International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1. Clinicoanatomical Relationship between Eustachian Tube Dysfunction and Middle Ear Disease
Chaitanya C. Bharadwaj, Hanumant Giri, Pooja Nayak, Deepti Kulkarni, Rahul Shenoy
Objectives: The main objective of this study is to assess the ET function and its relationship with middle ear disease and outcome of tympanoplasty. Method: The patients, age ranges from 13 yrs to 55 yrs presented with perforation of tympanic membrane were selected. Anatomical evaluation of Eustachian tube patency was tested clinically, radiologically. Patients underwent tympanoplasty. Post operative results were analysed and compared with preoperative analysis of the Eustachisn tube function. Results: Total 30 patients were included in study, amongst whom 11 were males and 19 were females. Ear discharge followed by loss of hearing were main complaints preoperatively. Patients with normal Eustachian tube function preoperatively showed good results in terms of tympanic membrane healing and improvement in hearing. Patients with hypofunction or obstruction of Eustachian tube showed persistent of ear discharge, non-healing of tympanic membrane or non-improvement in hearing in postoperative period. Conclusion: There is positive correlation between the Eustachian tube dysfunction and middle ear disease. Patients with the Eustachian tube dysfunction in preoperative period has negative effect on surgical outcome.

2. Clinical Profile and Different Types of Arrythmias among Elderly Patients in a Tertiary Care Hospital in Western Maharashtra – A Prospective Observational Study.
Neelam N Redkar, Sheela O Pandey, Radheshyam Shinde, Prakash Ram Relwani, Sameer S Yadav, Sweta Jadav
Introduction: In the elderly age group, frequency of cardiac arrhythmias is projected to increase and thereby greatly impact health care resource utilization. Several clinical factors are associated with risk of arrhythmias. Aim: To study clinical profile and different types of arrythmias in elderly patients, identifying various etiologies and complications associated with arrhythmias. Materials and Methods: A prospective observational study was conducted at H.B.T. Medical College & Dr. R.N. Cooper Hospital, a tertiary care hospital, Mumbai, Maharashtra, India after obtaining institutional ethics committee permission. In this study, 63 patients aged more than 60 years fulfilling eligibility criteria from medicine OPD or admitted to medicine ward/ intensive care unit were enrolled after obtaining prior informed consent from patient or patient’s relatives. The study duration was for one year (February 2019 – January 2020). ECG, detailed medical history, clinical examination findings, 2D-Echo and required investigations reports were noted. The collected data was analysed and qualitative data was presented as frequency and percentages and analysed using chi-square test, whereas quantitative data was presented as mean and SD and compared by t-test. P-value < 0.05 was taken as level of significance. Results: Of the 63 study subjects, there were 48 males (76%) and 15 females (24%). Among them, more than 70 years age group (44%) was the most common affected group and mean age was 68 ± 5.1 years. Alcohol and tobacco chewing was observed in 32% and 36% subjects respectively. The most common symptoms reported was shortness of breath (72%) followed by chest pain (46 %), palpitations (37 %), seizure (12%), altered sensorium (10%), hemiparesis (10%) and hemiplegia (5%). The most common arrhythmia noted amongst studied group was atrial fibrillation (37%). The most common etiology observed, was IHD (39.7%). Most common complications noted in this study, was congestive cardiac failure (44.4%). On analysing the data from different age group of patients, Chi-square test showed a p-value of 0.561 indicating that there was no significant association of age with different types of arrhythmias. Conclusion: The prevalence of arrhythmias in very elderly patients is rising. Atrial fibrillation was the most common arrhythmia observed in current study. The most common etiology found, amongst study subjects was IHD. The most common complications observed, was congestive cardiac failure followed by embolic stroke, angina, and infective endocarditis. Gaining an appreciation of the epidemiology of arrhythmias in the elderly will assist the clinician in diagnosing and managing such patients.

3. Assessment of Treatment Satisfaction and Efficacy of Vildagliptin Compared with Glimepiride as a Combination Therapy to Metformin in Patients with Type 2 Diabetes Mellitus Attending a Tertiary Care Hospital in India.
Mondal M, Pramanik S, Sengupta M, Raychowdhuri P
Background: Type 2 diabetes mellitus (T2DM) is a massive health problem in India which leads to serious chronic morbidity. While metformin is the first line drug to treat T2DM, in patients not controlled by metformin monotherapy, glimepiride or vildagliptin can be added. Treatment satisfaction with these oral antidiabetic drugs can be measured by Diabetes Treatment Satisfaction Questionnaire (DTSQ) which can influence overall success and adherence to therapy. Objective: To compare the treatment satisfaction level of patients between metformin-glimepiride and metformin-vildagliptin regimens using DTSQ and to also compare the efficacy between the two regimens. Methods: An open-label, prospective, observational study was carried out in the Diabetology OPD and the Department of Pharmacology. Patients with T2DM not controlled on metformin monotherapy were divided in to groups: Group A with 58 subjects received metformin 1000 mg + glimepiride 2 mg twice daily and Group B with 62 subjects received metformin 1000 mg + vildagliptin 50 mg twice daily. Patients were assessed for DTSQ scores, FBS, PPBS, HbA1c and other clinical and biochemical indicators at baseline, 6 weeks and 12 weeks. The study parameters were compared between two groups statistically using unpaired t-test. Results: Patients in Group B receiving metformin-vildagliptin combination achieved better control of FBS at 6 weeks (p<0.01) and 12 weeks (p < 0.001) compared to those in Group A receiving metformin-glimepiride combination. Similarly Group B patients had better reduction of HbA1c (p < 0.001) compared to Group A at the end of study. Group B patients also had better DTSQ score (p <0.05) and less perceived frequency of hypoglycemia (p <0.001) compared to Group A at 6 weeks and 12 weeks interval. Group B also showed significant reduction in body weight (p <0.05) and BMI (p<0.01) compared to group B at the end of study period. Conclusions: Vildagliptin-metformin combination leads to better treatment satisfaction profile, better glycemic control, lower risk of weight gain and lower risk of hypoglycemia; and can be a better treatment alternative to glimepiride-metformin.

4. Stature and Gender Determination Skull Measurements Among Adults in Southern Rajasthan.
Meghna Bhaumik, Uday Bhaumik, Priyanshi Bhaumik
Background: Personal identification plays a major role in criminal and civil cases. it is accomplished by many routes but in cases of mutilated, partial or decomposed remains, the anthropometric measurements are vital in identifying the individual. Materials and Methods: The present study was conducted to ascertain the utility of using cranial measurements in determining gender and stature among the selected study population of adults in Southern Rajasthan. The study was conducted at Geetanjali Medical College and Hospital, Udaipur. The study involved a pool of 100 subjects. The measurements taken were done using lateral radiographs and clinical examination. The study concluded that human skull exhibits anatomic variability between genders. For gender determination, all the 14 lateral cephalometric measurements were used together in discriminant model to differentiate between males and females. Results: The resulting equations were statistically significant and could predict gender with an accuracy of 82% in males and 85% in females using the given parameters. Hence, the accuracy of the given model comes out to be 83.5% to predict gender for the adult Target population. Conclusion: Lateral cephalogram apart from giving information about facial relationships, planning for orthognathic surgery, orthodontic treatment, and assessing the growth in children are also helpful aid in identification. With availability of the skull as only skeletal remains, it is possible to determine sex and estimate stature from various cephalometric dimensions for establishing identity.

5. Association of Smoking and Covid Severity – A Cross Sectional Study.
Sri Vengadesh Gopal, Rakesh Raj E, Saravanan Pandian, Arulprakash Ramesh, Arun Tipandjan
Background: Novel Corona virus (SARS-COV2) infection discovered in late 2019 in china, became a pandemic and caused mortality due to severe acute respiratory syndrome (SARS) around worldwide. Smoking is well known to cause acute and chronic injury to respiratory epithelium and parenchyma leading to chronic obstructive pulmonary disease (COPD). The relationship of Cigarette smoking and coronavirus infection is paradoxical. There is no clear conclusion regarding the relationship between smoking and covid infection and its severity. Objective: The purpose of the current study was to determine how smoking affected Covid severity amongst patients admitted to Covid-designated tertiary care hospitals. Material and Methods: In a tertiary care institution that has been designated by COVID, this retrospective, cross-sectional study was conducted. The patients who were admitted for covid illnesses between Jan 2021 and June 2021 were included in research after receiving clearance from the institute’s ethics committee for human studies, and the medical records department reviewed their case files. Patients hospitalized for observation for fewer than 24 hours, patients with missing or untraceable data, and patients for whom a CT scan of the chest was not performed were all excluded from our research. To ensure the integrity of the data, the acquired information was put into Epicollect. Using SPSS, descriptive statistics were used to analyze the data (version 24). Result: The majority of the participants in our study (n=1109) were men, 848 (76%). The ratio of men to women was 3:1. The majority of patient data (715, or 64.47%), fell between age range of 30 to 60 yrs. Majority of patients (363; 32.7%) had mild CT severity. The most prevalent 369 (33.27%) comorbidity in the study population was diabetes. 987 (89%) of the patients who were hospitalized were nonsmokers. The majority of smokers and non-smokers had CT severity that was normal or mild to severe. Smokers and non-smokers both had comparable distributions of CT severity. Conclusion: The majority of individuals who needed hospital admission for the management of chronic illnesses were nonsmokers. In our investigation, there was no correlation between smoking and the severity of the COVID condition. For further clarification of our findings, more research with a larger sample size is required.

6. Clinical Profile, Maternal and Perinatal Outcome in Sars-Cov2 Infection in Pregnancy.
Sajini B, Sathi M. S., Sajith Kumar R, Jabin John Jacob, Sagar Krishnan EU
Introduction: Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Maternal physiological adaptations in pregnancy, and the physiological state of relative immune suppression, place pregnant women at increased risk of infection [1,2]. The present study is important due to the tremendous impact Covid 19 has on people at large, especially expectant mothers. In our study, we collected information on pregnant women with confirmed SARS-CoV-2 infection. Aim and Objective: (1) To estimate clinical features, maternal and perinatal outcome of Covid 19, during first, second and third wave of covid pandemic. (2) To compare the Obstetric outcome in first and second wave with third wave. (3) To estimate vertical transmission to new born child in this institution as evidenced by test positivity. Method: Retrospective observational study was designed to examine the clinical characteristics and outcome of covid positive pregnancies admitted in our institution. Result: In our study of 266 pregnant women with covid, it was noticed that the mean age of the patients was found to be 27.55 years with a standard deviation of ±4.99 years. 55.64% of cases belonged to category B1, 33.08% in B2 and 11.28% in C. 2nd wave had more patients in category C. Gestational diabetes complicated 28.95% and hypertension in 17.29% of study population. Inflammatory markers were more elevated in 2nd and 3rd wave. There was a total maternal death of 11 patients. Out of this, 10 was (91%) due to covid pneumonia and ARDS. Breast feeding was given for 88.7% of the babies and for 88% of the babies rooming in was practiced. Only 2.6% of the babies turned positive within a week. Conclusion: Our study shows that expectant mothers were more severely affected in the second wave. Maternal mortality was associated with increased maternal age (> 35 years), raised CRP levels (> 75mg/L) and higher D dimer levels (> 3000 ng/ml) and is found to be statistically significant. There is no evidence to show any vertical transmission of the disease as only 2.1% of the neonates (7nos) were affected within a week.

7. A Randomized, Controlled Study Comparing Nurse Feeding to Feeding with a Feed Rail for Stable Preterm Infants.
Sujith Kumar Palleti, Manish Rathor
Objective: To analyze the difference in feeding rate as well as the amount of time needed to complete meals while manually versus automatically feeding through feed rail. Methods: Randomization was used to assign preterm newborns who were stable and weighed between 1 and 2 kg to either the gravity or feed rail feeding group, depending on whether they were receiving partial or complete enteral feeds by gavage. For the purpose of the study, each of the forty nurse-baby pairs consisted of ten nurses and four infants. Forty instances of feeding were documented for each of the groups. Results: The median amount of time spent eating in the group that used feed rails was 18.5 minutes, while the time spent eating in the nurse-led group was only 15 minutes (p = 0.34). When adjusted for bodyweight, the feeding rate in the feed rail group was between 0.8 and 2.3 mL/kg/min, whereas the feeding rate in the control group (which used manual gravity feed) ranged between 2.5 and 8.9 mL/kg/min. This difference in the variance of the feed rate was statistically significant (the p value was less than 0.0001) The median feed rate when using feedrail was 1.3 mL/min, but the median feed rate when using manual gravity feeds was 4.1 mL/min. Eighty percent of the time, nurses were able to feed patients using feed rails without needing their hands. Conclusion: When compared to manual nurse-led feeding, feeding using a feed rail results in gravity feeding that is gradual, steady, and has minimal change at a rate of 1 to 2 mL/kg/min without influencing the overall time of the meal.

8. Evaluation of the Efficacy and Safety of Intravenous Labetalol in Pediatric Patients Suffering from an Acute Hypertensive Crisis.
Ashwini Baban Kundalwal, Manish Rathor
Objective: The purpose of this study was to evaluate the effectiveness and safety of intravenous (IV) labetalol in the treatment of hypertensive crises in children. Methods: A analysis of the medical records of 56 children who were consecutively hospitalized to a pediatric intensive care unit (PICU) with hypertensive crises during the years of July 2009 and 2019. Results: The percentage of children who reached the primary endpoint (target 95th percentile in more than 12 to 48 hours) was significantly higher in the group that received labetalol as first-line or add-on treatment (n = 23) than it was in the group that did not (62.5% vs. 30.3%, p = 0.03). This difference was statistically significant. In the labetalol group, a significantly larger number of patients experienced neurological recovery (56.2% versus 18.7%, p = 0.02) In both therapy groups, the percentage of children who experienced hypotension during the first 12 hours was comparable (13% vs. 15%, p = 0.82) The differences in clinical practice over two time periods of five years each (2009–2013 and 2014–2019) demonstrated a statistically significant increase in the use of labetalol in the most recent cohort (53% for 2014–2019 vs. 25% for 2009–2013, p = 0.03). Conclusion: When compared to intravenous (IV) nitroprusside or nitroglycerine, labetalol was found to be more effective in achieving the primary endpoint in children up to 12 years of age who were experiencing hypertensive crisis. This was the case regardless of whether the drug was administered on its own or in combination with another medication. Labetalol was shown to be safe and was connected to a faster neurological recovery.

9. Evaluate Similarities and Differences between Endoscopic Findings, the Rapid Urease Test, and Conventional Histopathology in the Process of Diagnosing an Infection with Helicobacter Pylori.
Manjushree Ghadi, Supriya Joshi, Ashwini S. Khadatkar, Chetana Bagul, Renuka Ghatale
The gastritis caused by Helicobacter pylori (H. pylori) is a serious public health problem in countries that are still building their healthcare systems. There is a significant incidence of morbidity and death, with symptoms ranging from chronic gastritis to cancers of the stomach. There is a large amount of variation in the prevalence of H. pylori infection from one nation to the next, and even within a country, from one area to the next. The purpose of this study was to evaluate the commonly available diagnostic methods, such as the Rapid Urease Test (RUT), and conventional histopathology in the diagnosis of H. pylori gastritis, as well as to investigate the association between H. Pylori and the development of gastrointestinal complications. Settings and Design: A prospective cross-sectional study was carried out between May 2012 and September 2014, with data collection beginning in May 2012. The components and the procedure: The research was conducted in a tertiary medical college hospital in  India for the purpose of this study. Endoscopy was performed on patients who presented with dyspeptic symptoms, and histological examination and RUT were used to determine whether or not H. pylori infection was present in the biopsy specimens. The presence of H. pylori was determined to be the case if either of the diagnostic tests produced positive findings. Results: A diagnosis of H. pylori was established in 330 out of 550 individuals. There was a substantial statistical association between H. pylori infection and the occurrence of endoscopic abnormalities and major gastrointestinal complications (peptic ulcer and dysplasia/cancer). When it came to the diagnosis of H. pylori infection, RUT exhibited predictive values that were on par with those of histology. Conclusion: It has been suggested that H. pylori is responsible for a large amount of morbidity and death that is caused by related gastrointestinal problems. It is crucial for the avoidance of major problems to conduct early and precise detection using many cost-effective approaches, maintain strong patient compliance, and initiate treatment as soon as possible.

10. Management of Hypertension Before, During and After General and Orthopedic Surgeries- A Pragmatic Approach of Anaesthetists.
Naseeba Fatima, Asiya Fatima, Arjun Peddapally, J. Hari Babu
Background: Among all the risk factors encountered before, during and after General and Orthopedic surgeries, Hypertension was considered as the foremost in the minds of all the Anesthetists. However, there is no definite and uniform protocol of using antihypertensive drugs in its management in the Indian literature. The situation such as this initiated the idea of conducting the present clinical trial. Aim of the Study: To study the peri-operative evaluation, care and management of the patient with hypertension undergoing general & orthopaedic surgeries.  The objectives were to study the antihypertensive drug usage, types of anesthesia and their effects and side effects on hemodynamics during the surgery and their management strategies in peri-operative period. Methods: A tertiary care center where this cross-sectional, observational study was conducted included patients from General Surgery and Orthopaedics Departments. Patients were examined by the Anesthetists before, during and after the surgeries up to 48 hours postoperative period. The variables included Initial blood pressure, Antihypertensive drugs used, Anaesthesia drugs used, Blood loss during surgery, Blood and Intravenous fluids used during the surgery. Statistical analysis done by using descriptive measures, mean, standard deviation and nonparametric tests and P < 0.05 was taken as significant in the study. Results: 93 Hypertensive patients undergoing General surgery and Orthopedics surgeries were included in this study. A Shpairo Wilk test was applied to test the normality of the subjects. There were 51/93 (54.83%) General surgery patients and 42/93 (45.16%) Orthopedic patients. There were 58 (54.83%) males (General Surgery- 38 (40.86%) and Orthopedic surgery- 20 (21.50%) and 35 (37.63%) female patients (General Surgery- 13 (13.97%) and Orthopedic surgery- 22 (23.65%) in the study. The male to female ratio was 1.28:1. The mean age was 34.85±6.15 years in General Surgery patients and 37.25±4.60 years in Orthopedic patients. Among The General Surgery patients the mean duration of history of Hypertension was 54.86±7.50 months. Among The Orhtopedics patients the mean duration of history of Hypertension was 52.31±2.75 months. Conclusion: Intra-operative hemodynamic changes were less in patients who used regularly Beta blockers than other antihypertensive drugs. They had lower heart rate also. Patients on diuretics on the morning of the surgery showed gross hemodynamic changes such as raised SBP and DBP. Other antihypertensive drugs did not show significant hemodynamic changes intra-operatively.

11. Evaluation of Neck Masses with Multidetector Computed Tomography Scan.
Harshika Singh, Seema Pandey, Mariyam FatimaB, Ashish Kumar Pandey
Aims and Objective: To find out multidetector computed tomography used to evaluate neck lesions in terms of tumour location and size along with tumor spread, invading nearby vascular and visceral tissues. Material and Methods: Patients who had neck lesions that were clinically suspected or who had been identified as having neck lesions on ultrasonography were referred to CT for further characterization and underwent a prospective study. The patients had neck pain and a palpable neck tumor as their symptoms. Multidetector CT was used to evaluate the patients. Result: There were 25 benign lesions and 15 malignant lesions in the current investigation. Histopathology supported the imaging diagnosis of malignant and benign lesions. One of our cases of mandibular osteosarcoma was mistakenly diagnosed as osteomyelitis, leading to a false negative. Conclusion: The localization and characterization of neck lesions have improved thanks to multidetector computed tomography. An accurate CT scan disease delineation allows for a solid preoperative diagnosis, radiation port planning, and post-treatment follow-up.

12. A Shifting Trend in Liver Abscess Appearance, Demographics, and Microbiological Flora.
Poulami Nandi, Purbasha Ghosh, Anwesha Pan
Aim: Space-occupying liver lesions known as pyogenic liver abscess (PLA) have a high mortality and morbidity rate. The purpose of this study is to examine the epidemiology, clinical trends, and management of PLA in the Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal. Methodology: For patients treated for PLA between 2020 and 2021, we carried out a retrospective, explanatory case series at a single hospital to evaluate demographic traits, presenting patterns, etiological variables, microbiological aetiology, and medication. Result: A hundred patients were located. The majority of patients (72%), right upper abdomen discomfort (63.2%), vomiting, and nausea (28.3%), all presented with fever. Increased blood levels of C-reactive protein and fibrinogen were the most prevalent laboratory abnormalities among the listed items, occurring in 97% and 93.8% of cases, respectively. In 42.3% of instances, abdominal ultrasonography served as the primary diagnostic test. A CT scan or MR imaging was used in 51.0% and 3.2% of cases, respectively. Only 53.4% of the 90 cases with blood or pus cultures that we observed had positive microbiological findings. Escherichia coli was the most typical organism found, followed by Streptococcus spp. All patients received early antibiotic therapy, and 66.6% of cases required diverse techniques, including percutaneous abscess drainage in 66% of cases and ultrasound- or CT-guided needle aspiration in 10% of patients. Conclusion: Due to its atypical presentation, PLA is a difficult condition to diagnose. The microbiological yield discovered had an Escherichia coli infection predominance and was typical of Europe. Once diagnosed, percutaneous drainage and antibiotic therapy serve as the cornerstones of PLA care.

13. Comparison of the Effects of Laparatomy and Laparasopy during Non-Obstetric Procedures on the Mother and the Foetus.
Shipika, Prince Pankaj, Ankita Sharma
Introduction: With laparoscopy, superior newborn care facilities, pre- and post-operative intensive care for the female patient, the dangers connected with pregnancy surgeries are significantly minimised. Aim: The purpose of the current experiment was to determine whether laparoscopy during pregnancy is as helpful as open surgery in non-pregnant participants, including a decrease in surgical time, postoperative infection, and perioperative hospital stay. Method: Admission for surgery, age, gestational age, twins or a single foetus, surgery type, weight, age, hospital stay, intraoperative time and complications, contraction, post-operative complications, time of birth, and readmissions from surgery to delivery were all taken into account in 45 females. Fetal outcomes include foetal age at delivery, birth weight, gender, congenital defects, length of hospital stay, and perinatal mortality. The gathered information was evaluated statistically. Result: The results were statistically significant for the mean length of hospital stay, which was 3.7±3.6 for laparoscopy and 5.3±3.2 for open surgery with a p-value of 0.1206. Laparoscopy took longer than other surgical procedures to complete, with a mean time of 22.0±8.20 and a statistically significant p-value of 0.0137. Additionally, there were less post-operative problems in the laparoscopic group (17.5% versus 47.5% in laparotomy). Conclusion: According to the results of the current study, laparoscopy for non-obstetric surgeries consistently produces better mother and foetal outcomes than open surgery, regardless of the gestational age at delivery, the length of the operation, or foetal death.

14. Evaluation of Safety and Feasibility of Single Incision with That of Conventional TEP Laparoscopic Repair of Inguinal Hernia.
Pragya Singh,Vilas Panditrao Kulkarni
Introduction: There is advent of surgical techniques for hernia repair as well as tension-free repair with a prosthetic mesh has become the standard of care in herniorrhaphy. Laparoscopic inguinal hernia repair has several advantages over open repair. Laparoscopic Trans abdominal preperitoneal (TAPP) and totally extra peritoneal (TEP) techniques are therefore frequently used. Pain as well as issues associated to incisions was thus reduced. Single-incision laparoscopic surgery (SILS) was designed to decrease the invasiveness of traditional laparoscopy and has been performed successfully by many surgeons. Aims and Objectives: This study intends to find efficacy and safety profile of conventional totally extra-peritoneal and single-incision multiple port laparoscopic Totally Extra Peritoneal in managing inguinal hernia. Methods: This prospective study considered patients who visited the outpatient department of our hospital. The patients scheduled for inguinal heria repair was considered for comparison between their managements. Based on age (groups of 40 and >40 years), side of hernia (direct/indirect), and unilateral versus bilateral kinds, the patients were given single-incision multiple port laparoscopic Totally Extra Peritoneal (S-TEP) or conventional totally extra-peritoneal (C-TEP). Baseline characteristics were determined before the surgical procedure and complication and safety were assessed after the surgical procedure. The statistical analysis was conducted between the groups. Results:  35 patients from the S-TEP group and 35 patients who underwent C-TEP could be matched equally in order to assess surgical outcomes and cosmetic outcomes. S-TEP for unilateral and bilateral hernia repair had a substantially longer mean surgical time (P = 0.002 and P = 0.003) than its conventional equivalent (C-TEP). Both groups saw a similar amount of average blood loss (P = 0.1). In neither of the groups were there any cord or nerve injuries. The study also found that 2 (5.7%) patients in the S-TEP group underwent standard laparoscopy but no open conversion.  The mean pain score (VAS) in the S-TEP group was initially significantly higher (p<0.05), although it was similar on the 7th day. Conclusion: The study conclude that SILS has the potential to give patients better cosmetic results, less pain, and higher patients’ compliance. The VAS score for the single incision approach didn’t show any advantages in terms of cosmesis or pain. There was no statistically significant difference in any of the other secondary outcomes, including postoperative pain (VAS), blood loss, complications, conversion, and the length of hospital stay.

15. Study of Clinical Manifestations and Management of Thyroid Swelling.
Bikram Chandra Lenka, Gurudutt Bhaskar Basrur
Introduction:  In India about 170 million people suffer from thyroid disease. The world’s largest goiter belt is the Himalayan goiter belt from Kashmir in the north to Naga Hills in the east. Thyroid disease is a condition that affects the functioning of the thyroid gland. Methodology: The present study was carried out in Department of Surgery, for last one year. We randomly selected patients with thyroid swelling. We collected data from 50 patients for this study. The patients history, clinical presentation, investigations and followed up management was clearly and in detail recorded in patients sheets. The data was filled in excel sheet and was further analysed and tabulated. Results: In our study included 50 patients of whom 42 were female patients (84%) and only 8 (16%) male patients. The median age group was found to be 36.78 years in our study. In our study, 24% required surgical treatment while 76% of patients underwent treatment .We found, 62% benign, 24% dangerous, while 14% had hashimottos. We included patients with inflammation of the neck (100%). Conclusion: Thyroid inflammation was most commonly seen during the 3rd and 4th centuries of life, with the abuse of women. The most common benign thyroid gland is Colloid goiter and papillary carcinoma was the most common malignant disease. Histopathology is considered a gold standard.

16. A Cross-Sectional Study of Dengue Virus to Observe Neutrophil-Lymphocyte Ratio as a Predictor of Severity.
Sundeep Jain, Shikha Jain, Birjesh Kumar Thakran, Yogesh Kumar Chahar
Background: A viral febrile disease termed as dengue can cause a variety of illnesses, including shock and hemorrhagic disorders. In numerous clinical circumstances, the neutrophil to lymphocyte ratio proved a reliable indicator of stress and morbidity. Our research intends to determine the relationship between NLR, thrombocytopenia, and dengue virus fever symptoms in patients. Method: In a tertiary care facility, this prospective cross-sectional study is being conducted. In this investigation, 54 patients with a history of a fever higher than 38.5 degrees Celsius and positive results for the NS1 antigen or Dengue IgM were included. From the first day of admission to the time of recovery or discharge, all patients had standard investigations (NS1 antigens, IgM dengue). Patients are clinically followed up on, and CBC was done every day. For this study, the patients were divided into three groups, I – without any haemorrhage, II – with haemorrhage, and III – suffering from shock, based on the signs and occurrence of both haemorrhage and shock. Results: In study, 32 (59.25%) males and 22 (40.75%) women out of 54 were enrolled. Most patients were between the ages of 18 – 25 years. The study group’s average N:L ratio ranged from 0.23 to 2.20 on day 1 to 2.10 (0.1 to 7.8) on day 7. 13 individuals out of 54 exhibited bleeding manifestations, and among them, 6 showed shock symptoms. Despite the patients’ lower platelet counts on day 7, NLR does not statistically significantly decrease. There is a statistically significant correlation between bleeding and shock occurring and a decrease in NLR in dengue patients. Conclusion: In view of this, there was a substantial correlation between the neutrophil to lymphocyte ratio and the severity of dengue fever in adult patients. By monitoring the NLR, we may therefore anticipate the prognosis and the severity of the disease in patients. A lower NLR ratio makes the condition more severe.

17. A Prospective Study of Clinical Presentation and Management of Patients with Thyroid Swelling at Tertiary Care Hospital.
Pramod, Anil Ready Pinate, Fazelul Rahman Soeb, Mohammad Noor Alam
Background: Thyroid nodule can symptomatic or asymptomatic, small or maultinodular and benign or malignant. The proper evaluation of nodules with various investigations is required to choose the correct type of management. Objective: (1) To evaluate the incidence of different type of thyroid disorders (Benign or Malignancy) and usefulness of clinical features, cytological and sonological investigation for management of the study. (2) To study the outcome of the surgical management. Methods & Materials: A total of 100 patients who meets the inclusion criteria were included in the study. The signs and symptoms of the patients were evaluated with proper history of the patient. The necessary investigations such as thyroid function tests, FNAC and imaging techniques were done. Based on investigations and clinical examination, either surgical therapy or non-surgical therapy was chosen. Results: The majority of the patients were in the group of 35 to 45years (36%). The patients coming to surgery OPD presented with neck swelling associated with difficulty in swallowing and pain in the neck and signs, symptoms of hyperthyroidism and hypothyroidism. The cytodiagnosis shows that most of patients were suffering with non-neoplastic nodules (82) than neoplastic nodules (18). Majority of the patient underwent Hemithyroidectomy (33%) due to single lobe involvement. Few patients (6%) which are found be malignant by postoperative histopathological diagnosis were again taken for complete thyroidectomy. In 54 % of the patients were taken for total thyroidectomy, when both the lobes are involved.

18. Prediction of Scrub Typhus in Tertiary Care Centre of Northern Bihar.
Firoz Alam, Atanu Ray
Objectives: This present study was to evaluate the severity of scrub typhus in various age group in tertiary care centre of northern Bihar. Methods: ELISA for IgM antibody was performed to detect Scrub Typhus IgM by following instructions. The antigen used to coat the wells was a recombinant 56-kDa type-specific antigen. The absorbance was read at 450 nm and an optical density of > 0.5 was considered positive. A nested polymerase chain reaction (PCR) was also performed for scrub typhus. DNA was extracted from the whole blood, blood clot, or eschar material by the phenol–chloroform method, and was amplified to detect scrub typhus according to nested PCR protocol. The oligonucleotide primers used were based on the nucleotide sequences of a gene encoding for the 56-kDa antigen of a Gilliam strain of O. tsutsugamushi. The specific PCR products of size 484 base pairs were sequenced in a few representative samples to confirm the diagnosis. Results: A total of 50 scrub typhus patients with age group 18 to 60 years were enrolled. Most of the cases 30(60%) were in age group of 40-60 years. Most of the cases 18(36%) were males. Most of the common symptoms 47(94%) of scrub typhus was high grade fever with chills and rigor followed by 41(82%) shortness of breath, 17(34%) jaundice, 15(30%) abdominal pain, 13(26%) headache. Most common signs of scrub typhus were 29(58%) hepatomegaly followed by 21(42%) splenomegaly, 15(30%) hypotension, 14(28%) pneumonitis, 11(22%) pallor, 9(18%) eschar. thrombocytopenia was the most common laboratory findings of scrub typhus patients followed by 32(64%) increased SGOT/SGPT ratio, 23(46%) hyperbilirubinemia, 29(58%) anemia. Conclusions: Scrub typhus was more prone in middle age male population. High-grade fever with chills and rigor and shortness of breath, hepatomegaly and splenomegaly were the most common symptom and sign of scrub typhus. Thrombocytopenia and SGPT/SGOT (≥ 2 times normal) were the most common laboratory findings of scrub typhus patients.

19. Assessment of FNAC, Trucut Biopsy and Histo-Pathological Examination in Breast Lumps at a Tertiary Centre in Bihar.
Subodh Kumar Sahu,  Aman Raj,  Ashish Ranjan, Sunil Kumar, Reena Sinha, C. P Jaiswal, Pawan Kumar Shah
Background: Breast is host to many diseases which range from benign and malignant neoplasm’s, inflammatory conditions to infections, most of which present as lumps in the breast. Breast lumps are one of the commonest complains encountered in surgical OPD’s which makes it important to differentiate between benign and malignant conditions before treating it. Aim and objectives: The present study was conducted to assess FNAC, Tru-cut biopsy and histopathological examination in breast lumps. Materials & Methods: 86 patients with palpable breasts were subjected to FNAC, Tru-cut biopsy, and correlation with histopathology was done. Sensitivity, specificity, PPV, and NPV were carried. Results: Age group < 20 years had 7, 21–30 years had 20, 31–40 years had 21, and >40 years had 38 cases. The difference was not significant (P>0.05). The diagnosis in FNAC was benign in 50, malignant in 31 and suspected in 5 cases. The difference was significant (P <0.05). The diagnosis in tru-cut biopsy was benign in 46, malignant in 34, and suspicious in 6 cases. The difference was non-significant (P> 0.05). The histopathological diagnosis was benign in 45 cases and malignant in 41 cases. The difference was non-significant (P> 0.05). FNAC sensitivity was 86%, specificity was 100%, PPV was 100%, and NPV was 85%. The sensitivity of Tru-cut biopsy was 96%, specificity was 100%, PPV was 100%, and NPV was 97%. Conclusion: We observed that using FNAC to evaluate a breast lump shows high sensitivity, specificity, and accuracy, but trucut always provides a better histological diagnosis and is more accurate.

20. Assessment of Effect of Teneligliptin Vs Metformin on Glycemic Control in Patients with Type 2 Diabetes Mellitus at a Tertiary Centre in Bihar.
Uddesheya Kumar, Ashish Ranjan, Prabhat Ranjan, Dinesh Kumar, Krishna Prasad
Background: Diabetes mellitus (DM) is one of the very oldest diseases and was mentioned three thousand years ago in Egyptian literature. Aim and objectives: The present study assessed effect of teneligliptin vs metformin on glycemic control in patients with type 2 diabetes mellitus. Materials & Methods : The mean age  of patients was 48.06±10.25(Mean±SD) years and out of these 52.87% were males and 47.14% were females.70 type II DM patients of both genders were divided into two groups. Group I patients received 500 mg metformin monotherapy and group II patients received 20 mg teneligliptin monotherapy. Parameters such as changes from baseline FPG and 2h-PPG values at 12 weeks were evaluated. Results: Group I had 25 males and 10 females and group II had 12 males and 23 females. The mean BMI (Kg/m2) was 27.6 and 26.1, FBG (mg/dl) was 168.3 and 163.5, PPBG (mg/dl) was 240.2 and 242.5, HbA1c (%) was 7.8 and 7.9, LDL- C (mg/dl) was 132.5 and 145.1, HDL (mg/dl) was 41.7 and 44.3 and triglyceride (mg/dl) level was 187.2 and 195.4 in group I and group II respectively. The difference was non- significant (P> 0.05). There was significant decrease in HbA1c, FBG, PPBG in all groups (P< 0.05). Conclusion: We observed that Teneligliptin, aDPP4 inhibitor reduced HbA1C, FBG and PPBG significantly as compared with monotherapy of metformin in treatment of type II diabetes mellitus.

21. A Correlative Histopathological and Cytological Study on Lesions of Thyroid Gland at a Tertiary Centre in Bihar.
Aman Raj, Subodh Kumar Sahu, Ashish Ranjan, C. P Jaiswal, Sunil Kumar, Pawan Kumar Shah
Background: Thyroid gland disorders usually manifests as enlargement of the thyroid gland (goiters) or as variations in hormone levels or as both. Aim and objectives: The present study was conducted to assess a correlative histopathological and cytological study on lesions of  thyroid gland. Materials & Methods: 105 patients of thyroid disorders of both genders underwent ultra-sonographic (USG) findings, thyroid scan, and operative findings. Results: Out of 105 patients, males were 40 and females were 65. Common non- neoplastic lesions were multi nodular goiter in 45, lymphocytic thyroiditis in 24, Hashimoto’s thyroiditis in 11, adenomatous goiter in 3 and granulomatous thyroiditis in 2 cases. The difference was significant (P≤0.05). Neoplastic lesions were follicular adenoma in 7, papillary carcinoma in 3, follicular carcinoma in 5 and Non-Hodgkin’s lymphoma in 5 cases. The difference was significant (P≤ 0.05). Conclusion: Common non- neoplastic lesions were multi nodular goiter, lymphocytic thyroiditis, Hashimoto’s thyroiditis, adenomatous goiter and granulomatous thyroiditis and neoplastic lesions were follicular adenoma, papillary carcinoma, follicular carcinoma and non-Hodgkin’s lymphoma.

22. To Evaluate the Adverse Drug Reactions of Antibiotics in a Tertiary Care Hospital in Bihar.
Prabhat Ranjan, Dinesh Kumar, Uddesheya Kumar, Krishna Prasad
Background: It has been established long ago that the drug itself might be lethal; as the adage accurately goes, “Drugs are Double-Edged Weapons.” As defined by the World Health Organization (WHO), an ADR is “any response to a drug which is noxious and unintended and which occurs at doses normally used in man for prophylaxis, diagnosis, or therapy of disease, or for the modification of physiologic function. Aim and Objectives:The purpose of this research is to assess the adverse drug reactions to antibiotics in a tertiary care hospital. Materials & Methods: The current prospective spontaneous reporting study was conducted under the supervision of treating physicians on 100 patients of both genders (60 males and 40 females) attending in all departments, Jannayak Karpoori Thakur Medical College & Hospital, Madhepura, Bihar (India), to investigate ADRs (adverse drug reactions). Results: AMAs were responsible for 100 (20%) of the ADRs reported spontaneously during the course of the study. The antimicrobial medications associated with the development of ADRs were cephalosporins (40%), fluoroquinolones (20%), penicillins (14%), antitubercular medicines (12%), macrolides (10%), sulfonamides (2%), and tetracyclines (2%). The most common ADRs were produced by Ceftriaxone (25%), Ciprofloxacin (13%), Rifampicin (10%), and Azithromycin (8%). Fixed Dose Combinations (FDCs) were responsible for 14% of ADRs, with Amoxicillin+Clavulanic Acid accounting for 4% and the irrational combination (FDC) of Ciprofloxacin+Tinidazole accounting for 4% of ADRs, respectively. Conclusion: As more and more medications reach the market, it is imperative that adverse event reporting (AER) remain a constant process. Most adverse drug reactions (ADRs) were traced back to cephalosporins and fluoroquinolones.

