieved and data were collected. The collected data was entered in Microsoft Excel to maintain the quality of data. The data was tabulated and analyzed by using Statistical Package for the Social Sciences (version 24). The data was analyzed and percentages were calculated. Result: Our study reported slight predominance of female patients (71.1%) than male patients (28.8%) among the study population. The majority of both gender patients were between the age of 30-50 years (55.78%), with 23% of patients were more than 50 years and only 21.1% of patients were less than 30 years. Females suffered the maximum (43.24%) from hypothyroidism than the males. Females suffered from the maximum duration of both acute and chronic illness (71.1%) from hypothyroidism than the males. The maximum number among hypothyroid patients were suffering from chronic illness. Conclusion: In conclusion, there is an increased prevalence of hypothyroidism in cases of anal fissure among females.

47. Convectional Dressing versus Platelet Rich Plasma in the Management of Diabetic Foot Ulcers – A Prospective Comparative Study.
Siva Mandadap
Introduction: Diabetic foot ulcers are major medical issue that causes hospitalization and amputation in diabetics. Platelet rich plasma (PRP) is an effective method in the field of wound healing by supplying growth factors and diminishing inflammation. The preset study was aimed to evaluate the efficacy of platelet rich plasma dressing versus conventional dressing in the management of diabetic foot ulcers. Material and Methods: Forty-eight cases diagnosed with diabetic foot ulcers between age group 41 to 65 years were randomly divided into two treatment groups i.e. group C with conventional dressing and group P with platelet rich plasma dressing. Cases were evaluated for the rate of wound contraction and reduction till 12 weeks. Ulcer characteristics and dimension was measured on every dressing. Results: Ulcers on plantar aspect of foot (70.83%) were common in group C and on dorsal side of foot (54.1%) in group P. The mean duration of diabetes was 8.63 years and 9.37 years in group C and group P respectively. 91.66% cases in group P and 50% cases in group C showed complete healing by 5th week. Conclusion: Platelet rich plasma dressing is safe and powerful tool for the management of diabetic foot ulcers as it enhances healing, reduce wound contraction, wound area of reduction and infection than conventional dressing.

48. Study to Determine the Predictors of Postoperative Hypocalcemia Requiring Augmentation of Routine Calcium Supplementation after Total Thyroidectomy.
Amit Kumar, Kunal Ranjan
Aim: The aim of this study was to determine the predictors of postoperative hypocalcemia requiring augmentation of routine calcium supplementation. Methods: The present study collected data of 50 patients who underwent total thyroidectomy with or without central compartment node clearance (CCC) and/or lateral neck dissection (LND) for malignant or benign conditions in the Department of Onco Surgery, Bihar cancer surgical Hospital, Malahi Pakri Chowk, Patna, Bihar, India. Results: Out of these 50 patients, 80% were females. Median age at the time of presentation was 46 years (range 16–80 years). A total of 44 patients (88%) underwent surgery for thyroid cancer, while the remaining 6 (12%) underwent surgery for benign conditions. There were 35 patients (75%) who did not require alteration in routine calcium supplementation, 12 patients (24%) required an increase in oral calcium supplementation, while 3 patients (6%) were escalated to i.v. calcium supplementation for correction of hypocalcemia. There was a significant correlation between the number of congested parathyroid glands at the end of surgery and the requirement of calcium augmentation. Out of 20 patients in the low PTH group, 10 patients (50%) required increase in oral calcium supplementation and 2 patients (10%) required i.v. calcium correction for hypocalcemia. While in the high PTH group (30 patients), only 3 patients (10%) required increase in oral calcium, none requiring i.v. calcium correction. This difference was statistically significant (p < 0.001). Conclusion: The risk of developing hypocalcemia and the need for calcium dose augmentation after total thyroidectomy was significantly associated with CCC, parathyroid gland congestion, and serum PTH levels. Identifying parathyroid gland congestion at the end of surgery and measurement of the serum PTH levels are effective strategies in the reduction of morbidity from postoperative hypocalcemia with implications on time and cost.

49. Assessment of Different Treatment Modalities of Meniscus Repair: An Observational Study.
Pankaj Kumar
Aim: The objective of the present study was to compare clinical and functional results of meniscus repair treated with various modalities. Methods: The present study was conducted and presenting in the Department of Orthopaedics, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India having meniscus injury identified on the basis of clinical examination and MRI findings, the patients were treated with menisceal repair techniques. The study population was made up of 20 knees with medial meniscal lesions and 30 knees with lateral meniscal lesions. Results: This study represents a case series of 50 athletes who underwent repair of isolated meniscal lesions of the knee. Cases of discoid meniscal lesions and combined ligament injuries were excluded. The mean age of the patients was 22.9 years ranging from 12 to 50 years. The meniscal injury on right knee was 30 cases and left knee were 20. The most frequent type of tear in the medial meniscus group was the bucket handle tear that was seen in 8 of 20 knees (40%), while the most frequent type for the lateral meniscus group was the longitudinal tear that was seen in 12 of 30 knees (40%). Conclusion: All meniscus repair techniques outside in, inside out, and all inside technique combination of all yields comparative clinical and functional outcome and statistically difference of result is not significant. Excellent to good results were in 99.66% cases.

50. Comparative Study of Preoperative and Post Operative Astigmatism in Small Incision Non phaco Cataract Surgery from Superior and Temporal Incision and Phacosurgery.
Saket Bihari Choudhary
Aim: The aim of the present study was to evaluate the preoperative and post-operative astigmatism in small incision non-phaco cataract surgery from superior and temporal incision and phacosurgery. Methods: The present study was conducted in the Department of Ophthalmology,  Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of one year. 150 patients were selected in the study. All the patients underwent manual small incision cataract surgery (MSICS), 50 with superior scleral incision, 50 with superotemporal incision and rest of the 50 with phacosurgery. All were evaluated and managed in the same hospital and they underwent post-operative follow up as outpatient in the same. Results: A randomized comparative study of astigmatism at postoperative follow ups following superior (SI), superotemporal scleral incision (STI) and Phacosurgery in manual small incision cataract surgery in total 150 patients with 50 each with each incision. In the present study, it was found that 74% of the patients of both groups who underwent MSICS had visual acuity less than 6/60, whereas rest 26% had visual acuity more than 6/60. In this study, it is seen that 18(36%) patients who had WTR astigmatism underwent SI, 17 (34%) underwent STI and Phacosurgery 16 (32%), whereas 22 (44%) patients of those who had ATR astigmatism underwent SI, 46% underwent STI and 24 (48%) underwent Phacosurgery. Conclusion: This study suggests that sutureless superotemporal scleral incision produces less post-operative astigmatism than superior scleral incision and phacosurgery. It was seen, that superotemporal incision causes with-the-rule astigmatism in most of the cases postoperatively along with a capability of neutralizing against-the-rule astigmatism which will be present in majority of elderly patients with cataract, whereas superior scleral incision causes against-the-rule astigmatism in the most.

51. Electrocardiographic Changes in Subclinical Hypothyroidism: A Case-Control Study.
Sanjay Kumar
Aim: The objectives of this study were to study the electrocardiogram (ECG) changes in a group of newly diagnosed subclinical hypothyroid females and to compare the ECG changes in subclinical hypothyroid females with normal healthy euthyroid individuals. Methods: This study was conducted in the Department of Physiology, Patna Medical College and Hospital, Patna, Bihar, India,for one year. We studied 50 patients with newly diagnosed and untreated primary SCH who presented to Patna Medical College and Hospital, outpatient department (Dermatology, Medicine, and Obstetrician-Gynecologist) with non-specific complaints such as fatigue, mild weight gain, dry skin, and depressive feelings but without overt symptoms and signs of thyroid hormone deficiency. Results: A total of 50 subjects (25 in the study group and 25 in the control group) were included in the study. Both groups were well matched with regard to age and BMI. Heart rate and blood pressure were comparable in both the groups. TSH levels were significantly higher in SCH patients than controls, but fT4 and fT3 were comparable. Mean QTc interval of the study group was significantly longer than those of the control group (P = 0.027). Other parameters in ECG were comparable in both the groups. Conclusion: The present study concluded with the following important finding that patients of SCH have prolonged QTc interval, which predisposes to the potentially life-threatening ventricular arrhythmias. Cardiovascular manifestations are common in thyroid disorders.

52. A Hospital Based Descriptive Assessment of Clinical and Hematological Profile in Dengue Fever.
Shatrughan Kumar, MD. Tarique Anwar
Aim: This study is an attempt to elucidate the positive laboratory profile of serologically diagnosed dengue patients so as to facilitate early diagnosis, treatment, management and vector control measures, to reduce the morbidity and mortality because of this disease. Methods: This was a descriptive study with analysis of patients who were admitted for dengue fever in the Department of Medicine, Sadar Hospital, Motihari, Bihar, India for duration of 6 months. This study was conducted on 100 indoor patients. Patients presenting to the emergency department, outpatient department (OPD) or pediatric OPD with complaints of fever and clinical features of dengue with positive NS1 antigen test or dengue antibody serology IgM or IgG or both were included in the study. Results: Most of the cases were seen in the 20-30 years age group followed by 31-40 years age group. Majority of the patients were males compared to females and the male to female ratio was 2:1. Fever was the most common presentation and was seen in 40 cases (40%) cases. Present study showed hemoglobin range of 6 gm% to 17 gm% (Table 3). Raised hematocrit (>47%) was noted in 15 (15%) of patients at presentation and the hematocrit ranged from 20-51%. The total leukocyte count ranged from 1500 cells/cumm to >11000 cells/cumm. Leucopenia with less than 4000 cells/cumm was present in 25% cases. In the present study out of 100 cases of dengue fever, 90% cases had thrombocytopenia and 10% cases had severe thrombocytopenia (<20,000/cumm) with bleeding manifestations. Conclusion: Hemoconcentration, leucopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that dengue cases can be diagnosed in their initial stages. This facilitates early treatment and aggressive fluid replacement therapy with good nursing care so that fatality rates can be reduced.

53. A Prospective Randomized Assessment of the Intrathecal Dexmedetomedine and Magnesium Sulfate as Adjuvants to Bupivacaine in Total Hip Replacement.
Madhukant, Nikita, Sudama Prasad, B.K. Kashyap
Aim: The purpose of this study was to evaluate the onset and duration of sensory and motor block as well as perioperative analgesia and adverse effects of dexmedetomidine and magnesium sulfate given intrathecally as adjuvants to bupivacaine in total hip replacement. Methods: The randomized, prospective comparative study was conducted in the Department of Anesthesiology, Patna medical College and Hospital, Patna, Bihar, India. 120 patients, belonging to ASA (American Society of Anesthesiologists) grade I-II scheduled for total hip replacement. Results: 120 patients were enrolled in the study. All the patients completed the study protocol and were included in the data analysis. Thus group B, group M and group D consisted of 40 patients each. There was no significant difference in the demographic data between the three study groups [p >0.05]. The time to reach T10 sensory dermatome, Bromage 3 motor block and regression of the sensory block to L1 dermatome, motor block to Bromage scale 0 were statistically significant between group D, group M and group B. onset of sensory block was rapid and regression of motor block was prolonged significantly in group D. whereas onset of both sensory and motor block was delayed in group M which is highly significant (p <0.001) when compared to group D. regression of sensory dermatome to L1 and motor block to bromage 0 was highly significant (p<0.001) between three study group. Conclusion: Intrathecal DXM supplementation of spinal block seems to be a good alternative to intrathecal Mg as it produces earlier onset and prolonged duration of sensory and motor block without associated significant hemodynamic alterations.

54. A Prospective Comparative Assessment of Effect of Platelet Contamination on the Coagulation Screening Tests.
Md. Imteyaz Alam, Arun Roy, Poonam Kumari
Objectives: To evaluate the effect of platelet contamination on the coagulation screening tests (Prothrombin time and activated partial thromboplastin time) and to evaluate and compare effect of platelet contamination on the normal and abnormal coagulation screening tests (Prothrombin time and activated partial thromboplastin time). Material & Methods: This is a prospective analytical study conducted over a period of six months at the Department of Pathology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India. Results: A total of 40 samples for this study. A total of 40 samples were analysed. 19 of them had coagulation parameters in the normal range and rest 21 had abnormal coagulation studies. The mean difference in APTT values between intervention and standard spin technique was 0.1 second and 95% LoA was -1.5 to +1.2 in samples with normal APTT values. Analysis of the samples with prolonged APTT values yielded a mean difference of 1.1 seconds with 95% LoA of -4.1 to +6.3. Conclusions: Platelet contamination of plasma insignificantly shortens the coagulation test results and remains clinically useful.

55. A Hospital Based Prospective Assessment of the Association of Hba1c Levels with Diabetic Retinopathy.
Binod Kumar, Rajesh Kumar Singh, Bhupendra Prasad
Aim: The aim of the present study was to evaluate the association of Hba1c levels with diabetic retinopathy in Bihar region. Methods: The present study was conducted in the Department of ophthalmology, GMC, Bettiah, Bihar, India  for 1 year after taking the approval of the protocol review committee and institutional ethics committee. 200 patients were included in the present study. Results: There were 120 males and 80 females in our study group, revealing a male predominance in our recruited study population. The mean age of participants in this study was 62.08 ± 7.20 and out of the 200 participants. The mean age of 100 patients at diagnosis was 48.4± 6.32 and mean duration of diabetic age was 16.32 ± 6.90. The mean of Glycosylated haemoglobin (HbA1c) in the study population was 8.90 ± 1.88. The present study constituted 10% mild NPDR, 20% moderate NPDR, 45% severe NPDR, 20% PDR and 5% high risk PDR. Out of 100 retinopathy patients studied severe and very severe NPDR accounted for nearly half the patients while the other half consisted of early PDR, mild and moderate NPDR, the latter being higher than the former. Conclusion: The value of glycosylated haemoglobin (HbA1c) showed an increasing trend as severity of diabetic retinopathy increases. The poor metabolic control as demonstrated by high HbA1c is significantly associated with severity of retinopathy and presence of CSME.

56. Study of P16 and Ki-67 Immunoexpression in Squamous Cell Neoplastic Lesions of Oropharynx and Larynx.
Cheatna Pradhan, Swagatika Agrawal, Sunil Agarwal, Subhrachandan Pradhan, Itishree Chowdhury
Background: The cancerous lesions of  head and neck region show diverse clinicopathological features and are mostly linked with poor outcome. Aim: To evaluate the p16 and Ki-67 expression in benign lesions, dysplastic lesions and squamous cell carcinoma (SCC) of oropharyngolaryngeal (OPL) region. Materials and Methods: 62 histopathologically diagnosed cases were taken from the pathology department of our institute. It comprised of 6 benign cases, 12 dysplasia cases and 44 SCC cases of OPL region. Immunohistochemistry was done to investigate the expression of p16 and Ki-67. The scoring was done based on percentage of positive tumor cells and the staining intensity. Results: Out of 62 cases, 39 cases(62.9%) showed p16 expression and 58 cases(93.5%) showed Ki-67 expression. There was significant increase in staining intensity and percentage of tumor cells expressing p16 and Ki-67 from benign lesion to dysplasia to different grades of SCC. Conclusion: We came to a conclusion in our study that p16 and Ki-67 immuno markers can be used in future studies as prognostic indicators. The combined study of p16 immunohistochemistry and HPV detection may play an important role in the clinical management.

57. Maternal and Perinatal Outcome in Pregnant Women with Oligohydramnios in a Tertiary Care Centre.
Nagesh Gowda B L, Shwetha S, Pratibha
Background and Objectives: Amniotic fluid is clear slightly yellowish liquid which surrounds the foetus, it is alkaline and its volume is related to gestational age. It protects the fetus by functioning like a shock absorber, maintains even temperature, allows for the growth and free movements of foetus and prevents adhesions between fetal parts and amniotic sac. Polyhydramnios, severe oligohydramnios are around 1.25% and 1- 5% of the pregnancies. Oligohydramnios is more associated with fetal anomalies, morbidities and maternal hypertension. We noticed there was a drastic change in the patterns of the levels of amniotic fluid among the labour class women. The present study was designed to evaluate the effects of decreased amniotic fluid levels on the mother and the baby. Materials and Method: A cross sectional study was conducted in the Department of Obstetrics and Gynaecology , ESIC-PGIMSR Bangalore between January 2019 to June 2020. 254 pregnant women with normal and oligohyframnios were included in the study. The maternal and fetal outcomes were observed in pregnant women with normal AFI and decreased AFI. Results: Among 254 women 151 had normal AFI and 103 had oligohydramnios. Age ranged from 26-28 years. In oligohydramnios group, higher induction of labor 61(59.2%) vs 40(26.5%), cesarean section rate 59(57.3%) vs 46(30.5%), APGAR <7 at 5 minutes 17(16.5%) vs 3(2%), low birth weight babies 42(40.7%) vs 27(17.9%) and NICU admission 36(35%) vs 25(16.6%) with a p≤0.001 when compared to normal AFI group. Conclusion: Amniotic fluid index is an important part of antepartum fetal surveillance. Abnormalities of AFI are associated with higher maternal cesarean sections and NICU admissions.

58. Risk Factors of Acute Otitis Media among Infant in Tertiary Care Center: A Cross Sectional Study.
Anil Pandey, Anupama Pradhan, K. Krishna Medha, Anshul Singh, Ankita Yadav
Objectives: Otitis media are well identifying as an infection and/or inflammation of the middle ear. New-born’s and infants are more likely to infect with AOM because of the immature immune system. This present study was to evaluate the various risk factors of acute otitis media in infants in tertiary care centre. Methods: A questionnaire form was prepared by the researchers in order to collect all the relevant data associated with the study sample. The questionnaire form contains of (11) items that are (Age, gender, residency, type of feeding, nasal obstruction condition, child position during feeding, mother’s position during feeding, upper respiratory tract infection, using bottle feeding at night, exposed to second hand smoke, and using the pacifiers when sleeping). Results:  Most of the infants 16(40%) of case group were in age 7-9 months. 29(72.5%) bottle feeding infants were seen in case group and 27(67.5%) bottle feeding infants were seen in control group. Nasal obstruction was seen in 30(75%) case and 23(57.5%) control group infants. Child’s position during feeding in case group of majorities of cases 27(67.5%) had supine. Child’s position during feeding in control group of majorities of cases 22(55%) had semi flower’s. Upper respiratory infection was seen in 18(45%) infants of case group and 24(60%) infant of control group. Bottle feeding at night (for breast feeding infants) was seen in 10(83.33%) infants of case group and in 9(75%) infants of control group. Children exposed to passive smoking was seen in 34(85%) infants of case group and 24(60%) infants of control group. Conclusions: This present study concluded that the bottle feeding, nasal obstruction, supine position during feeding, child exposed to passive smoking are major risk factors for acute otitis media in infants.

