International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1.Evaluation Of Risk Factors for Conversion to Open Surgery Among Patients with Acute Cholecystitis Undergoing Laparoscopic Cholecystectomy at the Tertiary Care Center
Prabhu Dayal, Anil Kumar, Parikshit Singh Chandawat, Mangi Lal Seervi
Abstract
Background: Laparoscopic cholecystectomy is becoming the gold standard operative procedure for cholelithiasis but still the conversion rate of open cholecystectomy from laparoscopic cholecystectomy is 5 to 10%. Laparoscopic cholecystectomy has also the benefits of preservation of the patients’ immunity and reduction in the inflammatory reactions in comparison to open cholecystectomy. Material & Methods: The 50 patients who had symptomatic cholelithiasis and gave consent to undergo laparoscopic cholecystectomy were enrolled by simple random sampling in the present study. Institutional Ethics Committee Clearance was obtained before the start of the study. Strict confidentiality was maintained with patient identity and data and not revealed, at any point in time. Results: In the present study on the comparison of the ultrasonography findings and intraoperative findings we found a statistically non-significant association between i.e. p-value > 0.05 between intra-operative difficulty during laparoscopic cholecystectomy and number of gall stones (P-value > 0.05), gall bladder wall thickness (P-value > 0.05), size of gall stones (P-value > 0.05), position of impaction of gall stone at bladder neck (P-value > 0.05) and multiple gall stones (P-value > 0.05). Out of total study participants, 10 patients took more than 90 min of intra-operative duration to undergo the laparoscopic cholecystectomy, bleeding more than 100 ml was seen in 6 patients, difficult anatomy was found in 7 patients, adhesions with subsequent adhesiolysis was done in 9 patients, difficulty in gall bladder extraction was seen in 10 patients, intra-peritoneal gall bladder contents spillage seen in 13 patients (bile alone and stones along with bile were spilled in 10 and 3 patients respectively) and conversion to open surgery seen in 2 cases. Conclusion:  Increased gallbladder wall thickness, gall stones size >2 cm in diameter, gall stone impacted at gallbladder neck, biliary colic, palpable gall bladder, and BMI >30 kg/m2 had a significant association with difficult laparoscopic cholecystectomy and should be considered as risk factors for conversion to open surgery among patients with acute cholecystitis undergoing laparoscopic cholecystectomy.

2.Synergistic Bacterial Detoxification of Rayon Grade Pulp Paper Mill Effluent
Amit Kumar Garg, Mohammed Faheem, Summer Singh
Abstract
The rayon grade paper (RGP) manufacturing industry discharges a huge amount of effluent containing high level of colr, COD, BOD, resins, tannins and many potentially hazardous compounds released during various processing stages. Microbes especially bacteria are Mothers nature’s innovative recyclers, converting toxic compounds into harness by product.  In this study, bacterial strains were first isolated from sludge sample by nutrient enrichment technique and then subjected into two rounds of screening. The first screening was based on the bacterial efficiency to decompose lignin + PCP in the presence and absence of a simpler form of carbon and nitrogen and second on the basis of their COD, color and lignin reduction ability. Two bacteria designated as XPB4 and XPB6 showed highest ability to remove pollution parameters and were identified as S. marcescens, and Bacillus megaterium, respectively. These selected bacteria were used for further RGP treatment studies. Overall, the maximum reductions of COD, color and BOD after bacterial co-culture treatment were 91.6%, 76% and 85.8%, respectively than single culture. We also evaluate the BOD/COD ratio during bacterial treatment of RGP effluent, with this ratio increasing from 0.4 to 0.7 (42%) higher. This increase of BOD/COD indicates that the complex compound contributing to COD was decreasing more in RGP effluent. In addition, HPLC, GC-MS and Genetoxicity assessment showed that most of the toxic organic pollutants from RGP effluent have been removed by this develop bacterial co-culture.