23. Cross Sectional Study of Anxiety Disorder in Patients with Chronic Kidney Disease Undergoing Hemodialysis in a Tertiary Care Hospital.
Pankaj Kumar, Bajrang Lal, Siddharth Rathore, Hemant Kumar, Tushar Jagawat
Background: Chronic kidney disease (CKD) is one of the major world-wide public health problems, with adverse outcome of kidney failure, cardiovascular disease (CVD), and premature death. Haemodialysis is the most common method used to treat advanced and permanent kidney failure. In recent years more advances such as compact and simpler dialysis machines have made dialysis increasingly attractive. But even with all the advances, haemodialysis is still a complicated and inconvenient therapy. Patients on Haemodialysis experienced a range of symptoms, with considerable variation in the frequency, severity of symptoms experienced. Scarcity regarding the prevalence and impact of anxiety disorders in patients with ESRD treated with HD; however, many of the seemingly irrational behaviours of patients, or behaviours which place them in conflict with staff and physicians, such as behavioural non-compliance, may be the outcome of an underlying anxiety disorder. Aims And Objectives: To describe socio demographic characteristics of CKD patients undergoing haemodialysis. To determine prevalence and severity of anxiety disorder in CKD patients undergoing haemodialysis. Methodology: This study was conducted in the Department of Psychiatry and Department of Nephrology of NIMS&R Medical College and Hospital, Jaipur, Rajasthan. The sample of the study was constituted of 100 patients suffering from CKD who underwent a dialysis procedure in the dialysis unit of Nephrology department of NIMS Hospital. The diagnosis of anxiety disorder was made according to ICD 10. Severity was assessed using HAM- A. Results: 33% of the patients were found to have anxiety disorder undergoing Haemodialysis Conclusion: This study concludes that patients undergoing haemodialysis can have anxiety disorder. Early identification of anxiety disorder and management can improve the life quality of Haemodialysis patients.

24. A Comparative Study of Transdermal Fentanyl Patch Vs Sustained Release Oral Morphine in Patients on Palliative Care in Sms Hospital with Special Reference to Bowel Function Discomfort.
Meena Dal Chand, Meena Chetna, Mathur Ashwin
Objective: The aim of study was to compare quality of life, side effects especially GI side effects and efficacy between transdermal fentanyl and oral morphine in palliative care. Materials and methods: A hospital based prospective randomized observational study done on 240 eligible cases in Palliative care center, R.K.Birla cancer center, SMS hospital, Jaipur. In this study 240 cases of malignancies reporting in palliative care reported during one year of study period were put on oral morphine & transdermal fentanyl patch. EORTC_QLQ_C30 score was analyzed using paired –t test. Continuous data were expressed in the form of proportions. Results: There was no statistically significant difference in EORTC global quality of life between transdermal fentanyl and oral morphine (P>0.05).  Fentanyl was associated decreased incidence of constipation (P<0.001), no significant difference in nausea and vomiting (P>0.05) compare to morphine. There was no significant difference in effectiveness of management for pain between both treatment groups. Conclusions: we conclude that compared with oral morphine, fentanyl transdermal patch equally controls cancer pain and it has lesser side effects in term of constipation.

25. A Hybrid Type of Cross-Sectional Study to Assess Loneliness, Coping Mechanisms and General Wellbeing and their Correlation in Adolescent Orphans Residing in Orphanages of Western-Maharashtra.
Vibha Bhide, Anand Bhide, Motiram Kamble, Sujata Muneshwar, Sowmya Peri, Bhaweeka Varanjani
Background: Adolescence is the period of growth between childhood and adulthood, and it plays a significant influence in determining how an individual’s life will turn out. Children between the ages of 12 and 18 go through several physical and mental milestones during this time. Adolescents are undergoing a variety of psychological and physical transitions, and they also have a strong need to understand their place in the complex system known as “society,” even if it is as small a part as a gear. They are prone to making mistakes unless they have the proper instruction and ongoing assistance. Orphans, who are a more susceptible group, must deal with this turbulent time alone. Aim: to assess loneliness, coping mechanisms and general wellbeing and their correlation in adolescent orphans residing in orphanages of Western-Maharashtra. Methods and Materials:  Cross-sectional study for assessing loneliness, coping mechanisms and general well-being through questionnaires. (Quantitative analysis) In-depth interviews of the parents of the randomly selected children from the study population and previous residents of orphanages. (Qualitative analysis). In order to achieve our third goal, we conducted in-depth interviews with the parents of 10 randomly chosen children to understand the circumstances that led to their admission into institutions, as well as with five former orphanage residents to obtain insight into their current situations.To accomplish our initial goal of data collecting, the children’s levels of loneliness and coping were assessed using the R-UCLA and BRCS measures, respectively. Our second goal was achieved after we analysed the data and connected the results from the R-UCLA and BRCS scales with the replies on our self-made scale for general wellbeing based on the personal hygiene, nutritional, reproductive, and sexual health of our focus population. Results: 2×2 contingency table is made for finding the association between different variables such as R-UCLA and low BMI (p= 0.002), R-UCLA and undernourishment (p= 0.002), R-UCLA and frequency of sudden high fever (p= 0.040), R-UCLA and frequency of headaches (p=0.002) and BRCS and sleep deprivation (p=0.015). Then after applying Pearson’s Chi Square test, it is found out that there is significant association between the two variables under study. Conclusion: Our study projected that, high degree of loneliness and poor coping mechanisms have a direct impact on the general wellbeing of adolescent orphans. Through the interviews we learnt their reasons for admission to the orphanage and how the variables of our study affect their lives beyond the orphanage.

26. A Clinical Study on Methods of Anesthesia and its Effects on Peri-Interventional Morbidity Following Rigid Bronchoscopy.
Asiya Fatima, Naseeba Fatima, Mohammed Naseeruddin Mujahid, Arjun Peddapally
Background: Providing Anesthesia for rigid Bronchoscopy is a challenge to the Anesthetist and ENT surgeon as they both compete for the same Airway. Rigid Bronchoscopy is an interventional procedure requiring General anesthesia of course with different strategies. The range of complications includes both mechanical and systemic types, depending on the technique of anesthesia used. Aim of the study: To assess the Anesthetic strategies used for Rigid Bronchoscopy and their role in peri-interventional morbidity. Methods: 68 patients of rigid Bronchoscopy were included and divided into two groups. Group A included patients in whom Total Intravenous Anesthetics were used (TIVA group) and group B where patients were administered Gaseous anesthetics (Volatile group). In group A, 46 patients were included and in group B 22 patients were included. In comparison, group A patients (TIVA group) consisted of more Hypertensive patients than the group B. Foreign body removal was performed under inhalation anesthesia in 21/68 (30.88%) patients (TIVA group- 11 and 10 Volatile group), Biopsy of Bronchogenic carcinoma was done in 11/68 (16.17%) patients (TIVA group- 06 and 05 Volatile group) and diagnostic Bronchoscopy was done in 14/68 (20.58%) of the patients (TIVA group- 06 and 08 Volatile group) to investigate the cause of hemoptysis. Both the groups of patients received similar ventilation irrespective of the indication for Bronchoscopy. Results: The hemodynamic showed the pre-operative and post-operative arterial blood gas, pulse oximetry and pulmonary function test data. The baseline values of these parameters were similar in the both groups. Post-operative estimation of arterial blood gas (7.42 ± 0.42 vs. 7.35 ± 0.17, P = 0.021) showed a lower PH in the patients who received volatile anesthesia than the TIVA group. But the volatile group patients were found to have a greater forced vital capacity (Volatile: 2.98 ± 0.60 vs. TIVA: 2.19 ± 0.62, P = 0.034) than the TIVA group after rigid Bronchoscopy. The Volatile group patients showed greater incidence of systemic complications like Hypertension postoperatively, 14.25% in TIVA group than in Volatile group: 15.25%. Conclusion: The present study concluded that the two methods of anesthesia and ventilation used for rigid Bronchoscopy produced similar results and none of the both have shown to be superior over the other. Propofol and remifentanil combination used in TIVA group was better and appeared to be popular as it had attenuated haemodynamic response during the procedure. Both the groups showed improvement in spirometry mea- surements. The incidence of hypoxia or hypercapnia was also similar.

27. Study of USG Guided Adductor Canal Block and IPACK Block for Postoperative Analgesia in Knee Surgeries.
Rupal B Shah, Dhwani S. Soni, Gargi M Bhavsar, Dhara M. Shah, Krupali Patel, Riddhi Modi
Background and Aim: Targeting postoperative pain relief in major knee surgery is a real challenge for the new advancements in technology and knowledge. The development of ultrasound guidance to block acute and chronic pain has gained more and more trust in the last decade. The aim of the study was to evaluate the effect of USG guided Adductor Canal Block and IPACK block for postoperative analgesia in elective knee surgeries. Material and Methods: Sixty adult patients of ASA grade I and II, aged between 18 and 70 yrs posted for elective knee surgeries were selected and all the patients were operated under spinal anaesthesia using 0.5% 3 ml heavy Bupivacaine. Patients were divided into 2 groups at the end of surgery. Group R+D (Ropivacaine+Dexamethasone): USG guided 0.2% Ropivacaine 19 ml + Dexamethasone 1 ml (4 mg) for each block ie.ACB and IPACK block (Total 40 ml) Group C (Control): Patients received no block, however, postoperative pain was relieved by giving rescue analgesic Inj Tramadol. (1 mg/kg) when VAS≥4. Vital parameters like Heart Rate (HR), Blood Pressure (BP), Respiratory Rate (RR), Oxygen saturation (SpO2) at room air were noted. Patients were observed for VAS Scale and any complications and toxicity of the drugs injected. Results: There was no significant difference in both groups in terms of demographic variables. The difference in VAS score among both the groups during 4 to 7 hours was statistically significant. Vitals were comparable between both groups. Total Consumption of Analgesic Drug (Inj Tramadol) in 24 Hours was 75±25.42 mg in Group R+D, whereas it was 195±15.26 mg in Group C, which was statistically significant. Conclusion: The ultrasound-guided ACB+IPACK block could relieve pain during the first 24-hour postoperative period, decrease the total postoperative analgesic consumption in 24 hours and significantly prolong the time for first rescue analgesic requirement after knee surgeries like Total knee arthroplasty and Arthroscopic knee surgeries.

28. Graft Uptake in Type 1 Tympanoplasty by Elevation of Circumferential Tympanomeatal Flap: Our Experience.
Mahesh V Kattimani, Shweta Anand
A prospective cohort study was done at NIMS Jaipur from Jan 2021 to Jan 2022 with the aim to assess the graft uptake by circumferential tympanomeatal flap elevation in type 1 tympanoplasty. 100 cases of inactive mucosal type of chronic otitis media with central perforation were operated for type 1 tympanoplasty after detailed history, clinical examination, examination under microscope, pure tone audiometry, x ray mastoids and routine preoperative investigations. Temporalis fascia graft was placed medial to handle of malleus after elevation of circumferential tympanomeatal flap. Examination of ear under microscope was done for the postoperative patients coming to follow up at the end of first week and later after one month. Graft uptake was assessed and complications if any were noted. Graft was taken up successfully in 98 (98%) cases. From this study, we conclude that type 1 tympanoplasty done by elevation of circumferential tympanomeatal flap results in high rate of graft uptake.

29. Endoscopic Septoplasty for Correction of Deviated Nasal Septum: Our Experience of 50 Cases.
Mahesh V Kattimani, Shweta Anand
This study was performed with the aim of assessing the advantages of endoscopic septoplasty while treating cases of deviated nasal septum. 50 patients of deviated nasal septum who underwent endoscopic septoplasty were assessed both pre and postoperatively in NIMS Jaipur from march 2021 to march 2022. Isolated septal spurs were noted in 17 (34%) patients. Caudal deflection was noted in 8 (16%) patients. 19 (38%) patients had c shaped septal deviation. 6 (12%) patients had combination of multiple septal defects. Post operative intranasal synechiae was found in 5 patients (10%) at the end of 3rd week follow up. 45 patients (90%) presented with improvement in nasal obstruction at the end of 3rd week. No case of post operative septal perforation was encountered within 3weeks of follow up. From this study we conclude that endoscopic septoplasty has advantages of better visualization of posterior septal deformities, lesser complications of synechiae, septal perforation and it acts as an effective teaching tool.

30. The Interaction of Vasopressin and Corticosteroids in Septic Shock: A Study in Southern Rajasthan.
Akanksha Yadav, Abhyudaya Soni, Naresh Tyagi, Kamlesh Shekhawat
Overview:  Vasopressin and corticosteroids are both commonly used adjunctive therapies in septic shock. Retrospective analyses have suggested that there may be an interaction between these drugs, with higher circulating vasopressin levels and improved outcomes in patients treated with both vasopressin and corticosteroids. Material and methods:  Prospective open-label randomized controlled pilot trial conducted at the intensive care units (ICU) within Pacific Institute of Medical Sciences, Udaipur, Rajasthan. Inclusion criteria were adult patients (≥16 years) who had sepsis and who required vasopressors despite adequate intravenous fluid resuscitation. Result: Initial vasopressin intravenous infusion titrated up to 0.06units/minute and then intravenous hydrocortisone (50mg 6-hourly) or placebo. Plasma vasopressin levels were measured at 6-12 and 24-36 hours after hydrocortisone/ placebo administration. Thirty-one patients were allocated to vasopressin + hydrocortisone and 30 patients to vasopressin + placebo. The hydrocortisone group required a shorter duration of vasopressin therapy (3.1 days, 95%CI 1.1-5.1, shorter in hydrocortisone group) and required a lower total dose of vasopressin (ratio 0.47, 95%CI 0.32-0.71) compared to the placebo group. There were no differences in mortality rates (23% 28-day mortality in both groups) or organ failure assessments between the two treatment groups. Conclusions: Hydrocortisone spared vasopressin requirements, reduced duration and reduced dose, when used together in the treatment of septic shock but it did not alter plasma vasopressin levels. Further trials are needed to assess the clinical effectiveness of vasopressin as the initial vasopressor therapy with or without corticosteroids.

31. Mono-Centric Retrospective Comparative Study of Sufentanil and Dexmedetomidine as Neuraxial Adjuvants in Cesarean Section.
Vivek Singh, Ankur Garg, Rohit Kansal, Ashish Nahar
With a full and predictable nerve block, a quick onset, and few problems, spinal anaesthesia is a popular option for caesarean deliveries. The quality, duration, and side effects of anaesthesia are improved with the administration of various intrathecal adjuvants. This analysis of medical data involved 62 patients who had spinal anaesthesia used during caesarean deliveries. In this retrospective analysis, we evaluated 62 patients who received hyperbaric bupivacaine (0.5%, 10 mg) and dexmedetomidine (10 µg) in group 1 (n=31) and bupivacaine (0.5%, 10 mg) and sufentanil (5 µg) in group 2 (n=31). Difference in the postoperative pain, motor and sensory block, unfavourable effects within the first 24 hours after delivery, and neonatal outcomes were measured in these two groups. The sufentanil group required much less analgesia than the dexmedetomidine group. According to the VAS scale, postoperative pain in G1 was more severe than in G2. There were no obvious variations in intraoperative sensory and motor block, motor recovery times, or neonatal Apgar ratings between two groups. Shivering was only noticed in G2. The dexmedetomidine group did not experience itchiness or shivering. The sufentanil group had better postoperative analgesia, although there were more side effects overall. Dexmedetomidine used as an adjuvant stopped postoperative shaking. Contrary to what has been reported in the literature, dexmedetomidine does not produce greater or equivalent analgesia to sufentanil.

32. Correlative Study between Preoperative HRCT Finding and Intra Operative Finding of Attico-Antral Disease.
Man Singh, Narendra Sharma, Jaideep Singh Chouhan, Sonu Parmar, Mohd Shakeel
Background: To find the correlation between preoperative HRCT finding & intra-operative finding of attico-antral disease. Methods: The proposed study was conducted in the Department of Otorhinolaryngology, Mathura Das Mathur Hospital, Dr. S. N. Medical College Jodhpur, on patients of chronic suppurative otitis media -attico antral disease admitted   between  July 2011 to January 2013.  All the patients were evaluated by detailed history, clinical and otoscopic examination as per attached Performa. Then preoperative HRCT-temporal bone both in axial and coronal was done. The operative findings were correlated with finding of HRCT temporal bone. Results: The HRCT was highly sensitive and specific investigation in diagnosing soft tissue mass density suggestive of cholesteatoma, but not able to differentiate between cholesteatoma and granulations. The HRCT was also very good technique for identifying erosion of lateral semicircular canal, sinus plate destruction, tegmen plate erosion, Malleus Handle and Incus destruction. Conclusion: The present study shows that there was good correlation between HRCT finding and operative finding. It was both sensitive and specific in diagnosing cholesteatoma, disease extention, bony erosion and ossicular destruction. High resolution computed tomography was less sensitive to identify the facial canal dehiscence and stapes suprastracture erosion.

33. Study on Ozonized Water in the Management of Erosive Oral Lichen Planus.
Roopa M C, Kumari Anamika Jha
Introduction: “Oral Lichen Planus” (OLP) is a chronic inflammatory dermatosis affecting oral mucosa with an unfamiliar cause that affects about 2% of people. It is commonly seen in middle-age (30-60 years), with a woman to man ratio of 2:1. The most common and usually painless forms are reticular, papular, and plaque-like; they resemble white abnormal lesions of oral mucosa like leukoplakia, making an appearance as silvery hyperkeratotic striae or plaques. Treatment mainly focuses on alleviating symptoms and extending relapse free durations, but the whole elimination of the disease is not possible. Aims and Objectives: The study intends to evaluate the performance indices and efficacy ratings of ozonized water and conventional chemotherapeutic steroids in the management of erosive oral LP. Methods: A randomized control study was conducted on patients who presented with Oral Lichen Planus (OLP) diagnosed according to WHO criteria. They were divided into 2 groups. Group A received ozonized water treatment, which consisted of 1-minute oral rinses with a double-distilled water-to-ozone ratio of 2:3, repeated four times, twice weekly for four consecutive weeks, for a total of eight applications. Patients in Group B received a placebo treatment, which consisted of oral rinses with double-distilled water that were the same duration and timing as Group A’s treatments. Patients were assessed prior to treatment (T0), two weeks later (T1), at the conclusion of treatment (T2), and then again three months later as a follow-up (T3). OLP clinical course was evaluated by gauging pain intensity, lesions’ size, clinical indicators, and therapy effectiveness. Results: 70 individuals with atrophic-erosive OLP completed the study. Four individuals were omitted from the trial because they missed their T2 sessions and follow-up .Among 70 cases 47were women and 23were men. The patient’s average age was 65.89. (range 45-84). Both at T1 and T2, group A experienced considerably less pain (p = 0.05). At T0, the majority of the patients reported a VAS score of 2, which decreased to a score of 1 or 0 at T2. At both T1 and T2, the difference in VAS scores between the groups was statistically significant (p = 0.05). The rate of Thongprasomsign score improvement was higher in group A, but only at T1 (p=0.001)  there was  a statistically significant difference. At every time point, group A’s EI of the therapy was considerably higher (p 0.05). Conclusion: The study concluded that ozone has marked anti-microbial activity. The study has shown that the group which received ozone therapy had reduced candidiasis infection. It has been shown that ozonized water treatment is efficient in managing erosive lichen planus.

34. Study of Various Clinical Presentations of Sinonasal Tumours from a Tertiary Care Centre in India.
Ingita Bhardwaj, Vivek Harkare, Sonali Khadakkar, Priyank Sharma
Introduction: Sinonasal tumours are relatively common in ENT OPD. These patients have different etiologies but may have similar clinical presentations, which causes hindrances in making a definitive diagnosis. Aim and objective: The study aims at understanding the various clinical presentations of patients having sinonasal tumours and their histopathological diagnosis. Materials and Methods: Every consecutive patient of sinonasal tumour attending ENT OPD from Nov 2016 to October 2018 was included in the study, while those having a history of previous sinonasal surgeries and congenital sinonasal tumours were excluded from the study, which turned out to be 72 as sample size. Results: The study showed an almost equal ratio of males to females. A maximum number of patients in the age group of 31-40 years had nasal obstruction as the most common symptom. The highest number of cases were of non-neoplastic inflammatory etiology, i.e., 47.2%. Among benign neoplastic patients, inverted papilloma had the highest cases, i.e.13.8%, and among neoplastic malignant cases, the highest number belonged to SCC of the maxilla and sinonasal SCC each, i.e., 2.77%. Conclusion: Various sinonasal tumours may have similar clinical presentations but diverse etiopathogenesis; therefore, detailed history and clinical examination along with incisional or excisional biopsy are to be done to reach the final diagnosis so that the treatment can be given accordingly.

35. Study on High Risk Behavior and Prevalence of  Opportunistic Infections in HIV Patients Attending ART Centre of a Medical College of Rajasthan.
Chandra Prakash Sharma, D.P.Singh, Vivek Bhardwaj, Jainendra Sharma
Background: HIV infection/AIDS is a global pandemic, with cases reported from virtually every country. At the end of 2018, an estimated 37.9 million individuals were living with HIV infection according to the Joint United Nations Program on HIV/AIDS (UNAIDS). It is spreading due to high risk behavior as unprotected sex (including anal and oral sex), contaminated blood transfusions, hypodermic needles etc. With the fall in CD4 count the risk of opportunistic infection increases. Methods: This study was conducted at ART centre of RNT Medical College, Udaipur (Raj.) on 200 HIV/AIDS patients during the period of March 2018 to February 2019 with the objective to study their sociodemographic profile, high risk behavior and opportunistic infection. Results: Majority of study subject i.e 39% were in the age of 41-50 years. The most common presenting complaint was fever as seen in 57.5%. Common opportunistic infection study subject suffering were oral candidiasis (40.5%) cases followed by Pulmonary TB [37.5%] and esophageal candidiasis [16%] cases. The most common high risk behavior  was unprotected heterosexual sex [54%] followed by IDU [9.5%] and  MSM (1%). Conclusion: Among PLHIV attending ART centre males with 41-50 years were in majority with heterosexual sex and IDU was the commonest high risk behavior among them. Oral candidiasis was the commonest opportunistic infection among them.

36. Prevalence of Subclinical Hypothyroidism in Pregnancy and its Maternal and Fetal Outcomes:  A Prospective Analytical Study Done in a Tertiary Hospital of Southern Odisha.
Anuradha Mishra, Jagdish Behera, Kuladeep Sethy, Aishwarya Sahu
Background: Pregnancy can be viewed as a physiological state in which a combination of events concurs to modify the thyroidal economy. There is change in the level of thyroxine-binding globulin, total thyroid hormone level and level of thyroid stimulating hormone (TSH) during normal pregnancy. Subclinical hypothyroidism is defined when TSH level is elevated but free thyroxine (T4) and free tri-iodothyronine(T3) levels are normal. The prevalence of Subclinical hypothyroidism in child bearing age women in iodine sufficient areas is between 4 and 8%. Maternal hypothyroidism is associated with an increased risk of adverse obstetrical outcomes like preeclampsia, low birth weight, preterm labour, placental abruption, miscarriage and prenatal mortality. The aim of our study to find out the maternal complications and perinatal outcomes and how it has direct relation to the thyroid status of the mother. Objectives: The prospective study aims to detect the prevalence of subclinical hypothyroidism in pregnancy and its maternal and fetal outcomes. Materials and methods: The prospective study was conducted in the department of Obstetrics and gynaecology MKCG MCH Berhampur for a period of 2 years (July 2019 to July 2021) in consultation with department of Endocrinology MKCG MCH Berhampur. Blood samples of all patients were collected for assessment of thyroid profile which was done by machine ARCHITECT 1000 SR by electrochemiluminence (ECLIA) method. The fetal and maternal outcomes are great concern in our study. Results: In our study we included 283 number of cases, out of which 15 cases were found to be SCH (sub clinical hypothyroidism) and 268 number cases found to be euthyroid. Prevalence of SCH in our study has observed to be 5.3% as against 94.7% euthyroid cases. Maximum cases of SCH (11 cases  73%) below 30 yrs. and maximum percentage is between 25-30 yrs., 60% from rural areas, 60% from upper middle SES. 46.6% received treatment, 53.3% patients were from third trimester. Out of 15 maximum were primigravida (73%). 20% patients developed placental abruption, 20% preterm delivery, 6.7% spontaneous abortion, 93.3% viable births, 6.7% prom occurred, 6.7% developed PIH, 6.7% developed IUGR. Maximum birth weight of baby was 77% and weight above 2.5 kg. 4 cases undergone LSCS (27%) and 11 were NVD (73%).33.4% cases admitted in NICU for various reason. APGAR score >3 in 5 minute was 93.3% cases. Conclusion: Overt maternal hypothyroidism manifests during pregnancy and if occurs in the first trimester, is associated with pregnancy complications like preeclampsia, preterm birth, abruptio placenta, low birth weight, fetal death and intellectual impairment during childhood. SCH which is a mild form of thyroid disorder has various pregnancy complications and poor perinatal outcomes.

37. A Study of Lethal Congenital Anomalies Undergoing Termination of Pregnancy at a Tertiary Care Hospital.
Rekha, Meera Rajagopal, K. Latha Sree, Dheeravath Kanyakumari, Jagannagari Sushma
Background: India does not have national birth defects surveillance in spite of congenital anomalies causing significant neonatal and foetal mortality. There is paucity of data regarding lethal congenital anomalies which are mostly diagnosed late in pregnancy making their termination risky to pregnant women. Aims and objectives: This study was conducted in pregnant women who underwent termination of pregnancy, for lethal congenital anomaly in foetus, to find their demographic and clinical profile, types of congenital malformations, risk factors and methods of termination. Material and methods: This was a retrospective hospital based study of women undergoing MTP for lethal anomalies in foetus at Mediciti institute of medical sciences from October 2020 to October 2021.  Data about women’s age, gravidity, occupation, consanguinity, periconceptional folic acid, previous obstetric outcome, gestational age at diagnosis, type of congenital anomaly in foetus, lactational status in pregnant women, risk factors in pregnancy, foetal sex, last child birth time period and MTP method was recorded. Data were analysed and frequencies and percentages presented in descriptive statistics. Results: Majority (44%) of women were 21-25 years age. 62% were housewives 48%  women were 2nd gravida. 28.56% had abortion in previous pregnancies. 64%  anomalous foetuses were female. 86% anomalies were detected from 16-20 weeks’ gestation. Consanguinity was noted in 20% women. Fever in first trimester in 80%, urinary tract infections in 1st trimester in 86%, hypertension in 8%, hypothyroidism in 8%, anaemia in 4% and gestational diabetes in 6%.  97.22% parous women continued breastfeeding in pregnancy and 66.66% had last child birth between 7-9 months. 96% did not take periconceptional folic acid. Majority (52%)   were CNS anomalies. Anencephaly was commonest. All pregnancies were terminated medially. Conclusion: There is need for better health facilities including periconceptional care, educating women on birth spacing, early pregnancy booking and ultrasound. Folic acid food fortification is good option.

38. Effect of Mode of Delivery & Method of Feeding on Risk of Mother to Child Transmission (MTCT) of HIV in Pregnant Women Registered Under the PPTCT Programme.
Vidhi Singh, Shalini Srivastava
Introduction: Mother-to-child transmission of HIV is a major route of new infections in children. MTCT is multifactorial and are affected by various factors including both virus and host factors. Identifying factors associated with MTCT of HIV will have paramount importance in eliminating new HIV infections among children. This study focuses on mode of delivery and method of feeding obtained by HIV positive mother and we will review how these 2 factors influence the risk of MTCT. Method: This was a retrospective observational study. For the study, analysis of data of pregnant women registered under the PPTCT programme from 2014 onwards upto their delivery and follow up of their babies upto 18 months post-delivery was done. Throughout the study period confidentiality was maintained. Results: This study showed that mode of delivery is not related to MTCT (p value- 0.348) while method of feeding significantly associated with risk of MTCT (p value- <0.0001). Among 103 HIV positive newborns, 78.6% HIV positive newborns delivered vaginally while 21.3% HIV positive delivered by caesarean section, and 90.2% HIV positive newborns were given mixed feed, 3.7% HIV positive newborns were on breast feed while 5.8% HIV positive newborns were given replacement feed. Conclusion: This study concluded that optimally managed HIV positive pregnant women can continue labor and deliver by vaginal route. C-section should be performed for obstetric indications only. Ideal method of feeding is replacement feed as it has no possibility of MTCT. In resource poor countries, exclusive breastfeeding is the best option. Mixed feeding should strictly be avoided.

39. A Comparison between Median and Paramedian Technique of Giving Spinal Anaesthesia in Elderly Patients Undergoing Elective Lower Abdominal and Lower Extremity Procedures.
Bindu George, Sonai Datta Kakati
Introduction: Spinal anaesthesia is difficult in the elderly because of the age related physiological changes of the spinal anatomy and difficult positioning by the classical midline approach. The paramedian approach, although not widely used, can overcome these difficulties. The study was done to compare the technical ease in performing spinal anaesthesia between these two approaches in the elderly. Materials and Methods: This prospective randomised  double blinded study  was done  in elderly patients of age more than 65 years  undergoing lower abdominal and lower extremity surgeries. Successful puncture at first attempt, Number of attempts, Redirections of the needle, Duration of the procedure, Failures and Incidence of paraesthesia and backache  were noted.  60 patients were randomized  into two groups of 30 each : Group M: Patients received spinal anaesthesia by Median approach. Group PM: Patients received spinal anaesthesia by Paramedian approach. Results: The success rate at the first puncture was much high in the paramedian group compared to the median group. (p=0.015). Number of fresh needle attempts, needle redirections and failures were significantly less in paramedian group compared to median group.(p<0.001), (p=0.005), (p<0.001) respectively. No difference was found in the incidence of paresthesia in the two groups. The incidence of backache was more  in the median group in the immediate postoperative period. (p<0.001). Conclusion: Paramedian approach has more success rate, less technical difficulties and more patient comfort than the median approach in elderly patients and it should be considered  as the preferred  initial approach of giving spinal anaesthesia in the elderly.

40. Comparative Study of Fneneedle Aspiration Cytology, Acid Fast Bacilli Staining and Cartridge Based Nucleic Acid Amplificationtest in the Diagnosis of Extrapulmonary Tuberculosis.
Nilima Chaudhari, Chandni Patel
Introduction: In underdeveloped nations such as India, tuberculous lymphadenitis is one of the most prevalent OPD presentations. However, anti-tuberculous medication cannot be supplied solely on the basis of clinical suspicion. Using cytomorphology with acid-fast labelling to diagnose these instances and cultures is a beneficial technique. The purpose of the study was to examine the utility and limitations of fine needle aspiration cytology, as well as the varied cytomorphological presentations of Ziehl-Neelsen staining in tuberculous lymphadenitis, in correlation with the cartridge-based nucleic acid amplification test(CBNAAT) MTB. Materials and Methods: The study was conducted for 2 years from January 2020 to December 2021 with 142 cases at a tertiary care centre, Shri vinoba bhave civil hospital, Silvassa, Dadra and Nagar Haveli. The patients with clinically suspected tuberculous lymphadenopathy were selected. Results: AFB positivity was 30 % Epithelioid cell granulomas with caseous necrosis were the most common cytological picture and cases showing necrosis had highest AFB positivity. Posterior triangle was the most common site of involvement. Conclusion: FNAC is a straightforward, safe, cost-effective, and practical method for diagnosing TB lymphadenitis. A comparison study of cytomorphological patterns, ZN staining for AFB, and the CBNNAT test for bacterial analysis can boost the diagnostic yield and diagnostic precision. Due to the absence of epithelioid granuloma or caseation necrosis in some cases of acute suppurative lymphadenitis, CBNAAT was a highly effective treatment strategy. CBNNAT’s limitations include its inability to detect additional lymph node-associated diseases.

41. Washings, Biopsy and Bronchial Brushings in Diagnosis of Lung Collapse: A Comparative Study.
Anil Nigam, Chinmaya Jethi, Ashish Gangwar
Background: An essential tool in the toolbox of techniques indicated for the diagnosis of respiratory issues is the bronchoscopy. The study’s goal was to contrast the two bronchial findings related to lung collapse. Objectives: In order to examine the sensitivity of bronchial brushings, washings, and biopsies in determining the cause of the collapse, as well as to assess the value of fiberoptic bronchoscopy. Materials and Methods: Forty individuals who were enrolled in our tertiary institution participated in the current study. Patients who showed collapse-like persistent opacities on chest radiography underwent fiberoptic bronchoscopy. If the patient satisfied the requirements of our study, a thorough clinical history, physical examination, and normal investigations were performed, followed by a fiberoptic bronchoscopy. For the analysis, SPSS version 21 was utilised. Results: The patients ranged in age from 18 to 60, and there were 3:1 more men than women among them. On bronchial biopsy, malignant causes were identified in 25 (65%) of the total 40 cases, and inflammatory causes in 10 cases (35%) of the cases. As validated by a biopsy, bronchial washing revealed 14 true positive, 7 true negative, 8 positive, and 11 negative instances, whereas bronchial brushing revealed 16 true positive, 6 true negative, 10 positive, and 8 negative cases. Conclusions: We draw the conclusion that fiberoptic bronchoscopy has proven to be quite effective in identifying the precise cause of diverse lung collapse situations.

42. Bacteriological Analysis of Bile Culture in Cholecystectomy Patients: A Retrospective Study.
Parul Joshi, Neha Ahuja, Amrita Sinha
Introduction: In healthy people, the regular excretion of bile aids in flushing out bacteria that enter the biliary tract. Gallstones are the cause of the obstruction in 80% of cases. Currently, cholecystectomy procedures are commonly carried out. The bacterial colonization of the bile is related to the occurrence of gallstones in the gallbladder or biliary tree. Materials and Methods: Each patient had approximately 5 ml of bile aspirated from their gallbladder before having a cholecystectomy, which was then delivered to the lab in a sterile test tube. The Bacteriology laboratory received the bile samples in liquid media in blood culture bottles. At 37 °C, the bottles were incubated for 24 hours. Samples were placed on Blood and MacConkey agar the following day and incubated aerobically at 37°C overnight. Every plate was checked for evidence of growth. In accordance with the accepted microbiological practice, the colonies were identified. The modified Kirby Bauer Disc Diffusion method was used to examine the bacteria’ antibiotic sensitivity on Muller Hinton agar. Results: 81 (26.47%) of the 200 bile samples that were submitted to the microbiology lab for investigation were culture-positive. Escherichia coli 30 (37.03%), Pseudomonas sp. 24 (29.62%), Klebsiella sp. 12 (14.81%), and Citrobacter sp. 12 (11.11%) were the most common isolates. Additionally, 3 (3.7%) isolates of each Coagulase Negative Staphylococcus (CONS) and Staphylococcus aureus were found. Conclusion: To effectively treat bile duct infections, it is crucial to identify the microorganisms at fault as well as their pattern of drug susceptibility. Better management will result from this, lowering patient morbidity and mortality rates.

43. A Prospective Study on Drug Reaction with Eosinophilia and Systemic Symptoms.
Sonam Singh Sachan, Nilabh Kumar Singh
Introduction: “Drug reaction with eosinophilia and systemic symptoms” (DRESS) disease is a severe dermal as well as comprehensive medication answer with numerous problems, a long way, and a 10% humanity rate. In addition to this, the physician needs to take into account numerous different serious nerves, search for good quality materials and impeding functionalities of the DRESS symptoms, and differentiate it from other serious severe skin bad effects (SCARs) such as “Stevens-Johnson syndrome/toxic epidermal necrosis” (SJS/TEN) and exertional modified exanthemata’s pustulosis. Body temperature, skin infection, eosinophilia, atypical lymphocytosis, lymphadenopathy, as well as hepatitis are the classic symptoms of DRESS syndrome. However, pneumonitis, kidneys, and other physiological injuries are all potential complications that could arise, and they might be substantial. Aims and Objectives: To evaluate the spectrum of clinical features of DRESS and further analyze their demographic features. Methods: A prospective study was conducted on 30 patients who visited the outpatient department of our hospital. A detailed medical history of the patients was taken and examined and diagnosed. All the patients were analyzed for various parameters, based on DRESS and SJS. Results: The study also found that 45.7% of the DRESS cases had probable casualty and AED accounted for 80% of the probable drug cases. Further, the study found 93.33% of people had a fever of at least 38.5°C, whereas 7% had a fever of 38.0-38.5°C, and 21% had multiple episodes of fever of at least 38.0°C. In 86.67% of cases, lymphadenopathy was seen. Every case (100%) displayed one or more hematopoietic abnormalities. Absolute eosinophil counts below 700 L1 and above 1500 L1 were both detected in 46.67% and 73.33% of cases with eosinophilia, respectively. There were abnormal lymphocytes in 8 instances (53.34%). Conclusion: The study has validated the scoring system for DRESS which is considered to be a severe adverse drug reaction involving many organs, presenting combinations of features. Delayed diagnosis or management will reduce the chance of survival and hence, prompt treatment and early diagnosis are required which can only be possible if awareness can be made among the patients and also hospital staff.

44. Maternal and Fetal Outcome of Anaemia in Pregnancy.
Divya Sara Raju, Sajini B, Reeba Sara Mathew, Anjali Prem
Background and Rationale: The commonest nutritional deficiency disorder affecting the pregnant women in India and other developing countries is Anaemia.  Anaemia if not treated during pregnancy would lead to poor pregnancy outcome and can cause complications which would threaten the life of both mother and foetus. The prevalence of Anaemia changes with the progression of time due to multiple factors such as awareness, nutritional schemes and improved Health services. Subsequent to the published data of National Family Health survey-5 (NFHS-5) in 2019, a study is contemplated to estimate the proportion of anaemia in the southern Kerala. Aims and objectives: To estimate the proportion of anaemia in pregnancy and its maternal and foetal outcome in admitted pregnant women in Kottayam Medical College Hospital and to correlate its outcome on the maternal and foetal health; to estimate risk factors associated with anaemia. Objectives: To estimate the proportion of anaemia in OBG inpatients during their confinement for delivery in Kottayam Medical College  Hospital and to estimate the risk factors associated; to estimate the mother and foetal outcomes in   pregnant women with anaemia. Research question:  What is the proportion of anaemia in pregnant women admitted in Kottayam Medical College and Hospital and its outcome of foetal and maternal health? Materials: A Descriptive Retrospective study on 268 pregnant women with Anaemia was conducted for 12 months in a Government Medical College Hospital Kottayam, Kerala. Women of child bearing age between 18 to 45 years were included. Pregnant women with anaemia due to acute blood loss (APH), medical disorders such as diabetes, hypertension, cardiac disease and chronic renal disease were excluded from the study. The Primary Outcome of the study was to assess the Prevalence of Anaemia in pregnant women at the time of admission. The secondary Outcomes were grading the severity of Anaemia among the pregnant women. Observing the risk factors associated with Anaemia among the admitted pregnant women. Haemoglobin estimation is the most important test for detection of anaemia in the community level. Mild anaemia was considered when Haemoglobin was between 10-10.9 g/dl, moderate when Haemoglobin was between 7-9.9g/dl and severe anaemia when Haemoglobin was less than 7g/dl. Results: Among 268 pregnant women there were 28.35% in the age group of 18 to 22, 22.01% in the age group of 23 to 27, 19.40% women in the age group of 28 to 32, 14.55% were women in the age group of 33 to 37, 08.58% in the age group of 38 to 42, 19/268 (07.08%) women in the age group of above 42 years. The mean age of the patients included in this study was24.35± 3.64 years. There was no significant association between prevalence of Anaemia and the incidence among the different age groups, body weight, BMI, age at marriage, educational status, economic status and occupation. But there was significant correlation between the prevalence of Anaemia and parity and number of members of the family to which the women belonged. Conclusions: Anaemia is a very common condition diagnosed in pregnant women with its effects on the Health of the mother and the newborn. The prevalence of Anaemia acts as a Health Care indicator of any society. The prevalence of Anaemia was in the form of mild, moderate and severe degrees in anaemia were 26.86%, 48.88% and 24.25% respectively. The risk factors were age of menarche, malnutrition, parity, heavy menstruation and irregular menstrual cycles.