59. Medico-Legal Aspects of Microscopic Findings in Drowning.
Jiju V.S., Tomy Mappalakayil, Sasikala K.S.
Background: In this study we wanted to find out the relevance of microscopic evidence of foreign bodies in lungs in case of drowning and determine the proportion of cases in which diatoms in bone marrow and those in the drowning medium were identical. Materials and Methods: This was a descriptive study conducted among 100 cases in the Department of Forensic Medicine, Govt. Medical College, Kottayam. Results: Striking feature which was brought out from this study was that when light microscopy found foreign bodies in distal air passages and alveoli in only 22% cases, polarisd microscopy could do the same in 34% cases. Conclusion: Polarised microscopy is important in the diagnosis of ante-mortem drowning. Though we always insist of finding diatoms in bone marrow which are identical to those in the drowning medium not only as a dignostic tool but also as a pathognomonic feature of recognising the drowning medium, this finding was present only in 9% of cases. This suggests the low specificity & low sensitivity of the test and hence this particular test cannot be relied upon at all if it turns negative.

60. Prospective Hospital-Based Assessment of the Clinical Profile of both Falciparum, Vivax and Mixed Infections.
MD. Tarique Anwar, Shatrughan Kumar
Aim: The objective was to study clinical profile and outcome of malaria in two species and mixed infection. Methods: The present study was done in department of Medicine, Sadar Hospital, Motihari, Bihar, India. The study was carried out on 120 patients admitted for the period of nine months in this hospital. It was a prospective cohort study. Results: In the present study, out of 120 patients more number of males (80 patients) was affected when compared to females (40 patients). The predominant age group affected was 20-30 years, which constitutes to about 41.66%, followed by 31-40 years (33.34%). Up to 75% of patients affected were in the age group of 20-40, who were young and working outdoors. The mean age of in this study was 38.52 years. Fever is the most common presentation in all 120 patients both falciparum and vivax infected patients. This is followed by chills and rigors were present in 70 patients, 40 of patients with falciparum and 30 of the patients infected with vivax. Nausea and vomiting where another common complaint observed in 60 of total patients, more in falciparum 35 than vivax 25. Conclusion: Malaria is very common disease in our country especially, which is one of the endemic areas. Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity.

61. Evaluation of Appropriate Measures to Meet the Health Requirements to Reduce Morbidity and Improve Quality of Living of Geriatric Population.
Anupama Arya, Deendayal Verma, Shalabh Jauhari, Hem Chandra
Background: With myriad health problems, suitable health services are needed for this ever-increasing segment of the population.  However, most of the hospitals in India (both private and government) do not have an exclusive geriatric unit to provide better support system to the older population.  Often, the early diagnostic process among the older people is ignored as symptoms are considered to be a part of ageing process. The ideal healthcare system for senior citizens should be economical, accessible, all-inclusive, and ensure continuity over both time and in terms of content. Aim: Evaluation of appropriate measures to meet the health requirements to reduce morbidity and improve quality of living of geriatric population. Methods and Materials: After establishing trust and maintaining anonymity, the person was interviewed and examined, and information was gathered using a pre-made questionnaire. There was analysis regarding the access of primary health care among geriatric population of rural India, number of medical camps witnessed by the elderly population in last month, last one year, last 5 years or never witnessed any medical camp. There was evaluation regarding presence of any systemic disorder, socioeconomic status, type of medicine commonly used. Results:  In this study 10.2% of geriatric population in rural India had good access to primary care hospitals. 23.4% of of geriatric population in rural India had satisfactory access to primary care hospitals. 9.5% of study participants had no idea about the presence of primary care hospital. It was observed that most of the study participants 44.62% had witnessed a government organized medical camp 5 years back. 23.42% of study participants had witnessed medical camp once in year while only 10.12% study participants had witnessed medical camp once in month. 21.82% of study participants had never faced any medical camp in their life. Conclusion: The results from this study has reflected the fact that status of healthcare facilities available to geriatric population in rural India is not satisfactory and there is serious need to appropriate measures to meet the health requirements to reduce morbidity and improve quality of living of geriatric population.

62. A Comparative Study of Injection Ferric Carboxy Maltose and Injection Iron Sucrose for Treatment of Iron Deficiency Anaemia in Pregnancy at Kamla Raja Hospital, Gwalior.
Megha Bandil, Renu Jain, Yashodra Gaur, Vrunda Joshi
Background: Iron deficiency anaemia is the most common form of anaemia during pregnancy. It may have detrimental effects on the mother and growing foetus. There is need to study the effectiveness and safety of injection ferric carboxy maltose and injection iron sucrose in pregnant women havinganaemia. Aim: To carry out a comparative study of injection ferric carboxy maltose and injection iron sucrose for treatment of iron deficiency anaemia in pregnancy at Kamla Raja Hospital, Gwalior. Methods and Materials: A total of 100 pregnant women with microcytic hypochromic anaemia (iron deficiency anaemia) as determined by peripheral smear were included. The total dose will be determined using the formula. While women in Group B (n=50) received injections of iron sucrose, women in Group A (n=50) received injections of ferric carboxy maltose. Results: Most patients in Group A (46%) and in Group B (46%) had their pre-treatment Hb in range of 8-8.9 g/dl. Majority of patients in both groups had their pre-treatment serum ferritin in range of 10-19.9 mcg/l. At 2 weeks and three week post treatment, the rise in mean Hb level was more in Group A as compared to Group B. Statistically the rise was highly significant. Conclusion: From our study we concluded that injection Ferrous carboxy maltose appears to be safe and efficient for correction of iron deficiency anaemia in third trimester of pregnancy with lesser adverse effects and better patient compliance.

63. Prospective Randomised Clinical Trial Examined the Impact of Dexamethasone on the Analgesic Effectiveness of Transverse Abdominis Plane Block during Laparoscopic Gynaecological Operations.
Syed Farhan, Karuna Batheja
Background and Aims: More recent evidence suggests that dexamethasone, when used as an adjuvant to adjacent sedatives in peripheral nerve blocks, may reduce the need for narcotics, making it a more popular choice. However, the precise mechanism(s) through which dexamethasone exerts its effects remains unknown. We compared the deterioration leisure time in patients undergoing laparoscopic gynecological systems under general anesthesia when dexamethasone was managed primarily by means of intravenous (IV) course despite block only, to that of patients who had dexamethasone directed as an adjuvant with adjacent narcotic in Transversus abdominis plane (TAP) block (GA). Material and Methods: A double-blind, prospective, randomized, parallel treatment experiment is now being carried out. Our most important discovery concerned the period that elapsed before the patient needed rescue analgesia. Four hundred patients were randomly assigned to the perineural (PN) Group or the intravenous (IV) Group using a computer-generated random numbers table and the sealed opaque envelope method. Once the PN group was under general anesthesia, 15 ml of 0.25% levobupivacaine and 4 mg (1 ml) of dexamethasone were injected into the tibial artery and femoral artery (TAP) under ultrasound supervision. Patients in the IV group were given a dexamethasone dose (8 mg) and a TAP block (both sides, 15 ml of 0.25% levobupivacaine). Results: The PN group waited 6.63 hours before asking for more pain relief, whereas the IV group waited 5.04 hours. Pain ratings were similar across the two groups. Conclusion: When paired with 0.25 percent levobupivacaine, the analgesic effects of a TAP block were not noticeably different whether dexamethasone was administered intravenously or by TAP block.

64. Prevalence of Abnormal Semen Analysis in Patients of Infertility in a Tertiary Care Hospital.
Prabhavathi C., Poonam Rani, Vadakaluru Uthpala
Background: More than 70 million couples worldwide are affected by infertility. With a male factor infertility accounts for about half of the cases. Semen analysis is the first step to identify male factor infertility. Objective: The objective of this study was to determine the prevalence and patterns of male factor infertility based on semen analysis in patients visiting Karpaga Vinayaga Institute of Medical Sciences with infertility complaints. Materials and Methods: This is a retrospective, descriptive cross sectional hospital based type of study conducted on 100 males who attended the infertility clinic at Karpaga Vinayaga Institute of Medical Sciences. Semen analysis was performed for them to assess the quality of semen according to WHO criteria. The descriptive statistics and frequency studies were conducted using the SPSS version. Results: Out of total 100 patients, 58(58%) partner showed abnormal semen parameter and remaining 42 (42%) showed normal semen report. This indicates that contribution of male pattern infertility was 58% in infertile couple who were taken for the study. Out of 58patients, 37.93% patients showed oligozoospermia, which was the common abnormality detected. In our study maximum patients were from 30-40 years of age group. It is also observed that obese patients had lower number of sperm count. Conclusion: The prevalence of male factor infertility was found to be a little higher. Further prospective studies to determine the risk factors for male infertility is highly recommended.

65. Ketamine in Treatment Refractory OCD – A Case Series.
Ayushi Soni, Hiral Kotadia
Obsessive-Compulsive Disorder (OCD) is a chronic debilitating neuropsychiatric disorder, affecting 2% of global population and 0.6 % of Indian population. Treatment Refractory OCD (TR-OCD) is defined as poor response to serotonergic drugs, augmenting antipsychotics and behavioural therapy at optimal dose and duration. Various receptors involved in OCD are serotonergic, dopaminergic, glutaminergic (N-Methyl-D-Aspartate – NMDA) and Gamma Amino Butyric Acid receptors. There is significant evidence regarding the role of serotonergic and dopaminergic receptors in neurobiology of OCD. Though the research in the role of glutamate and glutaminergic receptors in OCD is emerging, the current evidence regarding same is still limited. Along with this, research regarding the role of NMDA receptor inhibitors in treatment of OCD is also limited to few case reports. Ketamine is an inhibitor of the NMDA receptor. Ketamine has been used in treatment resistant depression. However, there is dearth of literature regarding use of ketamine in TR-OCD. Here we present 3 cases of TR-OCD responding to ketamine. The possible role of glutaminergic receptors in neurobiological mechanism of OCD is also discussed.

66. Association of Lactate Dehydrogenase and C-reactive Protein Levels as Predictors of Respiratory Failure in Covid-19.
Dimple Kinjalbhai Pandya, Sangita Naranbhai Parikh, Krupalben Patel, Shah Darshna Rakesh, Roshni Tripathi, Batavia Karan Amul
Background and Aim: Inflammatory markers reproduce amount of disease development or revival. They are used to assess improvement or worsening of the illness. Hence the aim of the study was to determine the correlation of laboratory markers (LDH and CRP) and oxygen requirement with clinical severity in Covid 19 subjects. Materials and Methods: There were 216 subjects admitted to the emergency department of the hospital. The incorporated subjects were divided into two groups: group I subjects had covid19 pneumonia and in group 2 subjects did not have covid 19 pneumonia. Blood count and serum values of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were quantified in all subjects enrolled in the research. An automated hematology analyzer was utilized to perform blood count according to the manufacturer’s protocol. Serum samples were analyzed on a fully automated clinical chemistry Instrument. Results: LDH was amplified in 82% of subjects, CRP resulted elevated in 98% of subjects, only 21% of subjects presented pathological values of white blood cell (WBC), but 18% had a neutrophils count above the upper normal range value, while 89% of subjects had lymphocytes count below the lower normal range value, as formerly reported.  Conclusion: LDH and CRP could be helpful for the premature identification of subjects who are at elevated risk for acute respiratory failure. They should be considered a helpful test for the early recognition of subjects who need closer respiratory monitoring and more aggressive supportive therapies to avoid poor prognosis. These subjects could be benefited from a quick hospitalization, a closer observation and correct treatments.

67. A Short Term (Six-months) Follow-Up of Growth Parameters and Co-Morbid Conditions in Severe Acute Malnutrition (SAM) Children Discharged from Nutrition Rehabilitation Centre (NRC) at Tertiary Level Care Hospital, Indore.
Kachhwaha Chandan, Prajapati Jyoti, Biswas Manju, Eske Gunvant Singh, Choudhary Prashant Kumar, Malpani Preeti
Objective: Globally in 2018, the 49.48 million children under five were wasted 17 million were severely wasted. In India 21% are wasted, in Madhya Pradesh 25.8% are wasted and 9.2% are severely wasted. This study evaluates follow up of post discharge SAM children and  access them for growth outcomes and associated co-morbidities, risk factors leading to poor growth outcomes. Study Design:  A prospective observational study. Setting: the study was conducted in Nutrition Rehabilitation Center of Chacha Nehru Balchikitsalaya and Maharaja Yashwant Rao hospital a tertiary care hospital over a period of 1 year. Participants/Patients: 246 post discharged SAM children of age 1-59 months were enrolled and followed up for 6 months. Intervention: Variables recorded were weight monitoring and response criteria. Follow up was done for next 8 visits to assess growth outcomes during follow up. Results: Out of 246 SAM children, 51.8 % were females with 84% being <2 years. 37.6% had weight for height/length <-3 SD, 4.4% follow MUAC, 2.2% had Oedema, 53.1% follow Z score and MUAC both criteria at presentation. Successful follow-up seen in 91.9%, mean weight gain seen was 6621g at discharge to 8029g at 6-months, MUAC increase from mean value at discharge 108 mm to 111 mm at 6-months, 35.8%, 49.2% were below <-3 SD and <-2 SD at discharge to 3.1%, 7.1% at 6 months respectively, all found to be statistically significant. Most common morbidity associated was diarrhoea and pneumonia. 42.2% of children required inpatient management. Conclusion: Along with Nutritional Rehabilitation Centre, a Community based programme of severe acute malnutrition is need of an hour.

68. A Clinicopathological Study of Tubo-Ovarian Lesions and its Correlation.
Namita Kumari, Shaziya Noor, Manoj Kumar
Background: Tubo-ovarian mass present differently clinically, morphologically and has characteristic histological features. The aim of this study is to categorise the tubo-ovarian lesions according to primary complaints, age, microscopic features with different clinical presentation and their histopathological co-relation and radiological study. Methods: The clinico-pathological correlation of various tubo-ovarian abnormalities in 75 cases over the course of a year served as the foundation for the current prospective study (September 2021 to August 2022). The tubo-ovarian lesions were categorised using the histological reports, which also correlated with and supported the radiological and clinical findings. Results: Out of 75 cases, 51 (68%) involved the ovary, 18 (24%) the tubal, and 6 (8%) the both at the same time. Six of the 18 tubal lesions were ectopic gestational lesions, and the remaining two were salpingitis. Of the ovarian lesions, there were 41 cases of ovarian neoplasms, which were divided into benign and malignant types. The most prevalent benign tumour was a serous cystadenoma, while the most aggressive tumour was a serous cystadenocarcinoma. Conclusion: The correlation between the clinical, radiological, and histological diagnoses was statistically analysed, and it was shown to be highly significant. The accuracy of the diagnosis is increased by a thorough clinical, radiological, and histological evaluation.

69. Relationship between Fine Needle Aspiration Cytology and its Histopathology in Breast Lump Diagnosis.
Shaziya Noor, Namita Kumari, Manoj Kumar
Background: Breast lesion diagnosis by fine needle aspiration cytology (FNAC) is easy, cheap, minimally invasive, outpatient-based, and quick. The current study set out to investigate the accuracy of FNAC in the identification of breast lesions and to connect cytological findings with histological findings. Material and Methods: 109 breast aspirates in total were investigated. In 62 cases, histo-cytopathological associations were found. Haematoxylin and Eosin (H and E) stain was used to colour all of the aspirates. Results: Among the 109 patients, 106 of them were women and only 3 were men. In 74 instances (67.9%), benign breast lesions were discovered, with fibroadenoma being the most prevalent lesion (30.27%). In 17 cases (15.59%), malignancy was noted; ductal carcinoma was the most common lesion (13.76%) among these. In 71 out of 72 instances, histopathological confirmations were obtained. Histopathology determined that all 35 aspirates were malignant. Histological exams were used to confirm the benign reports in 35 of the 36 cases, with the exception of one case, which had its histology used to determine that it was cancerous. According to reports, FNAC’s breast lesions sensitivity and specificity were 97.2% and 100%, respectively. Conclusion: It’s crucial to keep in mind that a breast lesion’s FNAC results do not rule out the diagnosis of carcinoma, especially when there is a clinical suspicion of malignancy and/or an abnormal mammography.

70. Study of Primary Caesarean Section in Multigravida Patients at SKMCH, Muzaffarpur, Bihar.
Subhasini, Sayeeda Parveen, Chanchal
Background: One of the most often done major surgical operations worldwide is a caesarean section. Primary caesarean section in multigravida refers to the initial caesarean section performed on a patient who has had one or more vaginal deliveries of viable newborns in the past. The purpose of this study is to examine the prevalence and causes of primary caesarean sections in multigravida, as well as the outcomes for the mother and the baby after the procedure. Methods: The department of Obstetrics and Gynecology at SKMCH, Muzaffarpur, Bihar, conducted a prospective study on 95 cases of primary caesarean sections among multigravida who had a prior normal vaginal delivery for a period of 7 months from March 2022 to September 2022. Maternal and neonatal outcomes were examined while different caesarean section reasons were examined. Results: In 6.34 percent of all deliveries, a primary caesarean section was performed. The bulk of the instances were unbooked and in the second or third trimester of pregnancy. Foetal discomfort was the most frequent reason for a primary caesarean section (29.5%), followed by cephalopelvic disproportion and malpresentations. Conclusion: If a pregnant woman who has previously given birth vaginally experiences any of the several unanticipated difficulties listed above, an emergency caesarean section may be necessary. They can have a better maternal and perinatal outcome if they are carefully assessed during the prenatal and intranatal periods.

71. Perinatal Outcome of Meconium Stained Liquor in Pre-Term, Term and Post-Term Pregnancy.
Priyanka Gahlout, Subhasini, Abha Rani Sinha
Background: A newborn baby regularly passes meconium, a dark green liquid that contains bile, mucus, and epithelial cells. Obstetricians are very concerned about the possibility of meconium in the amniotic fluid. Although occasionally it may be natural and have no effect on the foetus, it is a potential sign of foetal hypoxia. To ascertain the prevalence of meconium-tainted labour, related risk factors, and perinatal outcomes in preterm, term, and post-term pregnancy.  Materials and Method: This prospective observational study was conducted on women visiting the OPD and labour rooms to give birth. The profiles of these women were reviewed, and records were kept about the appearance of meconium, the mode of delivery, the perinatal outcome, the Apgar score, and a comparison to the control group. Results: In our study, the prevalence of MSL is 11.01%. (185 patients). In 93 cases (50.2%), the liquor had thin staining (light green), 49 had moderate staining (yellow), and 44 had thick staining (deep green). Meconium staining of liquor and maternal age did not significantly correlate, but women over 30 years of age had a higher incidence of 11.6%. The incidence of staining was higher i.e. 17.1% in higher gestational age of foetus i.e. 41-42 weeks. Our study also yielded results of rising incidence of low –birth weight babies (less than 2.5kg) in meconium stained liquor cases. Instrumental vaginal deliveries (3.3%) and caesarean sections (44.6%) were found to be more prevalent in these cases. When compared to newborns with clear liquor, it was discovered that newborns with meconium-stained liquor had significantly lower APGAR ratings at 1 minute, 5 minutes, and 10 minutes (P<0.05). The densely stained group (3 patients) had more cases of meconium aspiration syndrome than the thinly stained group (zero patients). In comparison to cases complicated by thinly stained or clear liquor, mean Apgar Scores were significantly lower in cases complicated by thickly stained liquor. Pregnancies complicated with meconium stained liquid had a greater frequency of admission to the newborn critical care unit, meconium aspiration syndrome, neonatal fatalities, assisted vaginal delivery, and caesarean birth. Conclusion: Meconium-stained liquor is linked to older mothers, earlier gestational ages, higher caesarean section rates, poorer apgar scores, higher NICU admission rates, and newborn outcomes.

72. Clinical Profile and Outcome of Malaria Patients with Acute Kidney Injury.
Major Durga Shankar, Md. Aftab Alam
Malaria causes a wide range of clinical effects and renal consequences, including acute kidney injury that can be fatal. This study involved 50 patients at our institution who had AKI related to malaria. To assess the clinical profile and outcome, malaria patients with smear positivity and positive for Parasites V and F who also had AKI according to the RIFLE classification (Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease) were chosen. In our study, there were 50 patients, of which 12 were female and 38 were male. 42% of people were aged 26 to 40. The most frequent initial symptom was fever (100%), which was followed by chills and rigours (90%), headache (74%), vomiting (70), myalgia (60%), altered sensorium (30%), and sclera discoloration (36%). The most typical symptom was pallor (62%) and it was followed by splenomegaly (62%), icterus (40%) and hepatomegaly (34%). All patients received artemesinin combination medication, and 12 (24%) patients received renal replacement therapy. We had a 12% death rate, and every single patient had significant problems. Patients who were 70% infected with Plasmodium falciparum most frequently experienced acute renal damage from malaria. Applying the RIFLE criteria aids in the early detection of high-risk cases, allowing for the early initiation of rapid treatment and a consequent decrease in mortality.

73. A Study between 0.5% Levobupivacaine and 0.5% Levobupivacaine with Dexamethasone 8 mg Combination in Brachial Plexus Block by the Supraclavicular Approach.
Satyendra Kumar, Garima Gaurav, Bijoy Kumar, Ashok Kumar
Background: Motor and sensory blockade is prolonged when dexamethasone is added to bupivacaine for supraclavicular brachial plexus (SCBP) block. Levobupivacaine and dexamethasone (8 mg) have not been thoroughly researched to see how they interact. This study looked at the analgesic effectiveness of dexamethasone when used as an adjuvant to levobupivacaine in the SCBP block. Methods: The ultrasound-guided SCBP block was administered to 60 patients who were divided into two groups at random. Both Group S (thirty patients) and Group D (thirty patients) received 2 mL of normal saline with 25 mL of levobupivacaine (0.5%), while Group D received 2 mL of dexamethasone (8 mg) with 30 patients in Group S. The first rescue analgesia response time, the total number of rescue analgesics needed in a 24-hour period, and various block properties were evaluated. For statistical analysis, the chi-square test and Student’s t-test were utilised. Results: In Group S, it took 396.13±109.42 min to request the first rescue analgesia, whereas in Group D, it took 705.80± 121.46 min to request the same (P<  0.001). In comparison to Group D, Group S had a greater need for rescue analgesics. Comparing Group D to Group S, the onset of sensory and motor block occurred more quickly in Group D. Group D had sensory and motor blocks on average for substantially longer than Group S. Conclusion: With a quicker onset and longer duration of sensory and motor block, the addition of dexamethasone to levobupivacaine in SCBP blocking lengthened time for initial rescue analgesia and decreased the need for rescue analgesics.

74. A Prospective Study on Relation of Subclinical Hypothyroidism During Pregnancy With its outcomes at SKMCH, Muzaffarpur, Bihar.
Sayeeda Parveen, Subhasini, Abha Rani Sinha
Background: Both the mother and the foetus experience significant physiological stress throughout pregnancy. There is a significant risk of unfavourable outcomes for both the mother and the foetus when endocrine abnormalities like hypothyroidism are present during pregnancy. All pregnant women should be screened for subclinical hypothyroidism, especially in the Indian context where there is a higher risk of iodine deficit during pregnancy. Therefore, the purpose of this study was to determine how subclinical hypothyroidism affected the course of pregnancy. Method: A prospective analytical study was conducted at SKMCH, Muzaffarpur, Bihar from April 2022 to September 2022.   The sample size was made up of 73 expectant women who visited the prenatal OPD. During the initial appointment, a thyroid profile (serum TSH, FT3 and FT4) was performed. TSH >2.5mIU/L in the first trimester, >3mIU/L in the second trimester, and >3.5mIU/L in the third trimester were the cutoff values used by the SCH to assess the findings. Information was recorded about the participants’ general characteristics. The participants checked in to assess the delivery method, the mother’s and fetus’s health, and any co-morbid conditions that might have developed. Women with SCH are treated as such. Results: Thyroid screening was done on 73 pregnant women, and 24.7% of them showed subclinical hypothyroidism. In contrast to 72.3% of euthyroid women, 55.6% of SCH women were under the age of 25. For iodized salt consumption, food type, and BMI, there was no discernible difference between the SCH and euthyroid groups (p>0.05). SCH was linked to increased incidences of elevated blood pressure (27.8% vs 7.3%, p=0.02) and low birth weight (38.9% vs 14.5%, p=0.03) in infants compared to euthyroid condition. In contrast to euthyroid women, the proportion of SCH women with anaemia and a low APGAR score was also higher. The significance was merely somewhat high. (Poor APGAR score: 27.8% vs. 9.1%; Anaemia: 72.2% vs. 45.5%, p=0.049). Conclusion: Indians have a rather high prevalence of subclinical hypothyroidism among pregnant women. Unfavourable maternal and foetal outcomes were observed in pregnant women with SCH, with a higher risk of high blood pressure and low birth weight neonates. In order to improve maternal and perinatal outcomes, routine maternal thyroid function testing is required.

75. A Comparative Study between Outcome of Vaginal Birth after Caesarean Section (VBAC) and Planned Repeat Caesarean Delivery (PRCD).
Subhasini, Priyanka Gahlout, Chanchal
Background: Post-Caesarean pregnancy has become one of the commonest indications for Caesarean section in multipara. As CS rates in primigravida rise, these patients form a load for the future obstetrician who has to manage their next pregnancies with repeat sections. But we must remember that many post-Caesarean patients can be safely delivered vaginally, thus helping to reduce CS rates and avoiding complications of repeat Caesarean section. This study was planned to assess advantages and complications of VBAC in comparison to PRCD in managing post-caesarean pregnancy. Methods: Present study was conducted at Obstetrics and Gynaecology Department of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from May 2022 to October 2022. All admitted patients taking proper history of previous caesarean section, clinical assessment, use of PARTOGRAM, USG for ‘Feto-Placental Profile’, Colour Doppler study and CTG. Antenatal mothers booked at antenatal clinics. After proper counselling cases were divided in 2 groups- in one group VBAC attempts (TOL) was undertaken and in the second group PRCD were done. Results: Of the 40 mothers who underwent TOL in our study, 25 delivered vaginally; this gave a very good rate of success (62.5%). This is comparable to the ranges of VBAC success of 55 to 85% mentioned in most literature. No patient in my study require Oxytocin augmentation for successful VBAC, which is also consistent with findings in literature. Study of mode of delivery was the next objective and showed that most patients who underwent VBAC had vaginal delivery with episiotomy (92%) in our centre for post-Caesarean mothers. Conclusion: VBAC was significantly more beneficial to the patient than PRCD with respect to shorter duration of hospital stay and early return to normal activities and breast feeding, with no increased risk of morbidity to mother or baby. VBAC is thus a safe and attractive alternative to PRCD as mode of delivery of the post-Caesarean mother.

76. Stability Indicating HPLC Method Development for a Marketed Retinol Acetate.
M. K. Velhal, A. N. Hasnain, N. V. Nibe, R. R. Todkari, A. G. Alhat
A rapid, sensitive, and accurate stability indicating high performance liquid chromatography for the determination of retinol acetate from the marketed sample was developed. Retinol acetate is a vitamin A acetate, useful in normal eye vision, also acts as a supportive anticancer, which works by binding to glycocalyx of colon slowing or stopping the growth of cancer cells. The chromatographic separation was performed on a HPLC system consisted of Plus intelligent LC pump® PU-2080 from Agilent, Germany equipped with a Agilent®UV-2075 Intelligent UV-Visible detector, an injector Rheodyne®7725 (Rheodyne, Cotati, CA, USA), along with Agilent chromapass chromatography data system software (Version Column Purospher Star 5μm Agilent® RP C18 XDB (4.6 mm × 150 mm) using a sonicated, degassed mobile phase containing solvent A: acetonitrile and solvent B: methanol in ratio (89:11v/v) having pH 3.5 with a flow rate of1 mL/min. The elution was detected by a uv-visible detector at 360 nm. The total chromatographic runtime is 20.0 min with a retention time for sample BASF stabilized sample and standard Sigma Aldrirch internal standard was of 8.05 and 8.2 min, respectively. The method was validated over a dynamic linear range of 10-50µg/mL for retinol acetate with a correlation coefficient (r2) 0.999. The forced degradation study also revealed the susceptibility (sensitivity) of a drug towards heat, acid, base, hydrogen peroxide, light and photolytic degradation. This indicated photosensitivity and temperature sensitivity of the drug substance.

77. Thyroid Disorders in Pregnancy and Pregnancy Outcomes.
Yadav Sameer S, Joshi Harshal J, Pandey Sheela O, Redkar Neelam N.
Thyroid disorders constitute one of the most common endocrine disorders seen in pregnancy. Thyroid disorder in pregnancy is associated with adverse obstetrical and fetal outcomes. Material and Methods: The present study was prospective observational study conducted in tertiary medical hospital in Mumbai. Study was conducted over duration of 6 months. 85 patients fulfilled inclusion criteria and were enrolled in study. Patients were diagnosed as overt hypothyroid or subclinical hypothyroid. TPO antibody was done in hypothyroid patients. Patients were treated with thyroxine as per protocol. Result: Most of pregnant patients with thyroid dysfunctions were in age group of 20-30 years (75%). 52.9% had gestational age between 24-36 weeks. Subclinical thyroid disease was present in 94.1% while overt thyroid disease was seen in 5.9% of patients. Sub clinical and overt hypothyroidism was common in gestational age group of 24-36 weeks. Thyroperoxidase antibodies tested positive in 70.6% patients. Subclinical hypothyroidism 80% patients underwent normal delivery while 12% patients had abortion. In patients having overt hypothyroidism, 2 patients underwent normal delivery while 3 patients had abortion. Conclusion: Early detection of thyroid disorders in pregnancy leads to safe pregnancy with minimal maternal and fetal complication. Subclinical hypothyroidism is the commonest thyroid dysfunction in pregnancy.

78. Associated Risk Factors and Pregnancy Outcome among Women with Gestational Diabetes Mellitus.
Monika Singla, Komal Bharti Singla, Tarunkumar Chavda, Sonal Chavda
Introduction: Gestational diabetes mellitus (GDM) is characterised by variable degrees of glucose intolerance with onset or initial detection during pregnancy. GDM is a major public health concern in India. Materials and methods: This case control study was carried out among 50 antenatal women with GDM and 50 antenatal women without GDM. Fasting blood glucose was measured after which they were given 75 g oral glucose and plasma glucose was estimated at 2 h. Patients with plasma glucose >140 mg/dl were labeled as GDM. Thus WHO criteria were used for diagnosing GDM. Data was collected from all subjects on family history of Diabetes and hypertension, BMI, etc., and pregnancy outcomes were studied. Results: Gestational diabetes mellitus was found to be significantly associated with age, and BMI. The most common complication observed among GDM was gestational HTN followed by PROM and vaginal candidiasis. Still birth and NICU admission was observed more in GDM than in non GDM. Conclusion: GDM adversely affects maternal and fetal outcomes. Appropriate interventions are required for its control.

79. Outcomes of Minor Anorectal Surgeries under Local Anesthesia versus Spinal Anesthesia in a Tertiary Care Hospital – A Comparative Study.
Subhodaya, M.B. Aparajita, Sharanabasavaraj Javai, Shruti Sahu
Introduction: Minor ano rectal disorders presenting to the hospital are usually benign and easily manageable surgically. Treatment can be achieved by various methods of surgery under either spinal or local anaesthesia. This study compares the intraoperative and postoperative pain, complication rates, and duration of hospital stay between minor ano-rectal surgeries done under spinal and local anaesthesia. Materials and methods: A randomized trial was conducted among 120 patients requiring surgical intervention in view of minor ano rectal disorders. Patients were divided into two groups – group A and group B (60 patients each) who underwent the procedures under spinal and local anesthesia respectively. Baseline data, intraoperative and postoperative data was collected, and results were compared. Results: Intraoperative pain (Nil. In spinal group vs. 3/60 [5%] in LA group; P = 0.079) and post operative complications (19/60 [15%] vs Nil.; P= 0.002) in both groups were comparable. Whereas postoperative pain after 24hrs (mean 1.85 [SD-1.48] vs 1.2 VAS [SD-0.40]; P=< 0.001) and hospital stay (4.05 days [SD-0.99] vs. 1.20 days [SD- 0.40]; P =< 0.001) had significant favorable outcomes for patients of group B. Overall there was no technical failure or recurrence in both the groups. Conclusion: Local anesthesia is effective and safe in minor anorectal surgeries, and it eliminates the need for prolonged hospitalization, thus minimizing lifestyle disturbances and giving the patient psychological benefit. It also decreases the surgeon’s dependency on anesthesiologists, making it possible to do such procedure in smaller and peripheral hospitals with inadequate infrastructure, where the services of trained anesthetists are not always available. Patients being discharged after a very short hospital stay also will reduce the load on the capacity of surgical wards. More studies on the positive effects of local anesthesia need to be undertaken to come to a final and long-lasting conclusion, that all minor anorectal procedures should be converted from regional anesthesia to local anesthesia in all General Surgery centers.

80. An Analgesic Efficacy Between TAP Block and Infiltration Around Incision Site Post Operatively in Caesarean Section: A Comparative Study.
Deepak Kumar Mangal, Shweta Narsingani, Balraj B Joshi, Vishal K Prajapati
Women’s pain satisfaction post-cesarean section remains a challenge. Accurate assessment of pain severity of post-cesarean section helps to choose the most appropriate anesthetic approach, drug, and dose, as well as improvement of treatment of postoperative pain. Our objective was to compare the efficacy of  transversus abdominis plane (TAP) block  by double pop Technic and infiltration around incision site in the first 24 h postoperative in women who underwent cesarean section. The primary outcome was postoperative pain at 2, 4, 6, 12, and 24 h. The secondary outcomes were intestinal mobility, early mobilization, nausea, vomiting, heart rate, and respiratory rate. Materials and Methods: The study population consisted of 60 patients posted for elective and emergency caesarean section. They were blindly divided into two groups of 30 patients each. Group T received 40ml 0.25% Ropivacaine in Transverses abdominis plane (TAP) block for postoperative analgesia and group I received 40ml 0.25% ropivacaine as infiltration at incision site for postoperative analgesia. Patients were observed for numeric pain score NPS, analgesic requirements, total analgesic consumption and adverse effects if any. Results: There was highly significant difference in numeric pain scores at 2nd, 6th, 12th and 24th hours (p<0.0001). Both the time for first rescue analgesic and total amount of analgesic consumed are statistically significant (p<0.0001). Conclusions: TAP block is an effective postoperative analgesic procedure for post caesarean section patients.

81. The Assessment of Antibiotic Utilization in Cholecystectomy Patients in a Tertiary Care Hospital: A Prospective Study.
Ratna Palit, Ashok Singh Chouhan, Sapan Kumar Palit
Background: Laparoscopic cholecystectomy, a minimally invasive procedure, decreased postoperative pain, hospital stay, and surgical site infection (SSI). Most surgeons use intravenous antibiotics as prophylactic to avoid any complications. Furthermore, there is still debate over whether or not antibiotic prophylaxis is useful before elective laparoscopic cholecystectomy. We, therefore, carried out a study to evaluate the use of antibiotics in patients having cholecystectomy at a hospital. Materials and Methods: A 6-month prospective analytic analysis was conducted on 100 patients who were scheduled to have open or laparoscopic cholecystectomy procedures at the Department of Pharmacology, Hitech Medical College & Hospital, Bhubaneswar, Odisha. During the recovery period, information about prescribed antibiotics, including their dosage and route of administration, was gathered via patient data. The patient was monitored up until discharge for any drug additions, and the date of discharge was recorded to indicate how long the patient had taken drugs following surgery. Results: In our analysis, the majority of cases (54%) and the preponderance of females (71%) were observed in the 40–5 year age category. Metronidazole (46%) and Cefoperazone-Sulbactam (24%) are the most commonly utilised post-operative antibiotics in open cholecystectomy. The average hospital stay was between 5 and 8 days. The majority of patients undergoing open cholecystectomy received metronidazole for a maximum of seven days. The typical post-operative hospital stay for a laparoscopic cholecystectomy is four to five days. In these situations, cefoperazone sulbactam and metronidazole have been used most frequently. Conclusion: In low-risk patients undergoing elective laparoscopic cholecystectomy, antibiotic prophylaxis is safe and helpful in lowering surgical site infections, systemic infections during hospitalization or after release, and postoperative length of hospital stay.