45. Risk Factors and Outcome of Ectopic Pregnancy.
Sajini B, Rani Lakshmi S, Reeba Sara Mathew, Divya Sara Raju
Background: Among the emergency conditions in Obstetrics and Gynaecology, Ectopic pregnancy stands apart from other with high morbidity and mortality. The incidence is increasing in the present days all over the world. Understanding the Risk factors, clinical presentation, diagnostic criteria to confirm its diagnosis, and initiating early surgical management is possible when a definite protocol is in practice in all the tertiary care Hospitals. Otherwise it will jeopardize the future pregnancies in them. Aims of the study: To study the Risk factors of Ectopic Pregnancy in patients admitted in Kottayam Medical College Hospital and to study their clinical presentations and outcome; to formulate a protocol for early diagnosis and surgical intervention. Objectives of the study: To enumerate and find the prevalence of risk factors of Ectopic Pregnancy in patients admitted OBG department for Ectopic pregnancy; to describe the clinical features, diagnostic criteria and early surgical intervention. Materials: 346 pregnant women with ectopic gestational sac were included in this retrospective study conducted at Government Medical College and Hospital, Kotttayam. Kerala. Patients of all ages diagnosed with pregnancy on USG or on direct laparoscopic or laparotomy observation were included. Patients with symptoms of Ectopic Pregnancy like Nausea, Vomiting, Pain in the abdomen, diarrhoea, dizziness, sensitivity to light, indigestion, vaginal bleeding, referred pain to the shoulder and fatigability were included. Patient’s   demographic data and clinical variables like pain abdomen, vaginal bleeding, fever, dizziness, signs of rupture, ultrasonography, septicaemia and methods of treatment were recorded and analysed statistically. Results: 346 medical records of pregnant women with ectopic pregnancy admitted in the Government Medical college Hospital, Kottayam between Jan 2021 to July 2022 were analysed retrospectively. The mean age was 25.24±3.65 years. 48/346 (13.87%) were aged 18 and 22 years, 62/346 (17.91%) aged between 23 and 26 years, 78/346 (22.54%) aged between 27 to 30 years (the age group with the highest incidence of the study), 69/346 (19.94%) aged between 31 to 34 years, 54/346 (15.60%) aged between 35 and 39 years and 35/346 patients (10.11%) aged between 40 and 45 years. Diabetes Mellitus was in 08/346 (02.31%), Hypertension was in 11/346 (03.17%), Hypothyroidism was in 32 (09.24%), Cardiac disease was in 06/346 (01.73%) and malnutrition was noted in 12/3465 (03.46%) of the patients. Conclusions: The incidence of Ectopic Pregnancies is not uncommon even in today’s Obstetrics practice. A high index of suspicion, early detection by screening of high-risk patients and surgical intervention helps in reducing the morbidity and mortality of ectopic pregnancy. Early child bearing age groups are affected by ectopic pregnancies due to early marriage age in India. Delayed referrals, rupture of the ectopic, shock and blood volume loss and hemoperitoneum are factors caused delayed Hospital discharges.

46. Comparison between WHO (1999) Vs IADPSG Diagnostic Criteria of Gestational Diabetes Mellitus and their Association with Maternal & Neonatal Outcome.
Biswas Palash, Char Debasish, Mandal Priyadarshi, Biswas Sucheta
Background: Poor maternal & perinatal outcomes are associated with gestational diabetes mellitus (GDM). The aim of this current study was the prevalence comparison of GDM using IADPSG criteria & WHO criteria of the Indian population. We also find out associated fetal, neonatal & maternal outcome by lowering the cutoff value of IADPSG criteria vs the older criteria of WHO. Materials & Methods: The prospective interventional comparative study was done involving 500 pregnant women attending the OPD for the duration of one & half years. Those who were eligible & willing to take part were subjected to a standard 75 gm OGTT between 24-28 weeks of Gestational age. Based on their report, they were selected under IADPSG or WHO criteria group. The prevalence of GDM was the primary outcome. Maternal & neonatal complications were the secondary outcome measures. Result: Higher prevalence of GDM was detected when IADPSG criteria was used (31%) in respect to WHO criteria (9%). Statistically, significant difference was not found in the studied groups in relation to the occurrence of Pre-eclampsia, gestational period at delivery, mode of delivery birth trauma during delivery, incidence of neonatal sepsis, hypoglycemia, hypocalcaemia or NICU admission rate. But the significant difference was found statistically in the incidence of UTI (p < 0.011), mean birth weight (p < 0.015) & APGAR score at 5 minutes (p-value 0.002). Conclusion: Adoption of IADPSG criteria increased the number of cases diagnosed as GDM & therefore management could be started. Overall, no major benefit was noticed related to maternal outcome  &  in the IADPSG group marginally better neonatal parameters were noted.

47. Study of Clinical Profile of Dengue Fever in Tertiary Care Hospital.
Muhammad Shajil p t, Chintale Kailas N, Bhattacharya Meenakshi A
Background: Dengue fever is a most common arboviral disease in India. Dengue viruses are spread to people through the bite of an infected Aedes species (Ae.aegypti or Ae.albopticus). Dengue has a varied and wide spectrum of clinical presentations. Objectives of this study were to evaluate the clinical profile of dengue fever and to study Outcome and clinical predictor of mortality in dengue patients. Methods: This was a cross sectional, descriptive observational study done in tertiary care hospital and teaching institute, study period was from December 2018 to December 2020. Patients of age more than 12 years admitted in medicine wards with dengue were included in this study (diagnosis of dengue was done on the basis of clinical features and positive NS1 or positive IgM antibody against dengue). sample size was 375. Results: While classifying patients according to WHO classification most of the patients were in dengue fever without warning signs (68.5%), dengue with warning signs (21.9%) and severe dengue 9.6%. The presenting symptoms were fever (100%), chills (77.3%), headache (91.7%), retroorbital pain (21.8%), facial puffiness (2.1%), severe abdominal pain (6.6%), petechiae (8.8%) and mucosal bleed in 1.6%. Conclusion: The application of the clinical spectrum of the WHO classification system is not as very simple and straightforward because clinical features may overlap among different categories of dengue. The most common clinical presentation was fever and most common sign was conjunctivitis. Thrombocytopenia and leukocytopenia were the main laboratory abnormalities.  In the present study liver function test abnormality was also found in one-third of patients. Blood pressure and hematocrit should be monitored for evaluating the progress of the disease. Management of patients with dengue is mainly supportive. Mortality in this study was less than 1%.

48. Correlation of Spirometric Parameters with N-Terminal Pro B-Type Natriuretic Peptide Levels in Chronic Obstructive Pulmonary Disease Patients.
Manish, Khushboo Jain, Mohammed Riyaz Bhati, Hardayal Meena, Rajesh Jain
Introduction: Brain natriuretic peptide (BNP) is widely used as diagnostic test for the management of left ventricular dysfunction. Brain Natriuretic Peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP) are derived from pro-BNP that is synthesized in response to stretching by ventricular myocytes. BNP is helpful for diagnosing patients suspected of having heart failure. BNP assays are more easily available for diagnosing heart failure as compared to other tests like echocardiography. However, studies designed for assessing the diagnostic credibility of BNP for detecting or ruling out heart failure in COPD patients are less. Method: This cross-sectional research was done from January 2020 to June 2021 on 100 randomly selected COPD patients>18 years of either gender. N terminal-proBNP test-NT-proBNP levels were done and was compared with spirometry findings of patients. Results: The mean age was 63.26 years, the mean duration of illness was 8.98 years and the mean pack years were 44.89.  The mean BMI was 22.54 in the current study.  88% patients were smokers in the current study. According to spirometry findings, 50 patients belonged to stage 2, 42 patients belonged to stage 3 and 8 patients belonged to stage 4. There was significant difference in FEV1, FEV1(%), FVC, FEV1/FVC(%) between maximum and minimum values at stage 2. The mean NT-PRO BNP values were 109.40±22.60, 198.57±50.71 and 330±32.95pg/ml for GOLD stage II, III and IV respectively. The mean NT-PRO BNP increased from stage 2 to stage 4. It was maximum at stage 4. Multiple linear regression analysis shows fairly strong negative relationship among FEV1(%) and FEV1/FVC(%) with NT-PRO BNP. While no corelation was seen with FVC. Conclusion: Results from this study demonstrate statistically significant negative correlation between NT-pro BNP and FEV1. Also, NT-pro BNP level increases with the increase in severity of airway obstruction based on the GOLD criteria hence NT-pro BNP level can be used for the staging of COPD patients in whom spirometry is either contraindicated or cannot be done. NT-pro BNP level can also be used as a prognostic marker for predicting the clinical outcome.

49. Impact of Covid-19 Pandemic on Otorhinolaryngology Practice in India.
Aju Ravindran, Sandeep Sreedhar, Cindya Vidyadharan, Divya Bharathan, P. Muraleedharan Nampoothiri
Background: Covid-19 has dramatically changed everyday life across the globe. Otorhinolaryngologists were at the forefront of being exposed to the virus. As the virus evolved so did the practice of otorhinolaryngology in the country. Some innovative tacks for protecting otorhinolaryngologists and improving patient care were put into our practice by many doctors. Assessment of these techniques will help us to overcome the difficulties if a similar situation arises in the future. Materials and Method: An online survey was conducted among Indian otorhinolaryngologists. The invitation to participate in the survey was circulated among otolaryngology consultants and postgraduates all over India through multiple modalities on social media. The survey consisted of 4 sections with a total of 24 questions, related to covid vaccination status, changes made in practice, OPD (outpatient department) consultations during the lockdown period, and modifications done in outpatient and operation theatre setups. Google forms were kept open for one month. Results: There were changes in outpatient and operation procedure management like screening of patients before treatment and surgery, patient health care declarations, vaccination status, improvisation done in the methods of sterilization of ENT instruments, endoscopes, case selection of elective OT (operation theatre) cases. This paper aims to give a brief overview of current knowledge about the impact of covid 19 on otolaryngology practice using the best available evidence. Conclusion: COVID-19 had made crucial changes in ENT practice forever which will help otorhinolaryngologists in the better care of patients if a similar situation arises in the future.

50. Correlation of Fine Needle Aspiration Cytology and Histopathology in Palpable Breast Lesions.
Abhilasha Pallavi, Akanksha Singh, Deepali, N. K. Bariar
Background: This study compared the diagnostic value of fine needle aspiration cytology (FNAC) with the gold standard of histopathological diagnosis in breast lesions. Methods: From April 2022 to September 2022, the Pathology Department of Patna Medical College and Hospital, Patna, Bihar, worked in partnership with the Surgery Department to carry out this descriptive cross-sectional study. 88 FNAC of palpable breast lesions were carried out, and their associated histological findings were compared. Age of the patient, the location of the breast lesion, and other pertinent observations were documented on a proforma that had been previously developed. Slides were prepared, processed, and stained for cytology and reported by a cytopathologist. In order to conduct a diagnostic and histological investigation, biopsies were processed. Breast lesions in all female patients of any age were included, and those for which there was no histological report were omitted. The mean and standard deviation were calculated using the Statistical Package for Social Sciences (SPSS) version 20. Frequencies with percentages were also calculated. Additionally, algorithms were used to calculate the specificity, sensitivity, diagnostic accuracy, positive predictive value, and negative predictive value. Results: The age range in this study was 16 to 80 years, with a mean age of 34.44±21.57 years. Ages 26 to 35 were the most prevalent, followed by 36 to 45. In this investigation, the metrics for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were each 83.33%, 100%, 100%, and respectively. Conclusion: FNAC breast is a simple, less intrusive, affordable, quick, and nearly accurate diagnostic technique for both palpable and non-palpable breast lesions.

51. Fine Needle Aspiration Cytology Evaluation of Thyroid Lesions in Children and Youth by the Bethesda System for Reporting Thyroid Cytopathology.
Akanksha Singh, Abhilasha Pallavi, N. K. Bariar
Background: Children and young people rarely develop thyroid lesions. They have a higher malignancy rate than adults. Between the ages of 20 and 24, the incidence peaks. Objectives: To assess the usefulness of “The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)” in reporting thyroid lesions in children and adolescents. Materials and Methods: An investigation that was prospective was carried out between October 2021 and September 2022. 106 children and youth between the ages of 1 and 24 who were categorised using the TBSRTC underwent FNAC. Results: 18.9 years old was the median. The majority (57.5%) of those in the 20- to 24-year-old age group were female. 4.7%, 85.8%, 4.7%, 1.9%, 0.9%, and 2% of the 106 patients fell into the TBSRTC diagnostic categories I, II, III, IV, V, and VI, respectively. Surgery was performed on six (5.6%) individuals, and histological research was conducted. The percentages for accuracy, sensitivity, and specificity were 100%, 97.8%, and 98%, respectively. Conclusion: A definitive diagnostic test called TBSRTC for FNAC of the thyroid is used to classify patients according to whether surgery is necessary and to distinguish between malignant and non-malignant lesions in children and adolescents.

52. A Clinico-Pathological Study of Gastric Polyps and their Relationship with Helicobacter Pylori Infection at Katihar Medical College, Katihar, Bihar.
Amaresh Kumar Sudhanshu, Rajesh Kumar
Background: Stomach polyps are uncommon gastric abnormalities that are often asymptomatic and discovered by accident during an endoscopy. This study conducts a clinicopathological analysis of gastric polyps in hospitals in Katihar, Bihar, in light of the fact that some polyps are connected to Helicobacter pylori infection and can be a sign of upcoming malignancies. Materials and Methods: From the archives of the pathology department of KMCH, Katihar, Bihar, the records of all the patients who had undergone endoscopy between January 2018 and March 2019 and had pathology reports of gastric polyps were extracted. Their demographic information, including age, gender, the anatomic site of the polyp, clinical symptoms, Helicobacter pylori infection, and the histopathology of the polyp, was examined and recorded in a pre-developed checklist. At a significance level of P <0.05, the collected data were examined in SPSS-17. Results: 25 (34.7% of the 72 patients investigated) were men, and 47 (65.3%) were women. In the group of people over 60, polyps were most common (n=33, 45.8%). The stomach body (n=38, 52.8%) was the anatomic region where the removed polyps were found most frequently. The most common clinical symptom among the patients (n=37, 51.4%) was abdominal pain, while the most common form of polyps found (n=46, 63.9%) was hyperplastic polyps. The majority of the polyps (n=41, 56.9%) lacked comorbid diseases. H. pylori infection was only found in 12 instances, nine of which were women. Most H. pylori infections were found in people between the ages of 45 and 60. Gender and gastric polyp H. Pylori infection did not significantly correlate. Conclusion: According to the findings of earlier research on the subject, the likelihood of developing polyps rises with age, and since the majority of polyps are hyperplastic, there is a low likelihood that they would develop into cancer. Nevertheless, gastric polyps should be checked in everyone with idiopathic abdominal pain.

53. Histopathological Study of Thyroid Lesions and Correlation with Ultrasonography and Thyroid Profile at KMCH, Katihar, Bihar.
Amaresh Kumar Sudhanshu, Rajesh Kumar
Background: To assess the various thyroid lesion patterns found in surgically removed specimens and biopsies received at the department of pathology and to link the various histo-morphological aspects with regard to clinical findings, USG results, and thyroid profile findings. Methods: A total of 100 thyroidectomy cases—either partial or complete—were examined. Prior to surgery, a thorough clinical examination that included a USG scan and a thyroid function test assessment was completed. Results: The age range of 21 to 40 years had the largest incidences (51%) of thyroid enlargements, with females predominating (77%), and the ratio was 3.34:1. Out of a total of 100 instances, 28 were cancerous and 72 were not. All 100 cases underwent thyroid function testing, and 81 of them were found to be euthyroid. The neck swelling that was evident in all thyroid lesion patients was their most prevalent clinical complaint. In 55% of cases, multinodular goitre was the most frequent radiological result. One MNG case out of 55 instances was found to be malignant after histological analysis. Ten instances were identified by the USG as being malignant, however a histological study revealed that one case was benign. Conclusions: The association between USG and histology findings revealed 90% sensitivity, 98.8% specificity, and 90% positive predictive value when using the histopathology report as the gold standard.

54. Study of Periodic Paralysis Patients Clinical and Biochemical Profile with Particular Reference to Hypokalemic Periodic Paralysis at DMCH, Laheriasarai, Bihar.
Pankaj Mohan Shrivastava, U. C. Jha
Background: Skeletal muscle weakness that is episodic, hyporeflexic, and transient is a symptom of periodic paralysis. Patients frequently experience periods of weakness in the limb muscles that last a few hours to a few days and are frequently brought on by physical activity, a big meal, or fasting. Hypokalemia, abrupt flaccid paralysis, potentially lethal episodes of muscle weakness, and life-threatening cardiac arrhythmias are the hallmarks of the metabolic myopathy known as hypokalemic periodic paralysis (HPP). However, rapid and early diagnosis of this ailment and start of treatment can result in a superb recovery. Aim: To study the clinical and biochemical characteristics of those who suffer from hypokalemic periodic paralysis and to find out whether consuming fermented rice is associated with HPP. Methods: 52 HPP patients overall were chosen for the cross-sectional study design in the 21–60 year age range from the Department of Medicine, Darbhanga Medical College and Hospital, Laherisarai, Bihar from April 2022 to October 2022. The data were analysed using the descriptive study. Results: 52 patients in total were chosen. The patients were 37.98±9.18 years old on average. The majority of the subjects (n=42, 80.7%) are men who consume fermented rice (bassi) in their diet (n=51, 98%) and who have experienced no precipitating events. The majority of the cases (n=50, 96.2%) showed decreased tone in all four limbs, DTR absence (n=33, 63.46%), a haemoglobin level below 12 g/dL (n=34, 65.4%), low serum potassium levels below 3.5 meq/l (n=42, 80.7%), and sinus bradycardia on the ECG (n=13, 25%). Conclusion:The study limitations include its limited sample size and lack of a control group. An episodic, transient, and hyporeflexic weakening of the skeletal muscles is known as periodic paralysis. Most individuals had hypokalemia and regularly ingested fermented rice (bassi). Regardless of whether the serum potassium level was low or normal, intravenous potassium should be administered to patients who had acute flaccid progressive motor paralysis since they responded well without showing any signs of residual weakness.

55. Grading of Lymphocytic Thyroiditis Cytologically and Relationship to Hormonal Condition of the Thyroid.
Rajiv Ranjan Singh, Renu Kumari, Ajit Kumar Chaudhary
Background: The second most frequent thyroid lesion identified on FNAC after goitre is lymphocytic thyroiditis. Along with FNAC, other diagnostic factors include clinical characteristics, thyroid antibody titres, thyroid hormonal profile, and ultrasonography. The goal of the current study was to assess thyroid fine needle aspirates for the presence of lymphocytic thyroiditis, grade lymphocytic thyroiditis cases using predetermined cytological criteria, and determine the relationship between cytological grades and thyroid hormonal state. Methods: From March to August 2019, this retrospective study was carried out at Department of Pathology, Darbhanga Medical College Laheriasarai, Bihar. According to Bhatia et al., cytological criteria were used to further categorise lymphocytic thyroiditis patients that had been reported using the Bethesda system. Where data were available, cytological grades were associated with thyroid hormonal status. Results: According to the Bethesda method, a total of 162 instances of lymphocytic thyroiditis were documented in our study. Further grading revealed that grade II thyroiditis accounted for the majority of cases (104, 64.2%), followed by grade I (48, 29.6%), and grade III (10, 6.2%). Out of the 78 cases with accessible thyroid hormonal profiles, the majority of patients (42; 53.85%) were hypothyroid. Euthyroid (21; 26.92%) and hyperthyroid (15; 19.23%) individuals were next in line. With a P value greater than 0.05, there was no statistically significant correlation between grades and hormone status. Conclusion: The “gold standard” test for diagnosing lymphocytic thyroiditis is still the FNAC. However, in our investigation, there is no statistically significant link between the cytological grades and thyroid hormonal condition.

56. Hematological Parameters in Various Acute Febrile Illnesses: A Comparative Study.
Rajiv Ranjan Singh, Renu Kumari, Ajit Kumar Chaudhary
Background: Malaria, dengue, typhoid, chikungunya fever, meningitis, urinary tract infections (UTIs), and other atypical diseases are major causes of acute febrile illnesses (AFIs). Aim: Identify which haematological variables are more likely to lead to a provisional diagnosis of a variety of acute febrile illnesses and trigger the initiation of a particular treatment. Methods: From January 2020 to June 2020, a prospective study was done at Department of Pathology, Darbhanga Medical College, Laheriasarai, Bihar. It comprised 300 instances of acute febrile infections in patients between the ages of 18 and 58. For each patient, a complete blood count and a malarial parasite microscopy were done. Where necessary, additional pertinent tests were performed to confirm the diagnosis. Results: Malaria was found in 17%, dengue in 28%, typhoid in 16.3%, UTI in 14.7%, meningitis in 7%, and non-specific fever in 17% of the 300 cases of AFI. There were 159 males out of 300 and 141 females. The age range of 18 to 28 years saw the highest percentage of cases (43%) overall. Malaria was associated statistically significantly with thrombocytopenia, anaemia, increased red cell and platelet distribution widths, and decreased packed cell volume (PCV). In P. falciparum compared to P. vivax, thrombocytopenia, anaemia, and decreased RBC and PCV were all seen. Platelet count drop, leucopenia with lymphocytosis, and a reduction in PCV in 56% of dengue cases were all detected. Increases in TLC and neutrophil count were common symptoms of meningitis and UTI. When compared to malaria, patients with typhoid had a normal platelet count, a slight anaemia, and a mildly reduced PCV. Conclusion: In patients with acute febrile illness, commonly performed laboratory tests such haemoglobin, PCV, leukocyte count, platelet count, and even red cell indices can serve as diagnostic markers.

57. A Study of Correlation between Body Mass Index and Lipid Profile in Postmenopausal Women in North Bihar.
Renu Kumari, Rajiv Ranjan Singh, Sheela Kumari
Background: Every woman experience menopause, a physiological phase of life marked by the end of menstruation brought on by hormonal changes. Between the late 40s and the early 50s, menopause takes place. Due to the decrease of estrogen’s protective influence on the cardiovascular system, postmenopausal women are more at risk for cardiovascular problems. Progesterone and estrogen levels decrease throughout menopause. Following menopause, there is an increase in fat storage and concurrent lipid deposition in the body’s central region. The body mass index (BMI), which has a significant impact on lipid profiles and blood pressure, is a reliable indicator of hypertension and hyperlipidemia. Women are more vulnerable to developing ischemic heart disease due to menopause. Aims and Objectives: In this study, postmenopausal women from North Bihar were examined to determine the relationship between BMI, blood triglyceride levels, and low-density lipoprotein (LDL). 100 postmenopausal women who appeared healthy underwent this research on these factors. Materials and Methods: Depending on how long they had been through menopause, the individuals were split into two groups: <5 years and >5 years. BMI, triglycerides, and LDL were among the variables examined. Results: In our study, BMI values increased in both groups but were not statistically significant (P = 0.920); nonetheless, triglyceride levels increased and were statistically significant (P = 0.059) and LDL cholesterol increased (P = 0.307) in the lipid profile. Conclusion: Because postmenopausal women lack estrogen’s cardioprotective function, they are more susceptible to cardiovascular illnesses. Poor dietary and lifestyle choices further raise the risk of cardiovascular disease. It is important to raise awareness of menopause and cardiovascular health among perimenopausal women and to motivate them to adopt healthy lifestyles.

58. Correlation of HbA1c with Serum Lipid Profile in Patients with Type 2 Diabetes Mellitus in Mithilanchal Area.
Renu Kumari, Rajiv Ranjan Singh, Sheela Kumari
Background: Diabetes mellitus is a diverse set of diseases caused by a variety of etiologies, genetic and environmental factors operating in concert. These diseases are characterised by a state of persistent hyperglycemia. The gold-standard indicator of chronic glycaemia in diabetes individuals is glycated haemoglobin (HbA1c). The key indicator of mean blood glucose level is HbA1c. Dyslipidemia, particularly elevated LDL, is prevalent in diabetes mellitus and is closely linked to inadequate glycemic control. Objective: to determine the relationship between HbA1C and lipid profile in Mithilanchal area patients with Type 2 Diabetes Mellitus. Method: Present study was conducted at Department of Physiology, DMC, Laheriasarai, Bihar. A total of 60 confirmed cases of type 2 diabetes mellitus were obtained from DMCH, Medicine Department. Males and females were included in the samples (40 -60 YR). As a control, 60 people of a similar age range without diabetes were used. Between the case and control groups, the following parameters were examined and compared: FBS, PPBS, HbA1c, TG, Chol., HDL, LDL, and VLDL. Result: The case group had significantly higher FBS, PPBS, and HbA1C levels. HDL is much lower than the control group, but LDL, CHOL, and TG were high in this case. Patients’ values for HbA1C/LDL, HbA1C/HDL, and HbA1C/CHOL are statistically strongly significant when compared to controls. Significant correlation exists between lipid profiles and HbA1c. Conclusion: Patients with type 2 diabetes are more likely to develop dyslipidaemia. Significant correlation exists between lipid profiles and HbA1c. Therefore, in addition to serving as a biomarker for glycemic control in type 2 diabetes, HbA1c can also be employed as an indirect predictor of dyslipidaemia.

59. Assessment of Depression and Anxiety Levels among Type 2 Diabetes Mellitus Patients and Healthy Individuals: A Cross Sectional Observational Study.
Amita, Kumawat Ashok Kumar, Kumar Manoj
Introduction: Diabetes is a chronic disorder which is characterised by rise in blood glucose level. Diabetes is a stressful condition, which may lead to anxiety and depression, if not managed properly. These negative emotions may cause worsening of diabetes. Hence, the present study aimed to determine Depression and Anxiety Levels in Type 2 Diabetes Mellitus patients and compare that level with healthy individuals, by using DASS – 42 (Depression Anxiety Stress Scale). Aim and Objective: The present study was aimed towards assessing and comparing Depression and Anxiety levels among Type 2 Diabetes Mellitus patients and matched healthy controls. Materials and Methods: The present study was a cross sectional comparative type of observational study conducted in the Upgraded Department of Physiology, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan, India, on 40 type 2 diabetic patients aged 40-70 years. An equal number of age and gender-matched healthy participants were recruited as controls. Before commencing the study, ethical clearance was obtained from the Institutional Research Review Board and Ethics Committee of the Institution and written informed consent was obtained from all the participants. DASS – 42 scale was used to assess the Depression and Anxiety levels. “Unpaired t-test ˮ was used to find the significance of difference between the two groups, using Statistical Package for the Social Sciences (SPSS) version 20.0. Statistical significance was designated at p – value of less than 0.05. Results: In present study, mean and standard deviation values of depression score for cases were 13.98 ± 9.80 and that of control were 8.4 ± 7.49. Mean and standard deviation values of anxiety score for cases were 16.28 ± 9.70 and that of control were 8.53 ± 7.19. The values were found to be significantly higher in type 2 diabetes mellitus cases as compared to healthy controls (p-value < 0.05). Conclusion: The present study concludes that there are significantly higher depression and anxiety levels in type 2 diabetes mellitus cases as compared to healthy controls. So, psychiatric interventions support in the management plan of diabetes are required for avoiding the further complication and better management of diabetes mellitus.

60. Isolation of Aspergillus Species from Various Clinical Samples in a Tertiary Care Hospital, Ahmedabad.
Shrivastava Juhi, Padaria Nishita, Shah Kinal
Background: In recent years, fungi have been emerging as a common infection in hospitalized patients of tertiary care centres. Now adays it has  become important to determine the prevalence of different Aspergillus species due to their ability to cause wide spectrum of   also in the view of difference in antifungal susceptibility noted in some species. Objective: To isolate different species of Aspergillus in various clinical samples received in mycology laboratory at our institute. Methods: The retrospective study was conducted in the department of Microbiology for the period of three years (Jan 2019 –Dec 2021) . The samples were collected  under aseptic precautions from the patients presenting clinically with suspected fungal infections and analysed by direct microscopy (KOH and Gram stain).Fungal culture was being done on SDA (Sabouraud dextrose agar) and the growth was identified by colony morphology, gram staining, Lectophenol cotton blue preparation and slide culture as per recommended procedures. Results: Out of a total of 950 samples processed over a period of 3 years in our laboratory, 86 samples were culture positive for Aspergillus species. The highest number of isolates belongs to A.fumigatus (37.21%) which were from respiratory samples like sputum, ET secretions and BAL followed by A. flavus(23.25%). A. clavatus accounted for the least number of isolates (2.33%). Maximum numbers of isolates were from males(66.9%). Conclusion: Local aetiology should be determined to know the common isolated fungal species in the given geographical area and early diagnosis of fungal infections using conventional and rapid tests( KOH) should be carried out for the prompt management of the cases by selecting empirical antifungal therapy and formulating prophylactic and pre- emptive stratergies.

61. Estimation of Stature from Cranial Parameters in Gujarat Population.
Divyesh Patel, Bharati Umarvanshi, Dhaval Patel, Satyen Patel
Background: The height of humans has been a symbol of status and dominion over different residing beings, whether human or animal kingdoms, for all time. Estimation of stature has been defined as a fundamental examination for the identification of unknown individuals and consequently, an essential tool in forensic examination especially, while anonymous, putrid, dispersed, and disfigured human remains are worried. Aim: This study aimed to determine data on cranial dimensions of Gujarat adolescents and to acknowledge the applied significance of the current study to forensic, plastic, and reconstructive surgery. Materials and Methods: At the Govt. Medical College in Surat, Gujarat, 400 undergraduate medical students—200 men and 200 women—were included in the study. Each individual was healthy and free of any visible deformities. Maximum head length, maximum head breadth, horizontal circumference of the head, and stature were the measurements used in the study. All data were recorded, and using the regression coefficients, a fictitious regression equation was created. Results: Each of the three cranial factors for both genders is positively and significantly connected with stature, according to the study’s findings. Once we see the finding of males and females separately, all the three cranial parameters for females are positively and significantly correlated with stature, but in males, only MHL and HHC are positively and significantly correlated with stature. The outcomes suggest you’ll be able to successfully estimate stature from various cranial parameters in situations where cephalo-facial is the only viable element remaining for identification. Conclusion: This study has shown that cranial measurements for estimating stature are reliable and worthwhile to pursue. This can be helpful to practitioners in cases of solitary cranioids or situations in which the skull is the only remaining viable piece, giving shaky information for the identification of anonymous people.

62. A Prospective Randomized Comparison of Active vs Expectant Management and Outcome Assessment of Maternal and Neonatal Outcome in Premature Rupture of Membranes at Term Pregnancy.
Priya, Kalpana Jha, Vivek Ranjan
Aim: The study aimed to compare the maternal and neonatal outcome in patients with term PROM receiving active induction versus expectant management. Methods: The present study was a prospective randomized controlled trial, conducted on 100 term antenatal women in the Department of Obstetrics and Gynaecology, RDJM Medical College and Hospital, Turki, Muzaffarpur, Bihar, India for one year. Results: Majority of women in both the groups belonged to 20 -25 years. The mean gestational age in active and expectant group was 38.64±0.94 weeks and 38.48±0.97 weeks. 34% of active management group and 30% of expectant management group were admitted in 4 -6 hours. 42% of active management group and 30% of expectant management group had a latency period of 12-20 hours and results were found to be statistically significant ( p value = 0.005). 40% of active management and 20% of expectant management were delivered within 6 12 hours and 46% of active management and 28% of expectant management group were delivered within 12-20 hours and results were highly significant (p value = 0.0001). Majority of the antenatal women (70% in active management group and 54% in expectant management group) delivered vaginally. The most common indication of caesarean section was foetal distress in both groups. Conclusion: Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any increase in caesarean section rate as compared to expectant management group.

63. Prospective Outcome Assessment of Surgical Management in Lumber Disc Prolapses: A Follow-Up Study.
Amresh Yadav, Ravi Shekhar, Sudhanshu Verma, Shiv Shankar
Aim: The aim of the present study was to evaluate the surgical outcome in the treatment of Lumber Disc Prolapse (LDP). Methods: The prospective study was done in the Department of Orthopaedics, institute of medical sciences BHU, Varanasi, Uttar Pradesh, India , during the period of 1 year. 55 cases were selected during study period but out of them 50 cases were feasible to be included in the study; remaining 5 cases were lost during follow up. Patients of both sexes aged between 18-70 years with prolapsed lumber intervertebral disc admitted in the Department of Orthopedics. Results: The mean age of the patients were 38.9 ± 14.0 years ranging from 20-67 years. The mean age of the male patients was 38.5 ± 13.5 years and a female patient was 39.8 ± 16.2 years. Though the mean age of the female patients a little bit higher than the male, but the mean difference was not statistically significant (p>0.05). Data indicated that maximum number of the patients was in age group >40 years (40%) followed by 28% in the age group 21-30 years, 24% in the age group 31-40 years and 8% were in the age group <20 years. Conclusion: From this study it reveals that management of prolapsed lumbar intervertebral disc by laminotomy and discectomy is an effective method of treatment and it reduces the complications and increases the chances of successful outcome.

64. An Analytical Assessment of the High Maternal Blood Lipid Levels during Early Pregnancy and its Association with Increased Risk of Congenital Heart Disease in Offspring.
Iffat Zaman, Nuzhat Zaman, Md. Faizul Hassan
Aim: This study aimed to investigate whether maternal blood lipid levels during early pregnancy are associated with the occurrence of congenital heart disease (CHD) in their offspring. Methods: The present study was conducted in the Department of Obstetrics & Gynecology, Madhubani Medical College & Hospital, Madhubani, Bihar, India  and Cases were mothers pregnant with a fetus with CHD were included. Controls were women giving birth to healthy infants during the same period of time, and were matched based on gestational week at the first prenatal examination of the cases. Initially 335 controls were selected, after further careful investigation of medical records, three of the controls had a family history of CHD, 23 had their blood test performed after the 14th week of gestation, and 12 controls used lipid-altering medication, and 3 family history of CHD so were excluded. Finally, a total of 200 cases and 300 controls were included in the study. Results: In general, maternal age of the CHD mother was slightly older compared with the control group. Most of the women were within the normal BMI range. Gestational weeks and BMI were comparable between cases and controls. More mothers with CHD infants were pregnant through assisted conception compared with controls. There were no differences for the sex of the child and parity. There were 40/200 (20%) infants with severe CHD and 160/200 (80%) infants with mild CHD. All suspected cases during pregnancy had undergone neonatal echocardiography. Conclusion: Elevated maternal lipid profile was associated with increased risk of CHD in offspring.

65. A Hospital Based Prospective Clinic Pathological Assessment of Ovarian Tumor.
Kalpana Jha, Jyoti
Aim: The objective of the study was to study the correlation ovarian masses regarding their clinical presentation investigation and histopathological report. Methods: Prospective hospital based study was done on all the women who presented with lump and/or pain or menstrual problem attending Obstetrics and Gynaecology OPD of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India for one year and 100 patients were included in the study. Results: The mean age of presentation was 40.5 years (range, 21–60 years).40 patients belong to the age group of 40 years or older and 60 patients were less than 40 years of age. Table 1 showing distribution to tumours according to consistency (by USG) and relation with Malignancy.73% were cystic, 14% were solid and 13% were mixed type of tumours. Among there 86% were benign, 2% were borderline and 12% were malignant. There is significant association between USG finding and consistency of tumour. Maximum number (45%) patients had TAH with BSO, 20% had unilateral cystectomy, 14% had TAH with BSO and chemotherapy, 0.97% had debulking and 1% had BSO after in past hysterectomy. There is significant association between USG finding and surgery. Conclusion: Benign tumors are common than malignant ovarian tumors in all age groups. Early diagnosis and management help in better prognosis.

66. Refractive Errors among the School-Going Children in Bihar: A Cross-Sectional Study.
Binod Kumar, Mrityunjay Kumar
Aim: The purpose of the present study was to assess the magnitude of refractive errors in the school going children in Bihar region and to study its age and sex distribution, types, distribution and the possible factors associated with them. Methods: The present study was conducted among the school children in Bihar region for one year. The screening was carried out in 30 schools which included primary, higher secondary, monastic, and private schools. A total of 15,000 children were screened for refractive errors. Permission was taken from the principals of the selected schools. Informed and written consent was obtained from the teachers prior to enrolling the students for the study. Ethical clearance was obtained from the institutional ethics committee. Results: A total of 15000 school children were screened from 30 different schools of Bihar region. Refractive error was highly prevalent in the age group of 14–17 years with 9.5% (n = 380) among 4000 students followed by 8% (n = 400) in the age group 10–13 years in a total of 5000 children. However, the age group between 6 and 9 years had comparatively less prevalent refractive errors with 3.3% (n = 200) among 6000 students. Regarding gender, out of 7000 males, 6.8% (480) had refractive errors whereas 6.2% (500) females had refractive errors from a total of 8000. Conclusion: The study provides a useful and baseline data about the refractive error amongst the school children of Bihar region. A larger study needs to be conducted in all the schools of the state to get a clearer picture of RE and other eye related diseases to detect vision problem as early as possible.

67. Histopathological Spectrum of Ovarian Lesions: A Retrospective Analysis.
Durga Nand Jha, Ajit Kumar Chaudhary
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 systematic study using existing patient data retrieved from the records of the Department of Pathology, Darbhanga Medical College and Hospital, Laheriasarai,  Darbhanga, Bihar, India  during the period of around two years from 2019 to 2020. 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.