82. A Prospective Study of Postoperative Pain Following Ankle Fractures Surgery.
Saroj Kumar Parida, Akash Kumar Samal, Anshuman Mishra
Background: Ankle fracture fixation postoperative pain has a significant impact on both the success of the procedure and patient satisfaction. Patients who need substantial doses of narcotics are more likely to use painkillers long-term. Only a small number of prospective studies examine patient pain during the treatment of ankle fractures. Method: The discomfort felt by 50 patients following open reduction and internal fixation of the ankle was retrospectively assessed. Preoperatively, postoperatively (PP), at 4 days (4dPP), and 4 weeks, the Short-Form McGill Pain Questionnaire was given (4wPP). Postoperative pain that was anticipated (APP) was noted. Results: There were no discernible changes between PP, APP, and 4dPP; however, 4wPP was much lower. Both the preoperative and postoperative Short-Form McGill Pain Questionnaire scores as well as the correlations between PP and APP were determined to be significant. Only APP was able to predict 4wPP, while PP and APP were both predictive factors of 4dPP. Age, sex, and whether a patient was an inpatient or outpatient were not significant determinants. There were no statistically significant differences in pain levels across different forms of fracture. Conclusion: The level of postoperative pain is predicted by the severity of prior pain as well as the predicted postoperative discomfort. Orthopedic doctors ought to pay more attention to postoperative pain control and patient preferences following operations.

83. Role of Bispectral Index (BIS) Monitoring Vs End Tidal Anesthetic Gas Concentration in Predicting Recovery Time and Extubation in Surgeries Performed Under General Anesthesia.
Alok Kumar, Vinod kumar Verma, Nidhi Arun
Aim: The aim of the present study was to compare the effect of BIS versus end tidal anesthetic gas (ETAG)-guided anesthesia on time to tracheal extubation in surgeries performed under general anesthesia. Methods: The present double blind randomized controlled study was conducted in the Department of Anesthesiology & Critical Care Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The study protocol, informed consent form (in Hindi & English) and case report form (CRF) were submitted to the ethical committee of Indira Gandhi Institute of Medical Sciences, Patna for approval. Study was done after taking approval from institute ethical committee. Written informed consent was taken from each participant of the study. The data was collected between – Pre induction time to extubation. Results: Maximum patients were 7 (23.33%) and 10 (33.33%) in 37-46 years and 47-56 years respectively in both the groups. The females were predominant than males in both the groups. In group A, there were 18 (60%) females and 12 (40%) males and in group B there were 24 (80%) females and 6 (20%) males. In group A, 18 (60%) patients were in ASA I and 18 (60%) patients were in ASA II according to ASA grade.

84. A Hospital Based Observational Study to Assess the Role of Hematological Biomarkers, Coagulation Profile and CRP (C-Reactive Protein) in Covid-19 Patients.
Ram Ugrah Prasad, Vivek Kumar Pandey
Aim: In this study, the roles of biomarkers from a peripheral blood sample were used in the diagnosis of COVID-19 patients who have history of fever and have been admitted to hospital are examined. Methods: The present study was conducted Department of Pathology, SKMCH, Muzaffarpur, Bihar, India where the patients having history of fever were admitted during the period of 3 months. A total of 100 patients were included who were suspected cases of corona. RTPCR was done for all the patients and were categorized into covid negative and covid positive patients. Results: Out of 100 patients included in the study that came with history of fever and was admitted in hospital, RTPCR was done and 65% patients were positive. Out of which 66.2% were male patients and 33.8% were female patients. Hematological parameters were recorded and presented in a tabular data as described in Table 1. Parameters included were total leukocyte count, neutrophils, hemoglobin, lymphocytes, NLR, PLR, SII, and Platelets. In patient with negative test results, it was found that total leukocyte count, neutrophils, platelet, NLR and SII values were higher. Whereas, haemoglobin, lymphocytes and PLR was found to be higher in patients with positive test results. Conclusion: In our study, low values of leukocytes, neutrophils, platelets and high values of hemoglobin, Lymphocytes were found with a CBC test which is easily available are found to be valuable in terms of the initial diagnosis of COVID 19. In addition, low values of NLR and SII and high value of PLR and CRP are also indicative of COVID-19.

85. Postoperative Analgesic Efficacy of Epidural Ropivacaine and Ropivacaine with Tramadol in Adults Undergoing Abdominal Surgeries under General Anaesthesia: Prospective Randomized, Double Arm, Single-Blind, Controlled Study.
Vinay Kumar
Aim: The aim of the study was to compare the postoperative analgesic efficacy of epidural Ropivacaine and Ropivacaine with Tramadol in adults undergoing abdominal surgeries under general anesthesia. Methods: The study was a prospective randomized, double arm, single-blind, controlled study. The study was conducted in patients scheduled for abdominal surgeries done under general anesthesia at Sadar Hospital Muzaffarpur, Bihar, India for 1 year. The sample size was determined based on the study. In our study, 50 subjects were included. Results: In our study while analyzing the age distribution, in the Ropivacaine group, the majority of the study subjects belonged to the 31-40 years age class interval (n=10, 40%) with a mean age of 43.07 years. In patients belonging to Ropivacaine group, the majority of the study subjects belonged to ≤ 240 minutes duration of postoperative analgesia class interval (n=24, 96%) with a mean duration of postoperative analgesia of 220.57 minutes. In the Ropivacaine with Tramadol group majority belonged to 300-360 minutes duration of postoperative analgesia class interval (n=15, 60%). The association between heart rate distribution and intervention groups is considered to be non-significant since p-value was > 0.05 as per unpaired t-test. The association between mean peripheral capillary oxygen saturation distribution and intervention groups is considered to be non-significant since p-value was > 0.05 as per unpaired t-test. The association between mean respiratory rate distribution and intervention groups is considered to be nonsignificant since p-value was > 0.05 as per unpaired t-test. Conclusion: We concluded that the addition of 1 mg/kg of Tramadol improves the postoperative analgesic efficacy of epidural 0.2% Ropivacaine by prolonging the duration of analgesia and providing good sedation with no significant hemodynamic alterations, nausea, vomiting and pruritus.

86. Intravenous Bolus Doses of Phenylephrine Vs Ephedrine Along with Crystalloid Co-Loading in the Prevention of Hypotension during Spinal Anesthesia for Caesarean Section: A Randomized Comparative Study.
Vinay Kumar
Aim: The objective of the present study was to compare the vasopressor effects of ephedrine and phenylephrine in ameliorating hypotension in elective caesarean delivery receiving crystalloid co-loading, during intrathecal bupivacaine injection. Methods: The present study was conducted in the Department of Anesthesia, Sadar Hospital Muzaffarpur, Bihar, India for 1 year and one hundred and twenty parturients of ASA (American Society of Anesthesiologist)-I and II, weighing 50-80kgs, of height 140-170 cms, having a singleton normal pregnancy more than 36 weeks of gestation, with indications for caesarean section under spinal anesthesia were taken for this study. Results: The patients’ characteristics like age, height, weight and ASA were similar and no significant difference was observed between the groups. The difference observed in baseline heart rate, systolic, diastolic, and mean blood pressures between two groups was statistically insignificant. There was higher incidence of bradycardia in patients receiving phenylephrine than those receiving ephedrine. The difference in mean heart rate till delivery compared between two groups immediately after spinal anesthesia, at 2, 4, 6, 8, 10, and 12 minutes was significant while it was insignificant at 0 and 14 minutes (P value < 0.05: significant). The difference in mean heart rate compared between two groups at delivery, 5, 10, minutes and at the end of the surgery was insignificant except at delivery and 15 minutes after delivery (P value < 0.05: significant). Conclusion: We concluded from this study that phenylephrine and ephedrine are equally efficient in managing hypotension during spinal anesthesia for elective cesarean delivery. There was no difference between two vasopressors in the incidence of true fetal acidosis. Neonatal outcome remains equally good in both the groups.

87. Correlation between NAFLD and Metabolic Syndrome.
Dasaraju Suma, Rengaraj Rengaraj, Leelakrishna Santhosh
Background: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease with a prevalence rate of 20% to 30 % in western countries. Studies introduced that NAFLD may progress to liver failure, cirrhosis and HCC (hepatocellular carcinoma).2Available data from Clinical, experimental, and epidemiological studies indicates NAFLD may be the hepatic manifestation of metabolic syndrome. Aim: To study the correlation between the non-alcoholic liver disease and metabolic syndrome. Methods: 50 Non-Alcoholic Fatty Liver Disease patients diagnosed by USG abdomen were enrolled in this study from august 2019 to December 2019. Patients were categorized into 3 grades of fatty liver. Parameters of metabolic syndrome (according to ATP III criteria) were assessed and correlated with the grade of fatty liver. Results: Out of 50 patients 27 (54%) females and 23 (46%) were males. Mean age of presentation was 45.12 years. 34(68%) patients had mild grade, 10 (20%) had moderate grade and 6(12%) patients had severe grade fatty liver. Among 50 patients 28 (56%) had low HDL levels (p =0.39), 30 (60%) patients had increased Triglyceride levels (p =0.03), 23 (46%) patients had increased waist circumference (p=0.05), 22(44%) patients had high blood pressure (p=0.01) and 37 (74%) patients had elevated Fasting blood glucose levels with a significant p value 0.02. As the number of components of metabolic syndrome was increased the grade of NAFLD had also increased with a significant p value (< 0.0001). Conclusion: The presence of multiple components of metabolic syndrome like hypertension, obesity, dyslipidaemia and diabetes mellitus in a same person increases the grade of NAFLD and liver injury.

88. A Comparative Study of Transvaginal Ultrasound and Bishop’s Score for Pre-Induction Cervical Assessment.
Sri Prathiba Mahalakshmi Nagarajan, Sivachandran Kabilan
Background: In this study, we wanted to evaluate the efficacy of transvaginal ultrasound in predicting the cervical status before pharmacological induction of labour and compare the efficacy of transvaginal ultrasound and Bishop’s score in pre-induction cervical assessment. Materials and Methods: This was a hospital based prospective comparison study conducted among patients who presented with antenatal term singleton gestation selected for induction of labour with intact membranes to the Department of Radiology at GRH, (Govt. Rajaji Hospital), Madurai, over a period of 6 months after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: When comparing the predictive values of the parameters of transvaginal sonography with Bishop’s score, it was evident that Bishop’s score was more predictive than the individual parameters. Conclusion: Transvaginal sonography is an ideal alternative for Bishop’s score to predict the outcome of induction of labour in nulliparous women with term gestation with intact membranes. The transvaginal sonographic parameters even as individual parameters are statistically more significant in pre-induction cervical assessment than Bishop’s score. Cervical length measurement by transvaginal sonography has the highest sensitivity followed by Bishop’s scoring system. Posterior cervical angle has the highest specificity followed by percentage of funnelling, both measured by transvaginal sonography. The comprehensive transvaginal sonography is therefore highly sensitive and specific than Bishop’s score in pre-induction cervical assessment. As transvaginal sonography is an easy, less time-consuming method, it may be used as an alternative for cases where there is subjective variation in assessment of Bishop’s score.

89. Increased Screen Time as a Cause for Further Myopia Boom- Follow up Study of School Health Survey.
Sachala Bhoi, Sabita Devi, Swikruti Jena, Tapasi Mohanty, Sonali Margaret Soy
Background: Myopia is a major health issue around the world. The World Health Organization estimates that half of the population of the world may be myopic by 2050. In the present years, insufficient time spent in outdoor activities has been recognized as a major risk factor for myopia development. The duration and intensity of near work are also associated with myopia progression. Aim: To study the increase in myopic shift in school going children during covid 19 pandemic due to increased screen time. Materials and Methods: A prospective cross sectional study was done as a follow up after 2 years (in March 2021) from a school health survey done in May 2019. 150 students, of ages 7-15 were included and spherical equivalent refraction was recorded for each child and progression of myopia was documented in dioptres. Children wearing contact lenses, with h/o any ocular surgery and children with pathological myopia were excluded from study. Results: Out of 145 children called for follow up, only 123 children reported in the OPD for follow up. The mean refractive error(spherical equivalent) had increased by +2D in children of ages 7-10 and by +1D in children from ages 11-13 and somewhat remained constant in older ages. The parents reported an increase in time spent on digital devices and prolonged near work and all this had a positive correlation with an increase in myopic shift. Conclusion: Shorter viewing distance, increased screen time and lesser outdoor activities is also associated with myopia progression, especially in younger children. Younger children’s refractive status may be more sensitive to environmental changes than older children, as they are in a more important period for myopic development and progression.

90. A Study of Perforative Peritonitis in a Period of One Year during Covid-19 Pandemic at a Medical College in Rajasthan.
Parthasarathi Hota, Apurva Damaraju, Rupali Kaur Sachar
Hollow viscous perforation is one of the most common emergency dealt by general surgeons worldwide. A high degree of suspicion is required and prompt management is warranted to reduce morbidity and mortality. Here we present a study of perforative peritonitis in our medical college at the outskirt of Udaipur city in the state of Rajasthan, India during the Covid-19 pandemic. During the one year study period from September 2020 to August 2021, a total of 16 cases of hollow viscous perforation admitted and treated. The number is relatively low because of the pandemic and there was a period of total lockdown with negligible patient footfall. All patient had free gas under diaphragm in plain x-ray and all of them were scheduled for emergency laparotomy after adequate resuscitation. Emphasis given on the location of perforation, etiology , organism on culture of peritoneal fluid and procedure undertaken.

91. A Study to Assess Feasibility and Safety of the Laparoscopic Technique in Acute Appendicitis and Compare its Results with Open Appendectomy.
Sachchidanand Prasad, Pradeep Kumar
Aim: The aim of the study was to assess technical feasibility and safety of the laparoscopic technique in acute appendicitis and compare its results with open appendectomy. Methods: The present study included 50 patients presenting with clinical diagnosis of appendicitis. In order to compare the two techniques, patients undergoing LA were compared to patients undergoing OA over a period of 6 months. Those patients were excluded who had perforated appendicitis. Study to be carried out over a period of 6 months includes patient diagnosed with appendicitis and admitted to surgery ward at Department of General Surgery, Fort U Mediemergency Hospital, Patna, Bihar, India  and enrolled in the study after obtaining the valid written informed consent. Results: The maximum number of cases was observed in the age group of 25‑36 years with a female (27) to male (23). The average age of patients undergoing LA was 26 years while it was 26.52 years for those undergoing OA. The mean operative time for the open appendectomy was 46.6 minutes and in laparoscopic appendectomy was 65.6 minutes. The difference between the two groups was significant, with a p-value of <0.001. Conclusion: Laparoscopic appendectomy is better than open appendectomy with respect to wound infection rate, early resumption of oral feeds, lesser postoperative pain, postoperative hospital stays and return to normal activities. Though the mean duration of operation was more in the LA group, it can be considered as gold standard surgical treatment for the management of acute appendicitis.

92. A Hospital Based Analytical Assessment of Pregnancy Outcome in Patients with First Trimester Bleed.
Kalpana Jha, Jyoti
Aim: The aim of the present study was to evaluate whether threatened abortion makes pregnancy high risk and has effect on maternal and neonatal outcome. Methods: The prospective study was conducted in the Department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India and a total of 200 patients were included in the study, of these, 100 patients had threatened abortion (Group A) and 100 patients were as control group (Group B) without vaginal bleeding during the period of one year. Results: In our study, in both the groups, maximum number of patients were found in between age group of 20-25 years. Minimum number of patients were found in between the age group of 18-20yrs in group A and >30yrs in group B. 60 patients were multiparous, contributing to the majority in group A. 55 patients were primigravida, contributing to the majority in group B. Conclusion: Threatened Abortion is an important condition to predict late pregnancy results, both maternal and fetal outcomes. Hence it is necessary to increase the knowledge of pregnant women in this regard for closer care.

93. A Prospective Observational Assessment of Parameters Associated with Severity of Acute Pancreatitis.
Pradeep Kumar, Sachchidanand Prasad
Aim: The aim of this study was to study the various predictors of severity know the association of the parameters with severity of disease. Methods: All consecutive cases admitted to the surgical wards of Department of General Surgery, Fort U Mediemergency Hospital, Patna, Bihar, India for a period of 18 months were studied. All consecutive patients were included in the study. A prospective observational study was carried out on 100 consecutive patients who were presented with features of acute pancreatitis between 20-80 years age group. Results: During the study period 100 cases of acute pancreatitis were admitted in general surgery department, out of which 70 (70%) were males and 30 (30%) were females. Age of the patient in our study varied from 20 to 80 years, the youngest being 25 years and oldest being 80 years. Majority cases were seen in between 41 to 50 years 40 (40%). In our study the 75 cases were mild acute pancreatitis (75%), 15 cases were moderately severe acute pancreatitis (15%) and 10 cases severe acute pancreatitis (10%). In our study the majority of cases who presented with acute pancreatitis were of alcohol induced type, 65 (65%). Gall stone pancreatitis accounted for 20 (20%) cases. Conclusion: Hence, from our study the following parameters were indicative of a severe disease and prompt treatment in terms of aggressive fluid resuscitation and supportive measures should be initiated at the time of admission. And one should not wait for any single scoring system to get scored for effective treatment.

94. A Clinico-Etiological Assessment of Vaginal Infections in Pregnant Women: An Observational Study.
Jyoti, Kalpana Jha
Aim: The present study was conducted to record the causes of vaginal infection in females. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India and It included 250 pregnant women with suspicion of symptomatic and asymptomatic vaginal infections. Results: In the present study, 200 (80%) out of 250 patients were found to be positive for vaginal infections. The study shows that age group 17- 25 years had 12% of cases, 26- 34 years had 63%, 35- 42 years had 18% and >42 years had 7% of cases. The difference was significant (P<0.05). The study shows that common microorganisms was Chlamydia trachomatis (35%), Candida albicans (28%), Mycoplasma hominis (13%), Gardnerella vaginalis (10%), Staphylococcus aureus (6%), Trichomonas vaginalis (4%), Neisseria gonorrhea (2%), E. coli (1%) and vibrio Mobiluncus (2%). Conclusion: Vaginal infections are quite common in pregnant women. The most common are Chlamydia trachomatis, Candida albicans, Mycoplasma hominis, Gardnerella vaginalis. Routine vaginal and cervical swab sample cultures should be performed on all pregnant women to avoid developing infections.

95. Clinico-Demographic Demographic and Perinatal Outcome Assessment in Women Presenting with Placenta Previa.
Rani Soren, Priyanka Chaudhary
Aim: The objective of the study was to study the demographic features, obstetric risk factors and management, and perinatal outcome in women presenting with placenta previa. Methods: The present study was conducted in the Department of obstetrics and gynaecology, Shahid Nirmal Mahato Medical College & Hospital, Dhanbad,Jharkhand and 60 cases of placenta previa were included who were admitted during the period from 01.08.2020 to 31.07.2021. Results: The maximum number of patients in the study group are seen in the age group of 25-29 years. Multiparous women are at higher risk of having placenta previa than primi. Diagnosis of type of placenta previa by ultrasonography showed the result that out of 60 cases 28 cases (46.66%) having placenta that partially cover internal os. 52% cases diagnosed during antenatal visits and 48% cases came with complain of bleeding per vagina and admitted in hospital. Most common etiological factor associated with placenta previa is previous caesarean section and in the study 66.66% cases are associated with that. Conclusion: Placenta previa is one of the most serious obstetrics emergencies, risk factor for placenta previa are multiparity, previous caesarean section, and previous abortion leading to serious maternal complication which adversely affect fetomaternal outcome. In the present study 36 patients accounted 60% of total cases were required blood transfusion whereas, other cases were not required any blood components.

96. A Study of Association of Serum Ferritin and Acid Base Status in Outcome of Acute Stroke Patients: A Prospective Observational Cohort Study.
Rahul Kumar Sinha, Barsha, Ravindra Kumar Das
Aim: To study the effect of level of serum ferritin and acid base status with early neurological deterioration and the outcome in patients of acute stroke. Materials and Methods: This prospective observational study was conducted on the patients of acute stroke diagnosed clinically, neurologically and radiologically and admitted in the emergency department of Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga. The study was conducted from June 2019 to June 2020. The work was started after getting the ethical approval from college ethics committee. A group of 200 patients of acute stroke with 108 patients of acute hemorrhagic stroke and 92 patients of ischemic stroke participated in the study. Serum ferritin values along with Acid-Base status were noted within 48hours of onset of symptoms considered Day 1 and subsequently on Day 6 to evaluate the outcomes. Glasgow Coma scale was used to assess the stroke severity along with CANADIAN STROKE SCALE, NIHSS (National Institute of Health Stroke Scale) in neurological assessment and further follow up of patients. Results: Majority of the population in both groups belong to age group between 60 – 69 years with the mean age of hemorrhagic stroke 64.814 (SD 10.0793) and ischemic stroke 64.010 (SD 8.7699).  Majority of the population in both groups belongs to male sex predominantly constituting 63.5% of total study population whereas 36.5% are female sex study population. Majority of hemorrhagic stroke population group have ganglio capsular hemorrhage. In ischemic stroke population the major type observed was LTPI- Left temporo parietal infarct. Conclusion: Elevated serum ferritin is strongly associated with early neurological deterioration in patients of stroke. Iron chelation therapy in acute stroke seems to be a strong theoretical possibility. Further studies and trials are required in this field to change the scenario of stroke patients.

97. A Hospital Based Oncologic Outcomes Assessment in Patients with Nonurothelial Bladder Cancer.
Alok Ranjan, Vivek Ranjan, Nisha Khanna, Prabhat Kumar Lal, Shiv Shankar, Kalpana Jha
Aim: The objective of the present study was to oncologic outcomes in patients with nonurothelial bladder cancer in Bihar region. Methods: The present study was conducted in the Department of medical oncology, IGIMS, Patna, Bihar, India. The patients diagnose with bladder cancer and refereed to our hospital were enrolled in the present study. Results: Majority of the cases were Urothelial cell carcinoma (50%) followed by Squamous cell carcinoma (16.66%). Most of the patients in the study were married male. The maximum number of patients fell under T1 stage and N0 stage. The univariable hazard ratio (HR) and 3-year and median OS and DSS by histologic subtype. With the exception of AC, all nonurothelial bladder cancers have a worse 3-year OS and DSS when compared to UCC. The worst DSS was demonstrated in small cell histology with 3-year survival probabilities of 41.6%. Conclusion: The data generated from the present study concludes that early detection and treatment of new / recurrent cases is required to optimize bladder preservation, reduce patient morbidity and increase quality of life. The incidence of bladder tumors of both urothelial and non-urothelial varieties is significantly lower in patients less than 40 years.

98. Comparison of Ephedrine, Mephentermine and Phenylephrine for the Management of Hypotension during Spinal Anesthesia for Caeserian Section.
Annet Thatal, Yogesh Narwat, Gunjan Arora
Introduction: Numerous pressor agents have been tried to counteract the hypotensive effect of subarachnoid block, usually by vasoconstriction and also by increasing the cardiac output.  In practice, the most commonly used drugs are the sympathomimetic agents which exert their effects through the adrenergic receptors, either acting directly or indirectly by inducing the release of noradrenaline which further acts on these receptors. Aim and objectives: To compare the efficacy of IV bolus phenylephrine, ephedrine and mephentermine for the maintenance of hemodynamic status and its effect on fetal outcome during spinal anesthesia in cesarean section. Methodology: This prospective double blind randomized controlled study was conducted in the Department of Anesthesiology and Critical Care in Alfalah institute of medical sciences, Faridabad, from July 2021 to July 2022. After a proper approval of Institute ethical committee and a written informed consent, 100 ASA grade I patients undergoing elective cesarean section under spinal anesthesia with a normal singleton pregnancy beyond 36 weeks gestation were recruited. Result: There is no significant variation of systolic BP  among all the 3 drugs, and there is no significant difference among the three groups with p value- 0.23, 0.076, 0.66 and 0.16, for diastolic Bp also there is no significant variation of diastolic BP  among all the 3 drugs, and there is no significant difference among the three groups with p value- 0.23, 0.21, 0.15 and 0.08, There is also no significant difference among three group of drugs for heart rate and MAP. Conclusions: On the basis of our study we concluded that all three drugs, i.e ephedrine, phenylephrine and mephentermine can be used to treat hypotension during spinal anaesthesia for caesarean section, however, phenylephrine has more fluctuation in vitals during spinal anesthesia.

99. Ropivacaine versus Bupivacaine for Post-Tonsillectomy Pain Management in Pediatric Cases – A Randomized Double-Blind Comparative Study.
Koti Sreenivasa Rao, C. Vikram Deo
Introduction: Post tonsillectomy pain management is important to mitigate common postoperative morbidity. The effective postoperative analgesia is important in reducing postoperative pain. The present study was designed to assess the efficacy of preoperative infiltration of ropivacaine and bupivacaine in postoperative analgesia in pediatric cases undergoing tonsillectomy. Materials and methods: A total of 36 children undergoing elective adenotonsillectomy between 2-12 years of age belong to ASA grade I and II were considered. Participants were randomly divided into two groups i.e. group A (3 ml of 0.25% of bupivacaine hydrochloride) and group B (0.2% ropivacaine hydrochloride 3ml).  Postoperative pain score was assessed by Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) till 24 hours after procedure. Results: The mean levels of hemodynamic parameters and rate of postoperative complications was comparable between two drug groups. The ropivacaine group showed low pain scores at all time intervals than bupivacaine group. The mean difference of pain scores was significant at 1 hour, 2 hours, 8 hours, 12 hours and 24 hours between two study groups (p<0.05). Conclusion: Both drugs are effective in minimizing the postoperative pain; however, ropivacaine was superior in postoperative pain relief as compared to bupivacaine.

100. Covid 19 Pandemic: An Overview.
Amod K Sachan, Sanjay Khattri, Rajendra Nath
In the 1930’s the corona virus was first identified as a highly contagious chicken respiratory virus. Two human coronaviruses were later identified, the human coronavirus 229E causing the flu and secondly the human coronavirus OC43. Others are also important as SARS-CoV. In late 2019 the outbreak of Pneumonia occurred in the Chinese city of Wuhan which was investigated as a result of the corona virus, renamed as 2019-nCoV by the World Health Organization (WHO) and. now called as SARS-CoV-2. The WHO has identified the global health problem as an epidemic. Respiratory droplets produced during coughing and sneezing are the main means of transmission of COVID-19. Infection with COVID-19 in an infected person may remain undetected. Common symptoms of fever and dry cough are less common in the production of sputum, fatigue and in some cases may be dyspnoea or shortness of breath. The COVID-19 virus is a type of RNA virus, the outer envelope containing a lipid bilayer in which various proteins are synthesized such as membrane (M), envelope (E) and spike (S). Hand washing, coughing, social isolation, wearing a face mask in public, disinfection areas, and isolation are various ways to prevent the disease. The diagnosis of COVID-19 can be made on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) tests. There are currently no antiretroviral drugs approved for COVID-19, only symptomatic and supportive treatment is used to treat people with this viral infection. Drugs that have been approved for the purpose of treating other viral infections are under investigation. Vaccination is an ultimate prevention and protection; few vaccines are given emergency approval and some are in progressive development phase in various countries to prevent this deadly pandemic.

101. A Comparative Study of Plating versus Interlocking Nailing in the Management of Distal Third Tibial Fractures.
Rama Manohar U, P. Jagadesh
Tibial fractures are among the most common skeletal Injuries and the incidence of tibial fractures is nine times more common than femoral fractures.  By Virtue of its location tibia is exposed to injury frequently.  1/3rd of surface is subcutaneous throughout the length, open fractures are more common in the tibia, than in any other long bone. The aim of this prospective study is to compare and assess the clinical results of distal tibia fracture fixation by interlocking nailing and plating. The study was done in Department of Orthopaedics Government Medical College, Kadapa from October 2020 to September 2022. Among the distal tibia fractures (Extra articular), 24 patients were selected randomly for this study, out of which 12 patients undergone Inter locking nailing and twelve patients undergone Plating for the study.

102. Effects of Preoperative Pulmonary Arterial Hypertension on Patients Receiving Valve Surgery for Rheumatic Heart Disease.
Pragateshnu Das
Background: Ankle fracture fixation postoperative pain has a significant impact on both the. Background and Aims: The data on the negative effects of pulmonary arterial hypertension (PAH) on outcomes following cardiac surgery for rheumatic heart disease is mixed (RHD). The researchers looked at Indian individuals with RHD and preoperative PAH who underwent cardiac surgery to see if they had poor short- and long-term results. Methods: This was a 407-patient retrospective observational study. The patients were classified as having no or mild PAH (pulmonary artery systolic pressure (PASP) <30 mm of Hg), moderate PAH (PASP 31-55 mm of Hg), or severe PAH (PASP >55 mm of Hg) based on PAH as measured by echocardiography. In-hospital mortality and significant morbidities were the primary endpoints, whereas long-term survival was the secondary objective. Results: In-hospital mortality was 24.9%, and there was no difference between patients with severe (9.1%), moderate (4.5%), or mild PAH (2.8%) (P = 0.09). Prolonged breathing was more common in patients with severe PAH (P = 0.007). >2-packed cell transfusion, extended breathing, and acute renal injury were all independently linked to mortality, but not moderate or severe PAH. On long-term follow-up [81.37 percent (mean duration 19.40±14.10 months)], patients with MS and severe PAH had significantly higher mortality (P = 0.03) than those with no or moderate PAH (P = 0.03). Mortality was 8% and not statistically different (P = 0.25) across PAH categories. Conclusion: Patients receiving valve surgery for RHD with moderate or severe PAH have similar short and long-term outcomes. Patients with MS who had severe PAH died sooner than those who did not have PAH.

103. Synthesis and Antimicrobial Evaluation of Some Novel Isatin Derivatives.
Manisha Chhaniya, Neelam Khan, Kratika Daniel
Present day challenge of managing microbial infection is ever increasing on account of many factors, out of which emergence of microbial resistance is topmost. Microorganisms are responsible for a number of diseases in human and other animals. As per a report, infectious disease is responsible for 16 million deaths every year worldwide and a lot of these are avoidable. The high level of antimicrobial resistance is a global public health concern. Resistance to potent and effective drugs such as cephalosporins, fluoroquinolones, and carbapenems is a particular concern, as is multidrug resistance. India occupies highest position in the world, in infectious disease list. Antimicrobial agents are considered to be ―miracle drugs‖ that are the leading weapons in combating infectious disease caused by microbes like bacteria, viruses, and fungi. Antimicrobial resistance (AMR), or drug resistance, is the ability of microbes, including bacteria, fungi, parasites, and viruses, to grow in the presence of antimicrobial agent that previously treated them effectively‖. Statistics of World Health Organisation (WHO), show that 490000, people developed MDR-TB, in 2016, globally. The drug resistance is also causing hindrance in fight against HIV and malaria. The study also indicates that people with methicillin resistance Staphylococcus aureus‖ is 64% more proven to death than people infected with non-resistant microbes.
Experts are constantly working hard to devise newer compounds to meet this challenge. Many pharmacophore have the potential as antimicrobial and anticancer agent. Pyrimidine, like Isatin also reported to possess versatile activity such as antimicrobial, anticancer, antifungal, anti-malarial, antiviral and anti-tubercular.

104. Characteristics, Comorbidities and Outcomes of Covid-19 in HIV Patients in a Tertiary Care Hospital.
Usha Rani, B. Archana, Swetha KS, S Sreedevi, V Chandra Shekar
Introduction:  The impact of HIV/AIDS on severity SARS-CoV-2 infection are limited. Hence a study was taken to find the incidence of COVID 19 among the HIV individuals. Materials and Methods: This were a retrospective study, conducted in KMC, Warangal form March 2020 to 2022. Study protocol was approved by the Institutional Ethical committee. HIV positive individuals who were reported for the anti-retroviral therapy (ART) were included. A standard patient information forms were maintained for the monthly follow-ups. Which include basic demographic characteristics as per the guidelines. In these patients COVID 19 was confirmed as per the by RTPCR, as per the guidelines. Individual HIV patient’s COVID-19 data was extracted from the electronic data. The data collection had two parts; first part included the HIV related data like age, gender, education level, comorbid conditions like DM or HTN or both, mode of HIV acquisition, duration of HIV infection, current ART regimens and treatment status, recent CD4 cell count and HIV viral load (< 12 months) and second part included COVID-19 related data like date of onset, symptoms and how many days they last, date of diagnosis, hospitalization with COVID-19, length of stay in hospital, treatment taken and date of death. Results: During the study period, 32 (0.5%) were tested positive for SARS-CoV-2, the male female ratio was 0.8 and mean ages were 35±7.8 and 34±11.5, respectively. Low CD4 count was reported. Tuberculosis was diagnosed in 1 (3.125%) patient; diabetes mellitus (15.625%) was the leading comorbidity Fever was the most (20/32; 62.5%) common symptom. Seven (21.88%) patients were sought hospitalization, 6 (85.71%) were male three (9.4%) were dead; 2:1 was male female ratio. Conclusion: Present study indicate there was less severe clinical presentation in HIV covid co infection. No increased rate of hospitalization.

105. A Observational Study on Effect of Subclinical Hypothyroidism in Pregnant Women in Our Population.
Pratibha, Radhika C, Shwetha S
Introduction: Thyroid dysfunction is second most common endocrine disorder affecting women of reproductive age group in pregnancy after Diabetes Mellitus. Pregnancy has a profound impact on the thyroid gland and its function. Materials and Methods: This study was conducted in Department of Obstetrics and Gynaecology, CSS. All the antenatal patients attending OPD of this hospital fulfilling eligibility criteria of this study and giving consent were subjected to study. Results: Out of the total 879 pregnant women during the period of study 116 pregnant women had subclinical hypothyroidism. Thus, as per the study the prevalence of subclinical hypothyroidism in pregnancy was 13.2%. SCH has significant effects on fetal and maternal health. Prevelence of presence Anti TPO antibodies in SCH mothers is 29% and prevalence of postnatal hypothyroidism in SCH mothers is 6.3%. Conclusion: Incidence of SCH is high in pregnancy so universal screening should be done during preconceptional period and in early pregnancy period.

106. A Challenging Case of Tropical Pyomyositis; Revisiting an Old Foe.
Vandana Tyagi, Shivadatta Padhi, Anand Derashri, Mohit Khandelwal, Susheel Kumar Saini
Tropical pyomyositis is an unfrequent disease characterized by skeletal muscle suppuration mainly occurring in tropical countries, few cases have been observed in India. The patients present with fever, localized swelling & pain. Mainly lower limb muscles are involved, other muscles involved are the chest wall, back, forearm & abdominal wall with a history of trauma or intramuscular injections. Due to non-specific signs & symptoms, early diagnosis is often missed Laboratory investigations reveal low hemoglobin levels, leucocytosis with neutrophil predominance, and increased levels of acute phase reactants. Diagnosis can be confirmed by pus aspiration from involved muscles & culture sensitivity shows Staphylococcus aureus. Ultrasonography, Computed tomography scan, and Magnetic resonance imaging can be done to confirm the findings. The first antibiotic of choice is Cloxacillin. Aggressive management should be instituted with incision and drainage. The clinician should be aware & familiar with the presentations of this disease as it can be life-threatening but with aggressive management it is curable.