68. Prospective Assessment of the Association between Neutrophil Hypersegmentation in Microcytic Hypochromic Anemia and Thrombocytosis.
Deepali, Akanksha Singh, Abhilasha Pallavi
Aim: The aim of the present study to evaluate  peripheral smears with hypersegmented neutrophils and classified the etiological factors. Methods: The present study was conducted in Department of Pathology, Patna Medical College, Patna, Bihar, India. EDTA blood samples received in the hematology laboratory were analysed for hypersegmentation of neutrophils using geimsa stained peripheral smears. Neutrophils hypersegmentation is defined as the presence of five or more five-lobed neutrophils per 100, or any neutrophils with six or more lobes. 100 such cases which satisfied the inclusion criteria were taken as sample size. Results: Majority of cases was males and majority of cases were in the age group 40-60. The major cases were contributed by macrocytic anemia, 40% cases were having microcytic hypochromic anemia. The result showed that out of the 41 cases with normocytic normochromic blood picture, only 10 had subnormal levels of either Vit B12 or folic acid values. Rest of the 30 cases had normal Vit B12 and folic acid levels. So we can come to the conclusion that out of the 100 cases with hypersegmented neutrophils in peripheral smear 31% cases were having pure microcytic hypochromic anemia without any vit B12 or folic acid deficiency. Conclusion: The present study indicated that other than the already established causes of neutrophil hypersegmentation, microcytic hypochromic anemia, myelodysplastic syndromes and inflammatory conditions also can cause hypersegmented neutrophils in peripheral smears.

69. A Prospective Hospital-Based Study to Evaluate the Utility of the Hematological Scoring System (HSS) in the Early Diagnosis of Neonatal Sepsis.
Akanksha Singh, Deepali
Aim: The aim of the present study was done to evaluate the utility of the hematological scoring system (HSS) in the early diagnosis of neonatal sepsis. Methods: The prospective study was conducted in the Department of Pathology, Patna Medical College, Patna, Bihar, India for the period of six months. A total of 200 neonates in the department of pediatrics and neonatology were included in the study. Results: A total of 200 neonates were classified into three categories, sepsis (n=90), probable infection (n=40), and normal (n=70), based on the clinical examination and laboratory findings. The total number of culture positive cases was 90 (45%) and culture was bacteriologically negative in 120 (60%) cases. The total number of preterm babies was 110 (55%) while 90 (45%) were term babies. Preterm babies were more affected by sepsis than term babies. There were 120 (60%) males and 80 (40%) females. Five (12.5%) of the normal neonates had score ≥5 suggesting the presence of sepsis, 15 (21.42%) had scores 3-4 suggesting possibility of sepsis, and 50 (71.42%) normal cases had scores ≤2 which suggested less likely sepsis in these cases. Conclusion: Diagnosis of neonatal septicemia may be difficult as the early signs of sepsis may be subtle and different at different gestational ages. The HSS is a simple, quick, and cost-effective tool which can be used as screening test for early diagnosis of neonatal sepsis.

70. A Hospital Based Retrospective Assessment on the Distinctive Clinical Manifestations, Neuro-Imaging Features, Treatment Administered, and Outcomes of Children with Cerebral Venous Sinus Thrombosis (CVST).
Supriya Chauhan
Background: CVST is a cerebrovascular condition characterized by thrombosis in the dural venous sinus or one or more cerebral veins. CVST can affect people of any age, although young females, particularly those in their peripartum and postpartum periods, are more likely to be impacted. The study’s goal was to meticulously document the clinical manifestations, neuro-imaging features, treatment administered, and long-term outcomes of children with cerebral venous sinus thrombosis (CVST). Methods: The study was carried out in the department of  neurosurgery, JIPMER, Pondicherry, India. The study design was a retrospective review of case records, with patient data retrieved from our electronic database for 12 years. A total of 20 patients were identified as confirmed CVST in the pediatric age group (<18 years). Results: The present study comprised 12 males and 8 females. The age range at presentation was between 2 days and 17 years with a median age of 5.5 years. Among these, seven were <1 year old (two neonates), four were 1–5 years, and nine were over 5 years old. The commonest predisposing factors were otitis media/mastoiditis which was seen in eight patients. Three patients had acute leukemia, while three critically ill neonates had central line-related thrombosis. Two patients with CVST were felt to be secondary to non-accidental head injuries (NAHIs). Conclusion: Pediatric CVST is uncommon and has a different range from adults, with specific clinical triggers and thrombophilic states. Management differs significantly across practitioners, partly to the scarcity of trial evidence and also due to the variability of this illness in children.

71. A Prospective Hospital-Based Assessment of the Clinical Features of Hyponatremic Dehydration in Acute Gastroenteritis.
Shaantanu Kumar, Satyendra Paswan, Satish Kumar
Aim: The aim of the present study was to estimate the incidence of hyponatraemic dehydration in neonates and children aged till 12 years and to evaluate clinical features associated with acute gastroenteritis associated dehydration. Methods: The prospective study was conducted in the Department of Pediatrics, Jawahar Lal Nehru medical College and hospital, Bhagalpur, Bihar, India for the period of six months and Study population consisted from Infants to children aged till 12 years attending the pediatric Department both OPD and IPD care for acute gastroenteritis are enroll in the study who was satisfying the criteria for Moderate to severe dehydration. A total of 100 Children including neonates were enrolled in the study. Results: It was found that 60% of the males were having acute gastroenteritis while it was 40% in female subjects. The data also reveals that higher incidence of acute gastroenteritis was noted between 6 to 24 months of age while the lower incidence was found in the subjects above 36 months of age. Hyponatremia was occurred in 37 subjects with high incidence in lower age group in both the genders. Males were more affected than females. Lowest sodium level was 127mmol. Among 100 individuals, 28 were severely dehydrated and rest of them was moderately dehydrated (59). The number of episodes of loose stools was correlating with the extent of dehydration. Higher the episodes the severe were the dehydration. Conclusion: The study suggested that routine estimation of serum electrolytes is not necessary however it is necessary whenever electrolyte imbalance is suspected on clinical grounds and in cases which do not respond satisfactorily with routine fluid electrolyte therapy.

72. Cadaveric Morphometric Study to Evaluate the Variations in Branching Pattern of Axillary Artery.
Sanjay Sah, Dharmendra Prasad, Khushnuda Perween
Aim: The aim of the present study was to contribute to the existing knowledge of the variations in the branching pattern of the Axillary artery, explaining its embryological basis and also its morphological and clinical significance. Methods: 20 cadavers (40 upper limbs) – 15 male and 5 females embalmed with 10% formalin were dissected for this study. The study was conducted in the Department of Anatomy, Government medical College, Bettiah, Bihar, India. Variations in the origin and branching pattern of axillary artery were noted. Results: Variable branching pattern was observed in 7% of the cases on right side and 8% of the cases on left side in first part of Axillary artery, 43% of the cases on right side and 52% of the cases on left side in second part and 50% of the cases on right side and 25% of the cases on left side in third part. Conclusion: Accurate and detailed knowledge of the normal and variant anatomy of the axillary artery is of importance for anatomists, surgeons, radiologists and clinicians during various interventional, diagnostic, therapeutic and surgical procedures on pectoral and axillary regions.

73. Prospective Outcome Assessment of Arthroscopic Suture Pulls out Fixation of Displaced Tibial Spine Avulsion Fracture.
Ravi Shekhar, Amresh Yadav, Sudhanshu Verma, Shiv Shankar
Aim: The aim of the present study was to evaluate functional outcome of arthroscopic suture pull out fixation of displaced tibial spine avulsion. Methods: The prospective study was conducted in the Orthopaedics, institute of medical sciences BHU, Varanasi, Uttar Pradesh, India , for the period of six months with a sample size of 50 who are fulfilling the inclusion criteria. Results: The mean age of subjects was 27.13 ± 10.298 years. The majority of subjects were in the age group 21 to 30 years (40%). In the study, 80% were males and 20% were females. In the study 6% had Fall from the cycle, 74% had fallen from Motorbike and 20% had Fall While Playing. The study Status of Physis was closed in 70% and open in 30%. In the study 72% had Type III and 28% had Type IV Meyers and McKeever’s classification. At 3 months, the mean Post op Lysholm score was 86.07 ± 1.760, at 6 months was 97.87 ± 2.047 and at 12 months was 98.17 ± 1.599. There was a significant increase in Post op Lysholm score at 6 months and 12 months. At 12 months, when compared to 6 months Post op Lysholm score, there was no significant increase in Post op Lysholm score. In the study 6% had Post Op Knee Stiffness. Conclusion: The goal of the treatment should be an anatomic reduction to restore joint congruity. This technique of arthroscopic fixation with transosseous sutures is very useful in treating these fractures. Approaching these injuries arthroscopically allows for complete inspection of the joint and dealing with associated injuries, early mobilization, fast rehabilitation, and decreased hospital stay.

74. A Hospital Based Prospective Assessment of Serum Sodium Levels in Patients of Lower Respiratory Tract Infections (LRTI) in Children.
Rajiv Kumar, Dinesh kumar Paswan, A.Kalaivanan, Rakesh Kumar
Aim: The aim of this study was to find out the association among hyponatremia and LRTI in tertiary care center in Bihar region. Methods: This was an observational, prospective and hospital-based study conducted in JLNMCH, BHAGALPUR, Bihar, India for the period of 18 months. The sample size was calculated to be a minimum of 70 subjects. All patients admitted in to the PICU and pediatric ward were included in the present study. Written and informed consent was secured from the parents participating in the study. Results: The sample population consisted of children ≥ 2months -12 months (40, 57.14 percent), 1-5 years (20, 28.58%) and > 5-12 years (10, 14.28 percent). There were 42 (60%) male children and 28 (40%) female children in the present study population. Hyponatremia was found to be more among 1 year-5 years age group compared to ≥ 2months-12 months and > 5-12 years age groups. In the current study no significant difference in the allotment of hyponatremia in infancy period, 1-5 years and > 5-12 years was observed. In the present study mean haemoglobin value found to be lesser among subjects with hyponatremia however the variance was statistically insignificant (p=0.280). Mean TLC count found to be significantly more among subjects with hyponatremia compared to subjects without hyponatremia (p=0.036). Mean Neutrophils count were more among subjects with hyponatremia and mean Lymphocyte count was lesser among subjects with hyponatremia though the difference was statistically insignificant. Conclusion: Hyponatremia is a significantly common association among hospitalized children with lower respiratory tract infections and it is mainly due to syndrome of inappropriate antidiuretic hormone secretion (SIADH).

75. Prospective Clinico-Pathological Assessment of Different Types of Neoplastic and Non-Neoplastic Lesions of the Ovary.
Krishna Murari, Manish Kumar, N.K Bariar
Aim: To analyses the frequency of ovarian (20%) cases was malignant. In benign ovarian neoplasm, most lesions their clinico-histological features in a rural set up. Material & Methods: A prospective clinico-pathological study of 120 cases of non-neoplastic and neoplastic lesions of ovary was conducted in Department of Pathology, Patna Medical College & Hospital, Patna, Bihar, India over the period of one year. The materials for this study, ovarian specimen was obtained from hysterectomy specimen with unilateral or bilateral adnexa, and oophorectomy and/or cystectomy specimens received in the department. Results: Amongst 120 cases studied during study period, 60 were nonneoplastic and remaining 60 were neoplastic. The most common non-neoplastic lesion found was solitary follicular cysts (65%) followed by corpus luteal cysts (28.3%) Incidence of malignancy is inversely proportional to parity. In the present study, it was observed that malignant tumor were common in nulliparous women. Conclusion: Ovarian lesion possess wide gamut of histology. Specific diagnoses are made on routine gross and histological examination.

76. To Assess the Ease of LMA Insertion with Ketofol versus Propofol in Paediatric Patients.
Krishna Kant Karunakar, Mumtaz Hussain, K. H. Raghwendra
Aim: The aim of this study was to compare the effect of the ketamine-propofol mixture (ketofol) and propofol on the insertion conditions of laryngeal mask airway in pediatrics. Methods: The Prospective Double Blind comparative study was done in the department of anesthesiology & critical care medicine IGIMS, Patna, Bihar after taking approval from institute ethical committee with CTRI Registration done: CTRI/2020/10/028242. Written informed consent was taken from each participants of the study. The Data was collected between – October 2020 to December 2021. There were total 100 patients in the study and divided into two groups with 50 each. Results: Patients under 2-14 years of age comprised the majority of study population. The P value is 0.524 and there was no statistically significant difference in the age of the patients between the two study groups. Patients under male and female comprised the majority of study population. 80% male and 20% female in Group FP and 88% male and 12% female in Group KP. Patients under ASA Grade I and II. The present study showed 94% patients in Grade I and 6% in Grade II of Group FP and 92% patients in Grade I and 8% in Grade II of Group KP. Patients of LMA size I and II. 84% patients in I and 16% in II of Group FP and 94% patients in I and 6% in II of Group KP. Swallowing/Gagging 90% patients Score 1, 6% patients score 2 and 4% score 3 of Group FP. 94 % patients Score 1, 4% patients score 2 and 2% score 3 of Group KP. The P. value is significant. (P = 0.001). Conclusion: In this study, I conclude that co-induction with Ketamine (1 mg/kg) and Propofol (2.5 mg/kg) for insertion of Laryngeal Mask Airway in children provided better insertion conditions and minimal alteration in haemodynamic parameters than co-induction with Fentanyl (1μg/kg) and Propofol (2.5 mg/kg).

77. Maternal Lipid Profile and Adverse Pregnancy Outcome: A Cohort Study.
Iffat Zaman, Md. Faizul Hassan, Nuzhat Zaman
Aim: The present cohort study was undertaken to explore the association between dyslipidemia in pregnancy and its adverse pregnancy outcome. Methods: The present study was undertaken in the Department of Obstetrics & Gynecology, Madhubani Medical College and Hospital for one year. 200 pregnant women were included in the present study. N=200 Study Group: 100 pregnant women who had deranged lipid profile. Control Group: 100 pregnant women who had normal lipid profile. Results: In our study the mean age of pregnant women in the study group was 24.89 ± 3.12 years whereas in the control group it was 24.72 ± 3.76 years. Both groups were comparable with regards to age distribution. In our study maximum number of pregnant women had pre-pregnancy weight of 51 kg to 55 kg in both study and control group.. In the study group 76% of pregnant women delivered by caesarean-section while in the control group 82% of pregnant women delivered by caesarean-section. On comparing the data of body weight and diet, there was statistically significant difference among the two groups (p<0.05). Conclusion: Evaluation of lipid profile during 2nd and 3rd trimesters can predict pregnancy associated complications. It may help in counseling the pregnant women to have a modified life style with increased physical activities, dietary modifications and timely interventions when required as the treatment of hyperlipidemia is a challenging issue in pregnancy due to the fact that most of the drugs used for the treatment of dyslipidemia.

78. A Hospital Based Prospective Observational Assessment of Thrombocytopenia and Variations in Platelet Indices in Neonatal Sepsis.
Durga Nand Jha, Ajit Kumar Chaudhary
Aim: The present study was undertaken to evaluate thrombocytopenia and variations in platelet indices in neonatal sepsis. Methods: This hospital based prospective observational study was conducted in a Darbhanga Medical College and Hospital, Laheriasarai,  Darbhanga, Bihar, India over a period of 12 months from February 2019 to January 2020. A total of 200 Neonates under the age of 28 days admitted in NICU, were studied and 100 at risk neonates’ were detected and included in our study. Results: Most common presentation in EOS is respiratory distress, and in LOS is refusal of feeds, and over all common presentation is refusal of feeds. Total 200 neonates were examined. 100 neonates (50%) were at risk. 12 (12%) were had no sepsis (NOS), 40 (40%) were Early onset sepsis (EOS) and 48 (48%) were Late onset sepsis (LOS). In EOS, thrombocytopenia was found in 80%, whereas it was 83.34% in LOS. It was seen that thrombocytopenia was the most sensitive marker (83.08%) followed by MPV and PDW in detecting neonates with culture‑positive sepsis. However, it has a low specificity (20.33%). But when we combine MPV and PDW or combined all the three markers (MPV + PDW + PC), the specificity increased to 46.34%. Conclusion: NNT can be used as screening tool in NNS as it is easy and cost effective. It requires further large scale studies and meta-analysis to validate. Mortality in sepsis cases increases with severity of thrombocytopenia.

79. Study of Peripheral Arterial Disease in Type 2 Diabetes Mellitus and its Correlation to Poor Glycemic Control.
Bijay Narayan Jha, Dipankar Ghosh Dastidar, Priyanka Mondal
Aim: The aim of the present study was to assess the correlation between peripheral arterial disease (PAD) and poor glycemic control in type 2 diabetes mellitus patients. Methods: The Cross sectional analytical study was conducted at General Medicine Department, Central Hospital, South Eastern Railway, Garden Reach, Kolkata for the period of 2 years. Type 2 Diabetic 100 patients including both male and female attending the OPD and indoor wards of General Medicine Department/Endocrinology OPD/Cardiology OPD, Central Hospital, South Eastern Railways, Garden Reach, Kolkata, were included in the study. Results: Majority of the patients with peripheral arterial disease had age between 61-70 years (47%) followed by 51-60 years (37.0%). There were 5% patients who had age between 41-50 years whereas another 11% patients were older than 70 years. Majority of the patients with peripheral arterial disease were males (60%) compared to 40% females. Majority of the patients with peripheral arterial disease had a duration of disease between 1-5 years (48%) followed by 40% patients who had diabetes since 6-10 years( 9%) where as 3% patients had diabetes for more than 15 years. Conclusion: So it can be concluded that strict glycemic control as monitored by HbA1c levels along with control of hypertension, dyslipidemia and dietary modifications are necessary in patients with Diabetes Mellitus to prevent development of macrovascular complications like Peripheral Arterial Disease.

80. A Hospital Based Observational Assessment of the Reluctant Use of ORS by Mothers of Children Under-5 Years.
Iquebal Hussain, Abhay Kumar, Rajranjan Prasad
Aim: The present study was conducted to identify the gap between knowledge and practices of ORS use and treatment practices during diarrhoea of under 5 children by their mothers. Methods: A cross-sectional study was conducted among mothers of children under 5years who suffered from diarrhoea within two weeks before study in field-practice areas of Urban Health Training Centre and Rural Health Training Centre, Shree Narayan medical Institute and Hospital, Saharsa, Bihar for the period of 6 months. Total 200 participants included in the study. Results: Majority of mothers in present study were educated up to secondary level in both rural (40%) and urban areas (42%). Most of the mothers in both areas were home makers (89%), followed by labours (8.5%). Job was doing only by 5 mothers and only in urban area. According to modified BG Prasad classification of socioeconomic status, majority of family (42%) belong to class IV. The result showed that mostly mothers (37.5%) knew that hand washing should be done before preparation of ORS. This knowledge was more in rural area (40%) than urban area (35%). The mothers of rural (20%) and urban area (15%) knew about the correct proportion of water and ORS for making solution. Only 14% mothers knew that 50-100 ml (1/4-1/2 cup) of ORS to children of <2year and 100-200 ml to the children of ≥ 2 year should be given at a time. Out of total 11% mothers knew that ORS use in diarrhoea is life saving and it prevents the dehydration. Only 5% mothers were fully aware about the preparation and use of ORS. Conclusion: The knowledge regarding use and preparation of ORS solution for management of diarrhoea was found to be inadequate in this study. Though most mothers are aware that it is useful, most are not aware of its proper preparation and use.

81. Hospital Based Assessment of the Usefulness of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors.
Anand Raj, Avinash Kumar, Naveen Kumar Bariar
Aim: The aim of the present investigation was to assess the diagnostic accuracy of FNAC, on parotid gland swellings, in order to determine its usefulness in the planning of parotid gland surgery. Methods: The present study was conducted in the Department of Pathology, Patna Medical College, Patna, Bihar, India and 100 patients were included in the study for the period of six months. All patients underwent FNAC under US guidance following clinical examination. In order to obtain homogeneous and comparable data, only FNAC performed in the Institute were considered. All details regarding demographic and clinical data, including age, sex, previous surgery, timing of symptoms, cytological and histological results, site and volume of the lesions, involvement of histological sample margins and relapses were saved in an electronic database. Results: FNAC samples were obtained in 100 cases. FNAC results were “non-diagnostic” in 22 cases (22%), “inflammatory/ benign lesion” in 70 (70%), “malignant neoplasm” in 8 (8%). In the present study, pleomorphic adenoma was in 45 patients (56.25%) and Warthin’s tumour in 20 (25%). Adenocarcinoma (2.14%) was the most common malignancy, followed by Mucoepidermoid carcinoma (2.5%) and squamous cell carcinoma (2.14%). The most common histopathological diagnosis was “benign lesion”, that occurred in 70 patients (87.5%). FNAC showed a sensitivity of 81% and a specificity of 99%. Accuracy for malignancy was 97%, accuracy for a benign lesion was 83%, overall diagnostic accuracy was 97%. Conclusion: Our study suggests that preoperative FNAC plays a useful role in the accurate diagnosis of parotid tumors. It is a safe and effective diagnostic modality for the treatment of patients with parotid tumors. Fine needle aspiration cytology is a reliable, cost-effective, well tolerated and an easy procedure to perform.

82. A Hospital-Based Assessment of the Maternal Anaemia and its Impact on Perinatal Outcome: An Observational Study.
Abhay Kumar, Iquebal Hussain, Rajranjan Prasad
Aim: The aim of the present study was to find the impact of maternal anaemia on perinatal outcome. Methods: The present study was conducted in the Department of Community Medicine, Govt. Medical College & Hospital, Purnea (Bihar) for the period of one year and 200 patients were included in the study. Results: Most (42% & 40%) of the pregnant women were in the 25-29 & 20-24 yrs of age group. Only (8%) of the pregnant women were less than 20 years of age and (10%) were more than 30 years. As the level of education increased, severity of anaemia decreased although the difference is not statistically significant. Most of the patients were second gravid i.e. 45%. Most the pregnant women were moderately anaemic i.e. 50% followed by mild (44%) and severe (4%) respectively. Among the pregnant women most common type of anaemia is Iron deficiency anaemia (70%) followed by Sickle cell anaemia (15%) and other cause (11.5%). Conclusion: Anemia being one of the most important cause of poor feto maternal outcome should be treated preconceptionaly. There is a need of health education programmes and adequate intake of iron rich diet during pregnancy, to be strengthened for safe maternal and foetal outcomes.

83. To Investigate the Near Point of Convergence (NPC) in Hyperopic Children.
Sonia Phulke
Purpose: This study was aimed to investigate the Near point of Convergence (NPC) in hyperopic children. Methods: The subjects comprised of school-going 76 children aged 5-14 years. The NPC was measured with the help of Royal Air Force (RAF) ruler. Refractive error is defined based on the spherical equivalent (SE) of cycloplegic refraction. The hyperopia is defined as SE equal to or greater than +2.00 D. Results: The mean age of the participants was 10+2.517 years (range 5-14) and 42 (53%) of them were boys. The patients had shown varying amount of hyperopia (+0.75D- +12.0D). The mean NPC was 7.09+/-2.52cm (median 6 cm at 50th percentiles) and NPA was 6.004+1.9015cm. The mean NPC was significantly higher in females (7.48+2.72 cm P= 0.049). There was no significant relation of NPC with amount of hyperopia (P= 0.774). Conclusion:We examined the relationship of NPC with the amount of hyperopia and after adjusting for age and sex, we did not find any significant relationship between NPC and the amount of hyperopia. Further studies including with larger sample size and comparison of NPC values with the different targets may help to determine the NPC distribution as per the amount of hyperopia in children.

84. Assessment of Awareness among Periodontitis Patients Regarding Gum Disease and Diabetes Mellitus.
Tessa Paul, Suma Samuel
Background: Diabetes Mellitus (DM) and periodontitis are very common and they interact with each other frequently. If information on knowledge and awareness of the link between diabetes and periodontal disease could be gathered, it might be used to inform public health campaigns and encourage individuals to change their lifestyles. Objective: The objective of the current study was to assess the awareness regarding gum disease among patients with periodontitis, the association between socio demographic variables and to find out the proportion of referred diabetic patients by medical practitioners to dentist. Methods: This prospective, cross-sectional, non-randomised and questionnaire-based study was carried out on 144 patients. The data collecting period was limited to twelve months, and statistical analysis was performed using SPSS statistical software. Results: In our study, maximum (43.1%) of the cases belonged to the age group 41-50 years. A substantial proportion of study participants (32.6%) showed awareness of gum disease. Our study revealed that the cases with good awareness was higher but not significant as in cases with age 30-40 years (37.5%) compared to the cases with age 51-60 years (15.5%) and 41-50 years (17.7%). Conclusion: The majority of research participants were aware of the connection between periodontal disease and diabetes. Only few diabetic patients were referred by medical practioners for dentist consultation.

85. Chronic Kidney Disease and Dyslipidemias.
More Mayur B, Chintale Kailas N, Bhattacharya Meenakshi A
Introduction: Patients of chronic kidney disease (CKD), like patients of end-stage renal disease, those who were treated with dialysis, or renal transplant recipients have an increased risk for cardiovascular disease (CVD) morbidity and mortality. Dyslipidemia is commonly seen in CKD patients, CKD is an important risk factor for cardiovascular disease (CVD) development. The purpose of this study was to study of significance of dyslipidemia in patients with chronic Kidney disease because these patients have high mortality rate due cardiovascular disease or cerebrovascular disease. Materials and Methods: This study was a cross sectional, observational study done in tertiary health care hospital and teaching institute, study period was from December 2018 to December 2020. A total 60 cases were included in this study as per inclusion criteria and exclusion criteria. Results: In the present study serum samples of 60 patients were studied to know the incidence of dyslipidemia in chronic kidney disease patients, the triglycerides, cholesterol, LDL and HDL values were measured and compared as per age and sex distribution.  The p values were found to be insignificant. Conclusion: The mean values of the lipid profile showed a borderline elevation of serum triglycerides, Serum cholesterol, HDL and LDL values were within normal range. There was no statistically significant variation in the lipid profile of the patients when compared with the co-morbid conditions of diabetes mellitus and hypertension.

86. To Study the Impact of Arts Based Therapy on the Self Esteem of Clients Admitted in a Rehabilitation Centre for Substance and Behavioural Addictions.
Anand Patil, Vibha Bhide, Anand Bhide, Gautam Bhaware, Soumya Gangwar, Navya Gupta
Background: Admitting and treating someone in a rehabilitation facility is one method of assisting them to overcome their drug dependence and acquire a healthy outlook and way of life. It gives them a more secure location to be in, away from drugs and associates or friends that use them. The rehabilitation centre has a scheduled schedule that allows programme participants to experience the advantages of having regular sleep and waking hours, exercise, regular meals, and introspection through engaging group and one-on-one sessions. The use of art in a therapeutic setting to achieve specific, personalised goals is known as arts-based therapy. Aim: This study was carried out to evaluate the impact of Arts Based Therapy on the self-esteem of clients admitted in a rehabilitation centre for substance and behavioural addictions. Methods and Materials: The participants in the group went through assessment by a psychiatrist, a proforma was filled to collect data. The diagnosis of comorbid psychiatric disorders was made according to the criteria in Diagnostic and Statistical Manual-5. 34 sessions of one hour duration at a frequency of two sessions in a week were conducted by ABT student. Out of which four hours were dedicated to administration of pre and post therapy scales and 30 sessions of ABT. The sessions were planned and recorded on Session Record Sheet (SRS). Results: It was found that there was there were significant improvement in the Rosenberg self-esteem scale scores after ABT sessions. There was strong negative correlation between absenteeism due to alcohol and self-esteem scores indicating that there with improved self-esteem absenteeism at work place will reduce. Conclusion: Considering the improvements in the scores of self-esteem and emotional regulation, Arts Based Therapy could be used widely in the treatment and rehabilitation of people having substance and behavioural addictions.

87. A Clinical Study of Iatrogenic Cutaneous Manifestations in Neonates in Intensive Care Unit in a Tertiary Care Hospital.
Joydeep Roy, Nalla Rakesh, Kinnor Das, Ann John Kurien
Background: Neonatal dermatology includes a wide spectrum of cutaneous issues that show up in a neonate’s skin during the initial month of life, ranging from regular phenomena to significantly morbid lesions. This review was done to find out the magnitude of iatrogenic issues so as to minimise and prevent them whenever possible. Aims and Objectives: To study the prevalence of iatrogenic problems among neonates in neonatal intensive care unit (NICU). Materials and Methods: In a hospital-based, prospective research conducted between November 2021 and October 2022, 1000 neonates admitted to the tertiary NICU of Silchar Medical College & Hospital were evaluated. Results: 110 (11%) of the 1000 newborns analyzed had iatrogenic cutaneous diseases. Out of these 110 neonates, 66 (60%) had just one problem, 23 (20.90%) had two, and 21 (19.10%) had three or more disorders going on at once. Preterm neonates (62.72%) were more likely than full-term (34.54%) and post-term (2.72%) neonates to have skin lesions. In terms of iatrogenic injuries, needle prick injuries (76.36%) and adhesive tape injuries (22.72%) were the most frequent. Diaper dermatitis (13.63%), Thermal injuries (10.90%), extravasation injury (2.72%), bronze baby syndrome (4.54%), CPAP injuries (4.54%) and perinatal injuries (3.63%) were manifestations which were commonly noted in low birth weight (LBW) neonates. Conclusion: A variety of iatrogenic injuries that occur in neonate can cause skin damage. Because of the scarcity of studies, obstetricians, paediatricians, dermatologists and nursing staff are less acquainted with these conditions. As a result, it is important to keep all medical professionals involved in infant care, up to date.

88. A Study of Neutrophil-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio and their Impact on Disease Activity in Rheumatoid Arthritis.
Ansh Rajput, Kushagra Tandon, Prakash Joshi, R K Jha
Background: Rheumatoid arthritis (RA) affects up to 0.5-1% of the adult population worldwide. Inflammation is the clue determinant and primary mechanism resulting in disability and increased mortality in RA patients. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have increasingly become indicators of subclinical systemic inflammation, which can be used to assess disease activity and prognosticate for a variety of infective, inflammatory, neoplastic, and autoimmune conditions, including RA. Aims and Objectives: To assess the relationship of NLR and PLR with disease activity in RA. Materials and Methods: A hundred patients of both sex and age 18–75 years diagnosed with RA were studied at the Department of General Medicine from April 2021 to September 2022. All patients were subjected to a detailed history. A thorough clinical examination and investigations were performed, including complete blood count, erythrocyte sedimentation rate, C-reactive protein, RA factor, and DAS score. DAS28 score was calculated and patients were grouped into moderate disease activity (MDA) (3.2 <DAS28 ≤5.1) and high disease activity (HAD) (DAS28 >5.1). Results: Rheumatoid arthritis was more prevalent in the age groups of 51-60 years and among males. Mean NLR was significantly higher in patients with HDA (4.860±1.083) than in patients with MDA (3.076±2.613). Mean PLR was significantly elevated in patients with HDA (228.52±89.185) compared to MDA (184.90±78.976). The area under the curve (AUC) for predicting the HDA of NLR was 0.627 (p= 0.030), whereas, for PLR, it was 0.669 (p=0.004). Based on the interpretation both NLR and PLR are fair instruments for predicting HDA in patients with rheumatoid arthritis. Conclusion: NLR and PLR are two emerging inflammatory biomarkers that could be used to evaluate disease activity in active RA patients. Both NLR and PLR values may be potential indices for RA disease-activity assessment.

89. Comparative Evaluation of Hip and Femur Fractures by DHS versus PFN Treatment.
Sanjib Kumar Behera
Aim: To assess and contrast the radiological and clinical results of patients with stable intertrochanteric fractures treated with proximal femoral nail (PFN) versus dynamic hip screw (DHS). Method:  The PFN and DHS groups each contained 50 patients with stable intertrochanteric fractures who were older than 19 years. An adapted ultra-short PFN and DHS with a three-hole side-plate and an anti-rotation screw were implemented for the lower population. The intraoperative, early, and late problems were noted, and the Harris Hip Score was used to evaluate each group’s functional result. Results: The Harris Hip Score was marginally lower in the DHS group over the course of 15 days than it was in the PFN group. However, the DHS group displayed higher mean scores than the PFN group at the 2- and 5-month monthly follow-ups; at the 6-month follow-up, both groups obtained comparable scores. Conclusion:  PFN offers a substantially quicker procedure with a smaller incision that causes fewer issues from the wound. However, because PFN is a technically more difficult procedure that results in more complications associated and the subsequent re-operations, the occurrence of technical mistakes was much greater in PFN when compared to DHS.

90. Treating Hip Fractures with the Novel DHS Fixation Technique without the Use of Traction Table.
Sanjib Kumar Behera
Aim: To assess a novel method of traction-free Dynamic Hip Screw (DHS) fixation. Method: 100 patients who had manual traction for DHS fixation between July 2020 and July 2021 had their results in terms of tip apex distance (TAD), fracture reduction quality, length of the procedure, and preoperative preparation time assessed. Result: Good to moderate decrease was possible in 96% of instances. The average screw cutout frequency was only 0.90%, the mean TAD was 19.1 millimetres, and the average operating time was 35 minutes. Conclusion: This method is very helpful for polytrauma patients who require multiple surgeries because it is simple, repeatable, affordable, and doesn’t lose reduction alignment or screw position.

91. Perinatal Outcome in Term (37 To 42 Weeks) Pregnancies Associated with Oligohydramnios.
Smriti Kumari, Udayan Sarkar, Miss Jeny, Anjali Suman
Introduction: Oligohydramnios is a disorder that poses a risk to the health of the foetus, although there are treatments available and more are being tested. Oligohydramnios is linked to perinatal mortality, congenital abnormalities, and more complicated pregnancies. The negative perinatal outcome and the amniotic fluid index (AFI) are inversely correlated. Clinically speaking, oligo hydramnios is defined as having an amniotic fluid index (AFI) of 5 cm or below. It occurs in 3-5% of pregnancies, on average. Sonographic assessment of amniotic fluid index is a reliable and repeatable way of diagnosing anomaly in amniotic fluid volume (AFI) (AFI). Small for gestational age (SGA) risk is frequently increased, along with the likelihood of caesarean sections, meconium stains, low Apgar scores, and NICU admissions. Objectives:  The objective of the study was to examine the foetal outcomes in low-risk term oligohydramnios. This research is prospective and descriptive. Methodology: The research was carried out at MGM Medical College & LSK Hospital, Kishanganj for a year, from May 2020 to May 2021. 90 pregnant women with AFIs of or less than 5 cm at term were included in the study. 100 pregnant women in the control group had AFIs more than 9 cm. The study group and the control group were contrasted. Using chi-square and p-value to analyse the foetal and pregnancy outcomes, specifics such as foetal weight and APGAR scores at 2 and 4 minutes were collected. Results: Delivery method, NICU admission, neonatal deaths, and labour induction. Oligohydramnios is linked to an elevated risk of prenatal morbidity and death as well as a high rate of pregnancy complications. Babies born to oligohydramniotic women typically have low birth weights. Conclusion: However, it can anticipate a safe and positive conclusion, which calls for appropriate foetal observation and frequent antenatal care visits.

92. Function of Magnetic Resonance Imaging in Identifying the Recurrence of Carcinoma Cervix in Patients Treated with Radiotherapy.
Guruprasadsinh J Vaghela, Premaram Choudhary
Background and Aim: Definitive radiotherapy is the mainstream treatment for cervical squamous cell carcinoma in early-stage and advanced cases. The goals of the current study were to investigate the function of MRI in detecting the recurrence of cervical cancer in patients who had received radiotherapy and to assess the reliability of MRI in detecting treatment response and recurrence in cervix cancer patients. Materials and Methods: The current study was conducted over a 2-year period in 100 women who had cervical cancer that had been histopathologically confirmed and who had been referred for an MRI pelvic at a tertiary care facility in India. Newly diagnosed individuals and patients who had just completed therapy were also included in this study. Patients with cervical cancer who were sent to the department for follow-up MR imaging after radiation were diagnosed. Results: A total of 64 treated cases and 36 newly diagnosed patients are taken into consideration for the study. A total of 56 patients received radiotherapy, and the majority of them (19 patients, 33.92%) were referred for an MRI due to symptoms between the ages of 1 and 5 years, followed by less than 6 months and between the ages of 6 and 12. After 2-3 years of irradiation, when the average period of recurrence is, post radiation problems are more likely to occur. Conclusion: After 2-3 years of irradiation, which also matched the usual duration of recurrence, post radiation problems were clearly more likely to manifest.

93. A prospective Study to Assess the Role of Third Trimester Ultrasound in Evaluating the Risk of Haemorrhage and Emergency Caesarean Section in Low- Lying Placenta and Determining the Mode of Delivery.
Gokul Raman Chandran, Avishek Bhadra, Kumari Anshulata, Sujata Dalai
Introduction: To follow up the patients with low-lying placenta in the third trimester and to do a detail placental study and determine its characteristics which may aid us to determine the occurrence of Antepartum Hemorrhage and mode of delivery they undergo – Vaginal Delivery or Caesarean Section and also to determine the consequences of low-lying placenta like Postpartum Hemorrhage, Peripartum Hysterectomy, Blood loss and the need for Blood Transfusion. Methods: This is a prospective observational study which was carried out in the Department of Obstetrics and Gynaecology, Eden Hospital, MCH, Kolkata. A total of 56 patients were included in this study. Results: Anterior placentation was seen in 32 (57.1%) patients and its strongly associated with previous Caesarean section. The mean distance between placental edge and internal os (Mean ± SD) is 1.44 ± 0.66. The mean placental edge thickness (Mean ± SD) is 1.96 ± 1.083. The incidence of APH in patients with edge thickness > 1 cm is 66.7% and 88.9% had a caesarean delivery in the same. In patients with marginal sinus – the incidence of APH is 70% and 93.3% had a Caesarean delivery. The estimated mean blood loss during delivery (Mean ± SD) is 645 ± 279.28. The incidence of PPH is 44.6% (25 patients), Peripartum hysterectomy is 7.1% (4 patients) and Still birth is 3.6% (2 patients). Conclusion:Our study concluded that patients having a low-lying placenta with placental – os distance 1 – 10mm, thick edge and a marginal sinus have a risk of significant bleeding which can result in an increased rate of Caesarean Section. Anterior placentation is influenced by previous caesarean section and anterior low-lying placenta itself is an independent risk factor for increased blood loss, increased rates of blood transfusion, postpartum haemorrhage and prolonged hospitalisation.