107. Comparative Evolution of Surgical Management of Symptomatic Varicocele: Laparoscopic Varicocelectomy versus Inguinal Varicocelectomy.
K.C. Bansal, Shreeram Gupta, Trilok Jain
Background: A varicocele is an accumulation of dilated Venus network in the pampiniform plexus that voids the testicles and is situated in the apex of scrotum just above the ostentatious testis. Varicocele is the commonest cause of male infertility which can be surgically corrected. Material & Methods: The present prospective study was conducted at department of general surgery of our tertiary care hospital. The study duration was of one year from January 2021 to December 2021. A sample size of 40 was calculated at 90% confidence interval at 5% acceptable margin of error by epi info software version 7.2. Patients with idiopathic symptomatic varicocele of grades I–III diagnosed by clinical examination and Doppler ultrasonography were randomly assigned to Laparoscopic varicocelectomy or inguinal varicocelectomy (20 patients in each group). Results:  In the present study, the indications for varicocele ligation in both the study groups were abnormal spirogram in 70% patients, scrotal pain in 40% cases and cosmetic impairment in 20% cases. Among the group A (Open Varicocelectomy) study participants, post op pain reported in all cases, wound erythema seen in 04 cases, wound infection reported in one case, hydrocele reported in one case and 03 cases had recurrent varicocele and among the group B (Lap Varicocelectomy) study participants, post op pain reported in 06 cases, wound erythema seen in 02 cases, wound infection reported in none case, hydrocele reported in one case and 01 case had recurrent varicocele. However, this distribution was statistically significant (P value <0.05) in terms of post op pain and recurrence between both the groups. Conclusion: In present study, Laparoscopic varicocelectomy was associated with shorter operative time, shorter hospital stays and cosmetically better outcome compared to inguinal varicocelectomy.

108. Screening & Management of the Undetected & Neglected Cases of Diabetic Retinopathy in Reach-in Camp Patients in a Tertiary Care Hospital in Southern Odisha.
Sarita Panda, Deepika Priyadarshini, Prativa Behera, Ankita Kumari
Background: A Prospective Cross-sectional study of the undetected and neglected cases of the Diabetic Retinopathy was conducted for early diagnosis and timely management of the sight threatening disease. Aim: Studying the profile of Diabetic Retinopathy, its association with various factors affecting it, and awareness about the effects of diabetes. To determine the plan for Treatment of those cases. Materials and Methods: A Prospective Cross-sectional study was done in a tertiary care center  from 1st August to 30th September 2022 of all patients attending the camp including the pre-existing diabetic retinopathy patients. Results: Out of 200 patients attending the camp, 40% were males and 60 % were females;  majority of which belong to the age group of 50-60 years. 76 new cases were diagnosed, treated and followed up. Conclusion: Early screening for DR, early diagnosis and early treatment for Retinopathy can reduce the incidence of severe loss of vision in a high percentage of patients with DR.

109. Comparative Evolution of Surgical Management of Enteric Perforation: Primary Closure and Loop Ileostomy.
Shreeram Gupta, Neeraj Bhateja, Trilok Jain
Background: Ileal perforation also a common surgical emergency especially in the tropical countries and in Indian subcontinent. It has been reported that ileal perforation is the fifth common cause of abdominal surgical emergencies due to high prevalence of tuberculosis and enteric fever. Material & Methods: Forty patients who were admitted to Surgical Emergency with acute abdomen had been selected for the study. These patients were taken up for emergency surgery after proper written consent. Patients were divided in two groups after randomization as group A (primary repair) and group B (loop ileostomy). Postoperative complications in each group was observed during follow up and duly recorded. Results:  In the present study, Among the group A (primary repair) study participants, wound infection was seen in 7 patients, wound dehiscence occurred in 06 cases, systemic complications observed in 04 patients and intraabdominal collections found in 3 cases. Among the group B (loop ileostomy) study participants, wound infection was seen in 04 patients, wound dehiscence occurred in 02 cases, systemic complications observed in 03 patients and intraabdominal collections found in 2 cases. However, this distribution was statistically non-significant (P value >0.05). The average duration of hospital stay of cases undergone primary closure was 15.9 days compared to 20 days among cases who undergone ileostomy, which included ileostomy closure. Conclusion: We concluded from the present study that the Ileostomy closure also decreases mortality as well as morbidity in patients. Ileostomy related complications may increase the postoperative stay but complications can be diminished by proper contrive of the stoma and issuance of appropriate nursing care of the stoma.

110. A Comparative Study on Efficacy and Safety for Management of Neuropathic Pain with Gabapentin, Pregabalin and Amitriptyline.
Sanjeev Jetli, Alok Verma, Himanshu Sharma
Introduction: Current treatment for neuropathic pain (NeP) are tricyclic antidepressants (TCA), gabapentin and pregabalin as first-line treatment for the most common NeP conditions. Current therapy for the treatment of neuropathic pain is often unsatisfactory. Considerable variation in treatment pattern still exists in spite of availability of sufficient literature from various guidelines. Recent Indian market data suggested that the utilization (sale) of drugs such as amitriptyline, pregabalin, and gabapentin is actually recommended in the guidelines. Methods: It is a prospective, comparative, open label, single centre, three arm study. A total of 300 patients diagnosed with cases of chronic lumbar radiculopathy based on symptoms, clinical examination, X-ray and MRI scan of lumbosacral spine, were randomized into three groups to receive Group A patients received Gabapentine 300 mg, Group B patients received Pregabaline 75 mg, Group C patients received Amitriptyline 10 mg. Patients were assessed for pain relief by using visual analogue scale and an overall improvement in their general condition by patient’s global impression of change scale. Adverse drug reactions were recorded on each follow up. Results: All patients had significant improvement in pain relief in three treatment groups. The mean Numeric pain rating scale (NPRS) score At 2 months, the Mean±SD of NPRS score in Group A was 3.72±2.65, in Group B and Group C were 3.63±2.65 and 5.21±2.65 respectively with F-value of 6.63 and p-value of 0.001 which was statistically significant. Intergroup comparison shows significant differences among three the treatment groups. The adverse effects reported occurrence of dizziness was significantly more in group B with 21 patients (23.33%) as compared to group A with 11 patients (12.22%) and group C with 4 patients (4.44%), [p=0.041). The sedation occurred in 28 patients of group B (31.11%), which was significantly more than group A i,e, in 23 patients (25.55%) and group C i.e. 22 patients (24.44%), [P=0.036]. Conclusions: In patients with NeP Thus, in conclusion three groups Gabapentine, Pregabaline and Amitriptyline are equally efficacious in relieving pain in NeP. Pregabalin has the advantages in terms of Numeric pain rating scale (NPRS) score over the Gabapentine and Amitriptyline.  Gabapentine has fewer reported adverse effects and hence a better patient compliance on long term use.

111. Evaluation of Drug Utilization Pattern of Antibiotics in Tertiary Care Hospital.
Kotra Vijay Kumar
Background: A Drug utilization study was planned to evaluate the use of antibiotics among  patients in the tertiary care hospital and their irrational use leading to the emergence of  drug resistance. Methods: It is a prospective study conducted on a total of 150 patients in the medical department of tertiary care hospital. The data was entered in Microsoft excel. Inclusion criteria include patients on antibiotics and exclusion criteria included patients who were not on antibiotics or had incomplete medical records. Results: Among the 150 patients 75% were male and 25% were female. About 64% were in 21-40 years age followed by 12% in 41-60 years age. Amoxicillin was the most commonly prescribed antibiotic. 30% of drugs prescribed were generic. 49% received two antibiotics followed by three antibiotic prescriptions. Discussion and Conclusion: Generic drugs should be prescribed more. The prescribers should prescribe according to WHO indicators. To prevent polypharmacy, the minimum number of drugs per prescription should be given. Laboratory investigations must be used for the prescription.

112. Trans-Septal Suturing as an Alternative to Nasal Packing Following Septoplasty – A Prospective Study.
Ankita Joshi, Nitish Virmani, Ratna Priya, Subrat Kumar Behera
Background: Nasal packing following septoplasty has been followed traditionally with the aim to stabilise repositioned cartilage and prevent postoperative hemorrhage, and septal hematoma. It is, however, associated with intense pain and discomfort in the postoperative period, besides causing dry mouth, sore throat, vestibulitis, poor quality of sleep, hypoxemia and increased risk of synechiae. Trans-septal suturing offers better patient compliance owing to minimal peri-operative pain and discomfort, and decreased incidence of pack-related complications. We have conducted a prospective, randomised controlled trial to assess the surgical outcomes, efficacy and rate of complications of quilting trans-septal sutures as compared to nasal packing. Methods: 50 patients presenting with symptomatic deviated nasal septum and undergoing septoplasty were randomly divided into two groups – Group A underwent nasal packing with soframycin-soaked ribbon gauze or merocel. Group B underwent trans-septal quilting suture without nasal packing. Patients were assessed for parameters like postoperative nasal pain, symptoms of dry mouth/sore throat, significant hemorrhage, vestibulitis, septal hematoma and synechiae. The results of both the groups were tabulated and analysed. Results: Patients with nasal packing had significantly higher mean pain score (MPS) in the postoperative period as compared to trans-septal suturing group, both at 24 hours (5 vs 2.12) and at one week (4.4 vs 1.8). The most painful event was removal of nasal packs (MPS = 6.2). The rate of synechiae was higher with nasal packing (20% vs 8%). Dry mouth/sore throat (72%) and vestibulitis (12%) was exclusively associated with nasal packing. None of the patients in either group had septal hematoma or significant hemorrhage. Conclusion: Nasal packing and trans-septal suturing are equally effective in preventing postoperative hemorrhage, septal hematoma and stabilising the repositioned cartilage. Trans-septal suturing avoids the severe postoperative pain and discomfort associated with nasal packing and can be used in all patients undergoing septoplasty as a reliable, cost-effective alternative.

113. Consensus Statement versus WHO Criteria: A Study to Assess Obesity among Indian Medical Undergraduates.
Mehta Maulik S., Patil Prashant H., Gadekar Kailas R., Gode Nikhil R.
Introduction: Obesity is a global epidemic occurring in the world. Obesity is a common risk factor among all NCDs and its prevention thus can prevent NCDs. Doctors are the worst affected cadre among all healthcare professionals. Budding doctors need to be examined for tendency to become overweight and obese. It has been observed that WHO criteria underestimate occurrence of obesity among Indians as compared to Indian Consensus statement criteria. This study aimed to find out occurrence of obesity among medical undergraduates and compare the results of WHO criteria and the Indian consensus statement – 2011 criteria of obesity in the study population. Materials and Methods: A cross-sectional study was conducted among medical undergraduates to compare the results of obesity between WHO and the Consensus statement. Anthropometric measurements were carried out as per the standard WHO guidelines. The results were compared with the chi-square test and Cohen’s kappa. Results: The BMI calculations indicated the occurrence of obesity among medical undergraduates based on WHO and Indian Consensus Statement – 2011 criteria as 2.4% and 15.66% respectively. The waist circumference calculation s showed that the occurrence of obesity based on WHO and Indian Consensus Statement – 2011 criteria was 9.23% and 25.70% respectively. Discussion: In comparison to WHO criteria, the Indian Consensus criteria showed an excess occurrence of 13.25% based on BMI calculations and a 16.46% excess occurrence of obesity based on waist circumference. The study had shown weak inter-rater reliability using Cohen’s kappa (κ) between WHO and Consensus criteria for obesity. Conclusion: Indian consensus statement provides us with a criterion that is more sensitive and specific for the Indian population than the WHO criterion.

114. A Prospective Study to Assess Electrolyte Changes after Hemodialysis among Chronic Kidney Disease Patients.
Devendra Choudhary, Kiran Palsania, Om Kant Sharma
Introduction: Acid-base and electrolyte homeostasis is vital for proper functioning of numerous metabolic processes and organ functions in the human body. Kidney diseases and dysfunction (chronic kidney disease, CKD) compromise the regulatory functions, resulting in alterations in electrolyte and acid-base balances that can be life-threatening. Aim: to assess electrolyte changes after hemodialysis among chronic kidney disease patients. Method: The index study was a cross sectional study conducted at the Department of Medicine, Rama Medical College and Research Institute, Hapur for a period of 6 months from 1st April 2022 to 30th September, 2022. The study included a total of 250-300 consenting adult patients who were either diagnosed with Chronic Kidney Diseases undergoing hemodialysis or patients referred from other institutions for hemodialysis. Results: Post dialysis sodium was statistically significantly higher than post dialysis sodium. Pre dialysis chloride was statistically significantly higher than post dialysis chloride. Conclusion: We found that post hemodialysis, serum potassium and chloride reduced and serum sodium increased.

115. Chronic Inflammation and Blood Cancer.
Nikolaos Tzenios, Mary E. Tazanios, ObGyn, Mohamad Chahine
Chronic inflammation may have a detrimental impact on human health as it tends to result in cancer. In addition, it is often linked to different steps that participate in tumorigenesis, including cellular transformation, survival, promotion, invasion, proliferation, angiogenesis, and metastasis. Hence, inflammation predisposes cancer development and plays a vital role in promoting all tumorigenesis stages. Inflammation is caused by many factors, such as bacterial and viral infections, tobacco smoking, autoimmune diseases, obesity[21], asbestos exposure, and many others, increasing cancer risk. Moreover, cancer can be enhanced by mutations that proceed to cancer progression. Consequently, it leads to immunosuppression and provides a favorable background for tumor development. Although many studies address the question of relationships between inflammation and cancer development, little attention is paid to the link between inflammation and blood cancer. Therefore, the current study reviews the role of inflammation in cancer development, particularly in blood cancer. A meta-analysis research approach meets the research objective and answers the research question. The review results indicate that chronic inflammation directly relates to the development of many cancer types, blood cancer in particular.

116. An Observational Study to See the Effect of Instillation of Local Anaesthetic (Bupivacaine) in Gall Bladder Fossa and Trocar Incision Site I/V/O Pain Following Laproscopic Cholecystectomy.
Kritika Soni
Introduction: Even though there are multiple benefits of laparoscopic cholecystectomy over the open cholecystectomy but still the postoperative pain has remained as a major issue. It is helpful to decrease the postoperative pain through the infiltration of local anesthetics like Bupivacaine inside operative wounds. The upper limit of bupivacaine is 2.5 mg per kilogram of the patient’s body weight. Aims and Objective: An observational study to see the effect of instillation of local anaesthetic (Bupivacaine) in gall bladder fossa and trocar incision site i/v/o pain following laproscopic cholecystectomy. (1) To determine the analgesic efficacy of bupivacaine in alleviating post operative pain. (2) To evaluate pain intensity by Visual analogue scale (VAS). (3) To reduce analgesic use post operative. (4) To reduce hospital stay post operative. Materials and Methods: This study was conducted to determine whether local infiltration of bupivacaine at trocar sites and gall bladder fossa has any effect in postoperative pain relief. This study was conducted on patients undergoing laparoscopic cholecystectomy. In these patients bupivacaine was instilled subcutaneously at trocar sites and 20ml of 0. 5% bupivacaine was instilled in gallbladder fossa after removal of gall bladder. Results: The efficacy of bupivacaine was observed at time duration gaps of 2 hours, 6 hours, 12 hours and 24 hours respectively where, Maximum of the patients did not experience the pain while the intensity was being measured by using the visual analogue scale. Conclusion: It is helpful to decrease the postoperative pain through the infiltration of local anesthetics like 0.5% Bupivacaine in operative wounds (Gall Bladder Fossa And Trocar Incision Site).

117. An Observational Assessment of the Association between Family History & BMI with Diabetes and Pre-Diabetes.
Abhay Kumar, Iquebal Hussain, Rajranjan Prasad
Aim: The aim of the present study was to assess the association between family history with diabetes and pre-diabetes in an urban area of Bihar. Methods: The present cross-sectional study was conducted in the Department of Community Medicine, Govt. Medical College & Hospital, Purnea (Bihar) for the period of 6 months among 510 respondents of 20-65 year age group in urban area of Bihar. In which 305 male and 205 females were interviewed by using pretested semi structured interview schedule. In the present study, 10 patients were excluded and total 500 patients were included in the study. Results: The result displayed that association of positive family history and risk of diabetes mellitus. Positive family history was observed more among pre-diabetics 33.34% and diabetics 25% as compared to respondents with normal blood glucose level 20%. The association was found to be statistically significant. The finding (table 3) shows the statistically significant association was observed between family history and BMI. More than 50% respondents who had positive family history of diabetes have high BMI. Conclusion: Based on our finding, it is possible that advancing age and obesity has increased in pre-diabetes. This highlights the importance of population based survey to monitor blood glucose for effective prevention and control.

118. A Cross-Sectional, Questionnaire-Based Assessment of the Perception and Attitude on Implementation of Pharmacovigilance Program among Junior Doctors.
Iquebal Hussain, Abhay Kumar, Rajranjan Prasad
Aim: The present study aimed to evaluate the perception and attitude on implementation of pharmacovigilance program on predesigned proforma among junior doctor. Methods: This study was a cross-sectional, questionnaire-based study involving, 100 resident doctors at Shree Narayan medical Institute and Hospital, Saharsa, Bihar. Results: Only 52% participants gave the correct definition of Pharmacovigilance while 80% participants responded correctly that Department of Drug Administration is responsible for monitoring ADR in Bihar. More than half of the participants (65%) agreed that reporting of ADR in Bihar is voluntary. 92% believed that reporting ADR of drugs is necessary. 52% participants thought pharmacovigilance should be taught in detail to healthcare professionals. 95% participants agreed that establishment of ADR monitoring center in every hospital is essential. 96% participants had never reported an ADR case. 6% participants had got training on pharmacovigilance. Conclusion: The present study concludes that resident doctors were lack of proper knowledge regarding pharmacovigilance, however attitude and perception were relatively better. Even though majority of the resident doctors came across ADRs and felt pharmacovigilance activity will be beneficial to the patient, reporting done by them is lower.

119. A Retrospective Assessment of the Various Histopathological Patterns of Ovarian Lesions, Their Classification and Relative Distribution of These Lesions.
Avinash Kumar, Anand Raj, Naveen Kumar Bariar
Aim: This study was undertaken to study the various histopathological patterns of ovarian lesions, their classification and relative distribution of these lesions. Methods: The study was undertaken as a retrospective study using existing patient data retrieved from the records of the Department of Pathology, Patna Medical College, Patna, Bihar, India during the period of six months. 200 ovarian mass specimens were received for evaluation, either as solitary specimens, or as part of total abdominal hysterectomy (TAH) specimens. Results: Majority of the Patients were in the age group of 10-39 years. A total of 170(85%) cases were unilateral while 20(15%) cases were bilateral. 39 cases were asymptomatic. Associated findings in specimens of Hysterectomy with salpingo-oophorectomy were also found. Most common was leiomyoma either alone or in combination with adenomyosis. Other associated findings were chronic cervicitis, carcinoma endometrium, carcinoma cervix; hydrosalpinx etc. Other non-neoplastic lesion were Cystic follicle (14 cases), Follicular cyst and Parovarian cyst (6 cases each), hemorrhagic cyst, ectopic gestation, Torsion ovary, Inclusion cyst and oophoritis. Conclusion:  Ovarian lesion comprises of wide spectrum of lesions and their presenting clinical, radiological and gross features are very similar. Hence Histopathology forms the mainstay of definitive diagnosis and categorization of these lesions.

120. Assessment of the Association of Maternal Early Pregnancy Lipid Levels with Patterns of Foetal Growth and the Risk of SGA and LGA: An Analytical Study.
Iffat Zaman, Md. Faizul Hassan, Nuzhat Zaman
Aim: The aim of this study was to examine the association of maternal early pregnancy lipid levels with foetal growth, patterns of foetal growth and the risk of SGA and LGA independent of maternal BMI and glucose levels. Methods: The present study was undertaken in the Department of Obstetrics & Gynecology, Madhubani Medical College & Hospital, Madhubani, Bihar, India . For the present study, we included 500 women with a live born singleton and available information on lipid measurements in early pregnancy. Results: We included 500 women. These women were on average 29.5 (± 5.1) years of age, and most women had a pre-pregnancy BMI < 25.0 kg/m2 (72%). Foetal growth parameters were available in 480 (96%) and 480 (96%) children in mid- and late pregnancy, respectively. Of all children, 300 were born AGA, 100 SGA and 100 LGA. Women with a child born LGA had higher levels of triglycerides and remnant cholesterol in early pregnancy than women with a child born AGA. No differences were observed in lipid distribution between women with a child born SGA and AGA. Conclusion: Our study suggests a novel association of early pregnancy triglyceride and remnant cholesterol levels with foetal growth, patterns of foetal growth and the risk of LGA. Future studies are warranted to explore clinical implication possibilities.

121. A Comparative Study to Evaluate Diagnostic Agreement of IMNCI Algorithm in Young Infants.
Rajiv Kumar, Puja Kumari, Mukesh Kumar, Rakesh Kumar
Aim: The aim of the present study was to evaluate diagnostic agreement of IMNCI algorithm in young infants. Methods: The comparative study was conducted in the Department of Pediatrics, JLNMCH, Bhagalpur, Bihar, India for the period of 18 months. 200 young infants were taken from Emergency and Outpatient Department of Pediatrics. Results: In this study out of 200 young infants, 120 were 0-7 days of age and rest 80 were 7 – 59 days of age. Out of 200 infants, 124 were males and 76 were females. There were 60% males and 40% females in age group 0-7 days of age group. There were 65% males and 35% females in infants 7 days to 2 months of age group. A total of 100 infants were recruited each from the OPD and Emergency. Out of which 110 infants were admitted, and 90 infants were sent home after initial management. There were total of 70 admissions, 4 from OPD and 66 form emergency and rest 48 were sent home in 0-7 days age group. There were 35 admission and rest 45 infants were sent home in 7days – 2 months of age. There was no mismatch in diagnosis in 47.5% infants while partial mismatch was present in 37.5% infants. Over diagnosis was present in 12.5% and under diagnosis was present in 5% of 0-2 months of age young infants. There was no mismatch in 43.34%, partial mismatch in 36.66%, over-diagnosis in 15% and under-diagnosis in 5% of infants in 0- 7 days of age respectively. There was no mismatch in 50%, partial mismatch in 40%, over-diagnosis in 7.5% and under-diagnosis in 2.5% of infants in 7 days- 2 months of age. Conclusion: Therefore, in conclusion, it could be mentioned that IMNCI is a quite sensitive strategy and could identify the severe illnesses of the young infants requiring referral to higher facility. Presence of other diagnosis with similar symptoms might result in false positive errors and low specificity. The algorithm covered most of the conditions, except some uncommon and rare ones.

122. Cemented Versus Un-Cemented Hemiarthroplasty Management of Fracture Neck of Femur: A Comparative Study.
Ravi Shekhar, Amresh Yadav, Sudhanshu Verma, Shiv Shankar
Aim: The study has been carried out to study the advantages, complications, morbidity and mortality rates, the recovery to physical independence encountered in each of the procedure and to draw a conclusion based on study results as to which of the above type of implant and type of fixation would be better in the management of fracture neck of the femur for elderly. Methods: The prospective comparative study was conducted in the Department of Orthopaedics, institute of medical sciences BHU, Varanasi, Uttar Pradesh, India   for nine months  included 50 cases of intracapsular fracture neck of femur in the elderly aged more than 60 years where 25 patients were treated by hemiarthroplasty using uncemented fenestrated prosthesis whereas 25 patients were treated with hemiarthroplasty using cemented non-fenestrated prosthesis. Results: 50 patients with fracture neck femur were operated on for hemiarthroplasty, cemented or uncemented, during the study period. The mean age was 66.30 ± 5.78years with the cemented cohort and 64.36 ± 6.20years in the uncemented cohort. Of these, 22 (44%) were men and 28(56%) were female. The most common mechanism of injury was a trivial fall (88%) as opposed to a road traffic accident (12%). Conclusion: Bipolar hemiarthroplasty whether cemented or uncemented is an excellent treatment for fracture neck femur. No significant difference between both methods in terms of functional outcome. Cemented hemiarthroplasty results in more blood loss and takes more operative time but is associated with less post-operative pain and complication and better functional outcome.

123. A Cross Sectional Survey to Assess the Functional Abdominal Pain in Relation to Behavioral Pattern Triggers in Children.
Satyendra Paswan, Shaantanu Kumar, Ankur Priyadarshi
Aim: The aim of the study was to ascertain the correlates of functional gastrointestinal disorders (FGIDs) and anxiety in children. Methods: The present study was conducted in the Department of Pediatrics, Jawahar Lal Nehru medical College and hospital, Bhagalpur, Bihar, India for six months and 50 children who qualified the Rome IV criteria for FAP in whom the clinician, pediatric gastroenterologist excluded organic causes by appropriate blood investigations and imaging (pertaining to individual cases) and endoscopy where appropriate/ indicated and warranted were included in the study. Results: A total of 50 children diagnosed with FAP completed the study. Thirty tree out of 50 children affected were female. Children were of average IQ level: 1) 56% with average intelligence; 2) 24% with low average (borderline and dull normal) intelligence; 3) 12% with mild mental retardation (i.e., IQ below 70); and 4) 8% with above average intelligence (bright normal). All the children were provided a 5-point Likert scale to assess their current anxiety. Most of the children, 44 out of 50 children, were rated at high and very high, which indicates that they had insight into their anxiety. Out of 44 children, 28 rated high and 16 rated very high anxiety levels. Conclusion: Children with FAP have variable IQ levels and high anxiety levels. The need for clinicians to counsel parents and children in order to address the stressors at home and school is warranted as this may help in management of FAP in children.

124. Outcome Assessment by Single Photon Emission Computed Tomography after Revasularization Procedure in Patients with Moyamoya Disease.
Supriya Chauhan, Sunil K Gupta
Aim: The purpose of this study was to assess brain perfusion on SPECT in preoperative period. This area of hypoperfusion will be then compared with post-operative SPECT Thus the functional usefulness of revascularization procedure can be assessed. Methods: The present study was conducted in the Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh. The duration of the study was from July 2014 -December 2015 (1½year) and 22 patients were included in the study. The follow-up period was 6 months. Results: Of the study population, 15 (68%) were males and 7 (32%) were females. There were 19 children and 3 adult patients who were all males. The number of patients below 13 years were 15 (68.2%), 14 – 20 years were 4 (18.2%) 21 – 40 years were 3 (13.6%). 18 (81%) patients presented with paresis which was unilateral in 11 (61.1%) and bilateral in 7 (38.9%).The distribution of symptomatology. Of the 21 patients, who underwent STA MCA bypass 8 (38%) patients underwent surgery on right side, 5 (23.8%) patients on left side, and 8 (38%) had bilateral surgeries done and one patient who underwent EDAMS alone underwent bilateral surgery. Conclusion: Our study showed the efficacy of revascularizations procedure in moyamoya disease. Hence there is growing evidence that symptomatic patients should be offered revascularization therapy. SPECT is an important tool and can be used to optimize the treatment strategies for patients with moyamoya disease.

125. An Analytical Study to Investigate the Relationship between Early Trimester Serum Lipid Concentrations and Risk of Preeclampsia.
Iffat Zaman, Nuzhat Zaman, Md. Faizul Hassan
Aim: The present study was aimed to investigate the relationship between early trimester serum lipid concentrations and risk of preeclampsia. Methods: The present study was conducted in the Department of Obstetrics & Gynecology, Madhubani Medical College & Hospital, Madhubani, Bihar, India . With the approval of the institutional ethics committee and written informed consent from each woman, total 230 women between 20-35 years of age with 13-20 weeks of gestation were enrolled. Results: The baseline demographic characteristics of two groups were similar (p>0.05) i.e. not differed statistically. The baseline blood pressures at the time of booking visit (13-20 weeks) were also not statistically different in both the groups. The result showed that levels of all lipid profiles (TC, TG, VLDL-C and LDL-C) except HDL-C, were significantly (p<0.001) higher in pre-eclamptic women than normotensive women. While pre-eclamptic women showed significant fall in High density lipoprotein cholesterol (HDL-C) level as compared to normal pregnant women. Conclusion: The measurement of serum lipid profile in early pregnancy may serve as early predictor of preeclampsia.

126. A Prospective Hospital-Based Assessment of the Predictors of Outcome in Pediatric Septic Shock.
Jiteshwar Prasad Mandal, Rakesh Ranjan Kumar
Aim: The aim of the present study was to analyze predictors of poor outcome in septic shock. Methods: The present study was conducted in the S.K. Medical College and Hospital, Muzaffarpur, Bihar, India for the period of 6 months. During the study period of 6 months, total 120 cases were admitted. There were 100 cases of shock of different etiologies and of these 57 cases of septic shock were enrolled in the study. Among the enrolled patients 3 did not give consent to participate in the study, 4 patients left against medical advice and 10 patients expired during the course of the illness. 40 of 50 (40/50 = 80%) cases enrolled in the study were discharged after recovery while 10 (10/50 = 20%) expired. Results: On analysis of clinical symptoms as predictors of outcome, fever was the most common symptom present in all the patients. On analysis of the vital parameters, a delayed capillary refill time (>3 seconds) was a statistically significant (p=0.008) predictor of poor outcome with all the 9 patients having failed to survive, having a prolonged CRT on admission. Amongst the laboratory predictors, a low mean pH on admission had a statistically significant (p=0.008) association with a poor outcome. Conclusion:A delayed capillary refill time on admission and a low mean pH were statistically significant predictors of mortality in septic shock, in this study.

127. A Hospital Based Retrospective Study to Determine the Efficacy of Short-Course Intravenous Methylprednisolone in the Management of Sudden Sensorineural Hearing Loss.
Renu Kumari, Ashish Kumar
Aim: The objective of this study was to determine the efficacy of short-course intravenous methylprednisolone in the management of Sudden sensorineural hearing loss. Methods: A retrospective review of the record data of the cases with SSNHL who received short course methylprednisolone therapy for one year was conducted in the Department of ENT, Patna Medical College and Hospital, Patna, Bihar, India for one year. Record data of 50 patients who met the inclusion criteria were included in the study. Results: There were 32 males (64%) and 18 females (36%). The age of the patients ranged from 18 to 72 years, with the mean age being 40.59 years. In the age group 0-20 years there were 5 (10%) patients, in 20-40 years there were 25 (50%) patients, in 40-60 years there were 14 (28%) patients, and in >60 years there were 6 (12%) patients. Conclusion: Comparing hearing loss, there was significant improvement after a short course of Methylprednisolone therapy. Short course Methylprednisolone can be an effective choice in a patient with SSNHL. Hearing outcomes are better in patients who do not have co-morbidities.

128. Feeding Practice and the Factors Associated with the Feeding Practice and to Compare the Health, Nutritional Status and Other Benefits: an Analytical Study.
Nayan Rukhaiyar, Snigdha Prasad
Aim: The aim of the present study was to study the feeding practice and the factors associated with the feeding practice and to compare the health, nutritional status and other benefits of the babies between various groups. Methods: The present study was conducted in the Department of Pediatrics, ESIC Medical College & Hospital, Bihta, Patna, Bihar , India  for three months and 200 breast- and bottle-fed babies and their mothers were selected for this study from our OPD. Keeping the Objectives and natures of the study in view, the ‘Descriptive Survey’ method of research has been adopted. Results: The mothers engaged in household activities were more in breast fed babies as compared to bottle fed babies while mothers engaged in service, teaching and labour were more in bottle fed babies as compared to breast fed babies. In the present study, the mean age of mothers at the time of marriage was 20.54 years which was more among the mothers of bottle fed babies (21.05 years) as compared to mothers of breast fed babies (20.53 years). Out of total respondents, majority of them (57.5%) were belonged to families having monthly income below Rs. 10000. The mean weight of breast-fed babies was more at the age of 6,7,8,9,10,11 and months as compared to bottle fed babies in the present study. The mean weight of breast fed babies (8.01 kgs) was found more as compared to bottle fed babies (6.79 kgs). Conclusion: Breast feeding can save families as much as Rs. 2500 per month formula costs. Breast feeding can save families even more money by reducing medical costs for healthier mothers and babies. Experts also agree that breast feeding holds many other benefits for both the mother and infant.

129. Observational Cross-Sectional Study to Assess the Dysnatremia in Patients with Chronic Liver Disease.
Manish Kumar, Syed Yousuf Faisal, Sudhir Chandra Jha
Aim: To  study  the  prevalence  of  hyponatremia  in  patients  with  chronic  liver  disease  attending  the  outpatient  department  of  a  tertiary  care  hospital. Methodology: An observational cross-sectional study was conducted in the department of medicine, Darbhanga Medical College and Hospital, Darbhanga, Bihar for one year .In this study, patients in the age group of 18 to 65 years were included irrespective of gender, diagnosed with chronic liver disease. A history, physical examination, biochemical markers, ultrasonography, and upper gastrointestinal endoscopy were used to identify cirrhosis. Child-Turcotte Pugh score (CPS) and model for end stage liver disease (MELD) score was calculated for all patients [16]. Those with serum sodium levels less than or equal to 130 meq/l were classified as group A, those with serum sodium levels between 131-135 meq/l as group B and those with serum sodium levels greater than or equal to 136 meq/l as group C. Descriptive analysis of quantitative parameters was expressed as means and standard deviation. Results: In the present study, 100 patients were included. It was observed that 32% were in group A (≤ 130 mEq/l), 34% were in group B (131 to 135 mEq/l) and 34% were in group C (≥ 136 mEq/l). The age or gender of the patients was not associated with serum sodium levels. It was observed that patients from group A had jaundice (p<0.05) and altered sensorium (p<0.05) significantly more commonly as compared to those from group B and C. Serum sodium levels was not significantly associated with alcohol consumption. Among all examination findings, icterus (p<0.05) and clubbing (p<0.05) were found to be significantly more common among patients from group A, as compared to patients from group B or C. Pallor, pedal edema, signs of liver cell failure and organomegaly were not significantly associated with serum sodium levels in our study population. Hepatic encephalopathy (p<0.01), hepatorenal syndrome (p<0.01) and coagulopathy (p<0.01) were found to occur significantly more common among patients from group A, as compared to those in patients from group B or C. We also observed that mean direct bilirubin, alanine transaminase, aspartate transaminase and alkaline phosphatase were significantly higher among group A patients as compared to those from group B or C respectively. In addition, we observed that mean MELD (The Model for End-stage Liver Disease) score was significantly higher among group A patients (18.04+7.52) as compared to those with group B (13.24+5.02) and group C (12.04+4.72). We also observed that mean Child Pugh score (CPS) was significantly higher among group A patients (10.04+2.82) as compared to those with group B (8.72+1.45) and group C (7.34+2.02). Overall, 12% of the patients expired. Conclusion: Decompensated Chronic Liver Disease is associated with abnormal serum sodium concentration. Individuals with lower serum salt levels had a substantially higher MELD score and CPS. Furthermore, hepatic encephalopathy, hepatorenal syndrome, and coagulopathy were shown to be considerably more prevalent in individuals with blood sodium levels more than 136 mEq/l than in other patients.

130. A Prospective Comparative Assessment of the Effectiveness of Oral Probiotics Supplementation in the Treatment of Adult Small Chalazion.
Rajeev Kumar, Abhilasha, Jawed Iqbal
Aim: The aim of the present study was to define the possible beneficial impact of probiotics oral supplementation on patients affected by chalazion. Methods: The study was conducted in the Department of ophthalmology, ANMMCH, GAYA, Bihar, India for the period of 8 months. Total 24 enrolled patients underwent a complete ophthalmologic examination, including the assessment of size, duration and location of the chalazion before the recruitment. Results: The trial was accomplished by all the participants. The mean age was matched in the two considered groups (P=0.74). Both groups had comparable baseline characteristics in terms of location, size and duration of the chalazion, with the exception of the sex; in fact, there was a higher prevalence in the female. The medical treatment with or without probiotics supplementation was effective only on the small size chalazia.  Medium and large size chalazia did not respond to medical treatment with or without probiotics supplementation over the follow-up period (3mo). Conclusion: The considerable difference in time taken for complete resolution of small chalazia between the two groups in favor of the experimental one confirms the presence of a gut-eye axis.