94. Review of Gynaecological Profile of Hysterectomies in a Rural Tertiary Teaching Hospital.
Ke Manga Reddy, Lakshmi Priyanka K, Tella Srivani, Thota Tejaswini
Background: Hysterectomy is the most frequently performed major gynaecological operation next to caesarean section. It remains the chief modality of treatment for various gynaecolgical conditions. Routes of hysterectomy include abdominal, vaginal, laparoscopic and combined approaches. Aim of the Study: To analyze the clinical profile, indications and postoperative complications of hysterectomies performed at a rural tertiary teaching hospital. Methodology: This retrospective study was conducted in the Department of Obstetrics and Gynaecology, Mediciti Institute of Medical Sciences, a tertiary teaching hospital at Medchal. Medical records of 240 cases of hysterectomies that were performed from January 2015 to December 2021 were retrieved from Medical Records Department. The socio-demographic profile, indications and postoperative complications of these hysterectomies were collected using a predesigned proforma. Results: Out of the total 240 hysterectomies, 51.25 % were in the age group of 40-49 years followed by the age group of 50-59 years i.e 19.5 %. Hysterectomy was commonly performed in para 2 and para 3. Common presenting symptoms were menstrual irregularities (55%), followed by mass per vagina (27.5 %). Common indications for hysterectomy were AUB (36.25%), Fibroid (34.58%) and UV prolapse (29.16%). Abdominal hysterectomy(62.5%) was performed more commonly than vaginal hysterectomy (29.16%). Conclusion: Indications for hysterectomy should be clearly evaluated and patient should be properly counselled about conservative options, risks and benefits of the procedure. Route of hysterectomy has to be decided on individual basis and attending clinician expertise.

95. The Expression of CD56 to Distinguish Papillary Carcinoma of Thyroid (Including its Variants) from Other Thyroid Lesions.
Hemaxi R Patel, Paras G Patel, Ankita A Shah, Jignesh D Patel
Aim of study: The main aim is to study the applicability of difference in CD56 expression as a marker that distinguishes papillary carcinoma of thyroid (including its variants) from other thyroid lesion. Methods: The study was conducted in department of the Pathology, SMIMER medical college, Surat. Surgically removed and formalin-fixed thyroid specimens were collected and processed for histopathological examination by H& E stain and immunohistochemical examination by CD56 IHC marker. Thyroid lesion were surgically removed and formalin – fixed specimen were received. After grossing specimen was kept for 24 hours with10% formalin for proper fixation, subsequently, dehydration by graded alcohol, clearing by xylene and embedding in paraffin wax was carried out. Blocks were made and serial sections of 3-5 micron thickness were taken and stained with haematoxylin and eosin (H & E). All 55 cases were subjected to Immunohistochemical staining with Monoclonal Mouse Antihuman CD56 antibody of Dako Company, clone 123C3, Lot 20049679 and ready to use. Only single variable staining density in neoplastic cells recorded. IHC staining was interpreted with an optical microscope under 10x and 40x magnification. For positive control, normal thyroid gland in the same specimen was considered. The strong and complete membranous expression with or without cytoplasmic staining of the tumor cells qualified the case as positive for CD56. Results: The present study was conducted on a total of 55 lesions. In present study there were 3 cases of papillary thyroid carcinoma out of which two cases were conventional papillary thyroid carcinoma and one case was follicular variant of papillary thyroid carcinoma. All three cases of papillary thyroid carcinoma were negative for CD56.There were 3 cases of well differentiated tumor of unknown malignant potential and all three were negative for CD 56. Conclusion: In this study CD56 expression was absent in Papillary carcinoma and that CD56 expression retained in majority of benign thyroid lesions.CD56 expression allowed the differentiation of papillary thyroid carcinoma from non-neoplastic lesions and other thyroid tumor derived from follicular cells with very high sensitivity and specificity.

96. Anthropometric Parameters as Predictors of Peak Expiratory Flow Rate in Primary School Children.
K. Karunakar, Soujanya. D, Jithendhar P, J. Rajamouli
Background: Children suffering from bronchial asthma have fall in the PEFR is one of the earliest signs of impending acute asthma attack. Serial PEFR measurements enables to determine response to treatment and to follow progression of the disease. Aim and Objectives: To find whether the anthropometric measurements are predictors of Peak Expiratory Flow Rate in Primary school children. Materials and Method: A Cross sectional study conducted on 867 among primary school children between 6 years to 12 Years, from RHTC Annaram of Karimnagar District, for the period of one year during July 2019 to June 2020, after fulfilling inclusion and exclusion criteria and after getting consent from patients. Results: Out of 867 patients females in the age group 9-12 years were in high number i.e., 269 (31%), mean age group of the study subjects in the present study was 9.05 + 2.026 years, The mean PEFR in the age group of 6-8 years and 9-12 years was 142.60 + 27.31 and 233.91 + 37.16 respectively. Mean PEFR among male and female gender was 199.75 + 57.127 and 191.21 + 54.86 respectively. Among males, the highest correlation was found between PEFR and height (r – 0.871), followed by BSA and PEFR (R – 0.860), weight and PEFR (R – 0.843), CC and PEFR(r – 0.798). Among females, the highest correlation was found between PEFR and height (r – 0.870), followed by weight and PEFR (R – 0.831), CC and PEFR (r – 0.826), BSA and PEFR (R= -0.095). Conclusion: As interpretation of PEFR data requires a comparison with predicted values in normal population, selection of the correct prediction equations is a crucial step.

97. Study of Maternal, Neonatal Interactions in Low Birth Weight Babies During the Hospital Stay.
Banothu Sudhakar, Balimindi Sravani, Venu Akkala, Guduru Vijay Kumar, T Jaya Chandra
Introduction: Low birth weight (LBW) has become one of the major challenges in maternal and child health in medicine. A study was conducted to find the clinical outcome of LBW babies with their mothers. Methods: It was a hospital based descriptive study conducted in the department of pediatrics, KMC, Hanumakonda. Study was conducted from November 2019 to October 2021. LBW babies who were critically ill and parents who have not given consent were included in the research. All mothers were interviewed on day 14 of post-natal life of their baby. They were asked if they had any doubt in any of the question or if they failed to understand anything in the questionnaire. All attempts were made to answer a participant’s doubt. If parental bonding questionnaire (PBQ) diagnosed any bonding disorder in the mother, she was referred to psychiatry department for the treatment and counselling. Mild disorder, mothers experience delay in the onset, ambivalence, or loss of the maternal emotional response to the infant. For this, Brockington et al. criteria was considered. Mean scores were compared using paired t test and ANOVA. P< 0.05 was statistical significance. Results: Out of the 305 babies in this research, 152 (49.8%) were male. Mean birth weight was 1833± 405. Majority (270; 88.5%) were lower middle class and the rest were upper middle category. Family wise, 71.8% were belong to nuclear family and 191 (62.6%) were gravida 1. Study included 85.6% mothers had no previous abortions and 14.4%mothers had previous abortion history. 155 (50.8%) were between 32-36 weeks of gestational age and 96.1% mothers had no previous illness. Conclusion: This study included 67% premature born babies; 1/3rd were small for gestational age. Only 50% of the mothers offered KMC, 86.2% mothers showed no bonding disorder. Multicentre study’s with large sample size for long time is recommended.

98. Comparison of Hematological and Ventilatory Parameters in Exercising and Non-Exercising Recruits of Police Training School.
Manohar Lal Bhandari, Ajay Bhatt
Background: Policemen and Sportsmen are symbol of physically fit healthy individuals. Medical facts are contrary as police recruits in training are anemic. Material & Method: 50 physically fit recruits aged 20-29 years of Police Training School, Indore were subdivided into three groups according to their exercising period as non-exercising, exercising for 2 months and 10 months respectively. Fasting sample of blood was collected for hematological parameters. These 3 groups were assessed for pulmonary function tests. Students t-test and Chi square tests were applied to all 3 groups. Results: Hematological parameters were lower in group B and C whereas the PFT were recorded higher in group B and C in comparison to group A but was not statistically significant. Conclusion: Hematological parameters shows decrease with increase in exercise indicating sports anemia.

99. A Prospective Study on Drug Reaction with Eosinophilia and Systemic Symptoms.
Sonam Singh Sachan, Nilabh Kumar Singh
Introduction: “Drug reaction with eosinophilia and systemic symptoms” (DRESS) disease is a severe dermal as well as comprehensive medication answer with numerous problems, a long way, and a 10% humanity rate. In addition to this, the physician needs to take into account numerous different serious nerves, search for good quality materials and impeding functionalities of the DRESS symptoms, and differentiate it from other serious severe skin bad effects (SCARs) such as “Stevens-Johnson syndrome/toxic epidermal necrosis” (SJS/TEN) and exertional modified exanthemata’s pustulosis. Body temperature, skin infection, eosinophilia, atypical lymphocytosis, lymphadenopathy, as well as hepatitis are the classic symptoms of DRESS syndrome. However, pneumonitis, kidneys, and other physiological injuries are all potential complications that could arise, and they might be substantial. Aims and Objectives: To evaluate the spectrum of clinical features of DRESS and further analyze their demographic features. Methods: A prospective study was conducted on 30 patients who visited the outpatient department of our hospital. A detailed medical history of the patients was taken and examined and diagnosed. All the patients were analyzed for various parameters, based on DRESS and SJS. Results: The study also found that 45.7% of the DRESS cases had probable casualty and AED accounted for 80% of the probable drug cases. Further, the study found 93.33% of people had a fever of at least 38.5 °C, whereas 7% had a fever of 38.0-38.5°C, and 21% had multiple episodes of fever of at least 38.0°C. In 86.67% of cases, lymphadenopathy was seen. Every case (100%) displayed one or more hematopoietic abnormalities. Absolute eosinophil counts below 700 L1 and above 1500 L1 were both detected in 46.67% and 73.33% of cases with eosinophilia, respectively. There were abnormal lymphocytes in 8 instances (53.34%). Conclusion:The study has validated the scoring system for DRESS which is considered to be a severe adverse drug reaction involving many organs, presenting combinations of features. Delayed diagnosis or management will reduce the chance of survival and hence, prompt treatment and early diagnosis are required which can only be possible if awareness can be made among the patients and also hospital staff.

100. Assessment of Control of Cardiovascular Risk Factorsin Type-2 Diabetes.
Umesh Teltumbade
Introduction: Diabetic patients are at increased risk for coronary heart disease and experience increased morbidity and mortality from coronary heart disease compared to their non-diabetic counterparts. he specific factors that can make this expanded hazard include obesity, hyperglycemia, high blood pressure (BP), insulin resistance, and dyslipidemia. When patients are physically inactive or smokers and have at least one cardiometabolic risk factor, this markedly increases the cardiometabolic risk. Also, clustering of these risk factors can markedly increase the risk of cardiovascular disease  (CVD). A multifactorial intervention to improve Cardiovascular (CV) hazard factors decreased cardiovascular events and mortality in type 2 DM patients. Aims and Objectives: This study is intended to assess the CV risk factors in type 2 diabetic patients. Methods: This is a cross-sectional study in which the diabetic patients were considered and the Glucose, lipid profiles, Blood pressure measurements and Anthropometric variables were determined and the outcome assessment was done. The patients were classified into 2 groups, those who received Oral hypoglycemic agents (OHA group) and those who received Insulin (Insulin group). Results: 56 % had previous Hypertension .16 % had previous Stroke. 60% patients received Oral hypoglycemic agents (OHA)alone and 40% patients received insulin therapy or both insulin and OHA. Only 10 % patients met the recommended ADA target of HbA1c < 7.0 %. More patients reached the target for FBS than for PLBS (34 % vs. 6%).  54 % of the whole population had BMI < 25 Kg/m2, 20 % women had waist circumference < 88 cms and 50 % men < 102 cms. Conclusion: The poor control of the majority of cardiovascular risk factors in the diabetic subjects, support the need for more aggressive management of modifiable CRF’s. It can be achieved only if specialists, primary care physicians and diabetic patients join forces to combat CAD.

101. Clinicopathological Study of Midline Swelling of the Neck in Rajendra Institute of Medical Sciences, Ranchi.
Komal Neha Khalkho, Md Anas, Ratna Kumari, Kumar Gaurav, Z. M. Khan
Background: Neck swelling is a very common presentation among patients that we encounter in our day to day life. This is present in wide range of age groups and have multiple differential diagnosis. Therefore this produces a need for the surgeons to properly understand the embryology and anatomy and the various causes in different age groups to reach to apt diagnosis and appropriate management algorithm. Method: A prospective study was conducted in otorhinolaryngology department of Rajendra Institute of Medical Sciences, Ranchi over a period of 18 months from April 2021 to September 2022. A total of 60 patients with midline swelling, who gave consent were evaluated and studied. Result: In our study 60 patients were studied. Thyroid swelling is the most common midline swelling (65%) found in our study followed by Ludwig’s angina (20%), thyroglossal cyst (10%) and dermoid cyst (5%). Wide range of age group from 6 years to 70 years presented with midline neck swelling. The midline swelling were of variety of origin from being congenital or acquired , inflammatory or non-inflammatory, benign or malignant. Patients were evaluated to reach a diagnosis. In our study FNAC could not diagnose the papillary and follicular variant of thyroid swelling which was confirmed on postoperative histopathological examination thus showing poor accuracy. Conclusion: Among the midline benign neck swellings, thyroid swelling was found to be the commonest. Thyroid swellings occur more commonly in the females than males. Though FNAC is the most readily available tool for diagnosis but it is not definite for thyroid swelling since aspirate could be taken from the benign site and malignancy could be missed. USG guided FNAC is more effective and safe option. However clinically suspicious malignant cases should be followed up. Treatment of benign neck swelling is surgical excision while in acute case Ludwig’s angina, incision and drainage followed by higher antibiotics coverage is effective.

102. Prospective Outcome Assessment of Triamcinolone in the Prevention of Recurrence of Keloids in the Pinna.
Ashish Kumar, Renu Kumari
Aim: This study was done to determine the efficacy of Triamcinolone in preventing recurrence of Keloid. Methods: Total 50 patients who underwent excision of keloid in Department of ENT, Patna Medical College and Hospital, Patna, Bihar, India for 12 months were included in this study. They were divided randomly into two groups of 25 patients each. Surgery alone was performed in 25 patients and surgery with post-operative intra-lesional Triamcinolone injection was given weekly interval for 6 weeks in another 25 patients. Patients were followed up for 1 year at every 3 months intervals. Results: In the age group of 11-20 years there were 20 patients. In the age group of 21-30 years there were 10 patients. In the age group of 31-40 years there were 16 patients. In the age group of above 40 years there were 4 patients. There were 48 female patients and 2 male patients. Recurrence was present in 7 patients at the end of 1 year. P-value was 0.02 which was significant. Conclusion: Thus, it can be concluded that multi-modality treatment would be far better in preventing recurrence. However, the best dosing schedule for steroid injections with regards to the amount of intralesional steroid to be given and the dosing frequency for the best possible results need to be determined.

103. A Hospital Based Observational Assessment of the Clinical Profile of Children Presented with Seizure.
Rakesh Ranjan Kumar, Jiteshwar Prasad Mandal
Aim: The aim of the study was to describe the clinical profile of children presenting with seizure including common causes of seizure and classify the seizure types. Methods: The present study was conducted in the Department of Paediatrics, S.K. medical college and Hospital, Muzaffarpur, Bihar, India for nine months and 120 patients were selected in the study. Results: Majority of the patients were in 6 months-5 years 55% followed by 6-10 years 25% and >10 years 20%. There were 70% were male as compared to female 30%. According to type of seizure, majority of the patients had GTC 55% followed by partial 33.40%. In the present study, majority of the patients had febrile etiology 30% followed by infection 25% and seizure disorder 16.66%. Out of 120 patients, 96 were discharged without deficit and 16 were discharged with deficit. Conclusion: Seizures are one of the most common neurological presentations leading to stress and anxiety among care takers. Seizures were found predominantly in male children. Most of the seizures witnessed were of Generalized Tonic Clonic type with febrile convulsion being the commonest variety of seizures in our pediatric population.

104. A Hospital-Based Study to Assess the Association between Quality of Life in Fertile and Infertile Women and the Factors Affecting it.
Lalan Prasad Shah, Rakhi Kumari, Amit Kumar, G.K. Mishra, Sanjay Kumar
Aim: The aim of the present study was to assess the quality of life in fertile and infertile women and the factors affecting it. Methods: The present study was conducted in the urban field practice area of Darbhanga Medical College and hospital Darbhanga, Bihar, India. in which 1000 participants (300 infertile and 700 fertile women) using purposive sampling were selected. To identify eligible women from the rural population, family planning documents in rural health’s houses were assessed, and a list of women with infertility problems were extracted. Results: Overall, the infertile women had a significantly higher physical functioning and physical role limitation than the fertile women. In the present study, women in the infertile group had a higher summary score than fertile women in the physical component summary. However, emotional role limitation, fatigue or vitality, social functioning, mean bodily pain, mental health, and the quality-of-life were not significantly different between the infertile and fertile women (P > 0.05). Conclusion: In conclusion, the results of the present study revealed a clear significant difference between the 2 groups in mental health and general health.

105. A Hospital Based Observational Study to Evaluate the Association of Vitamin D Deficiency with Recurrent Respiratory Tract Infections in Children Less Than 5 Years.
Bhawani Singh, Naveen Kumar, K.N. Mishra
Aim: The aim of the study was to evaluate the association of vitamin D deficiency with recurrent respiratory tract infections in children less than 5 years. Methods: The present study was conducted in the department of Pediatrics, DMCH, Darbhanga, Bihar, India and all patients aged less than 5 years with and without recurrent respiratory tract infections attending the outpatient department or admitted as inpatient in the Department of Pediatrics who fulfill the inclusion criteria were included in the study. A total of 100 children were considered for study during the study period. Out of total 100 cases, 50 children with recurrent respiratory tract infections were taken as group I, while 50 children without recurrent respiratory tract infections (RRTI) were taken as Group II. Results: Out of 100, 60 (60%) were males and 40 (40%) were females with mean age and mean weight of 35 ± 16.8 versus 36.3 ± 15.5 months and 12.1 ± 3.4 versus 11.5 ± 3.2 kg, respectively, and no significant difference was found (P > 0.05) between them. Majority (36; 36%) of the patients were in the age group of 51–60 months. In Group I (RRTI), 84% (42) children had vitamin D deficiency whereas, in Group II (no RRTI), 40% (20) had vitamin D deficiency having vitamin D deficiency increases the odds of RRTI by 11 times (the risk in increased by 11 times. In Group I (RRTI), Vitamin D was deficient in 55% of children who had not received exclusive breast feeding for 6 months whereas in Group II(no RRTI) 70% were Vitamin D deficient in  non-exclusive breast feeding. 76% of Group I (RRTI) 75% of Group II (no RRTI) who was not exposed to sunlight had vitamin D deficiency. Conclusion: Children with recurrent respiratory tract infections exhibited a significantly higher proportion of vitamin D deficient subjects. Vitamin D levels should be evaluated in children with recurrent respiratory tract infections and treated timely for better management of the problem.

106. An Observational Study to Evaluate the Efficacy of Genicular Nerve Block for Pain Management in Osteoarthritis Knee Patients.
Jaideep Singh, Shikha Mehrotra, Sushma Uikey, Sonali Gupta
Background & Method: Osteoarthritis also known as degenerative joint disease is the most common type arthritis most likely to develop as people age causing significant pain and functional limitation. Several studies suggested that genicular nerve BLOCK is a safe and effective therapeutic procedure for intractable pain associated with chronic knee osteoarthritis (OA). Ultrasound-guided genicular block provided > 50% pain relief in knees using this technique. This simple technique causes all three genicular nerves blocked. Methods: 60 patients (age 20-70 years) with advanced knee osteoarthritis pain (kellgran Lawrence grade 3-4) who failed conservative treatment underwent ultrasound-guided genicular nerve block. The genicular nerve block is performed. This method was used to inject a total of 6 mL of lidocaine plus 20 mg of triamcinolone (TA) at 3 separate target sites: the superior lateral, superior medial, and inferior medial genicular nerves). Outcome measures were assessed according to hospital visits at baseline and at 1, 4, and 12 weeks after the procedure via visual analogue scale (VAS) graded 0 to 10 .0 means no pain 10 means worst pain and Western Ontario and McMaster Universities Arthritis Index (WOMAC) The test questions are scored on a scale 0-4 which correspondence to None (0), Mild (1), Moderate (2), Severe (3), and Extreme 4. Results: At 3 month follow-up, the patient get relief from baseline knee pain and functional improvement. At 12 weeks, all outcome measures revealed statistically significant. Improvement in swelling, tenderness and knee pain is seen. Conclusion: Nerve block, a new promising local therapy for RA, can control disease activity in knee joints according to clinical and US scales. In conclusion, the results of this study have shown that genicular nerve block treatment is safe and beneficial in osteoarthritis related knee pain.

107. Study of Shape of Obturator Foramen of Stapes in Gujarat Population.
Kukadiya UC, Trivedi PN, Lakhani CJ, Rathava JK
Background: Only few studies have been described on shape of obturator foramen. It provides necessary information for the otologist, anthropologist and prosthetic designers. Objectives: To identify various shape of the obturator foramen of the stapes and establish common shape in Gujarat population. Methods: Examination of 60 stapes bone extracted from the human cadaver temporal bone collected from the three medical colleges of Gujarat. Intact stapes bones were count in the study and broken specimen were excluded. Results: The various stapedial foramen shapes were observed in Guajarat population. The most common shape was Triangle with unequal sides shape in 32 specimens (53.33 %) and second most common was circular shape in 11 specimens (18.33 %). The least common shape was isosceles triangle in 8 specimens (13.33 %).

108. Assessment of Arthritis and Vitamin D in Experimental Mouse Model.
Shikha Tyagi, Govind Singh, S. K. Tyagi, Brejesh Rathore
Background: Rheumatoid arthritis is an autoimmune disease that causes inflammation in joints tissue and is characterized by concomitant destruction of bone and cartilage. Total 1% of the worldwide population suffers from this disease. Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown aetiology marked by asymmetric, peripheral polyarthritis. Aetiology of RA is still unknown, and many environmental and genetic factors play a role in the development of this disease. Vitamin D is necessary for healthy bone, as it is helps in absorption of calcium from the gut. Deficiency of vitamin D has been implicated as common cause of diseases such as Osteoarthritis, rickets etc. Vitamin D deficiency is highly prevalent in the general population particularly in patients with musculoskeletal and autoimmune diseases. Vitamin D level and the link to RA disease can open up new gateway for the better understanding of this disease. The results would also help in better understanding of the role curcumin in the treatment of arthritis. The present study was designed to study the level of vitamin D and uric acid with arthritis mice and compare it with healthy controls. Thus, the present study was undertaken to study the association of vitamin D and Uric acid with Rheumatoid arthritis Swiss albino mice. Aim: The aim of the study was any change in Vitamin D level in experimental mouse model of arthritis as compared to normal. Methods: We planned an animal study as mice mimics the better phenotypic arthritis symptoms. Swiss albino mice (12 – 14 weeks old) were taken for this study. Adjuvant induced arthritis (AIA) mice were prepared by injecting Freund’s complete adjuvant (FCA) intra-dermally in the sub planter surface of the right hind paw, also a booster dose was given of FCA in order to produce autoimmune disease. Results: After 47 days, the biochemical investigations; rheumatoid arthritis factor (RA factor) test was found mild positive in normal healthy animals, on the other hand arthritic samples exhibited strong agglutination reaction. Serum uric acid and Vitamin D levels were also estimated. Conclusion: We observed the significantly elevated levels of uric acid in arthritic mice as compared to the normal mice, while there was no significant change in vitamin D levels in arthritic mice as compared to normal mice.

109. Conscious Sedation for Middle Ear Surgeries: A Comparative Study on Sedative Effect of Dexmedetomidine and Propofol Infusion in Mastoid Surgery.
Burulukui Hembram, Pradip Kumar Mandal, Subir Kumar Brahma, Iashanlang Dkhar
Background: In this study, we wanted to evaluate and compare the efficacy of dexmedetomidine with that of propofol in patients undergoing middle ear surgeries, with regard to sedation, analgesia, patient satisfaction and adverse effects. Materials and Methods: This was a hospital based observational comparative study conducted among 60 patients who underwent elective middle ear surgery under local anaesthesia and sedation in the Department of ENT, in a tertiary care teaching hospital over a period of one and a half years after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. For the purpose of this study the patients were randomly allocated in 2 groups – Group D: Patients receiving Dexmeditomidine (1ug/kg over 10 minutes as loading dose and 0.4ug/kg/hr as maintenance dose), Group P: Patients receiving Propofol (75ug/kg/min over 10 minutes as loading dose and 50ug/kg/min maintainence dose). Results: The onset of sedation in both the study groups was found to be statistically significant (p-value = 0.000). The time taken for the onset of sedation in group D was 15.00 minutes and in group P was 9.19 minutes respectively. The baseline means arterial pressures, the heart rates, the respiratory rates and the oxygen saturations of both the groups are comparable as the p-value is more than 0.005 which is statistically insignificant. Mean arterial pressure (MAP) measured at 60 minutes between the two groups was found to be statistically significant. Heart rate variation beats per minute (BPM), respiratory rate, oxygen saturation between the two groups, at baseline, 5 minutes, 10 minutes, 15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes, 90 minutes, 105 minutes, 120 minutes, 135 minutes and 150 minutes was not found to be statistically significant. Respiratory rate measured at 90 minutes’ mark was found to be statistically significant. Intergroup comparison of the mean values of the visual analog score (VAS) was done by student unpaired t test and the difference was found to be statistically significant. Association of rescue analgesia requirement between the two group was statistically significant (p = 0.000). Conclusion: Dexmedetomidine is better than propofol and can be safely used as a sedative in middle ear surgeries without much change to the haemodynamics of the patients. Dexmedetomidine provides analgesia and therefore requirement of rescue analgesia in patients is reduced. Most patients were satisfied with the anaesthesia conducted by use of dexmedetomidine. Side effects between the two drugs were insignificant. Therefore, dexmedetomidine may prove to be a useful alternative to propofol for sedation in patients undergoing middle ear surgeries.

110. Evaluation of Helicobacter Pylori in Patients Undergoing Upper GI Endoscopy.
Jayaprakash S., Suganya C., Thirumalaisami
Background: Helicobacter pylori (i.e. H. pylori), previously known as Campylobacter, is a gram-negative, helically shaped, microaerophilic bacterium usually found in the stomach. Its helical shape (from which the genus name, helicobacter, derives) is thought to have evolved in order to penetrate the mucosal lining of the stomach and thereby establish infection. Aim: To evaluate the prevalence of helicobacter pylori in patients undergoing upper gastrointestinal endoscopy. Material and Method: The present prospective study was conducted in the department of Surgery among 150 subjects who underwent endoscopy (done in all patients with upper abdominal pain of unknown etiology). The data was collected by a preformed structured interviewer-administered questionnaire that was pretested with modifications made prior to its use in the study. The patients were interviewed that requests for the demographic, socioeconomic status, medical history and previous history of taking any medications and supplements. Endoscopy was carried out using the “Olympus GIF -LV1” forward viewing video esophagogastroduodeno scope. RUT was performed by the following method i.e. One drop distilled water was put on urea containing strip. Results: Helicobacter pylori infection was present in 76.8% and 56.4% of the subjects living in urban and rural location respectively. Bloating was present in 72% of the subjects. Endoscopic abnormality was reported among 87.3% and 12.7% of the subjects with and without Helicobacter pylori infection. Chronic gastritis, duodenal ulcer and gastric ulcer was revealed among 86.36%, 88% and 87.5% of the subjects with Helicobacter pylori infection. Conclusion: In conclusion, there is a high prevalence of H. pylori infection in rural population in this study. Though, the prevalence of H. pylori gastritis and associated abdominal symptoms is high in number but serious gastrointestinal complications develop in few.

111. A Morphometric Study of Mandibular Lingula in Population of Udaipur, Rajasthan.
Meghna Bhaumik, Priyanshi Bhaumik
Background: Lingula is a sharp bony projection located on the medial aspect of ramus of mandible. It is very closely related to the mandibular foramen and inferior alveolar nerve and vessels. Lingula directs oral and maxillofacial surgeons to locate inferior alveolar nerve to provide anesthetic block during dental procedures. Objectives: Lack of precise knowledge on varying shapes of lingula in different population might be a cause for surgical failures. The aim of this study was to determine the morphology of mandibular lingula in relation to the surrounding structures in adult mandibles to provide an image that can be used during dental, mandible reconstructive surgeries and in neurosurgery treating trigeminal neuralgia. Materials and Methods: The study was conducted on 50 adult dry human mandibles (100 sides) in the department of anatomy, Geetanjali Medical College & Hospital, Udaipur, Rajasthan. The different shapes of lingula were observed by the classification given by Tuli et al. Results: Different shapes of lingula noted were truncated, triangular, assimilated and nodular type. The triangular, truncated, nodular and assimilated shape of the lingula was noticed in 51%,21%,18%and 10%.respectively. Conclusion: The lingula is a very important landmark where mandibular foramen has to be identified in procedures, such as inferior alveolar nerve block, bilateral sagittal split ramus osteotomy and for excision of nerves in facial neuralgia, and in mandible reconstruction surgeries. Variations occur in the anatomical structure of lingula , a surgeon should have keen understanding of such morphological changes to avoid any damage to the associated blood vessels & nerves of this region while anaesthetizing the area or performing mandibular arch surgeries. Different types of lingula can serve as important & useful anthropological marker.

112. A Prospective Randomized Comparative Study of Anaesthetic and Analgesic Advantages of Dexmedetomidine Versus Saline Infusion for Spine Surgery in Prone Position Under General Anaesthesia.
Sudha Helawar, Manali Nadkarni, Sudha Shree P, Kunder Samuel Prakash
Background: In this study, we wanted to evaluate the anaesthetic and analgesic advantages of dexmedetomidine with that of saline infusion for spine surgery in prone position under general anaesthesia. Methods: This was a hospital based randomized prospective comparative study conducted among 60 patients who presented with thoracic spine surgeries of duration 3-4 hours under general anaesthesia, in the Department of General Anaesthesia in Seth G S Medical College, KEM Hospital, Mumbai from 2013 to 2014 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: The sex distribution in both the groups was analysed using Pearson chi square test and the difference was not statistically significant. The mean isoflurane requirement in group D was 0.89±0.14 whereas that in group C was 1.04±0.11. The difference in mean was statistically significant with p value < 0.001. This shows that dexmedetomidine infusion in group D decreases the isoflurane requirement. Inj. vecuronium in group D patient was 12±1.64 mg and that in group C patients was 13.66±1.21mg. There was statistically significant difference in the requirement of Inj. vecuronium between two groups. Less requirement of Inj. vecuronium in group D patients indicated that dexmedetomidine infusion decreases the requirement of Inj. vecuronium. The mean requirement of injection fentanyl in group D patients was 140.33±17.90mgm where in as that in group C patients was 117.50±29.07mgm. There was statistically significant difference in fentanyl requirement between both the groups with p value < 0.001. Decrease in the requirement of Inj. fentanyl in group D patients was because of analgesic action of dexmedetomidine infusion. No difference was seen with regard to requirement of Inj. atropine between two groups. Inj. Ephedrine requirement was compared between group D and group C using Chi square test. There was no significant difference in the requirement of Inj. Ephedrine. Conclusion: Dexmedetomidine attenuates the pressure response to laryngoscopy, incision and extubation. Dexmedetomidine’s hypotensive effect reduces the bleeding at surgical site. We can conclude that dexmedetomidine infusion is good anaesthetic adjuvant in spine surgery under general anaesthesia in view of its hemodynamic stability, anaesthetic and analgesic sparing effect.

113. Dermatopathological Presentations of Cutaneous Tuberculosis: A Tertiary Hospital Experience.
Superna Ganguly, Jyoti Prakash Swain
Background: Even though Cutaneous Tuberculosis (CTB) is quite rare worldwide; in India, it constitutes 1.5% of all cases of extrapulmonary tuberculosis. Though Mycobacterium tuberculosis, mycobacterium bovis, and the BCG immunizing agent are the most common causative organisms, in a group of Cutaneous TB lesions called Tuberculids, no organisms may be found. These lesions arise through hypersensitivity reaction to TB antigens and are characterized by sterile, AFB-negative lesions. Diagnosis and identification of these lesions may be difficult, as they may resemble several other dermatological conditions clinically and histopathologically. The present study aims to document the spectrum of clinicopathological findings in Cutaneous Tuberculosis cases presenting at CIMS, Bilaspur, a tertiary care hospital in Chhattisgarh state of India. Materials & Methods: 20 cases clinically diagnosed as Cutaneous Tuberculosis in the Department of Dermatology and Venereology, CIMS, Bilaspur between July 2017 and Jan 2021 and confirmed at the Department of Pathology, CIMS, Bilaspur on the basis of histopathological and cytopathological examination along with Zeihl-Neilsen staining for acid-fast bacilli (AFB) were retrospectively analyzed. The cases were classified based on clinico-pathological diagnostic criteria as well as various incidental parameters like age, sex, site, clinical presentation etc. Results: Lupus Vulgaris (LV) and Tuberculosis Verrucosa Cutis (TBVC) were the most commonly diagnosed (30% each), followed by Scrofuloderma (SFD) and Erythema Induratum of Bazin (EIB) (15% each). Papulonecrotic Tuberculid (PNT) and Orificial TB (TBO) were least common (5% each). 30% patients had concomitant Systemic Tuberculosis, out of which one patient simultaneously exhibited features of Cutaneous Tuberculosis (SFD) and Lepromatous Leprosy (LL). 65% patients were males while 35% were females with a male to female ratio of 1.85:1. The mean age at presentation was 36.59 yrs. with the youngest being 9 years old and the oldest 63 years. Lower and upper extremities were the commonest site of involvement (85%) and 20% patients had lesions involving multiple sites. Size of induration on Tuberculin Skin Test (TST) was significant with 90% cases showing induration >10mm. Induration diameter nearabout or exceeding 30mm was particularly seen in Tuberculids like PNT and EIB. The most consistent histopathological findings were chronic inflammatory infiltrates (100%), epithelioid granulomas (95%), multinucleate giant cells (80%). Hyperplastic epidermal features were observed in 60% cases; most prominently in TBVC and LV. Caseous necrosis (25%) was observed in 2 cases of SFD and 1 case each of PNT, TBO and EIB. Septolobular panniculitis, necrotic fat lobules and perivascular inflammatory infiltrates were the most prominent histological features of EIB. 80% cases including all the Tuberculids tested negative for AFB. AFB positivity was particularly seen in SFD patients; and where SFD was concomitant with PTB and LL, plenty of AFB were visible in the purulent aspirates and imprint smears. Conclusion: Due to the diverse clinicopathological manifestations, confusion with other cutaneous disorders and the inability to demonstrate AFB in the lesions, precise diagnosis may be overlooked if a high index of suspicion is not maintained. Suggestive findings in clinical and histopathological examination along with a strong positive TST remains the cornerstone in the diagnosis and treatment of CTB.

114. Comparison between Lignocaine Nebulization and Airway Nerve Block for Awake Fiber Optic Guided Nasotracheal Intubation.
Rupal B Shah, Ishita Thaker, Gargi M Bhavsar, Renish Hudda, Margi Monpara, Teraiya Shubham Sanjaybhai
Background and Aim: A variety of techniques are currently used for airway anesthesia including Topical Anesthesia or Airway Nerve Blocks. Airway Nerve Blocks are frequently used for awake fiberoptic intubation because they provide rapid and deep anesthesia. The Aim of our study is to compare the effectiveness of 2 methods of anesthetizing the upper airway for awake fiberoptic guided nasotracheal intubation namely Airway Nerve Block versus Airway Nebulization. Material and Methods: This is a observational prospective clinical study to compare two methods of airway anesthesia for awake fiberoptic nasotracheal intubation in the terms of Ease of intubation, Vocal cord position, Cough severity, Patient comfort, Patient satisfaction and Hemodynamic variability. Patients were divided in two groups. Group N (Patients receiving nebulization), Group B (Patients receiving Nerve Block). All patients were observed for: Assessment of intubating conditions, Hemodynamic conditions and complications. Results: Among both the groups, the intubating conditions were better for group B patients than group N patients. Among both the groups, patients of group B had less cough then in group N. 27 patients had no cough in group B while 20 had no cough in Group N (P=0.02). There was no significant difference in both the groups regarding hemodynamic changes. Conclusion: Airway Nerve Blocks is gold standard for airway anesthesia as we get maximum benefit with minimum dose of local anesthetic as compare to Lignocaine Nebulization for awake fiberoptic bronchoscopy-guided nasotracheal intubation, in terms of ease of intubation and patient satisfaction. However, Lignocaine Nebulization can be used as an alternative technique for airway anesthesia when a nerve block is not feasible as we did not observe any case of failure of awake fiberoptic intubation or any complications in group of nebulization.

115. Analysis of Dengue Infection with Hepatic Dysfunction in the Pediatric Patients: Prospective Analysis.
Zahida Inkisar Khan
Background and Aim: Infection with dengue is a significant public health issue in the majority of tropical regions of the world, with the Indian subcontinent and other south east Asian nations having the highest risk. The clinical profile of dengue, however, has only been the subject of a relatively small number of researches. Hence the aim of the present study was to analyze the clinical correlates like clinical features, laboratory parametres, morbidity and mortality. Material and Methods: Patients for the research analysis were selected as per criteria. For the study to be statistically significant, a sample size of 200 was taken. Patients with dengue seropositivity were chosen, clinically evaluated for hepatatomegaly and jaundice, and given liver function tests, full blood counts, abdominal ultrasounds, and analyses of PT, APTT, Widal, HBsAg, and HCV. Results: 200 patients with dengue infection were hospitalised, and 84 were diagnosed as having probable dengue, 94 as having warning signs, and 22 as having severe dengue. Of the patients, 55% had hepatomegaly. 93.6% of patients with warning signs and 100% of those with severe dengue were found when the groups were compared. 74% of patients with probable dengue, 98% with warning signs, and 100% with severe dengue experienced thrombocytopenia. Conclusion: Dengue outbreaks are more frequent in developing nations like India. Early detection of the same would help to avoid life-threatening complications as hepatic impairment in dengue is temporary and reversible. This may aid in lowering dengue infection-related morbidity and mortality. More research is needed to examine how hepato protective medications affect morbidity and death.