131. Lymphocyte-to-C-reactive Protein (CRP) Ratio: A New Biomarker to Predict Perforation in Acute Appendicitis.
Sonal Agarwal
Background: In Appendicitis is a frequent cause of abdominal pain worldwide. Around 18%- 34% of patients may present with perforations & risk of life. Various inflammatory markers have been evaluated in this regard one such is the Lymphocyte to C reactive protein ratio which has shown to be a promising inflammatory marker with high sensitivity & specificity in the differentiation of perforated & non-perforated appendicitis cases. Aims & Objectives: The study aimed to assess the role of the Lymphocyte to C reactive protein ratio in predicting perforation in acute appendicitis. Material & Methods: This prospective observational study recruited 120 patients who underwent surgery for acute appendicitis who came to our Tertiary care Hospital between January 2022 and August 2022. Patients > 18 yrs of age, diagnosed with acute appendicitis and perforated acute appendicitis were included. For all the patients, preoperative complete blood count, and C reactive protein was undertaken, and histopathological samples were sent for analysis. The patients were divided into two groups: Group A included nonperforated acute appendicitis (n=102); Group B included perforated appendicitis cases (n=18). Age, gender, preoperative WBC count, platelets count, neutrophil count, lymphocyte count, C reactive protein, postoperative length of hospital stay & Lymphocyte to C reactive protein ratio were recorded. Results: Mean age in Group A was 38. 45±14.65 yrs while in Group B it was 49.67 ±16.43 yrs. The mean age in Group B was statistically significantly higher than Group A (p<0.05). Out of 120 patients with appendicitis, 58.4 % were males, and 41.6% were females. Average hospitalization days in group A were 1.52±1.21 which was statistically significantly lower than in Group B 4.72±1.01 days (p <0.05). The values of WBC, platelet, neutrophil & CRP values were statistically significantly higher in Group B (p <0.05). The lymphocyte and LCR values were statistically significantly lower in group B. LCR at a cut of 0.23, had a sensitivity & specificity of 74.8% & 84.4% at a 95% confidence interval. Conclusion: Thus, this study concludes that Lymphocyte to C reactive protein ratio an inflammatory marker can be used as a potential tool for predicting perforation in acute appendicitis patients. It is an easily available affordable marker with high sensitivity and specificity.

132. A Prospective Randomised Double-Blind Study Comparing the Analgesic Efficacy of Intrathecal Clonidine and Oral Clonidine in Parturients undergoing Caesarean Section under Subarachnoid Block.
Vaishnavi B.R., Vinayaka C.S., Shruthi H.R., Shashikala T.K., Sinchana R., Meghana R.
Caesarean section is the most common surgical procedure which is performed in women of child bearing age. Subarachnoid block is the most commonly performed anaesthesia technique, it is easy. It provides prolonged post-operative analgesia. Methods: Sixty parturients of age group between 19-35 years of ASA I & ASA II undergoing caesarean section are randomly allocated into two groups. Group OC received Tab. Clonidine 0.3mg orally 90mins before subarachnoid block (SAB) (1.8cc [9mg] of 0.5%hyperbaric bupivacaine + 0.5ml of Normal saline). Group ITC received(1.8cc[9mg] of 0.5% hyperbaric bupivacaine + 1mcg/kg intrathecal clonidine). Data collected are onset of motor and sensory block, duration of motor and sensory block, maximum level of sensory block, time of rescue analgesia, APGAR 1 and 5min and hemodynamic parameters (HR, MAP, SBP, DBP) and any adverse effects like bradycardia, hypotension, sedation, nausea, vomiting and shivering. Results: Onset of motor and sensory block were early in group OC (2.37+0.26 v/s 3.55+0.52, 2.25+0.35 v/s 3.26+0.5 mins respectively) when compared group ITC, which is statistically highly significant (p=0.000). Total duration of sensory and motor block were less in group OC (164.87+6.03, 153.6+5.8 mins) when compared to group ITC (236.33+15.63, 219.93+14.84 mins) which is statistically highly significant (p=0.000). Time of rescue analgesia was prolonged in group ITC (255+18.77 mins) when compared with group OC (178.73+5.26mins) which is statistically highly significant(p=0.000). HR was significantly reduced at various intervals in group OC(p=0.000). Conclusion: Intrathecal clonidine prolonged the duration of post-operative analgesia with better hemodynamic profile without any adverse effects when compared to oral clonidine.

133. A Hospital Based Clinico-Pathological Assessment of Soft Tissue Tumors.
Abhilasha, Manoj Kumar
Aim: To study the benign and malignant soft tissue tumors with respect to incidence of age, sex and site distribution and study of pathological features of soft tissue tumors. Materials and Methods: Retrospective study was undertaken for a period of 2 years in Department of Pathology, Sri Krishna Medical college, Muzaffarpur, Bihar, India. Results: Total 120 cases of soft tissue tumors were included in this study. It has slightly male preponderance with a male to female ratio was 1.4:1. Benign soft tissue tumors formed 93.3%(112) of all soft tissue tumors while malignant soft tissue tumors constituted 6.7%(8).  The commonest  tumor was Benign adipocytic constituting 68.3%(82) of all soft tissue tumors followed by vascular tumors 10%(12), fibrohistiocytic tumors 6.7%(8), peripheral nerve sheath tumors 5%(6), fibroblastic tumors 1.7%(2), Perivascular tumors 1.7%(2) of all soft tissue tumors. The Benign adipocytic tumor accounted for the majority of benign soft tissue tumors 73.2% followed by benign vascular tumors 10.7%, benign fibrohistiocytic tumors 7.1%, benign peripheral nerve sheath tumor 5.3%, benign fibroblastic tumor 1.8% and benign perivascular tumor 1.8%. Benign tumors of smooth muscle and benign tumors of uncertain differentiation are nil encountered in our study. In our study total 8 cases were malignant soft tissue tumor. 3 cases were of malignant fibroblastic group. 2 cases were of malignant skeletal muscle group. 3 cases were of malignant tumors of uncertain differentiation. 52.7%(59) of benign soft tissue tumors were in extremities, 23.2%(26) tumors were in head and neck, 13.4%(15) were in back and shoulder, 10.7%(12) were in trunk and abdomen. Most common site for malignant soft tissue lesions is lower extrimities followed by head and neck. Conclusion: The diagnosis and management of soft tissue tumors require a team perspective. Even though soft tissue sarcomas are rare and usually present just as painless mass, the clinician must be able to diagnose it early for better management. A careful gross examination of the specimen and adequate sampling of the tumor is essential.

134. Effect of Alcohol on Lipid Profile and Male Sex Hormones.
Atul B. Agte
Introduction: In fact, alcohol consumption exceeded a number of traditional risk factors, including poor water and sanitation, hypertension, high cholesterol, and tobacco use, according to the World Health Organization’s (WHO) most recent comparative risk assessment. Only unsafe sex and childhood underweight were more detrimental to the global burden of disease and damage. Alcohol use, especially binge drinking, increases the risk of many health issues and, as a result, adds significantly to the global burden of disease. In fact, alcohol consumption exceeded a number of traditional risk factors, including poor water and sanitation, hypertension, high cholesterol, and tobacco use, according to the World Health Organization’s (WHO) most recent comparative risk assessment. Only unsafe sex and childhood underweight were more detrimental to the global burden of disease and damage. Aim: Effect of Alcoholic Males in Sex Hormones. Material and Method: In total, 30 guys between the ages of 25 and 60 were included in this study. They were split into two groups, one of whom drank alcohol twice per week and the other of whom consumed it every day. Previous history of being a chronic alcoholic or the most recent amount of alcohol ingested, among other topics, were subjects who came from OPD. Subjects covered by the Department of Psychiatry and the Department of Biochemistry at the Government Medical College of Nandurbar. Result: Comparison between twice in a week takes alcohol males and daily in a week’s takes alcohol males serum cortisol and Testosterone valves are significantly increased in to daily in a week’s takes males to comparison twice in a week’s subjects the valves are normal in subjects the valves are shows statistically significant. P < 0.0001. Conclusion: Our study demonstrates that drinking too much alcohol on a regular basis increases the chance of developing heart disease, liver disease, kidney disease, and problems with the reproductive system including erectile dysfunction and early ejaculation or issues with anxiety and depression.

135. A Hospital-Based A Prospective Comparative Assessment of the Analgesic Efficacy of Intrathecal 1% 2-Chloroprocaine with or Without Fentanyl in Elective Caesarean Section.
Amish Kumar, Rishi Kant, Rajesh Verma
Aim: To compare the analgesic efficacy and safety of intrathecal fentanyl (25 µg) as an adjuvant to low dose 1% 2-CP (30 mg) in parturients undergoing caesarean section. Methodology: This prospective, double-blind, randomized, comparative study was conducted in Department of Anesthesia and critical care, Patna Medical college and hospital, Patna, Bihar for one year. 100 participants 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,  The anaesthesiologists who administered spinal anaesthesia recorded NIBP, HR, SpO2 and VAS every 10 min in post-operative period till patient requested for first analgesic agent. The duration of analgesia was considered from the time of subarachnoid injection of drug to the time up till visual analogue scale (VAS) for pain assessment score ≥4. The duration of sensory block was from the onset of sensory block till sensation was felt at the level of S2 dermatome, while duration of motor block was from time to achieve Bromage scores ≥2 to time to complete recovery of motor power. The adverse events like hypotension, bradycardia, nausea, vomiting, and pruritus were recorded for first 24 hours. The primary outcome of the study was the duration of analgesia, while secondary outcomes were onset of sensory block (time to achieve at T10 dermatomal level), onset of motor block, duration of sensory block, duration of motor block, time to achieve T6 and T10 dermatomal level, maximum cephalad spread, time for two-segment regression, Apgar score and any adverse effects. Results: The 100 participants were randomized in two groups. The participants in both groups were similar with respect to demographic data and duration of surgery. The mean duration of sensory block was prolonged in group CF in comparison to group CS, with the difference being statistically significant (101.6±14.92 versus 72.04±10.23 min, P < 0.0001). The mean duration of analgesia was prolonged in group CF compared to group CS, with the difference being statistically significant (114.2±25.44 min versus 79.82±10.83 min, P < 0.0001). The adverse effects namely hypotension, bradycardia, nausea, vomiting, pruritus, shivering, sedation and respiratory depression were comparable in both the groups. There was no statistical difference in the Apgar score of newborns in both the groups. In this study, none of the participants reported TNS in the follow-up period. Conclusion: Our study concluded that intrathecal preservative-free 1% 2-chloroprocaine (30 mg) with fentanyl (25 µg) as an adjuvant has added advantage in prolonging the post-operative analgesia, speeding up the onset and increasing the duration of the sensory block without affecting the recovery of motor block 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.

136. A Hospital Based Observational Evaluation of the Association of Cardiovascular Disease with Micro Albuminuria in Type 2 Diabetes Mellitus.
Abhay Kumar Sinha, Rakesh Kumar, Ashok Kumar, Devendra Kumar Sinha
Aim: The aim of this study was to determine the prevalence of cardiovascular disease with micro albuminuria in type 2 diabetes mellitus. Methods: This observational study was conducted at Department of  Geriatric Patna medical college and Hospital, Patna, Bihar, India for duration of six months. The study was comprised of 100 type 2 diabetes mellitus patients. Patients’ details demographics were recorded after taking written consent. Patients who had other medical illness and those did not give any written consent were excluded from this study. Results: Out of 100, 60 (60%) were males and 40 (40%) were females. Mean age of the patients were 45.71±16.9 years with mean BMI 26.14±9.22 kg/m2. Mean duration of diabetes was 6.08±9.64 years. Cardiovascular disease found in 75 (75%) cases. We found that 65 (65%) patients had microalbuminuria with mean ACR 160.4±74.6 mg/gm while rest of the patients 35 (35%) had normal albuminuria 19.14±5.4 mg/gm. Among 75 patients of cardiovascular disease HTN was the most common found in 23 (30.67%) cases followed by HTN+Stroke 18 (24%). Conclusion: We concluded in this study that the prevalence of cardiovascular disease with microalbuminuria in type 2 diabetes mellitus was significantly high <0.05 with increased systolic diastolic pressure and fasting blood glucose as compared to normal albuminuria.

137. Prospective Randomized Clinical Study to Assess the Effect of Intrathecal Dexmedetomidine and Magnesium as Adjuvants to Bupivacaine in Patients Undergoing Total Hip Replacement.
Amish Kumar, Rishi Kant, Rajesh Verma
Aim: To compare the effect of intrathecal dexmedetomidine and magnesium as adjuvants to bupivacaine in patients undergoing total hip replacement. Methodology: In this prospective randomized, double-blinded study in Department of Anesthesia and critical care, Patna Medical college and hospital, Patna, Bihar, India for one year. 90 ASA physical status I and II patients aged 18–45 years, of both the genders scheduled for total hip replacement surgery under spinal anesthesia were included. Patients received no premedication and, upon arrival of patients into the operating room, ECG, pulse oximetry (SpO2) and noninvasive blood pressure (NIBP) were monitored. Following infusion of 500 mL lactated Ringer’s solution and with the patient in the sitting position, lumbar puncture was performed at the L3-L4 level through a midline approach using a 25G Quincke spinal needle. Using computer-generated random numbers, patients were allocated into three groups. Group D received 15 mg hyperbaric bupivacaine and 0.1 ml (10 μg) DXM. Group M received 15 mg hyperbaric bupivacaine and 0.1 ml (50 mg) Mg. Group C received 15 mg hyperbaric bupivacaine and 0.1 ml normal saline as control. Results: The onset time of block, both sensory up to T10 dermatome and motor to Bromage 3 scale, was rapid in the DXM group D (2.83 ± 1.23 and 4.12 ± 1.26) and delayed in the Mg group M (6.73 ± 1.93 and 7.38 ± 1.47) in comparison with the control group C (4.72 ± 1.73 and 4.73 ± 1.27). The difference between the groups was statistically significant in both sensory and motor (P<0.0001). The regression time of block, both sensory up to T10 dermatome and motor to bromage 3 scale, was prolonged in the DXM group D (349 ± 45 and 329 ± 34) and in the Mg group M (278 ± 66 and 258 ± 55) when compared with the control group C (199 ± 57 and 137 ± 53). However, the duration was longest in the DXM group among the three groups. The difference between the groups was statistically significant in both sensory and motor (P<0.0001). The SpO2 was higher than 95% in all patients in the three groups, either in the intraoperative or in the PACU time. Conclusion: Dexmedetomidine leads to faster onset and prolonged duration of both sensory and motor block, prolonged duration of analgesia with minimal hemodynamic changes and side effects in comparison to magnesium sulfate when used as an adjuvant with hyperbaric bupivacaine in spinal anesthesia.

138. A Hospital Based Comparative Assessment of the Effect of Fentanyl and Tramadol as an Adjuvant to Ropivacaine in Supraclavicular Brachial Plexus Block.
Anant Prakash, Rahul Kumar, Krishna Kumar
Aim: The aim of the present study was to compare the effect of fentanyl and tramadol as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Methods: This prospective, randomized double-blind study was conducted in the Department of Anaesthesiology Sri Krishna Medical College & Hospital, Muzaffarpur, Bihar for one year. 100 patients of either sex aged 20-60 years, belonging to ASA physical status I or II undergoing upper-arm surgery were recruited for this study. Results: There was no statistically significant difference among the two groups in demographic characteristics. Majority of study participants were males but there is no statistical difference among two groups. The demographic status and data before the block were comparable among two groups (P > 0.05). Mean ± standard deviation for onset of complete sensory block prolonged from group RT (17.59 ± 1.07 min) and to Group RF (20.14 ± 1.50min). There was statistically significant difference in onset of complete sensory block among the groups RF p < 0.001.  Mean ± standard deviation for onset of complete motor block prolonged from Group RT (18.6 ± 1.86min) to group RF (n ¼ 21, 25 ± 1.50min). Conclusion: In conclusion, tramadol when used as adjuvant with local anaesthetic in peripheral nerve block provides better surgical anaesthesia and analgesia. Therefore, its use should be promoted for routine addition to local anaesthetics in peripheral nerve blocks.

139. Evaluation of Early Weight Bearing Mobilization Following Surgical Fixation of Unstable Ankle Fractures: A Prospective Study
Sunil Kumar Kar
Objective: The study aimed to evaluate and compare the benefits of immediate early weight-bearing over late weight-bearing mobilization and the results of early weight-bearingin unstable ankle fractures treated surgically. Design: Prospective study. Materials and Methods: The current study was a prospective study carried out at the Department of Orthopedics, IMS & SUM Hospital from Oct 2017 to June 2019. The Institutional Ethics Committee, IMS & SUM Hospital, Bhubaneswar approved the current study. The study proforma was designed according to the aim of the study and data were collected. A total of 120 skeletally mature patients underwent ankle surgery, 50 of which were allowed immediate weight bearing as tolerated (IWBAT) in the acute postoperative period and were taken into the study. Outcome Measures: Patients underwent wound assessment, radiographic analysis of fracture reduction maintenance, clinical evaluation of fracture healing and evaluation of complications necessitating additional surgery at the scheduled follow-up. Each patient was assessed six months later using the Modified American Academy of Orthopaedic Surgeons Foot and Ankle Scale (MAAOSFS). The study was carried out from Oct 2017 to June 2019 in IMS and SUM Hospital, Bhubaneswar. Results: The current study explored whether IWBAT is a safe substitute for a period of protected weight-bearing in a subset of patients with stable osteosynthesis after an ankle fracture. Early return to full weight bearing is linked to earlier weight-bearing without compromising the functional outcome scores. It was found that a fraction of 52% of patients come under the low energy falls mode of injury out of 50 patients. Conclusions: A safe substitute for a period of protected weight-bearing after an ankle fracture is IWBAT in a subgroup of patients with stable osteosynthesis. Better mobility, shorter hospital stays, and an earlier return to work have all been linked to earlier weight-bearing. Patients with closed ankle fractures that do not involve the tibial plafond, do not have syndesmotic disruption and have stable fixation are candidates for IWBAT.

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