116. Surgical Outcome of Spinal Tumors in a Tertiary Care Hospital, India.
Mohammed Minhajuddin Harsoori, Arvind Kumar Tyagi, Mayukh Kamal Goswami
Introduction: Now a day’s schwannomas, meningiomas and neurofibromas are more commonly seen spinal tumors in the cervical spine, thoracic spine and lumbar spine respectively. Intradural extramedullary spinal tumors are almost benign, however the aim of the surgical management is always total excision. Objectives: The current study was conducted to know the incidence of different types of tumours in intradural extramedullary compartment and analysis of the clinical presentation, to study the radiological features, to study treatment modality and functional outcome of after surgery. Methodology: A total of 44 patients with intradural extramedullary spinal tumor with all the age group and sex were included in the study. These patients were clinically evaluated for their signs and symptoms and they were investigated with X-ray, CT scan and MRI scan. The surgical excision was carried out based on the outcome of investigations. The various neurological scales like Frankel scale and McCormik scale were used to assess the functional outcome of the patients, postoperatively. Results: From the current study it can be concluded that the Intradural extramedullary tumors are majorly benign type largely affecting in 41-60 years of age with male predominance. Shwannoma and Meniongioma are the typical type of spinal tumors with dorsal location largely. The significant neurological and sphincter control improvement was observed in postoperative patients. Postoperative McCormik Grade II scoring was achieved with good functional outcome.

117. A Cross Sectional Study among Adolescent School Going Girls to Know Prevalence of Anemia and Factors Contributing it.
Abhay Kumar, Iquebal Hussain, Rajranjan Prasad
Background: Anemia is present when there is less levels of Hb% as per age and sex. Iron-deficiency anemia is the most common and intractable national problem of adolescent girls. Aim: To study prevalence & factors contributing to anaemia among adolescent school girls in secondary/ Higher secondary school of Purnea. Material and Methods: A cross sectional study was done among 260 school going adolescent girls (10-19Yrs) of government schools in Purnea region from July 2022 to September 2022. Two study groups were selected from two different girls’ school by random sampling method. Haemoglobin status of the study subjects were measured in the school. Data like Education of mother, Family size, SES, dietary habits, anaemia related knowledge, WIFs use, menstrual pattern, duration of menses, Hand washing practices etc among adolescents’ girls were collected by interview method and Statistical analysis were done by Microsoft Excel & SPSS software version 26. Result & Conclusion: The prevalence was 41% among adolescent schoolgirls. Prevalence of anemia was dependent on the knowledge about prevention of anemia, literacy level, food habits like frequency of Iron rich source viz. green leafy vegetable & non vegetarian diet, WIFs use, Sanitation etc.

118. Hyperglycemia and Hypertension are Associated as Parallel Risk Factors in Metabolic Syndrome at the Onset of Renal Dysfunction: A Cross-Sectional Study in a Rural Population of Northern India.
Gajraj S Yadav, Prerna Singh, Rajesh B Ramteke
Background: Studies were scanty in the rural population related to metabolic syndrome (MS) and renal dysfunction. Objective: To assess risk component of MS and its association in renal dysfunction of patients with metabolic syndrome in rural population. Materials and Methods: The study sample of 279 adult patients (143 male and 136 female) with metabolic syndrome, residing in a rural area of Jaipur district. The metabolic syndrome was defined as the presence of three or more of the following: elevated blood pressure, low high-density lipoprotein cholesterol level, high triglyceride level, elevated glucose level, and abdominal obesity. Blood samples were analyzed for serum urea, serum creatinine, eGFR. Results: (FPG and hypertension) Patients with serum urea above normal was 32.26% (male and female ratio was 1.2:1). Patients with serum creatinine above normal were 32.26% (male and female ratio was 1.25:1). Patients with eGFR below normal were 73.84% among them 32.62%, 13.26%, 11.47%, 7.89%, and 8.6% patients were reported under kidney disease stages of 2nd, 3rd a, 3rd b,  4th and 5th according to eGFR stages. Conclusion: Prevalence of renal dysfunction is high in patients with complication of uncontrolled & prolonged hyperglycemia and hypertension associated as parallel risk factors of MS components.

119. Prevalence of High Risk Human Papillomavirus (HPV) Type 16 and Type 18 in Carcinoma of Cervix Patients in a Tertiary Care Hospital in Western Rajasthan.
Khushboo Joshi, Mohan Singh, Garima Khatri, Sunita Bika, Nirmala
Introduction: Cervical carcinoma is one of the commonest cancers of female anogenital tract and the leading cause of morbidity and mortality. It is the second most common cancer among women in this country. The major risk factor is persistent infection of  Human papilloma virus (HPV) infection, High risk  HPV 16 and 18 confer a greater risk of having cervical cancer than other genotypes. Aim: To find out the prevalence of high risk type HPV 16 and 18 infections in carcinoma of cervix patients. Materials and Methods: In present study, total 200 cervical carcinoma patients above the age of 25 years were included. Cervical biopsy samples were collected from Acharya Tulsi Regional Institute of Cancer Research, Bikaner. Genomic DNA were isolated from commercially available DNA isolation kit as per manufactures instruction. For detection and amplification of HPV type 16 and type 18 Real time PCR technique was used. Amplified product was identified by fluorescent signal generated from the presence of an oligonucleotide probe specific for target DNA sequence. Results:  Mean age of Cervical cancer Patients was 50.28 ± 10.01 Years. Out of 200 samples, 179 (89.5%) were recorded positive for HPV DNA. A total of 152 (76%) and 43 (21.5%) patients were found infected with HPV 16 and 18 respectively. On the other hand 16 (8%) patients were infected with both HPV type 16 and HPV 18. Conclusion: Results suggest that HPV 16 and 18 infections are highly prevalent in the cervical cancer patients. These results will be useful in establishing the future guidelines for reducing risk of cervical cancer with the help of screening programs and by providing proper vaccines targeting HPV16 and 18.

120. Prevalence and Association of High Risk Human Papillomavirus (HPV) Type 16 and Type 18 with Various Risk Factors in Cervical Cancer Patients in North Western Rajasthan.
Khushboo Joshi, Mohan Singh, Sunita Bika, Garima Khatri, Nirmala
Introduction: Cervical cancer is one of the commonest cancers of female and the leading cause of morbidity and mortality. It is second most common cancer in India. In 2020, Globocan estimated 123,907 incident cases and 77,348 deaths, with an age-standardized incidence rate of 18 per 100,000 women and a cumulative risk of 2.01%. The major risk factor is persistent infection of  Human papilloma virus (HPV) infection, HPV  16  and  18  are  found  with  the  highest frequencies   and account for approximately two thirds of all cervical carcinomas worldwide, with HPV-16 occurring most frequently. Aim: To find out the prevalence and association  of high risk type HPV 16 and 18  with various risk factors in cervical cancer patients. Materials and Methods: In present study, total 200 cervical carcinoma patients above the age of 25 years were included. Cervical biopsy samples were collected from Acharya Tulsi Regional Institute of Cancer Research, Bikaner. Genomic DNA were isolated from commercially available DNA isolation kit as per manufactures instruction. For detection and amplification of HPV type 16 and type 18 Real time PCR technique was used. Amplified product was identified by fluorescent signal generated from the presence of an oligonucleotide probe specific for target DNA sequence. Results:  Mean age of Cervical cancer Patients was 50.28 ± 10.01 Years. Out of 200 samples, 179 (89.5%) were recorded positive for HPV DNA. A total of 152 (76%) and 43 (21.5%) patients were found infected with HPV 16 and 18 respectively. There was statistically significant association between  elder age, menstrual status and parity with HPV 16 and HPV18. Conclusion: In cervical cancer patients HPV 16 and 18 infections are highly prevalent and various risk factors  like elder age, parity were significantly associated with HPV.  These results will be useful for better management of disease in term of screening and early detection and prevention..

121. Intestinal Parasitic Infestation in School Going Children and its Effect on Their Growth.
Desh Nidhi Singh, Ramesh Yadav, Alok Kumar Gupta, Chitra Chauhan, Shrawan Kumar, Pranjal Pankaj, Khutija Sarah
Introduction: Environment protection has declined due to industrial growth and a population movement from rural to urban areas. Children that reside in these zones in particular struggle with their nutrition due to parasite and helminthic illnesses. One of the most significant social and medical issues is intestinal parasite infections. According to epidemiological research, parasitic infections are one of the most prevalent illnesses and a significant global public health issue. Entamoeba histolytica, Giardia intestinalis, Cyclospora cayetanensis, and Cryptosporidium spp. are the most prevalent intestinal protozoan parasites. Aims and Objectives: To investigate intestinal parasitic infestation among children. Methods: This prospective study was conducted on children between 6-12 years of age. The stool samples and necessary information were collected. Stool samples were collected in wide-mouthed containers and delivered in under an hour to the lab. The data was arranged and analyzed according to the distribution of parasites based on the occurrence and age of the patients. Results: The study found pathogenic eggs and cysts made up 74.5% of the total, while nonpathogenic intestinal parasites made up 36.1%. While helminthic infestation made up 42.2% of the total parasite infestation, protozoa made up 59.7% of it. Entamoeba histolytica (20%), Giardia lamblia (14.4%), Ascaris lumbricoides and Hymenolepis nana (6.7%).  Intestinal parasites were found in 54.2% of children with uneducated moms and 72.4% of children. Conclusion: The study concluded that A. lumbricoides was the most prevalent helminthic infestation in our investigation. 32.9% of the participants in our study had two parasite illnesses. Protozoal cyst isolation was higher than helminthic ova isolation. Our research revealed that E. histolytica was the most prevalent intestinal parasite found.

122. Sub-Tenon Anaesthesia for Cataract Surgery.
Bhaskar Dutt, Hariom Khandelwal, Anoop Singh Negi, Nigar Bari, Manu Bhardwaj, Nitish Kumar Parmar
Introduction: Sub-Tenon block is nowadays most preferred technique for analgesia in many eye hospitals for cataract surgery. It has gained popularity as it has lesser chances of major complications, which were remarkably more with other conventional blocks like peribulbar and retrobulbar blocks. It has been seen that its use is much safer in patients on anticoagulants and antiplatelets drugs. Studies have shown that the incidence of minor sub-conjunctival hemorrhage is increased in patients on aspirin, clopidogrel, and warfarin, but there is no increase in major hemorrhages. According to recent research, more than 87.6% of members of the British Ophthalmic Anaesthesia Society employ this approach in their regular practice. This block has gained popularity in several nations, including the United Kingdom. Aims and Objectives: To evaluate the efficacy of Sub-Tenon’s anaesthesia in cataract surgery. Methods: The study was conducted on 150 patients who underwent cataract surgery. After topical anaesthesia (0.5% proparacaine), a careful dissection in subtenon space in inferonasal quadrant was done 7-10 mm posterior to limbus and midway between the insertion of medial rectus muscle and the inferior rectus muscle. A blunt-tipped cannula was inserted and 2.5 ml of a 1:1 mixture of 2% lidocaine and bupivacaine 0.5% was injected into the posterior Sub-Tenon’s space. The study analyzed presence of chemosis, sub-conjunctival haemorrhage, degree of akinesia, and pain score. The pain was evaluated at the time of administration of the Sub-Tenon block and during the time of surgery. Results: The study found that while preforming STB 59.33% of patients had no pain and around 36.7 % of patients had mild to moderate pain. Most patients developed subconjunctival haemorrhage (94.67%) and chemosis (89.33%). Chemosis and conjunctival haemorrhage were frequent but caused no perioperative problems. Conclusion: The study concluded that Sub-Tenon block with Topical Anesthesia can be used safely as a sole Anesthesia technique in cataract surgery.

123. Effectiveness of Platelet Rich Plasma as an Adjuvant for Union in Humerus Shaft Fractures Treated Surgically.
Padala Ashok, K. Uma Maheshwar, Telakapally Mallikarjun
Background: Humerus fractures accounts for 3-5% of all fractures and diaphyseal fractures account for 30% of all humerus fractures. There are various treatment options from conservative treatment to different surgical fixations. The incidence of Non-union is 2-10% in conservatively treated fractures and 13% in surgically treated fractures. The ability of PRP in providing huge amount of growth factors stimulates tissue regeneration and healing process. This present study aims at studying effect of PRP on bone union and functional outcome of humerus shaft fractures treated surgically. Materials and methods: 20 patients with humerus shaft fracture after following inclusion and exclusion criteria were enrolled in this prospective non randomised study. All the patients received 5ml of PRP injection at the fracture site after internal fixation weather open or closed reduction is performed. The patients were followed up and evaluated for radiological union and Neer’s functional score[1] at end of 1st month, 3rd month and 6th month. Results: This study included 20 cases treated surgically. Out of which 70% were males and 30% females, with mean age being 40.58 yrs. Most involved side being right side. Mode of injury is RTA in 80% and self-fall in 20% none due to assault. Plating was done in 85% and nailing in 15%. 83% of patients achieved union by end of 3rd month probably due to PRP and 90% achieved excellent outcome by end of 6 months. Conclusion: The statistical improvement in p value for all components in Neer’s scoring system indicates there is some positive effect of PRP on pain relief, range of motion and functional outcome when used as adjuvant in fracture fixation.

124. A Study to Evaluate Maternal and Fetal Outcomes of Hypothyroidism Complicating Pregnancy.
Mallapu Varsha, Sahitya Jayaram. A, Yengoti Kusuma
Background: Pregnancy plays as a stress test to assess the function of maternal thyroid system. Thyroid dysfunction occurs very commonly in the pregnant women. Hypothyroidism occurs in more than 10% of all the pregnant women. Hypothyroidism may result in anaemia, low birth weight and mental retardation in the newborns. The present study analyzed the maternal and fetal outcomes of Thyroid dysfunction in pregnant women. Aim of the Study: To investigate the maternal and fetal outcomes in women who presented with Thyroid dysfunction during their pregnancy. To compare the same outcome variables with the pregnant women with normal thyroid function, attending Viswabharathi Medical College Hospital and General hospital, Kurnool. Materials and methods: This was a Prospective and comparative clinical study which included 50 pregnant women with hypothyroid status and 50 pregnant women with normal thyroid function results. The maternal and fetal outcomes of these pregnant women of two groups were studied and analyzed. Thyroid Function tests values of women were compared with American Pregnancy and Thyroid Association; the cut off values used were: The usual value for participants in the control arm was 0.1 to 2.5 uI U/L in the 1st trimester and 0.2 to 3 uI U/L in the second trimester. Those with TSH concentrations of more than 2.5 uI U/L in the 1st trimester and more than 3 uI U/L, in the second trimester were enrolled in the trial and their fT4 and anti-TPO levels were estimated. Results: The prevalence of normal deliveries and Abortions were statistically significant (p-value <0.05) and the other variables were not significant. 29/50 (58%) of the pregnant women with hypothyroidism and 18/50 (36%) of the pregnant women without hypothyroidism had Anemia and the difference was found to be statistically significant (p value <0.05). Conclusion: It is mandatory to estimate the targeted TSH screening for pregnant women especially those at high risk for thyroid deficiency before or during early pregnancy. It was necessary to estimate TPO antibodies in all the pregnant women who have higher levels of TSH values. The risk of pregnancy loss to mothers and preventing low birth weights in the newborns could be avoided effectively. The risk of pregnancy was more in patients with positive TPO antibodies.

125. A Study to Access the Role of Serum Ferretin Levels as an Early Prognostic Marker to Predict the Severity of Dengue Viral Fever.
Khushboo Jain, Manish, Mohammed Riyaz Bhati, Ravindra Tiwari, Chandra Kant
Dengue fever is among the world’s foremost viral hemorrhagic fevers, the most geographically widespread arthropod-borne viral illnesses. Compared to other bacterial and viral infections, the level of serum ferritin disproportionately raised in dengue fever and the raised level of serum ferritin corroborates with an increased risk of developing complications. Ferritin could be used as a marker to differentiate between dengue and other acute febrile illnesses. Method: In this prospective study we included 100 patients with confirmed diagnosis of dengue fever conducted for eighteen months. The patients underwent all routine investigations and serum ferritin levels. The ferritin levels are recorded and analyzed and compared with severity of dengue illness. Results: The mean age of study group was 37.8 years and the age of patients ranged from 21 to 56 years. 67% were males and 33% were females. Fever (100%) was the most common symptom. Only 12 cases were having severe dengue. 88 cases were not severe among 100 patients. AST (Aspartate aminotransferase) and ALT (Alanine aminotransferase) were higher in patients with severe dengue. P value=0.001. Serum ferritin levels during day 1 and day 4 were significantly higher in patients with severe dengue, as evident from the P value in the current study. Serum ferritin levels were more during day 4 of dengue compared to day 1. Conclusion: The study concluded that ferritin level as a good to excellent predictor in the diagnosis of dengue. We also had the same opinion. The study identified that high serum ferritin levels of more than 1,200 ng/ml could predict dengue hemorrhagic fever.

126. Evaluation and Treatment of Unexplained Infertility in a Tertiary Care Centre.
Sahitya Jayaram. A, Mallapu Varsha, Yengoti Kusuma
Background: Unexplained infertility is defined as the failure to conceive without any definitive cause for infertility. The incidence was 15-30% of all infertile couples. The diagnosis of unexplained infertility is made when regular investigations for infertility do not show any obvious barriers to conception. It was also termed as Idiopathic Infertility by some authors and included multiple and different conditions causing infertility. Aims: To evaluate and treat couples who were diagnosed to have unexplained infertility; to evaluate the outcome following treatment. Secondary Objectives: To compare and evaluate with couples who have other causes of infertility other than unexplained infertility. Methods: A total of 80 couples were divided into a study and a control groups. 40 were belonging to study group, Control group contained 10 cases of oligospermia, 10 of PCOS, 10 of tubal block, 10 cases of hypothyroidism. All the investigations were carried out, treated according to the cause and compared the outcome in different groups. The study was primarily aimed at investigating the couples to evaluate the cause of unexplained infertility and treating them accordingly. Results: According to the age of the couples, BMI did not show any significance as all were almost in normal limits. In case of PCOS, 60% had conceived with proper approach. HSA association in infertility has been proved where the p value was <0.05 which was statistically significant. In the control group out of oligospermia couples, 3 conceived with ICSI which showed a pregnancy rate of 30%. In Hypothyroid couples the conception rate was 40-50% which was statistically significant. IUI+COH was done in the study group on two days showed a conception rate of 45% when compared to OI alone. Conclusions: Proper categorization of the infertile couples was essential and most important in planning the management and avoiding unnecessary investigations. Proper counselling plays an important role in all the unexplained infertility couple in regards with investigations and treatment. The fertility rate in the infertile couples could be improved even though the exact cause infertility could not be explained. Finally, we conclude that proper identification and management will show a good outcome, irrespective of the cause of infertility.

127. Comparison of TIRADS [Thyroid Imaging Reporting and Data System] with Histopathology in Evaluation of Thyroid Nodules.
Raghunatha Reddy, G. Rakesh Sharma, J. Abdul Gafoor, O. Joji Reddy
Background: A noninvasive method for the initial evaluation of thyroid nodules is ultrasonography (US). Malignant thyroid nodules can be distinguished well by Thyroid Imaging Reporting and Data System (TI-RADS). The purpose of the study was to evaluate the reliability of ACR TIRADS score in distinguishing between benign and malignant thyroid nodules using histopathology as the gold standard. Materials and Methods: The prospective study was conducted on 50 patients referred to the Department of Radiodiagnosis at Viswabharathi General Hospital in Kurnool between 2021 and 2022. ACR-TIRADS categories were used to interpret patients with thyroid nodules. For these thyroid lesions, the patients had FNAC or biopsy. The risk of malignancy was estimated for each category and correlated with FNAC/Histopathology. Results: We have studied 50 patients with thyroid nodules, Out of 50 lesions, 42 were found to be benign and 8 lesions were malignant. The risk of malignancy for ACR-TIRADS1, TIRADS2 and TIRADS 3 were 0%, TIRADS 4 and TIRADS 5 lesions had 80 %, and 100 % risk of malignancy respectively. The most common malignant pathology in our analysis was papillary carcinoma, whereas the most common benign entity was benign follicular lesion. Conclusions: ACR TIRADS is more accurate in distinguishing benign from malignant thyroid nodules and more dependable in recommending thyroid nodules for FNAC. Unnecessary FNAC can be prevented by employing ACR-TIRADS.

128. Adenoidectomy in Paediatric Cases – Endoscopic Assisted Coblation Method versus Conventional Curettage Method.
Rhesa Noel, K. Rajashekhar, Mrudula Mukiri
Introduction: Adenoidectomy is a common surgical procedure in children. Conventional curette adenoidectomy claimed few disadvantages including high operative blood loss and postoperative recurrence. Endoscopic assisted coblation adenoidectomy gained better outcome with minimal postoperative complications. The present study was designed to assess the efficacy of endoscopic assisted coblation and conventional curettage method in adenoidectomy in paediatric patients. Material and methods: A total of 48 cases clinically diagnosed with adenoid hypertrophy between age group 5 to 15 years were included. Study participants were randomly divided in to two groups. Group 1 (conventional curettage adenoidectomy) and group 2 (endoscopic assisted coblation adenoidectomy). Parameters like total surgical duration, operative blood loss, recovery time and visual analogue score was recorded. Results: The mean operative blood loss was 30.78 ml in group 1 and 12.76 ml in coblation group. The mean pain score was 4 in group 1 and 3 in group 2. The mean recovery duration was 3.56 days in group 1 and 2.59 days in group 2. The mean difference of operative blood loss and pain score between two study groups was statistically significant (p<0.05). Conclusion: Endoscopic coblation adenoidectomy was effective in terms of minimal operative blood loss, less operative pain score, less recovery period and higher rate of adenoid tissue removal compared to conventional adenoidectomy.

129. Efficiency of Intubation between Mcgrath MAC Laryngoscope and C-MAC Video Laryngoscope in Patients Undergoing Elective Surgery
Parab Abaji Laxman, Prasanna Patil
Introduction: Tracheal intubation using Direct Laryngoscopy (DL) is a well-established and favored technique for opening the airway. Video laryngoscopy (VL) is crucial in the treatment of patients who experience unexpected airway problems or unsuccessful tracheal intubation. Because it allows for an enhanced view of the glottis without the need for a direct line of sight, indirect VL has grown to be widely acknowledged as a technique for learning the methods of airway management. The difficult airway task force of the American Society of Anesthesiologists (ASA) advises having a VL on hand as the fi rst rescue device for all patients undergoing intubation.Aims and Objectives: To compare the efficiency between McGrath MAC Laryngoscope and C-MAC Video Laryngoscope in terms of the success of endotracheal intubation in elective surgery. Methods: A prospective randomized comparative study was conducted on the patients of ASA-I and ASA-II status, who were planned for endotracheal intubation under general anaesthesia.  These patients were divided into two groups and baseline characteristics and grading were determined and analyzed. Results: The laryngoscopic views of grade I, IIa, IIb, III in both ML and CL were 57.7%, 26.9%, 11.5%, 3.8%, and 48.1%, 32.7%, 15.4%, 3.8% respectively. It has a p-value of 0.384 showing a difference between both the groups to facilitate is statistically not significant. In grade, I patients the time taken for intubation in CL was 22.04±3.63 and in ML was 33.6±14.79 secs. The requirement of aids in CL was 10 out of 52 (19.2%). Out of this 1.9& require bougie, 9.6% require ELM, and 7.7% require bougie plus ELM, whereas in ML patients 30.7% require air intubations out of which 7.7% require bougie, 11.5% require ELM, and 11.5% require both. Conclusion: The study concludes that the MCGrath MAC VL provides a better view in laryngoscope compared to C-MAC. For the endotracheal tube intubation, the time is comparable in both groups.

130. A Study of the Risk Factors for Lower Limb Amputation in Diabetic Foot: A Single Centre Experience
Rajesh Kumar Mahey, Sudatta Waghmare, Arjav H Nanavati, Tejas P Narkhede, Abhi H Kothari, Praveen Kumar
Introduction: Diabetes is a global health crisis, which results in major economic consequences for patients, their families and society. More than 415 million people are diagnosed with diabetes worldwide. This number is rapidly increasing and is expected to reach 640 million by 2040. About 15% of diabetics develop a foot ulcer and 12-24% of them require amputation, making diabetes a predominant aetiology for non-traumatic lower extremity amputations. Methodology: In this study, 75 cases of patients with diabetic foot, who were admitted and treated were considered with due consent. It is a prospective observational study conducted at a tertiary care centre for 1 year. Discussion: In our study, 40 out of 75 patients underwent amputation. The mean age group of our study was between the 5th and 7th decade with a male preponderance. Several factors were studied to find the statistical significance leading to amputations. Important risk factors for amputation in patients of diabetic foot identified as per our study were chronicity of diabetes mellitus, poor glycaemic control, foot deformity, higher Wagner’s grade (IV, V) and presence of infection, neuropathy and vasculopathy. Conclusion: Patients of diabetic foot ulcer presenting with one or more of the above risk factors should undergo a thorough evaluation, vigilant surveillance, strict glycaemic control with aggressive treatment and adequate patient counselling to prevent them from undergoing an amputation. To avoid amputation, a multidisciplinary approach is of prime importance in effectively managing patients with diabetic foot ulcer.

131. Functional Outcomes of Anterior & Posterolateral Rotatory Instability of Knee Managed with Arthroscopic ACL Reconstruction and Modified Larson Technique
H Varrdhaman Dhariwal, T. Aravinth, C. Mathan Kumar, T. Tholgapiyan, C Ashokan, K. R. Vidyaprakash
Background: Most common cause of failure following ACL reconstruction surgery is missing of posterolateral corner injuries. Posterolateral corner injuries are one of the most debilitating conditions that affects the knee joint, usually not occurring in isolation. It is frequently underdiagnosed (or) undertreated, resulting in the poor outcome of the ACL reconstruction surgeries performed. Through this paper it is firmly established that repairing the structures in the posterolateral corner using the modified Larson technique significantly improves the overall functional outcome of the patient and overall performance. Most of the patients presenting with PLC injuries will have reported instability affecting the daily activities of the person. Aim: To assess the functional outcome arthroscopic ACL reconstruction AND Modified Larson technique reconstruction done together. Settings and Design: Last 5 years retrospective review of functional outcome of both Arthroscopic ACLR and modified Larson technique reconstruction done together. Methods: 20 patients retrospective review with Lysholm-Tegner and IKDC (subjective). Results: Excellent to good functional outcome.18 person showed excellent functional outcome and 2 peson showed good functional outcome. Conclusions: ACL along with posterolateral corner injuries where the popliteus is not injured adding modified Larson technique to arthroscopic ACLR is of immense value.

132. A Study on Knowledge, Attitude and Practices among Healthcare Workers in Intensive Care Units about Safe Injection Practices in Tier-2 City in Maharashtra
Sneha Gupta, Nita M Gangurde, Devayani Hire, Sushil Suresh Anturlikar
Background: The magnitude of problem of unsafe injections including re-use and other unsafe practices has been estimated by WHO in 2000s are approximately 16.7 billion injections are administered worldwide with estimates indicating that up to 40% were given with the used equipment and citing reuse rates as high as 75% in some countries. In view of less availability of such studies and increasing harms regarding unsafe injection practices in India among healthcare workers this study was proposed and undertaken. Methods: This was a descriptive cross sectional study involving 200 participants. After obtaining written informed consent from the healthcare workers (HCW), they will be interviewed in the form of Self-administered questionnaire (SAQ). The SAQs had four parts: Knowledge, Attitude, Practices and Facility observation. WHO tool C was used for SAQ preparation with modification. Collected data was analyzed using Microsoft Excel & SPSS. Results: The Knowledge, attitude and practices were found to be satisfactory among the study participants. Though some important observations were , almost ( 74%) of the nurses believed that HIV is the pathogen that constitute the major chunk of blood borne pathogen which can be transmitted due to unsafe injection practices. Nursing staff included in the study (48%) was of the opinion that the multi dose vials can be used for more than one patients if it enters immediate patient area. Also, we observed that proper hand hygiene, using alcohol-based hand rub or soap and water, was performed prior to preparing and administering medications only in 60% of the nursing staff. Conclusion:In our study we observed fairly good amount of compliance among healthcare workers with respect to safe injection practices. Though, there were some lags in the practices among HCWs in few important areas. This study highlights the magnitude of the problems related to safe injection practices among HCWs.

133. To Study the Association between Weather Conditions and Changes in the Pain Perception of Subjects with Osteoarthritis Knee.
Satyen Joshi, Brijbhushan Mahajan, Krishna Anerao, Chinmayi Chitale, Raunak Phundwani, Jeetendra Singh
Background: This is an observational study regarding seasonal variation in perception of pain in primary osteoarthritis (OA) knee. This paper aims to gather information which might contribute in planning effective preventive strategies to maintain and to improve the quality of Life in patients with Primary Osteoarthritis knee. Materials and methods: It is a longitudinal study conducted in various orthopaedics OPD and clinics. Diagnosed cases of Primary OA of knee were interviewed using standard questionnaire and scoring using Visual Analogue Score (VAS) in the 3 Indian seasons. Result: According to VAS 73.3 % had most severe pain in winters followed by 26.2% in rainy and 0.4 % in summer. Gender -wise distribution suggested more pain in females as compared to males. As per age-wise distribution, the pain perception was more in patients in age group of 45-59 years of age as compared to those above and below this age group. Discussion: OA is a chronic degenerative disorder whose exact etiology is unknown and is multi-factorial disease causing pain. There are many theories of pain genesis; one of them is effect of change in temperature. It is well documented by the fact that various symptoms increased at lower temperatures including pain and there is subjective relief from the pain after application of localized heat remedies. Such heat remedies cause vasodilatation and hence, there is increased blood flow which leads to washing away of the inflammatory infiltrates, leading to relief from the pain. Environmental factors such as decrease in temperature and moisture have been noticed to contribute to symptomatic worsening. Also some other factors such as levels of hormones, antibodies, inflammatory factors and immune responses could also be responsible for this trend.

Conclusion: There is seasonal variation in the perception of pain in previously diagnosed osteoarthritis knee patients, with an increased level of pain observed when there was decrease in atmospheric temperature during winter and rainy season.

134. Significance of Tiotropiumin Early Chronic Obstructive Pulmonary Disease.
Umesh Teltumbade, Likhit Gandhi
Introduction: Chronic inflammatory lung disease (COPD) can be affected around 4% to 10% of people. Cigarette smoking is the main cause of COPD along with the environment and genetic variables which also increase the disease burden. On the other hand, the intention of COPD management, through different kinds of activities they want to prevent quitting smoking as well as enhance environmental sustainability. In addition, due to this COPD, people are several kinds of difficulties such as tiotropium lowering air trapping, alleviating exertional dyspnea, increasing exercise tolerance, and others. Aims and Objectives: To find out the efficacy of tiotropium in managing exacerbation of COPD. Methods: This future research will be conducted on kids who are between 6 to 12 years and collect their stool samples and other important data has been collected through this research. In addition, these stool samples have collected in wide-mouthed containers as well as it has been delivered in under an hour to the lab. Therefore, this data has been organised and examined as per the share of parasites based on the circumstance and age of the sick people. Results: This research has discovered that FEV1 can happen before bronchodilation. Similarly, this placebo group would be higher than the tiotropium group. In addition, at the same, it would be noticeable the bronchodilation can p<0.05. Therefore, this research has illustrated that sick people feel exacerbation significantly higher within two years. Even this Placebo group is compared with the Tiotropium group (p<0.05). Conclusion: This research has concluded that tiotropium can prevent COPD exacerbations compared to a placebo, through previous case studies. On the other hand, from dry mouth or pharynx discomfort, equally, if this trial does not indicate any significant differences between tiotropium and placebo in the duration of any negative circumstances, such as cardiovascular effects or urinary tract infection.

135. Risk of Adverse Pregnancy Outcome in Women with Polycystic Ovarian Syndrome (PCOS) at JLNMCH, Bhagalpur, Bihar.
Anupma, Gopal Sharan Singh, Anupama Sinha
Background: There is some evidence that pregnant women with polycystic ovarian syndrome are more likely to experience poor maternal and perinatal outcomes. There are few data from India analysing the success of pregnancies in women with polycystic ovarian syndrome. To assess the success of pregnancies in women with polycystic ovarian syndrome, this study was proposed. Methods: From May 2021 to October 2022, this descriptive study on 135 pregnant women with polycystic ovarian syndrome at the JLNMCH in Bhagalpur, Bihar. Using SPSS version 20, data on the current pregnancy, polycystic ovarian syndrome, and maternal/perinatal outcomes were analysed. Parity and various maternal and perinatal outcomes were evaluated as categorical factors. Results: With a mean age of 26.8 years, a high BMI of 77%, and a history of primary infertility in 88% of cases, With a mean age of 26.8 years, a high BMI of 77%, and a history of primary infertility in 88% of cases, Pregnant women who had hypertensive disorders were more likely to have PROM (18.5%), low APGAR scores at 5 minutes (13%) and gestational diabetes (13%) than those who did not. They were also more likely to experience miscarriage (2.2%), preterm birth (10.4%), caesarean delivery (30.4%), low birth weight babies (2%), macrosomia (0.7%), PPROM (8%), perinatal mortality (2%) and NICU admission (20%). Conclusion: However, the proportion of GDM, miscarriage, preterm delivery, meconium stained liquor, caesarean delivery, small for gestational age/IUGR, macrosomia, PPROM, perinatal mortality, NICU admission, and congenital anomalies was found to be either similar or lower in pregnant women with PCOS in our study compared to those described in the general pregnant population.

136. Comparison of Abdominal, Vaginal and Non-Descent Vaginal Hysterectomy and its Perioperative Outcome at JLNMCH, Bhagalpur, Bihar.
Anupma, Gopal Sharan Singh, Anupama Sinha
Background: The most frequent major gynaecological procedure performed on women is a hysterectomy. Abdominal hysterectomy (AH), vaginal hysterectomy (VH), and non-descent vaginal hysterectomy are the three primary forms of hysterectomy procedures currently available (NDVH). This study compares the intraoperative and postoperative consequences of hysterectomy performed via the abdominal versus vaginal routes. Methods: From May 2021 to October 2022, a prospective study was carried out at the JLNMCH in Bhagalpur, Bihar, in the department of obstetrics and gynaecology. 479 hysterectomies were included in the study. The majority of cases, 281 (58.6%), fell into category I (TAH), followed by 136 (28.3%) cases in category II (VH), and 62 (12.9%) instances in category III (NDVH). Results: The average operation time for categories I, II, and III was 74.01± 22.2 minutes, 69.19±19.01 minutes, and 67.5±23.12 minutes, respectively. Category I (TAH) had a considerably longer average surgical time than categories II(VH) and III (NDVH). As compared to categories II (VH) and III (NDVH), category I (TAH) patients experienced significantly greater postoperative problems, such as fever, wound infection, and UTI (p value <0.05). Conclusion: No scar, no adhesions, less problems, a shorter hospital stay, and quick recovery were just a few benefits of NDVH over abdominal hysterectomy. Therefore, wherever possible, the vaginal route for hysterectomy should be chosen.

137. A Tertiary Hospital Based Study of the Clinical Profile, Outcome, and Prognostic Factors of Acute Kidney Injury.
Man Bir Subba, Binay Kumar, Ashok Kumar Singh
Background: Acute kidney damage (AKI) is a significant factor in hospital mortality, particularly in patients who are critically unwell. Different clinical presentations are seen. To determine prospective areas for intervention, a thorough understanding of AKI is necessary. The course of renal disease can be stopped by early detection and treatment of AKI in a possibly reversible stage. Methods: This observational study was conducted at Department of Medicine, JLNMCH, Bhagalpur, Bihar from November 2021 to October 2022. The study population was evaluated once the relevant inclusion and exclusion criteria had been applied. The clinical profile of AKI was evaluated, including the aetiology, symptoms, indicators, and blood tests. AKI’s stage and result were identified. In an effort to better monitor patients with AKI, factors that influence AKI outcome were sought for. Using the chi square test and Kruskal Wallis tests, associations were identified.Results: The study’s population’s clinical profile was discovered to be comparable to prior research. The most frequent type of renal failure was intrinsic, and sepsis was the most frequent cause. A significant correlation between the result and eGFR, hospital days, and KDIGO stage of AKI was found. Poor outcome was linked to the need for hemodialysis, ventilator support, and inotropes. The 24-hour urine output, blood urea, and serum creatinine were the best predictive indicators. Conclusions: Any patient who is brought to the hospital should be kept on an input-output chart and have their urine output regularly watched for any changes. Hypotension and sepsis need to be treated right away. In the case of AKI, conservative treatment is the recommended course of action because, as with all diseases, prevention is always preferable than cure.

138. A Comparative Study between Diagnosis Accuracy of Fine Needle Aspiration Cytology and Histopathology in Salivary Gland Swelling.
Amit Ranjan, Bhavya Singh, Deepak Kumar
Objectives: The present study was to evaluate the diagnosis accuracy of fine needle aspiration cytology and histopathology of salivary gland swelling in various age group patients. Methods: Fine needle aspiration cytology was performed in all suspected patients of salivary gland swelling. Using a 22 or 23 G needle, FNAC was done in all patients using a standardized procedure. Strict adherence to the protocol was maintained in all steps of the procedure. Smears prepared were fixed in standard solutions and studied. The cytological diagnosis like chronic sialadenitis, pleomorphic adenoma, warthin’s tumors, monomorphic adenoma, adenoid cystic carcinoma, mucoepidermoid carcinoma and acinic cell carcinoma were reported. A scanty cellular smear or drying artifact making interpretation difficult was reported as inadequate. Results: 100 salivary gland tumours were diagnosed by FNAC. Among these, histopathological correlations were available for 66 cases. All the cases occurred in the age group of 10-70 years and a majority of them were seen in the range of 21-30 years (26%), with a male to female ratio of 3:2. 81(81%) were pleomorphic adenomas (PA), 1(1%) were Warthin’s tumours (WT), 4(4%) were mucoepidermoid carcinomas (MEC), 1(1%) were acinic cell carcinomas, 2(2%) were carcinoma ex pleomorphic adenomas, 1(1%) were primary lymphomas of the parotid gland, 1(1%) was metastatic deposits, 5(5%) were benign parotid tumours, 3(3%) were cystic lesions and 2(2%) were malignant tumours (unclassified). PA and MEC were the commonest benign and malignant tumours respectively. Conclusions: Salivary gland dysfunction was more preponderance in young age male population. FNAC is one of the best choices for the diagnosis of salivary gland swelling in terms of high diagnostic accuracy, immediate results and lack of complications.

139. Shoulder Subluxation and its Associated Risk Factors in Post Stroke Hemiplegic Patients.
Goswami Mithlesh, Jindal Rajeshwari, Prakash Om, Jharwal Rajesh K., Gaur Kusum
Objectives: Stroke is one of the leading causes of death or disability in India. One of the major sequale of the stroke is glenohumeral subluxation (GHS). This study was conducted to find out the prevalence of shoulder subluxation and its associating risk factors in post stroke hemiplegic patients. Material and Method: This descriptive study of post-stroke hemiplegic patients was conducted in the department of PMR, SMS Medical College, Jaipur, from December 2019 to September 2020. A plan radiograph (AP view) of the bilateral shoulder was taken in standing position with an unsupported dependent arm to diagnosed the shoulder joint subluxation. Muscle power and tone of the hemiplegic shoulder was rated by Medical Research Council scale and Modified Ashworth scale respectively. Results: Thirty-seven hemiplegic participants with mean age of 53.19 ±10.78 were recruited in this study. Out of 37 participants, shoulder subluxation was reported in 21 participants (56.76%). Shoulder subluxation was found to be associated with muscle power and muscle tone of hemiplegic shoulders. Whereas there was no significant association was observed between hemiplegic shoulder subluxation and participant’s age, gender, co-morbidity and with side of hemiplegia. Conclusion: There is a high probability of shoulder subluxation in post stroke hemiplegic patients. There is a negative correlation between hemiplegic shoulder subluxation and muscle tone as well as power of muscles around the hemiplegic shoulders. This study suggest that hemiplegic shoulders with decreased muscle power and tone need more care with proper positioning of upper limbs to prevent shoulder subluxation in acute phase of hemiplegia.

140. To Evaluate the Role of First-Trimester Uric Acid Level in Prediction of Gestational Diabetes Mellitus.
Sharma Archana, Mahala Urmila, Prakash Om
Objective: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Objective of this study was to estimate serum uric acid level in first trimester of pregnancy and correlate the first trimester serum uric acid levels and development of GDM. Methods: This prospective observational study was conducted at department of Obstetrics and Gynaecology, SMS medical college and associated hospitals, Jaipur from April 2021 to October 2022. After applying inclusion and exclusion criteria, 70 cases of singleton pregnancy with gestational age <12 weeks were included in this study. Obstetrics, family and personal history was obtained from patient, all routine ante-natal investigations and Hb1Ac was done. Uric acid level was measured using calorimetric assay with detection limit of 10g/dl. The coefficient was 0.9%. All antenatal mothers were followed for around 24-28 weeks for routine GDMs screening. Around at 24-28 weeks, OGCT with 75gm glucose was done irrespective of her fasting status or timing of previous meal (DIPSI). GDM was diagnosed if after 2 hour blood glucose value is ≥140 mg/dl. Results: In this study we observed that 32.3% patients with elevated uric acid level developed GDM and 9.3% patients with normal uric acid level developed GDM. This difference was statistically significant (p value = 0.001). In this study, elevated uric acid level (>4.2mg/dl) was found a predictor of GDM and has 75% sensitive and 60.7% specific with 32.3% and 90.6% positive and negative predicted values, respectively. Conclusion: Result of this study has suggested that serum uric acid level estimation in first trimester can be used as a marker to predict the GDM in pregnant women.

141. Study on Clinical Characteristics of COPD Patients Presented with Interstitial Lung Abnormalities.
Subhash Laxmi Shankar Yadav, Hariprasad Shetty
Introduction: Chronic obstructive pulmonary disease (COPD) is defined by recurrent respiratory symptoms and airflow restriction brought on by anomalies in the airways and/or alveoli that appear following prolonged exposure to noxious substances, such as tobacco smoke. The biggest risk factor for lung fibrosis and COPD is smoking. Aims and Objectives: To analyze the various clinical characteristics of COPD patients which are attributed to Interstitial Lung Abnormalities (ILA). Methods: This is a prospective cross-sectional, this  study gathered data from patient’s visits and data collection was done based  on patient  age, sex, BMI, FEV1, FVC, the mMRC dyspnea scale score, the CAT score, and the annualized incidence of COPD exacerbations per participant. Propensity score matching of 1 to 3 was done between the control groups and ILA and required statistical analysis was conducted. Results: Patients without ILAs showed a range of airflow restriction severity from Global Initiative for Chronic Obstructive Lung Disease or GOLD 1 to 4. Contrary, the severity of the airflow limitation was distributed across GOLD 1 to 3 in patients with ILAs, with a small number of patients in each class. Patients with ILAs demonstrated numerically, but not substantially. Conclusion:  The study has concluded that ILA lesions in patients with COPD progressed slowly and that the growth of ILAs had no bearing on COPD flare-ups. The study further concludes that ILAs following COPD may involve interstitial fibrosis brought on by smoking, which is distinct from some types of fibrosing lung disease with bad prognoses.

142. A Clinical Study of Serum Cystatin-C Levels in Acute Kidney Injury.
Ramesh, Somasekhar Patil
Background: A 45%–60% increase in mortality is linked to acute kidney injury. Dialysis can stop progression and lower mortality in individuals with acute renal damage with early identification and beginning. The conventional measure for AKI detection, serum creatinine, has significant drawbacks. The ability of cystatin C to diagnose AKI and whether it can do so earlier than serum creatinine was studied prospectively in this study. Methods: Patients at risk of developing AKI history of preceding Acute Diarrhoeal disease (ADD), and febrile illness with symptoms suggestive of AKI were selected. Patients having one or more risk factors for CKD and patients already having CKD are excluded. Also, patients with a history of alcohol abuse and chronic smoking were excluded since these can interfere with the measurement of cystatin C. Results: The estimation of levels of serum cystatin C showed early elevation of serum cystatin C on the second day in 77% of cases which increased to 94% on the third day and progressed to 100% on day 4 in patients with AKI depicted in table 5. The estimation of cystatin C in the remaining n=15 cases who did not progress to AKI revealed that n=13 cases had normal levels of serum cystatin C and increased in n=2 cases which were found to be transient and came back to normal levels at day 4. Conclusion: Serum Cystatin C is an excellent early biomarker for the detection of AKI. This biomarker can also accurately distinguish between prerenal and intrinsic AKI. The results of the current showed that elevated levels of serum cystatin c are produced earlier than the other conventional renal functional markers. Cystatin c is also less likely to be influenced by age, gender muscle mass, and ethnicity.

143. Clinical Profile and Etiological Pattern of Uveitis.
Mythili Kota, Pragna V
Background: Multiple aetiological elements contribute to uveitis, a complicated ophthalmic inflammatory illness. Although an infectious agent or trauma may be the source of inflammation, the underlying process almost always seems to be autoimmune in origin. The most prevalent kind of uveitis is anterior uveitis, with an annual incidence rate of 17 occurrences per 100,000 people. This study’s goal is to assess the causes, course of therapy, effects, and side effects of uveitis. Methods: All patients with anterior, intermediate, posterior, and pan uveitis during the duration of the study were included. A thorough ocular examination included best corrected visual acuity (BCVA), slit lamp biomicroscopy examination (SLE), indirect ophthalmoscopy (IDO), applanation tonometry (AT), and gonioscopy. In addition, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT)B scan ultrasonography were performed if needed. Routine blood investigations and baseline workups like chest x-ray were done. Results: Among the cases of anterior uveitis maximum numbers of 40% cases were due to idiopathic, 25% of cases were immune-related and 35% were due to infective causes. In the intermediate uveitis cases, the infective causes were found in 75% of cases and idiopathic in 25% of cases. In posterior uveitis cases, all were due to infective origin. The pan uveitis cases showed maximum cases of 62.5% were due to immune-related conditions and 25% were infective and 12.5% were idiopathic cases. The overall cases due to infective cases were 27/60 (45%) of cases followed by 30% in the idiopathic category and 25% in the immune-related causes. Conclusion: To prevent vision impairment due to uveitis, early identification and prompt treatment is crucial. Further research on the patterns and specific etiologies of uveitis from various regions of India and the world may aid in the early diagnosis and treatment of the condition.

144. A Study of Efficacy and Safety of Atorvastatin as Add on Therapy in the Treatment of Moderately Severe Asthma.
S Sirisha, Swathi
Background: Airway wall inflammation and asthma are very closely related. Statins appear to inhibit signaling molecules, which causes a reduction in gene expression and reduces the stability of lipid raft formation, which has effects on the activation and control of the immune system. By lowering cytokine, chemokine, and adhesion molecule production, both these effects affect cell death or proliferation. Methods: A total of n=60 cases were included in the study based on the inclusion and exclusion criteria they were randomly allotted equally (n=20) to one of the three groups. Detailed medical history and demographic details were obtained from all patients who gave informed consent for the study. The investigations included complete blood picture, ESR, Hb, Absolute eosinophil counts, RBS, Renal function tests, Liver function tests, lipid profile, ECG, Chest X-ray, Spirometry, and Asthma control score (ACS). Results: the asthma control scores were compared in the three different groups of the cases at different intervals at the baseline there was no statistically significant difference between the groups. The ACS subjective score is significant after 4 and 8 weeks of study for groups II and III. In between groups, there was statistical significance between standard group I with groups II and III. Also, there was a statistical difference between groups II and III suggesting that an increase in atorvastatin dose from 10 to 20 mg is beneficial in chronic asthmatics. Conclusion: we conclude that atorvastatin is effective as an adjuvant in the management of chronic stable asthma (moderate-severe). As an adjunct medication, atorvastatin 20 mg is more effective in treating asthma than atorvastatin 10 mg once a day.  The dosages of 10 mg and 20 mg of atorvastatin were proven to be safe for chronic stable asthmatics.

145. Evaluation of Functional Outcome of Floating Knee Injuries in a Tertiary Care Hospital.
Madas Ravichandra Yadav
Background: The simultaneous ipsilateral fracture of the femur and tibia that isolates the knee from the rest of the limb is known as a floating knee.  The intricacy of the injury and related consequences, including meniscal, collateral, vascular, and compartment syndrome injuries, continue to present a significant challenge to the treating orthopedic surgeon. Methods: The present study was conducted in the Department of Orthopedics, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. All the patients who were victims of high-velocity road traffic accidents were brought to our institute of treatment.  Patients were revived as per the ATLS procedure (maintenance of airway with cervical spine control, breathing, and circulation) as soon as they arrived. Standard protocols were followed for treatment and complications. Functional outcome was assessed by using KarlstromOlerud’s criteria. Results: The grading of fractures was done in the study as described in table 2. The most common fractures were IIIB and II followed by IIIA. Out of n=20 cases, n=11(55%) cases were having an extension of either femoral or tibial or both fractures into the knee joint (Type I floating knee fracture), and the rest 9(45%) cases were purely diaphyseal fractures (Type II) floating knee fractures.  Treatment Modality:Intramedullary nail fixation was done in a greater number of patients in the femur and external fixator in fracture tibia as compared to other modalities. Conclusion: The floating knee fracture is a complicated condition brought on by high-energy trauma. Each floating knee fracture is distinct, and the best course of action should be determined by the patient’s overall health, the specifics of the fracture, and the degree of soft tissue damage. Better outcomes are achieved with vigorous wound cleaning and stabilization in compound fractures and early internal fixation and mobilization in closed fractures.

146. A Comparative Study of Tension Free Desarda Repair with Lichtenstein’s Mesh Hernioplasty for Inguinal Hernia Repair in the Hilly Areas of Garhwal.
Shwetabh Pradhan, Sophiya, Biant Singh
Objectives: The present study was to compare effectiveness of the tension free Desarda technique with Lichtenstein mesh hernioplasty for inguinal hernia repair. Methods: A total of 80 patients of inguinal hernia with age group 18 to 70 years were enrolled in this study. 40 patients were in each group (Lichtenstein and Desarda).  40 patients underwent hernia repair by the tension free Desarda technique and 40 patients underwent Lichtenstein procedure. The primary outcome measure was chronic groin pain using an 11-point numerical rating scale (NRS 11) score at three months postoperatively. Secondary outcome measures comprised of operative time, haematoma formation, wound infection, early recurrence within three months, seroma formation, foreign body sensation, days to return to normal gait, days to return to normal work and postoperative pain scores using NRS scoring at 6 hours, day 1, day 7, 1 month and 3 months postoperatively. Results: Postoperative complication in most of the patients were marginally higher  in Lichtenstein repair as compared to Desarda repair. Duration of surgery, time to return to normal gait and normal work in patients who underwent  Desarda repair were lesser  as compared to Lichtenstein mesh hernioplasty however the difference was not statistically significant. Desarda group patients had a higher satisfaction rate 37(92.5%) than the Lichtenstein group patients 33(82.5%). Conclusions: Both Desarda repair and Lichtenstein’s mesh hernioplasty provided satisfactory treatment for primary inguinal hernia with low recurrence rates and acceptable rates of complications. Desarda repair is a simple and straightforward procedure with no complexity involved in the tissue dissection and repair. Desarda repair may potentially increase the number of tissue based methods available for treating groin hernias as it is cost effective, easy to perform and without the use of mesh prosthesis. The present study concluded that there is no difference between Desarda repair and Lichtenstein’s mesh hernioplasty in short term effectiveness however high quality long term follow up randomized controlled trials are needed to provide a more reliable evidence.

147. Study on Clinical Characteristics of COPD Patients Presented with Interstitial Lung Abnormalities.
Subhash LaxmiShankar Yadav, Hariprasad Shetty
Introduction: Chronic obstructive pulmonary disease (COPD) is defined by recurrent respiratory symptoms and airflow restriction brought on by anomalies in the airways and/or alveoli that appear following prolonged exposure to noxious substances, such as tobacco smoke. The biggest risk factor for lung fibrosis and COPD is smoking. Aims and Objectives: To analyze the various clinical characteristics of COPD patients which are attributed to Interstitial Lung Abnormalities (ILA). Methods: This is a prospective cross-sectional, this  study gathered data from patient’s visits and data collection was done based on patient age, sex, BMI, FEV1, FVC, the mMRCdyspnea scale score, the CAT score, and the annualized incidence of COPD exacerbations per participant. Propensity score matching of 1 to 3 was done between the control groups and ILA and required statistical analysis was conducted. Results: Patients without ILAs showed a range of airflow restriction severity from Global Initiative for Chronic Obstructive Lung Disease or GOLD 1 to 4. Contrary, the severity of the airflow limitation was distributed across GOLD 1 to 3 in patients with ILAs, with a small number of patients in each class. Patients with ILAs demonstrated numerically, but not substantially. Conclusion:  The study has concluded that ILA lesions in patients with COPD progressed slowly and that the growth of ILAs had no bearing on COPD flare-ups. The study further concludes that ILAs following COPD may involve interstitial fibrosis brought on by smoking, which is distinct from some types of fibrosing lung disease with bad prognoses.

148. The Effect of Continuing Aspirin at a Low Dose in Peptic Ulcer Bleeding.
Hariprasad Shetty, Subhash Laxmi Shankar Yadav
Introduction: Aspirin was once used to reduce swelling and pain, but because of its capacity to prevent blood vessels from clotting, this application has now changed. Many studies have found that patients who get a combination of antiplatelet drugs are more prone to experience gastrointestinal bleeding. Asymptomatic ulcers are nevertheless a major problem since they can injure the GI tract permanently even though they are commonly spotted and acknowledged. In particular, among the elderly population, aspirin use has increased to treat cardiovascular and brain conditions. Aims and Objectives: To find out the significance of aspirin therapy at lower dosage in cases of peptic ulcer disease. Methods: This randomized study was done on patients of peptic ulcer. 2 groups were made and one group received aspirin at lower dosage while another did not receive anything. After fixed time interval, both the groups were analysed for recurrent bleeding, complications, mortality rate, and many more parameters. Results: In this study, it was found that recurrent bleeding was found to be significant in aspirin therapy group as compared to placebo group (p<0.05).  Again, the study found that the mortality velocity was significantly lower in aspirin group than placebo group (p<0.05). Also, 15.3% of patients reported gastrointestinal bleeding while being treated for other medical conditions. Eight causes of recurrent bleeding in aspirin-using individuals came from duodenal ulcers, whereas one case was caused by stomach ulcers. Only duodenal ulcers were the known source of confirmed recurrent bleeding in the placebo group. Conclusion: The study has concluded that aspirin at low dosage causes recurrent bleeding significantly but decreases the mortality rate in the long run.

149. Clinical Profile of Scabies at Tertiary Care Hospital.
Joy Dhirendranath Das, Nisit K Surti
Introduction: Scabies is a widespread cutaneous ailment that can affect anyone. The female mite burrows into the host’s stratum corneum to lay her eggs, which starts the infection. It later transforms into nymphs, larvae, and adults. The webs in fingers, flexor surfaces of the wrist, axillae, elbows, buttocks, and genitalia are the most common locations to find the burrow, which is a wavy line. Primary lesions referred to as papules, vesicles, and nodules with Secondary lesions such as eczematous eruptions, excoriations, infections, and crusting are usually seen. Aims and Objectives: To analyze the clinical profile and quality of life in scabies. Methods: A non-interventional cross-sectional study was conducted on 155 patients. Itching, especially at night, a family history of itching, and distinctive lesions like excoriations, papules, and burrows in well-known places like webs in the genitals, fingers, etc. were required for the diagnosis. Results: A total of 66 (42.5%) students and 31 (20%) housewives were affected. A total of 154 patients (99.3%) had itching as their primary complaint, and 123 patients (79.3%) experienced nighttime itching that made it difficult to sleep. The severity of impairment in quality of life is seen more in questionnaire of C (only a little). The distribution along the sex is slightly more in femalesas compared with males. 24.5% of adults have no effect on quality of life while moderate is seen in 24.3% adults. No adults  had very large effects. Conclusion:  The study concluded that papules are the most commonly occurring lesion in scabies. The study also concluded that scabies decreased the quality of life. However, there was no significant reduction in quality of life.

150. Clinical Profile of Androgenetic Alopecia at Tertiary Care Hospital.
Nisit K Surti, Joy Dhirendranath Das
Introduction: Androgenetic alopecia is defined by a specific distribution in both males and females and a progressive loss of the scalp’s terminal hair anytime after puberty. According to studies, losing one’s hair can worsen psychological issues including sadness, anxiety, and trauma while also lowering one’s “quality of life” (QoL). Aims and Objectives: To analyze the different aspects of androgenetic alopecia with metabolic syndrome and its gradings. Methods: This case-control study was conducted on the patients with alopecia and controls with minor issues with hair. The patients were determined for general characteristics, correlated with the components of metabolic syndrome and compared that with healthy controls. Again, the grading of alopecia was correlated with the components of the metabolic syndrome.  Statistical analysis was conducted for analyzing possible correlation between metabolic syndrome components and alopecia. Results: The study found that there is elevation of fasting blood glucose in patients with androgenetic alopecia as compared to the healthy controls (P=0.041). It is also found that there is significant decrease in HDL in the patients of alopecia than the healthy controls (P=0.012). Conclusion: The study has concluded that androgenetic alopecia is significantly linked to metabolic syndrome components, specially with reduction in HDL and elevation in levels of fasting blood glucose.

151. A Study on Anatomy of Superior Laryngeal Nerve.
Mohd Abid Ali, S. Saraswathamma
Background: The innervation of intrinsic muscles of larynx, lacks its uniformity in the mode of branching and pattern of distribution of the superior and recurrent laryngeal nerves. Internal branch of superior laryngeal nerve gives motor fibres to the interarytenoid muscle. So, the nerve supply of interarytenoid muscle is yet controversial. The fact that internal branch of superior laryngeal nerve under the risk of injury causes loss in the cough reflex. Therefore the study on morphology of internal branch of superior laryngeal nerve is essential, as it is the only nerve traversing from lateral to medial. Aim and Objective: To study the anatomy of superior laryngeal nerve – its origin, course and terminal branches. Materials and Method: This is observational descriptive study conducted 20 adult human larynx specimens were collected from the Department of Anotomy, Bhaskar Medical College, Moinabad. Bilateral gross dissections were made on each specimen and fixed in 10% formalin to find the exact course, relations and terminations of internal, external branch of superior laryngeal nerve, recurrent laryngeal nerve and also the intrinsic laryngeal muscles innervated by them were dissected, analysed. Observation & Conclusion: From overall observation and discussion with other study, internal branch of superior laryngeal nerve under the risk of injury causes loss in the cough reflex. Therefore the study on anatomy of internal branch of superior laryngeal nerve is essential , as it is the only nerve traversing from lateral to medial. The EbSLN crosses about 1cm more above the superior pole of thyroid gland in 67.5% and lies dorsal to the superior thyroid artery in 75% of the dissected specimens. The EbSLN divides into two branches at the level of cricoids in 32.5% of the specimens and innervates cricothyroid muscle. The recent research shows the multiple roles of this nerve in voice and speech. Cricothyroid muscle is the primary control of fundamental frequency of voice.

152. Study on the Epidemiological Characteristics of Falciparum Malaria among Pediatric Population.
Hemantbhai Sanjivbhai Patel
Introduction: There were estimated 229 million cases of malaria worldwide in 2018. In South-East Asia, the Eastern Mediterranean, and the Western Pacific, P. falciparum is also very common. Children under the age of five and primigravidae are the most at risk for contracting malaria in places with high transmission rates; their deaths account for 67.3% of all malaria-related deaths worldwide.  P malariae has a similar geographic distribution to P. falciparum. The availability of more preventive measures, such as bed nets, as well as efficient new diagnoses and therapies, has expanded over the past 15 years, contributing to a 60.2% decrease in the fatality rate from malaria worldwide. Aims and Objectives: To evaluate the epidemiological characteristics of falciparum malaria among pediatric population. Methods: The prospective research was carried out on 51 patients who underwent clinical examination, and basic blood examination. The study has analyzed the baseline characteristics, distribution of the clinical features and Types of parasites, grading of parasitemia and result of LDH antigen test. Incidence rate and respective percentage of the patients have been determined. Results: The study found that 52.94 % of the patients are male and rest are female. The study also showed that 33.33% of the patients belong to Class V Socio-Economic Class (SEC), 31.37% of the patients in Class IV and 19.62% in Class III.. The study further found that all the patients had fever, 74.50% of patients had vomiting and 41.17% of patients had headache. The study also found that 52.94% of the patients had abdominal pain while 15.68% had diarrhea. The current study has presented that Trophozoites 29 (56.86%), Schizonts 13 (25.49%, and Gametocytes 9 (17.65%) of patients were discovered. In addition, Out of 51 patients with smear positive for P. Falciparum, 48 had also positive p-LDH antigen test for P. Falciparum. Conclusion: The study concluded that malarial incidence was found to be 0.36% while 64.70% of all patients were between 7 years old and 12 years old. The study further concluded that there is relative increase of percentage of patients with decrease of socio-economic classes. The study concluded that the fever, vomiting, abdominal pain and headache are the most common clinical features of falciparum infection.

153. Study on Demographic Characteristics of Tympanic Membrane Defect in Tertiary Care Hospital.
Nikesh Meghji Gosrani
Introduction: Tympanic membrane perforation is a condition in which the tympanic membrane that separates the middle ear from the external ear, tears. Hearing loss may occur in some cases whenever the tympanic membrane perforates because it can no longer produce vibrational patterns. Tympanic membrane rupture is most frequently seen in younger people and is linked to acute otitis media, though it can happen at any age. Aims and Objectives: To analyze the demographic characteristics of Tympanic membrane defect in Tertiary care hospital. Methods: A cross-sectional prospective study was conducted on 50 patients from whom thorough history was obtained, a general and systemic evaluation was completed, and any significant positive findings were noted. The analysis was conducted accordingly. Results: The majority of the patients were male (66%) compared to females (34%) and the majority live in rural areas (66%). The main complaint of the patient in the study was otorrhoea (100%) followed by deafness (92%). Medium-size perforation (56%) is seen mostly followed by large size (46%) and then small size (18%) while the majority of perforations are seen in the central position (56%). Conclusion: The study has concluded significant demographic characteristics like Patient ages ranged from 12 to 51 years with a mean age of 26.25 years. Again, males contributed to 40.51% cases while 59.49 % were females. the study concluded that the symptoms of ear discharge and reduced hearing were present in 100% cases.

154. A Hospital Based Observational Cross-Sectional Evaluation of the Effects of Metabolic Syndrome on Pulmonary Function Tests.
Manish Kumar, Syed Yousuf Faisal, Sudhir Chandra Jha
Aim: To study pulmonary function tests in patients of metabolic syndrome and to record the effects of metabolic syndrome on pulmonary function tests. Methodology: This study was an observational cross-sectional study. The study was conducted in Department of Medicine, Darbhanga Medical College and Hospital, Darbhanga, Bihar for 12 months. A proper history was taken from the patients and other available sources. The NDD spirometer was used to conduct pulmonary function tests in this study. A thorough general physical and systemic examination was done and final diagnosis was made after doing all the necessary investigations. Data thus obtained were analyzed statistically. The Data was expressed as mean with standard deviation (SD) for quantitative variables. Comparisons between groups were performed using Student’s t-test and Anova test for quantitative variables and Chi-square test for nominal/qualitative data. A value of p< 0.05 was taken as significant. Results: A total of 50 patients fulfilling the IDF criteria for metabolic syndrome were included in the study. Majority of the patients were women (70%) (n=35) while men constituted 30% (n=15) of the patients. Most of the patients belonged to the 61-70 years’ age group (n=16) followed by 41-50 years’ age group (n=13). The mean age of the patients was 55.35 (±12.36) years in men and 52.37 (±13.80) years in women (p=0.324). Patients with 3 components positive had a mean FEV1 of 1.32 (±0.65) L while patients with 4 components positive had a mean FEV1 of 1.49 (±0.72) L. Patients with all 5 components positive had a mean value of FEV1 was 1.35 (±0.60) L. Patients with 3 components positive had a mean FVC of 1.892 (±0.72) L while patients with 4 components positive had a mean FVC of 1.879 (±0.82) L. Patients with all 5 components positive had a mean FVC of 1.822 (±0.76) L. Both FEV1 and FVC correlated negatively with BMI, FBS, waist hip ratio and SBP. Only FEV1 had a negative correlation with Hba1c whereas only FVC had a negative correlation with waist circumference. Conclusion: Our findings highlight the notion that FVC and FEV1 are inversely associated with the accumulation of metabolic syndrome components and also independently associated with each component of metabolic syndrome.

155. A Hospital Based Prospective Observational Assessment of Maternal-Fetal Outcome in Women Undergoing Repeat Caesarean Section after Previous 2 Caesarean Sections.
Priyanka Kumari, Sangeeta Sinha, Amrita Sharan
Aim: This prospective observational study was conducted to study the maternal and fetal outcome in patients undergoing repeat caesarean section in case of previous 2 caesarean deliveries in a tertiary care centre in Bihar region. Methods: The present study was conducted in the Department of obstetrics and gynaecology, Patna medical College and Hospital, Patna, Bihar, India. The Study included women with Previous 2 cesarean deliveries admitted in the Department of obstetrics and gynaecology. The period of the study was 6 months and 120 patients were included in the study. Results: Study observed that majority of cases 45 (37.5%) are in the gestational age of 38-39 weeks, followed by 25 (20.84%) of cases are in the gestational age of 39-40 weeks and 24 (20.84%) of cases are in the gestational age of 37-38 weeks. The mean gestational age is 38.30 weeks. Most of the patients (29.16%) were taken for elective repeat caesarean section (ERCS) at term i.e. 37 completed weeks. Study observed that 100 (83.34%) of cases are observed term deliveries and 20 (16.66%) of cases are observed pre-term deliveries. Majority of neonates 60 (50%) birth weight is in the range 2.6-3.0 kg followed by 20 (16.66%) neonates birth weight is in the range of > 3 kg and 31 (25.84%) of neonates birth weight is in the range of 2.1-2.5 kg and 116 (96.66%) of cases Apgar score at 5 minute is ≥5. Conclusion: With an increase in the proportion of patients with a history of previous LSCS it is necessary for health care personnel to have proper antenatal counselling regarding VBAC and a well-defined management protocol to increase the no. of VBAC. Cesarean section should not be always followed by a repeat cesarean section.

156. A Hospital-Based Assessment of the Prevalence of Steroid-Induced Glaucoma among Patients Suffering from Vernal Kerato-Conjunctivitis: A Cross Sectional Study.
Abhilasha, Rajeev Kumar, Jawed Iqbal
Aim: The present study aimed to assess the prevalence of SIG in VKC patients treated with topical steroids and to determine the association between different types of topical steroids and the presence of SIG. Methods: This study was conducted as a hospital-based cross sectional study in the Department of ophthalmology, ANMMCH, Gaya, Bihar, India for nine months. The present study was conducted on a total of 200 cases of VKC managed using topical corticosteroids. All the patients belonging to the age range of 8 years to 18 years who were already diagnosed with VKC and were using topical steroids as treatment were included whereas patients with eye trauma, previous ocular surgeries, developmental or congenital glaucoma, or any angle anomalies were excluded. Results: In the present study, the mean age of the children with VKC was 13.8±3.2 years and the majority i.e. 65% of the patients with VKC on steroids was males. The mean age at onset of VKC was 12.2±3.6 years and the mean duration of use of TCS was 17.23±2.5 months. The majority of children had a history of eczema (20%), whereas asthma and allergic rhinitis were observed in 18% and 12% of the cases respectively. Conclusion: Steroids are the mainstay of treatment of VKC, and the use of high potency significantly increases the risk of steroid-induced glaucoma in these patients. Steroid-induced glaucoma is one of the common complications of injudicious and long-term use of topical corticosteroids particularly high potency steroids.

157. A Hospital Based Retrospective Assessment of the Role of FNAC in Diagnosis of Thyroid Lesions.
Suryajita Kumar Singh, Deepak Kumar
Aim: The aim of this study was to determine the role of FNAC in detection of thyroid swelling and to correlate the finding with tissue biopsy. Methods: This was a retrospective study carried out at Department of pathology, Jawahar Lal Nehru Medical College, Bhagalpur, Bihar, India over a period of one year. 100 patients of all age group and both sexes who underwent FNAC for thyroid swelling were evaluated. Out of 100 patients, histopathological diagnosis was available in 20 patients. Results: FNAC was performed on thyroid swelling of 100 patients, which included 80 (80%) females and 20 (20%) males with M:F ratio of 1:4. The FNAC results revealed 86 cases (86 %) as non-neoplastic and 14 cases (14%) as neoplastic. Out of 100 patients, histopathological diagnosis was available in 20 patients. The sensitivity, specificity, false positive rate, false negative rate and diagnostic accuracy of FNAC for detection of malignant lesions was calculated. Significant agreement was observed between FNAC and histopathology results as indicated by kappa (0.69) and p value (0.001). Conclusion: FNAC is rapid, simple, safe and cost-effective diagnostic modality in the investigation of thyroid disease with high sensitivity, specificity and accuracy. It can be used as initial investigation for the diagnosis of thyroid disease. FNAC diagnosis of malignancy is significant and such patients should be subjected to surgery whereas unnecessary surgery can be avoided in benign lesions.

158. Comparative Assessment of Oral Terbinafine versus Itraconazole in Tinea Corporis and Cruris.
Neelima Goyal, Saurabh Goyal
The management of dermatophytosis is challenging in India and there are reports of using systemic antifungals at higher doses. But there are multiple reports of increased treatment failures with terbinafine at standard dosage as well. To assess this a randomized, open label, comparative study was conducted where 80 patients with tinea corporis et cruris infection were included. Patients were either prescribed terbinafine 250mg twice a day or itraconazole 100mg twice a day for 4 weeks. Efficacy was assessed based on complete, clinical and mycological cure rate. At the end of six weeks, there was a statistically significant improvement (p value<0.05) in the total symptom score (erythema, scaling, and pruritus) in Group I as well as in Group II compared to baseline. None of the patients showed any significant side effect in both Itraconazole and Terbinafine groups. No changes in liver function were observed in both the groups. This study shows that the high dose of terbinafine in combination with topical ciclopirox is effective and safe in management of tinea corporis et cruris.

159. Study of Nutritional Status in Patients with Chronic Kidney Disease in North East India: A Hospital Based Cross Sectional Study.
H. R. Bharath, Sawjib Borphukan, Ajit Kumar Pegu
Background: Chronic kidney disease (CKD) is a progressive irreversible loss of renal function over a period of months or years. Malnutrition is an important cause of morbidity and mortality in CKD. Malnutrition occurs in varying degrees with respect to the stages of CKD. Nutritional assessment in patients with CKD should be a multidisciplinary approach which has been tried to analyse in the present study. Our study aims to find out the proportion of under nutrition in patients with CKD and also aims to correlate the degree of under nutrition with stages of CKD. Methods: The study was a Hospital based observational study conducted in Assam medical college, Dibrugarh. Study was done in patients with chronic kidney disease, aged more than 13 years, during one year duration between June 1st 2019 and May 30th 2020. Every patient was subjected to clinical examination, anthropometrical assessment, Handgrip strength testing and few biochemical parameters were also tested. Mean ± standard deviation was used to express continuous variables. Frequency and percentage were used to express categorical variables. Test of significance for qualitative data was assessed by Chi square test (for 2 x 2 tables). P value less than 0.05 was taken as statistically significant. Results: The mean age of patients with CKD was 46.39±12.50 years, The commonest symptoms at presentation were swelling of lower limbs and other parts of the body (64.29%). Most of the cases belonged to CKD stage 5 (69.29%), followed by CKD stage 4 (24.29%) and CKD stage 3 (6.43%). Based on BMI estimation 17.14% of the patient’s had undernutrition. According to Triceps Skin Fold Thickness, mid arm circumference and Hand Grip Strength measurements, undernutrition was detected in 38.57%, 60.71% and 68.57% of the cases respectively. About 44.29 % and 45% of the patients had undernutrition according to Subjective Global Assessment (SGA) form and Mini nutrition assessment scale (MNA) respectively. On estimation of biochemical markers of nutrition, anemia was found in 92.14%, hypoalbuminemia in 31.43%, hypocholesterolemia in 22.14% and Lymphocytopenia in 57.86% cases respectively. However statistical significance was attained for all the above parameters with undernutrition (P<0.05), except for hypocholesterolemia with undernutrition. The proportion of undernutrition detected by using different nutrition assessment tools in the study was found to be significantly high with an increase in severity of chronic kidney disease, CKD stage 3 to CKD stage 5 respectively (P< 0.05). However statistical significance was not seen for hypocholesterolemia for undernutrition with severity of CKD. Conclusion: A multimodal approach using clinical, anthropmetry and laboratory parameters to assess undernutrition in patients with CKD showed undernutrition in almost all parameters of varying degree. Undernutrition increases with its increase in severity of CKD i.e from stage 3 to 5 which were statistically significant except for hypocholestrolemia. These parameters can be used which are cost-effective, feasible in day to day clinical practice, so that early nutritional intervention can be done in patients with CKD.

160. Association of Ocular Biometric Parameters in Type 2 Diabetes Mellitus Patients with Diabetic Retinopathy at a Tertiary Care Hospital in Rajasthan: A Prospective Observational Study.
Navin D. Patel
Background: Diabetic retinopathy causes loss of visual acuity associated with longer duration & poorely controlled diabetes. Still there is no single consensus on its pathogenesis. This study is aimed to evaluate the association of ocular biometric parameters in Type 2 diabetes mellitus patients with diabetic retinopathy at a tertiary care hospital in Rajasthan. Material & Methods: This prospective observational study recruited 140 patients in the age range of 30-80 yrs who came to the outpatient department of our Hospital with diagnosis of type 2 diabetes mellitus from March 2022 to September 2022. Study group (n=70) included type 2 diabetes mellitus with diabetic retinopathy while control group (n=70) included patients with no diabetic retinopathy. All patients underwent complete ocular examination involving Best Corrected Visual Acuity using an Autorefractometer. Fundus examination was done using a +90 diopter lens. All the Refractive errors were grouped as Myopia, Hypermetropia or Emmetropia(on the basis of  Spherical equivalent). Individual eyes of patients in both the groups fulfilling the inclusion criteria were assessed. Axial length(AL), corneal curvature (CC) and anterior chamber depth (ACD) were measured using an optical biometer and three readings were measured and average reading was put to statistical analysis. Diabetic retinopathy was graded into mild, moderate, severe and proliferative. Results: The baseline characteristics were comparable with no statistically significant difference. The HbA1C levels were statistically significant higher in study group (11.03±1.42) than in control group (8.4±2.85) (p<0.05). There was statistically significant higher duration of diabetic years in study group (15.42±6.25). Mean spherical equivalent, mean axial length, mean Anterior chamber depth & mean Corneal curvatures in patients with Myopia, Emmetropia, Hypermetropia were not statistically significant in the two groups (p-value>0.05).  The difference in spherical equivalent with respect to severity of retinopathy was non-significant (p>0.05). The mean AL showed a progressive decrease with increase in DR severity. The mean anterior chamber depth decreased significantly with the increasing severity of DR which was found to be statistically significant( p value <0.05). Conclusion: No association between spherical equivalent and corneal curvature noted with the diabetic retinopathy. Longer Axial length and anterior chamber depth noted in control group & with milder diabetic retinopathy, thus seem to have a protective influence in developing progressive forms of the disease.

161. A Comparative Prospective Study of Astigmatism before & After Pterygium Excision.
Navin D. Patel
Introduction: Pterygium is a common ocular degenerative disorder seen in tropical regions. It threatens the visual axis & cause a significant loss of visual acuity, flattening of corneal curvature & astigmatism. Aims & Objectives: This prospective study was undertaken to evaluate the Visual acuity, corneal refractive status & astigmatism preoperatively & postoperatively after surgical excision of the pterygium & its relationship with length of pterygium. Material & Methods: The study recruited 60 eyes of 54 patients who came to the Department of Opthalmology of our Hospital with primary pterygium. Patients having Visual loss from proximity to visual axis or threatened visual axis, restricted eye movement, irritation & cosmetic concerns were included in the study. Patients with pseudopterygium, Glaucoma, Cataract, Macular degeneration, History eye trauma, Corneal opacity & Previous eye surgery were excluded from the study. At baseline, the length of the pterygium encroaching the cornea was recorded. The patients were divided into three groups on the basis of length of pterygium. Parameters assessed preoperatively & postoperatively (At baseline, at the end of 1st week, 4th week and 9th week) were Visual acuity, keratometry, Refraction with subjective correction for astigmatism assessment. Each eye underwent bare sclera pterygium excision. The pre and postoperative parameters were compared, tabulated and analysed. Results: 79%  cases having primary pterygium belonged to 25-50 yrs age range. It is more prevalent in males (55.67%) than females (44.33%). 75.35% of cases were from rural areas than 24.65% in urban areas. 84.01% patients working in outdoor had pterygium. Progressive pterygium was noted in 72.67% of patients while atrophic pterygium was noted in 27.33%. The length of pterygium ranged between 1.4 mm and 5.0 mm. The mean pterygium size was 3.25 ± 0.73 mm. 55.83% patients belonged to Group III, 25.17% patients in Group II and  19% patients in Group I. There was a statistically significant improvement in the  Visual acuity up to 1-3 lines Snellen’s visual acuity after the excision. There was a statistically significant reduction of Keratometry values postoperatively at 9 weeks, which signifies reduction of corneal astigmatism after pterygium excision & as measured by subjective correction. Conclusion:  Surgical excision of the pterygium results in improvement of visual acuity, reduction of astigmatism postoperatively. Early seeking of surgical treatment can result in better clinical benefits in all the three grades of pterygium. Residual astigmatism is more in cases with advanced pterygium Group III as compared to Group I and II cases.

162. Study of Lipid Profile in Patients of Chronic Anaemia and Correlation of Different Types of Anaemia with Lipid Profile.
Jitesh Aggarwal, Shokat Ali Bohra, Dhaneshwar Tripathi, Himani Dhingra
Purpose: This study was carried out to assess the lipid profile in anaemia as compared with that in age and sex matched controls and to correlate the extent of changes, if any, in the various lipid sub fractions with the severity of anaemia. Methods: A total of 100 anaemic cases and 100 normal subjects was undertaken to study the clinical presentation of anaemic cases and also to investigate the relationship between anaemia and lipid profile. Fasting venous blood sample (> 8 hours) was obtained for estimation of lipid profile. The clinical and laboratory profile, course in hospital, and outcome were documented. Result: Following the study the maximum cases had dimorphic anaemia followed by microcytic hypochromic anaemia and others. The most common presenting symptom was easy fatigability followed by dyspnoea, palpitations, giddiness and others. The mean serum total cholesterol levels, HDL levels, VLDL levels, TG levels and total cholesterol/HDL ratio were significantly lower (P<0.01) in cases of anaemia as compared to controls the correlation of anaemia with lipid profile was very large. Conclusion: We concluded that patient with anaemia have a beneficial effect on lipid profile. The type of anaemia did not have a significant effect on the mean lipid levels.  Anaemia is associated with significant hypocholesterolemia, with lowering in all lipid subfractions irrespective of the type and cause of anaemia. The extent of hypocholesterolemia is proportional to the severity of anaemia.

163. Estimation of Appropriate Size Endotracheal Tube for Anaesthetic Intubation in Children.
Anil kumar P., Neena Thomas, Mohamed Hussain Sait
Background: Endotracheal intubation is a common procedure for airway management and general anaesthesia in children. A selection of correct size endotracheal tube is one of the essential prerequisites for successful intubation, especially in children. In this study, we wanted to determine the appropriate size of cuffed endotracheal tube for anaesthetic intubation for different age subgroups of children between 4 and 12 years of age. Methods: This is an observational retrospective study conducted in the Government Medical College, Ernakulam, Kerala, over a period of 6 months from June 2021 to December 2021, among children between 4 and 12 years (completed 12 years). Results: The estimated appropriate size of cuffed ETT in 4 – 5 years age group is 4.5/5 (rarely 4), in 5 – 6 years age group is 5/4.5 (rarely 5.5), in 6 – 7 years age group is 5/5.5 (rarely 4.5), in 7- 8 years age group is 5/5.5, in 8 – 9 years age group is 5/5.5, in 9 – 10 years age group is 5.5/5 (rarely 6), in 10 – 11 years age group is 5.5/6 (rarely 5), in 11 – 12 years age group is 5.5/6 (rarely 5/6.5), and in 12 – 13 years age group is 6/6.5 (rarely 5.5/7). If a wider age category considered the ETT size requirement in different age group are 4 – 6 years – 5/4.5, 6 – 10 years – 5/5.5, 10 – 12 years – 5.5/6, 12 – 13 years – 6/6.5. On rare occasions, sizes smaller by 0.5 mm may be required occasionally and has to be anticipated. For cuffed ETT size smaller by 0.5 – 1 mm it can be derived by formula (Age + 4)/4. Conclusion: Since children need varying sizes of ETT and due to requirement of ETT sizes variable as anticipated from different formulas or recommended charts, a wide array of ETT sizes should be readily available in paediatric operation theatre.

164. Analysis of Management and Outcome of Falciparum Malaria among Pediatric Population.
Hemantbhaiv Sanjivbhai Patel
Introduction: The multistage lifecycle of the Plasmodium parasite causes recognizable cyclical fevers. Most persons get rapid symptom relief with prompt treatment; nevertheless, serious consequences, such as severe malarial anaemia, cerebral malaria, death, or coma may results.  About 40% of the world’s population travels to or lives in areas where malaria is prevalent. sub-Saharan and western Africa are home to P. falciparum. Early detection of probable respiratory failure should be the first step in the clinical assessment process, followed by the discovery of shock and a neurological evaluation. Aims and Objectives: To evaluate the management and outcome of falciparum malaria among pediatric population. Methods: This is a Prospective randomised double-blind control study which considered 51 patients with plasmodium falciparum malaria were given antimalarials per National and WHO recommendations. Patients who did not respond to first-line drugs to second-line drugs. The outcome was assessed by considering several factors and statistical analysis was conducted. Results: The study found severe anaemia being the most common complication, which was found in 19 (37.25%) patients followed by cerebral malaria (27.45%), acute renal failure (17.64%), Hepatitis 13 (25.87%), Acidosis 1 (1.96%), Hypoglycemia 1 (1.96%), Hypotension 1 (1.96%), Disseminated intravascular coagulation (DIC) 1 (1.96%). The  study showed that, out of 51 patients with P. falciparum malaria and the majority of patients were discharged from 5 to 10 days. Conclusion: The study concluded 66.67% patients responded to chloroquine, 90 % responded to quinine and  94.11 %  patients  responded to artemisinin. The study also added that the overall mortality rate was 3.84%.

165. Significance of Autogenous Graft Using Temporalis Fascia in the Management of Tympanic Membrane Defect.
Nikesh Meghji Gosrani, Pramod Shiralkar, Karan Suhas Vayangankar
Introduction: Myringoplasty is a surgical treatment used to repair perforations in the tympanic membrane, which improves hearing, keeps the ear dry, and lessens an individual’s susceptibility to ear infections. Depending on whether the graft is placed medially or laterally on the remains of the tympanic membrane, myringoplasty can be performed using the underlay or overlay approach. Myringoplasties utilizing temporalis fascia, vascular grafts, cartilage, and perichondrium have a success rate of 81–91% in the literature. Aims and Objectives: To find out the efficacy of using autogenous graft extracted from temporalis fascia in the management of tympanic membrane defect. Methods: This prospective study was conducted on 50 patients with chronic suppurative otitis media. All cases underwent standard tests, including pure tone audiograms (PTAs) to evaluate preoperative hearing loss and X-rays of the paranasal sinuses and mastoids. Temporalis fascia was most frequently harvested by extending a post-aural Wilde/end aural Lempert incision and was used to create cast. The graft was then reintroduced and the malleus handle passed through the slit which anchors the graft and prevents subsequent medial or lateral displacement. The elevated vascular strip and elevated skin of canal were repositioned. After 3 months of surgery, the follow up was done to evaluate the status of the graft. Results: Most patients had a small to a moderately sized central hole that was unilateral. The sclerotic type of mastoid is the most prevalent, and the average preoperative air-bone gap (AB gap) is 23.12. All the patients were approached by postural route only. The study found that the VG (72%) and TFG (92%) are both intact in first 3 months. AB gap post-operatively is 64% in the VG group and 60% in the TFG group. Conclusion: The study concluded that that fascia form graft technique is the technique of choice in large tympanic membrane perforations. Anatomic and functional results are significantly positive and  the postoperative complications are minimal.

166. Analysis of the Arrangement of Renal Hilar Structure and Their Variation.
Anjali Jain, G. S. Malipatil
Introduction: The hilum is the intermediate concavity of the kidney’s lateral edge that allows urinary vessels, lymphatic vessels, nerve plexus, as well as renal pelvis to transfer through it all and connect with the renal sinus. The main structures that pass through the hilum from front to back are the renal vein, urinary artery, as well as renal tubules. A subsidiary of the renal artery as well as distributaries of the renal vein typically transfers behind several renal pelvis. Variations in the configuration of renal hilar frameworks were frequently discovered by chance during investigatory image analysis as well as angiography methods. In the Indian population, nevertheless, there have been relatively few thorough anatomy research on the primary renal hilar systems. Researchers evaluated the configuration of significant renal hilar systems in the Indian population because it is important throughout urological surgical procedure as well as kidney transplantation. Aims and Objectives: To observe and document the renal hilar variation in samples of kidney specimens. Methods: The current study was conducted on 70 specimens from recently deceased bodies. The samples maintained in 10% formol saline were rinsed. After that, the samples were placed in a metallic tray, and the surrounding fat and other undesirable structures were carefully removed, but the structures at the hilum remained in place. The relationship between the renal arteries and the renal pelvis at the hilum was then studied broadly, and findings were made. Results: The renal vein was detected anteriorly in 69 (98.57%) kidneys and only 1 (1.25%) kidney was found with a renal artery anteriorly. The renal vessels were arranged anterior to posterior in the center of the hilum. The renal pelvis was seen to be two fold in each of the two 2 (2.85%) kidneys. Conclusion: There was a 1.25% difference in the arrangement of renal arteries when the hilum of the kidneys was examined anteriorly and in the center, whereas 2.85% of kidneys had a double renal pelvis posteriorly. In 12% of kidneys, the posterior division of the renal artery was visible behind the renal pelvis. Very little (1%) variance is seen here in the renal vessels’ middle and anterior positions. However, the location of the renal pelvis, which is always found posteriorly near the hilum, is the same. Occasionally, the renal artery’s posterior division is visible behind the renal pelvis.

167. A Study on the Cystic Artery in the Calot’s Triangle as Well as Common Hepatic Duct.
Kalpana Sharma, G. S. Malipatil
Introduction: The hepatocellular is made up of the gallbladder and liver. They are provided either by the coeliac trunk, which is one of the abdomen aorta’s ventrolateral divisions. These hepatocellular frameworks are genuinely provided by sections of the hepatic aorta perfect, a branch of the posterior portion of the widely accepted hepatic artery that delivers components of the stomach, duodenum, as well as bottom portion of the bile duct via its gastro duodenal branch, whereas the proper hepatic artery delivers the right gastric artery but instead splits into right and left sections that deliver the right and left liver lobes. The gallbladder is supplied by a cystic subsidiary of the correct hepatic artery that travels across Calot’s triangle. The mischaracterization of anatomical structures, along with the appearance of anatomical changes, have long been identified as contributing factors towards the occurrence of significant postoperative pain, especially biliary contusions, in the frame of reference of a cholecystectomy. Aims and Objectives: To characterize the course of the cystic artery concerning Calot’s Triangle. Method: This current study considered 35 specimens of gallbladders from the well preserved bodies of Indian individuals. These individuals ranged from 30 years to 90 years during the time of their death. Samples of gallbladders with intact cystic ducts were considered from bodies during their examination in the Department of Anatomy. The samples were obtained with in 36 hours after death to ensure considerable study conditions. The dissection was done carefully and the course of the cystic artery was observed and noted down, especially concerning the position of Calot’s Triangle. Result: The study found that 97.1% of the specimens showed that Calot’s Triangle contains the cystic artery. The study also found that there were 32 specimens which showed cystic artery crossing over the Common Hepatic Duct (CHD) and 2 specimens where cystic artery crossed behind the CHD. Conclusion: The study concluded that more than 85% of its length, the cystic artery can be within Calot’s Triangle and on average, 75% of its length crossed behind the CHD.

168. Spectrum of Benign Breast Diseases in the Hilly Areas of Garhwal, Uttarakhand, India.
Shwetabh Pradhan, Sophiya, Biant Singh
Objectives: This present study was aimed to evaluate the spectrum of benign breast diseases in terms of age, type, size and area of involvement in the women of  hilly areas of Garhwal, Uttarakhand, India. Methods: A total of 500 cases of benign breast diseases irrespective of age were enrolled in the study. A detail assessment, clinical examination and relevant investigations like ultrasonography or X-Ray mammography or FNAC (when needed) were performed in all women. Results: Fibroadenoma was found to be the most common benign breast disease with 51.2% incidence, followed by abscess 11.6% and mastalgia 10.4%. Out of 500 cases, most of the benign breast disease cases 257(51.4%) were in age group of 25-40 years. 130(26%) cases were found to be  in the age group of >40 years and 113(22.6%) cases were found in the age group of <25 years. Out of 256 cases of fibroadenomas, right breast was involved in 142 cases, left breast was involved in 109 cases and bilateral breast involvement was seen in 5 cases. Upper and outer quadrant was involved in most of the cases. The average size of fibroadenoma was 2 cm, with minimum of 0.5 cm and maximum of 10 cm. Conclusions: Benign breast diseases has a preponderance in the middle aged women and fibroadenoma is the most  common benign breast disease in the women of the hilly areas of Garhwal, Uttarakhand.

169. A Hospital Based Analytical Assessment of the Efficacy of Intravenous Esmolol and Intravenous Magnesium Sulphate in Attenuating Haemodynamic Response to Laryngoscopy and Endotracheal Intubation.
Soumya Singh, Amit Kumar Singh, Uma Shanker Singh
Aim: To compare the effects of intravenous administration of esmolol and magnesium sulfate on the hemodynamic changes due to LETI. Methodology: This study was a prospective study done on 50 patients in Department of Anesthesiology, AIIMS, Patna, Bihar for six months. Sixty patients posted for elective surgeries were randomly selected and were divided in two groups of thirty each i.e. Group E and group M. Patients were thoroughly evaluated pre-operatively, kept NPO from previous midnight, and were administered Alprazolam 0.5mg orally. Group E patients were administered Esmolol hydrochloride 1.5 mg/kg diluted to 10 ml with Normal saline over 1 min. Group M patients received Magnesium Sulfate 50 mg/kg diluted to 10 ml with Normal Saline over 1 min Endo-tracheal intubation was facilitated by Inj. Succinylcholine 1.5 mg/kg. Laryngoscopy and tracheal intubation were performed in less than 15 seconds. Heart rate and Blood pressure recording were done pre-intubation, immediately after intubation and at 2 minutes and 5 minutes after intubation. Results: In group E patients, mean heart rate before intubation was 84.85 + 14.22 which was increased to 83.85 + 14.22 but reduced to 79.8 + 9.84 after 5 minutes. In group M patients, mean heart rate before intubation was 85.6 + 12.50 which was increased to 94.52 + 13.62 but reduced to 86.10 + 11.90 after 5 minutes but still was increased than pre-intubation mean heart rate. In group E patients, mean arterial pressure before intubation was 99.5 + 10.15 which was increased to 116.86 + 18.68 but reduced to 98.26 + 16.54 after 5 minutes. In group M patients, MAP before intubation was 94.88 + 9.66 which was increased to 119.98 + 13.75 but reduced to 100.32 + 14.78 after 5 minutes but still was much more than pre-intubation MAP. Conclusion: HR and MAP was controlled 5 minutes after intubation in patients who were given esmolol in comparison to magnesium sulfate. The mean heart rate in group E was significantly lower than in group M immediately after intubation showing that esmolol had a greater control over heart rate than magnesium sulfate. In conclusion, Esmolol is a better agent to attenuate intubation response than Magnesium sulfate as it attenuates the rise in both heart rate and blood pressure.

170. A Comparative Study of Recurrence Rate of Conjunctival Autograft and Bare Sclera Techniques in the Treatment of Pterygium.
Ashutosh Kumar Anand, Arjun Choudhary
Aim: The aim of the present study was to evaluate bara sclera technique and conjunctival graft in the treatment of pterygium. Methods: Patients presenting to the OPD in Department of Ophthalmology, ANMMCH, Gaya with pterygium from June 2021 to January 2022 were included in our study. The study was carried out on 40 patients. Efforts were made to select patients with primary fleshy pterygium. Patients were divided into two groups, Group I and Group II. Results: 20 eyes included in both the groups with M:F ratio 14:6. In the present study, most of the cases 12 were in 41-50 age group followed by 31-40 and 58-62 age groups (8). In the present study, nasal pterygium were most i.e., 80% followed by both 12.5% and temporal 7.5 %. Conclusion: The recurrence rate of in patients who have undergone pterygium excision with Bare Sclera Technique (40%) in comparison to patients who have undergone pterygium excision along with Conjunctival Autography. In most of the patient’s improvement of visual activity occurred after pterygium surgery. Majority of the patients were outdoor workers 80% as compared to indoor workers. 40% have recurrence rate in group I and 10% in recurrence rate in group II.

171. A Study on Urinary Tract Infections and Antimicrobial Susceptibility Pattern in the Pediatric Age Group.
Radha Lavanya Kodali, Srinivas N, S. Srinivasa Sarma, Geddati Sudha Vatchala, T Jaya Chandra
Introduction: Urinary tract infections (UTIs) are the most prevalent bacterial infections in the pediatric age group. With these a study was undertaken to find the antimicrobial sensitivity pattern of various UTI causing bacterial pathogens in the pediatric age group. Materials and Methods: Study was conducted in the department of Microbiology, GSL Medical College from September 2021 to February 2022. Children <14 years presented with symptoms suggestive of UTI were included in the study. Clean, mid-stream urine samples were collected and cultured on blood agar, MacConkey agar and CLED media. Culture of the samples, identification of isolates and antibiotic sensitivity testing were done as per theavailable report, the empiric treatment for pediatric age group is not well established. Results: During study period, total 385 urine samples were collected, culture positivity was 72 (18.7%). In the culture positive cases, 35 (48.1%) were boys and 37 (51.4%) were girls. Among the 72 (100%) isolates, 65.3% (47) were gram negative bacilli, 29.1% were gram positive cocci and 4 (5.6%) fungi isolates are Candida species.  No significant drug resistance was identified. Conclusion: The prevalence of UTI was 18.7%. Among the gender, it was 51.4% in girl children and 48.6% in boys. Esch. coli was the predominant UTI causing isolate followed by Klebsiella species. No significant drug resistance was reported.

172. Comparative Assessment of Post OP Morbidity among Patients Undergoing Tonsillectomy Through Partial or Total Processes.
Rajendrakumar V Patil, Meghkumar U Jain, Suresh N Patil, Charuhas S Jagtap
Adenotonsillectomy (AT) is amongst the most widely performed pediatric surgeries in the whole world. AT includes two major surgical techniques: total tonsillectomy (TT) and partial tonsillectomy (PT). Several studies have been conducted to evaluate the difference between TT and PT and assess the comparative effectiveness, benefits, and sequelae between both. Methods: A prospective study was conducted including pediatric patients aged between 2 and 9 years, who were admitted for partial tonsillectomy (PT) or total tonsillectomy (TT) in 2021. An estimated number of children included were 50: 25 patients underwent PT, and 25 patients underwent TT. Patients were sent home on day 1 post-op with a questionnaire that evaluates the following over the first 10 days post-op: pain using the Wong–Baker Faces Pain Rating Scale and the “Parents Postoperative Pain Measure” (PPPM) questionnaire, and appetite using the visual analogue scale (VAS). Results: Patients in the PT group and in the TT, group had no demographical differences in terms of age, BMI, exposure to smoking, area of living, and attending a day care center. Comparison between PT and TT revealed a significant difference in both pain and appetite scales. Patients who underwent PT had significantly lower PPPM scores on the 1st, 2nd, 4th, 5th, 6th, and 10th day after surgery compared to the TT patients. Further validation showing that the PT surgery group experienced significantly less postoperative pain compared to the TT surgery group. Conclusion: In conclusion, the recovery process after the PT surgery causes less postoperative morbidity, thus an earlier return to normal activity compared to the TT.

173. The Effect of Functional Endoscopic Sinus Surgery on Sleep Patterns among Patients with Chronic Rhinosinusitis.
Charuhas S Jagtap, Rajendrakumar V Patil, Meghkumar U Jain, Arif Kaderi
Objective: Chronic rhinosinusitis (CRS) patients often complain of nasal obstruction, which may cause sleep impairment for them. The goal of this study was to investigate the influence of functional endoscopic sinus surgery (FESS) on sleep-related outcomes in CRS patients. Materials and Methods: CRS patients who received FESS were included in this study. Prior to FESS and 3 months after surgery the patients were asked about the severity of nasal obstruction and completed the 20-item Sinonasal Outcome Test (SNOT-20), along with the Epworth Sleepiness Scale (ESS) questionnaire. Endoscopic examination, acoustic rhinometry, and polysomnography were performed in all patients. They were divided into four groups according to their preoperative apnea-hypopnea index (AHI) scores: nonobstructive sleep apnea syndrome (non-OSAS), mild OSAS, moderate OSAS, and severe OSAS. Results: A total of 96 subjects completed the study. The scores of the sleep domain of the SNOT-20 and ESS decreased in all of the AHI groups, with the exception of the severe OSAS group, after FESS. A reduction in the AHI of less than 5 was achieved in 9 patients (13.2%) after FESS. Conclusions: Our results showed that FESS improved sleep quality in CRS patients, except those with severe OSAS, and a preoperative lower AHI was the only significant predictor of post-FESS OSAS outcome.

174. Assessment of Student Perception Regarding Use of Problem Based Learning Tools in Clinics.
Suresh N Patil, Yogesh S Zadbuke, Rajendrakumar V Patil, Shailendra R Patil
Introduction: Multiple learning tools have been used in education during the clinical years. Problem-based learning (PBL) is one of the learning strategies that has currently been introduced into curriculums. The success of PBL in the preclinical year has been reported on globally. Objective: This study’s aim was to assess the attitudes and knowledge of the students in their clinical year of PBL. Methods: The study was conducted among 387 medical students at the ACPM Medical College and Hospital, Dhule Maharashtra. Self-administered questionnaires were used to determine the attitudes and knowledge that had resulted. Results: The overall response rates were at 76.0%. Regarding the opinion of medical students toward PBL, the majority of them agree that PBL develops their communication skills (91.4%), skills necessary for working as a team (91.0%), competence in self-directed learning (91.4%), and enhances the information inquiry skills (89.0%). The majority of the students (76.8%) indicated that they appreciated PBL although it was time consuming (48.9%) and stressful (44.8%). Regarding the comprehension of PBL, 76.5% of the medical students had the misunderstanding that PBL requires knowledge obtained from conventional lectures. In comparison to other learning tools, the students have agreed that PBL is better than conventional lectures (41.8%) and report writing (62.8%).  Conclusion: The results indicate that clinical students have positive attitudes toward PBL and that the curriculum should integrate PBL with other learning strategies.

175. Assessment of Toe Exercises and Toe Grip Strength in the Management of Primary Metatarsalgia: A Prospective Observational Study.
Shailendra R Patil, Yogesh S Zadbuke, Meghkumar U Jain, Rajendrakumar V Patil
Background: The relationship of metatarsalgia and toe function is poorly understood. We investigated the efficacy of toe exercises for the treatment of metatarsalgia. Methods: Forty-one (56 feet) metatarsalgia patients (mean age ± SD: 63.4 ± 10.6) underwent toe strength measurement. We recorded pre- and post-treatment VAS score, AOFAS score, marble pickup, and single-leg standing time (SLST), and compared in two subgroups to evaluate the impact of disease duration on treatment outcome. Results: Post-treatment, toe plantar flexion strength improved (all p < 0.01); VAS scores decreased (p < 0.01); AOFAS scores, marble pickup, and SLST improved (all p < 0.01). Patients symptomatic for > 1 year had significantly lower changes in VAS scores (p < 0.01). Multivariate analysis showed patients with longer disease duration, and larger body mass index had significantly lower improvement in VAS scores (p= 0.029 and p = 0.036, respectively). Device consistency assessed by ICC was excellent (0.89–0.97). Conclusion: Toe function and metatarsalgia are improved by toe exercises, suggesting that they are closely related.

176. Spinal Anaesthesia for Elective Cesarean Section with Bupivacaine Associated with Different Doses of Fentanyl.
Vivek Singh, Gunjan Katiyar
Introduction: Spinal anaesthesia is commonly used in cesarean section using bupivacaine for anaesthetic effect at low dosage which is given with fentanyl. This enhances the anesthetic effect, lengthen the duration of anesthesia, minimize the post-operative nausea and vomiting. Although there are conflicting findings about the effectiveness of fentanyl when used with local anaesthetics. The drawbacks of continuous spinal anaesthesia includes probable post-dural puncture headache, technical challenges, and neurologic problems.  Microcatheters allowed to modify the dosage of fentanyl which is expected to have different pharma coeffect as fentanyl can modulate the effect of anaesthesia. Aims and Objectives: To compare different dosage of fentanyl given with bupivacaine for spinal anaesthesia in caesarean sections. Methods: This is a randomised, prospective research, conducted on 70 pregnant patients who were scheduled for caesarean section and received spinal anaesthsia using bupivacaine and fentanyl at 4 different dosages. There were several factors that were analyzed in each patient including anaesthetic block latency, sensory obstruction, motor block level, duration of block recovery, analgesic effect, etc. Results: The study found that  More individuals (14 (77.7%), 13 (72.2%), and 10 (55.5%), respectively) in the groups that are receiving a fentanyl-containing solution (Groups I, II, and III) rated analgesia as “Excellent”. Four members of Group IV (or 25%) said they had excellent analgesia. Comparing the fentanyl-treated groups to the control group, there was a significant difference (p = 0.0023). Conclusion: The study mainly found that bupivacaine with  15.1 μg fentanyl in 0.4 mL of solution is the most effective dosage combination which has maximum analgesic effect.

177. A Hospital-Based Assessment of the Management of Posttraumatic Posterior Elbow Defects by Non-Microsurgical Reconstruction.
Pranav Kumar
Aim: In this article, we studied management of Posttraumatic Posterior Elbow Defects by Non-microsurgical Reconstruction. Methods: A retrospective analysis was conducted at Department of Burn & Plastic Surgery ESIC Medical college, Bihta, Patna, Bihar, India for 12 months by including all patients with posttraumatic posterior elbow defects reconstructed with non-microsurgical flaps. Patients having anterior elbow defects and defects covered with free flaps were excluded from the study. Patients with injuries of and around the elbow were managed primarily by orthopaedic surgeons. Coverage of defects was performed secondarily after bony stabilization by plastic surgical unit. Data was collected from electronic medical records, departmental operative registers, and photographic records. Results: There were 40 males and 10 females in the study. Road traffic accidents were the most common presentation (n=40) followed by industrial accidents (n=8) and domestic accidents (n=2). The age of the patients varied from 8 to 72 years with mean age being 38 years. The defect size varied from as small as 2 x 2cm to as large as 14 x12cm. 28 patients were small defects (A) and 22 were large complex defects (B). Conclusion: Posterior elbow defects are a difficult problem to tackle. To achieve optimal results, all patients with elbow trauma should be attended and managed by orthopaedic and plastic surgeons in collaboration for optimal results. We believe that most of these defects can be resurfaced by nonmicrosurgical reconstruction with proper planning and execution and their utility cannot be understated.

178. A Hospital Based Prospective Observational Cross-Sectional Study to Assess the Thrombocytopenia and Variations in Platelet Indices in Neonatal Sepsis.
Rubaiya Ahmad, Mahesh Prasad, Manoj Kumar
Aim: The present study was undertaken to evaluate thrombocytopenia and variations in platelet indices in neonatal sepsis. Methods: This hospital based prospective observational cross-sectional study was conducted in Department of Pathology, SKMCH, Muzaffarpur, Bihar, India over a period of 12 months. A total of 200 Neonates under the age of 28 days admitted in NICU, were studied and 100 at risk neonates’ were detected and included in our study. Results: Most common presentation in EOS is respiratory distress, and in LOS is refusal of feeds, and overall common presentation is refusal of feeds. Total 200 neonates were examined. 100 neonates (50%) were at risk. 12 (12%) were had no sepsis (NOS), 40 (40%) were Early onset sepsis (EOS) and 48 (48%) were Late onset sepsis (LOS). In EOS, thrombocytopenia was found in 80%, whereas it was 83.34% in LOS. It was seen that thrombocytopenia was the most sensitive marker (83.08%) followed by MPV and PDW in detecting neonates with culture-positive sepsis. However, it has a low specificity (20.33%). But when we combine MPV and PDW or combined all the three markers (MPV + PDW + PC), the specificity increased to 46.34%. Conclusion: NNT can be used as screening tool in NNS as it is easy and cost-effective. It requires further large scale studies and meta-analysis to validate. Mortality in sepsis cases increases with severity of thrombocytopenia.

179. Evaluation of Nebulized Lignocaine versus Intravenous Lignocaine for Attenuation of Pressor Response to Laryngoscopy and Intubation in Controlled Hypertensive Patients: A Randomized Clinical Study.
Amit Kumar, Jitendra Prasad Singh
Aim: The objective of the present study was to study the evaluation of Nebulized Lignocaine versus Intravenous Lignocaine for Attenuation of Pressor Response to Laryngoscopy and Intubation in controlled hypertensive patients. Methods: This study was carried out in the Department of Anaesthesiology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India for the period of 1 year and Ethical committee clearance was obtained prior to the study. Total 100 patients aged between 18-65years k/c/o hypertension taking antihypertensive medications scheduled for elective surgical procedures belonging to ASA class II under GA. Results: The age distribution in group A and group B was from 18 – 65 years with p value 0.980 which is statistically not significant. The mean weight of the patients in both the groups was comparable with p value being 0.620. There was no significant difference in age, gender and weight distribution in the two groups. Statistically significant reduction in heart rate was seen (p value < 0.05) at 3, 5 and 10 minutes after endotracheal intubation in group A compared to group B. Statistically significant reduction in systolic blood pressure occurred in group A as compared with B group at 3 and 5 minutes after endotracheal intubation. The statistically significant reduction is observed in patients with group A as compared with group B at 7 minutes only after endotracheal intubation. The statistically significant reduction is observed in patients with group A as compared with group B at 3 & 5 minutes after endotracheal intubation. Conclusion: The study concludes that both nebulized and intravenous lignocaine are effective in attenuating pressor response but nebulized lignocaine gave slightly better results in our study than intravenous lignocaine in attenuating pressor response to laryngoscopy and endotracheal intubation without any significant side effects in controlled hypertensive patients.

180. A Hospital-Based Assessment of the Prevalence and Symptoms in Patients with Eosinophilia using Peripheral Smear Method.
Abhilasha, Manoj Kumar
Aim: The present study aimed to evaluate the prevalence and symptoms in patients with eosinophilia. Methods: The study was done in Department of Pathology, Sri Krishna Medical college, Muzaffarpur, Bihar, India for one year. Study protocol was approved by Institutional Human Ethics Committee. The study included total of 100 patients based on the inclusion and exclusion criteria. All the patients were explained study protocol and informed consent was obtained. Results: The study included 100 patients. 25 patients were in the age group of 41-50 years. 22 patients were between 51-60 years. 3 patients were in age between 1-10 and 2 patients in 81-90 years. Male (n=60) were more compared to females (n=40) in this study. A total of 18 symptoms observed in the study population. Fever was the most common (n=25) symptom compared to others. 20 patients showed cough and 18 had breathlessness. 12 had chest pain and 15 had rash. Least number of patients showed hemoptysis, hydrocele, headache, bleeding per rectum. 60 patients in mild, 30 in moderate and 10 in severe eosinophilia categories were observed in this study. Conclusion: The study showed middle age with male sex is more prone to eosinophilia. Fever and cough are the most common symptoms.

181. Tobacco Dependence, Willingness to Change Behaviour among Tobacco Users Attending Tertiary Care Hospital’s De-Addiction Clinic.
Vikram Singh, Mahaveer Singh
Introduction: In India, smoking is a major contributor to many respiratory illnesses and avoidable deaths. Due to a lack of information on the severity of the tobacco use problem, tobacco cessation programmes could not be developed or implemented around the Hill areas. In this study, tobacco users who visit a de-addiction clinic at a tertiary care teaching hospital will have their nicotine dependency and readiness to alter behaviour assessed. Materials and Procedures In this research, 100 tobacco users from a government hospital’s addiction clinic in Sikar, Rajasthan, India were included on purpose throughout the course of six months. Information was gathered using a standardised personal and clinical profile sheet, the revised smokeable and smokeless Fagerstrom Test for Nicotine Dependence, and the Willingness to Change Questionnaire. To produce the results, descriptive and inferential statistics were applied. Results: As per this study population, tobacco use started at an early age. The study’s participants chose bidi over all other types of smokable tobacco. According to the FTND scale, the majority of participants fell into the category of heavy nicotine dependency and were in the contemplation phase of quitting cigarettes (compared to the users who were in the action stage). Conclusions: Most subjects were at a high degree of nicotine dependency. While highlighting the need for need-based intervention and aided follow-up programmes for tobacco, it is important that willingness to alter behaviour to stop or reduce tobacco use.

182. An Open Label Prospective Analytical Assessment of Patient Satisfaction with Regional Anaesthesia and General Anaesthesia in Upper Limb Surgeries.
Rajesh Kumar Choudhary, Rishi Kant, Vijayendra Prasad
Aim: The objective of this study was to compare patient satisfaction between regional anaesthesia (RA) and general anaesthesia (GA) in patients undergoing upper limb surgeries. Methods: The present study was conducted at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for one year and evaluated to compare patient satisfaction following RA and GA. The study’s patient recruitment period took place. 100 patients from each group with RA and GA were enrolled in the study. Results: There were 65 male in general and regional anaesthesia respectively and majority of the patients were in ASA I followed by ASA II. A larger number of patients in the GA group fell into the ASA 1 category. In our study population, the overall patient satisfaction score for RA was greater than GA (89.5 4.7 vs. 74.6 6.1; P 0.001) lists the scores of the various patient satisfaction items compared between the groups. The compassion exhibited to them, information offered, feeling of safety, satisfying demands, giving attention, and feeling of wellbeing all had higher mean ratings in RA. Postoperative nausea and vomiting as well as feelings of worry received higher marks from the GA group. Conclusion: RA for upper limb surgeries provides better patient satisfaction than GA, along with a longer duration of analgesia and lesser duration of hospital stay.

183. An Observational Assessment of the Functional Outcome of Anatomical Reconstruction of ACL with Quadrupled Hamstring Graft.
Abhas Kumar, Kumar Gaurav, Rajeev Anand, N.P. Sinha
Aim: The objective of the present study was to assess the functional outcome of anatomical reconstruction of ACL with quadrupled hamstring graft. Methods: The present study was conducted in the Department of Orthopaedics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for the period of one year and 50 patients were included in the study who had undergone Anterior Cruciate Ligament reconstruction using quadrupled Hamstring graft. Results: The youngest patient was 21 years and the oldest patient was 52 years old. The maximum number of patients were in the age group of 18-25 (40%) followed by the age group 26-29yrs (30%). The mean age was 29.2 yrs. In our series of 50 patients, 40 patients (80%) were males and 10 patients (20%) female, (Male Predominance). It may be because of the involvement of males in outdoor activities like sports and motor vehicle accidents. Right knee was injured in 42 patients (84%) and left knee was injured in 8 patients (16%). Most of the ACL tears were caused by RTA (72%). Next common cause was sports activities (16%). Some patients (12%) got injured while doing daily activities like slip and fall. 40% Patients were having instability and 28% cases presented with knee pain. 12% gave history of locking of knee, 20% presented with instability and knee pain. Diagnostic arthroscopy prior to ACL reconstruction confirms the medial meniscal tear in 36% cases and 12% lateral meniscal tear. Both the menisci were injured in 8%. 44% were isolated ACL injuries. Conclusion: Anatomical reconstruction of ACL with quadrupled hamstring graft gives better clinical outcomes. The advantages of using hamstring graft are reduced donor site morbidity and less anterior knee pain in long term follow up. It has better subjective and objective functional outcome with low graft rejection or failure rate.

184. A Hospital Based Observational Assessment of the Relationship between Serum Vitamin D Levels with Acute Exacerbation of COPD and Also Assess the Sociodemographic Profile of These Patients.
Abhay Kumar Sinha, Ashok Kumar, Rakesh Kumar, Devendra Kumar Sinha
Aim: We aimed to assess the relationship between serum vitamin D levels with acute exacerbation of COPD and also assess the sociodemographic profile of these patients. Methods: This study was carried at Department of  Geriatric Patna medical college and Hospital, Patna, Bihar, India. A total of 150 patients admitted with AECOPD were selected consecutively who had given consent and agreed to carry out 25 (OH) D level assays during the period of one year. Finally, 100 patients were included because others were unable to carry out vitamin D assay. Results: Among them 75 (75%) were males, and 25 (25%) were females. There was male predominance (75%). The mean age of patients in this study was 72.2±13.8 years, with the majority in 65-70 years. The mean 25(OH) D level was 22.03±6.05 ng/ml (95% CI 8.1-40.2). The mean vitamin D level was higher in males (22.06±6.08 ng/ml) than the females (21.93±6.24ng/ml), but the difference failed to reach statistical significance (P= 0.950). The majority of the participants were former smokers (60%), and the mean pack-year of smoking was 22.09±6.14. In this study, vitamin D levels did not differ between smoking groups. Among non-smokers, it is 21.9±8.1 ng/ml, it is 21.4±5.1 ng/ml in those who are current smokers, and 22.3±6.1 ng/ml among Ex-smokers (P= 0.900). The majority (45%) of patients had mMRC Grade -2 dyspnea, followed by 40% in Grade- 1, 10% in Grade-3, and only 5% of patients had Grade- 4 dyspnea (p=0.270). Regarding vocational status, 70% were retired, 10% was house makers, farmers 5%, and rest of the 15% was service holders or business people. The mean level of vitamin D was high among farmers (24.26±2.75ng/ml) compared to other occupational groups. Conclusion: This study finds a high prevalence of hypovitaminosis D (85%) in AECOPD patients. Vitamin D deficiency and insufficiency are more prevalent in females. In this study, vitamin D levels did not differ between smoking groups.

185. A Prospective Observational Evaluation of One-Lung Ventilation Strategies for Infants and Children Undergoing VATS.
Amish Kumar, Rishi Kant, Rajesh Verma
Aim: This article aims to evaluate on one-lung ventilation strategies for infants and children undergoing VATS. Methods: The present study was conducted at Department of Anesthesia and critical care, Patna Medical college and hospital, Patna, Bihar, India  for 10 months and children with cystic hygroma with one-lung ventilation strategies for infants and children undergoing VATS were included in the study. Results: In the present study, we measured right and left bronchus according to Tan and Tan-Kendrick, aged 2 days to 16 years old using computed tomograms (CT) of the thorax and correlated it with the patient’s age and weight, in order to create a guide to size selection of the Fogarty catheter. For children, the Arndt Endobronchial Blocker® is only suitable if the ETT to be used is greater than 4.5 mm internal diameter, as the available 5 Fr catheter has a diameter of 2.5 mm and requires a small bronchoscope of at least 2.2 mm for positioning. Conclusion: General anaesthesia with one lung ventilation can be safely performed in infants undergoing VATS with through preparation of difficult airway cart and under expert anaesthetist guidance.

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