3.Human Myiasis: A Retrospective Case Series Study
Rajkumar Bhati, Bhupendra Saini, Mahima Singh, Jaideep Singh Chouhan
Abstract
The rayon grade paper (RGP) manufacturing industry discharges a huge amount of effluent containing high level of colr, COD, BOD, resins, tannins and many potentially hazardous compounds released during various processing stages. Microbes especially bacteria are Mothers nature’s innovative recyclers, converting toxic compounds into harness by product.  In this study, bacterial strains were first isolated from sludge sample by nutrient enrichment technique and then subjected into two rounds of screening. The first screening was based on the bacterial efficiency to decompose lignin + PCP in the presence and absence of a simpler form of carbon and nitrogen and second on the basis of their COD, color and lignin reduction ability. Two bacteria designated as XPB4 and XPB6 showed highest ability to remove pollution parameters and were identified as S. marcescens, and Bacillus megaterium, respectively. These selected bacteria were used for further RGP treatment studies. Overall, the maximum reductions of COD, color and BOD after bacterial co-culture treatment were 91.6%, 76% and 85.8%, respectively than single culture. We also evaluate the BOD/COD ratio during bacterial treatment of RGP effluent, with this ratio increasing from 0.4 to 0.7 (42%) higher. This increase of BOD/COD indicates that the complex compound contributing to COD was decreasing more in RGP effluent. In addition, HPLC, GC-MS and Genetoxicity assessment showed that most of the toxic organic pollutants from RGP effluent have been removed by this develop bacterial co-culture.

4.Immunotherapy As an Alternative for the Treatment of Covid-19 in Brazil: A Brief Review
Lucena M.L.C, Paulino S.J.S, Lucena A.E.S, Leite A.C.L
Abstract
Introduction: Since the beginning of the pandemic caused by SARS-Cov-2, much research has been done on possible treatments to combat the virus, but nothing has shown to be fully effective and the vaccination process in Brazil experienced financial and logistical difficulties in its course. In this context, Immunotherapy, already known and used clinically in the treatment of other illnesses, is one of the alternatives to be explored for the treatment of COVID-19, as it induces, through neutralizing antibodies, a rapid passive immunity in a short period of time. Among the available strategies are the use of Convalescent Plasma, Hyperimmune Equine Serum, Specific Intravenous Immunoglobulin G and Monoclonal Antibodies. Methods: This review consulted the databases Scielo, Science Direct, PubMed and Google Scholar, from which 83 articles and 7 scientific texts, presented by public agencies, published from 2016 to 2021, were selected. Results: The article identifies and discusses how immunotherapy works against the disease caused by SARS-Cov-2, what are the production technologies, benefits, risks, current limitations and their perspectives in the context of the Brazilian public health system. Conclusion: Several pre-clinical and clinical studies in progress evaluate the safety and efficacy of these therapies in the clinical management of COVID-19. Of these, monoclonal antibody is the most promising and technologically advanced product available at the moment.

5.Correlation of HbA1C with Fundoscopic Finding in Type-2 Diabetes Mellitus Patients
Anil Kumar, Neha, Madhuri Meena
Abstract
Background: Diabetes is a very common disease now days. It has adverse effect on many human organs as its duration increases. Many studies exist to show its bad effects on body organs in different parts of world. We have studied is there any relation between fundoscopic finding with HbA1c levels. Methods: we have done a cross sectional study from January 2016 to March 2017 in a tertiary health care hospital located in Jhalawar, Rajasthan. Our study includes all the known case of type 2 diabetes mellitus patients of age group of 45 years and above. Results: It was seen that, 81 patients had grade 1 fundoscopic changes from which 14 (17.2%) shows Hb1Ac was less than 6.5% whereas 67(82.7%) had Hb1Ac level more than 6.5%. 15 patients had grade 2 fundoscopic changes from which 1 (6%) had Hb1Ac level less than 6.5% and 14 (94%) had Hb1Ac level more than 6.5%. 4 patients had grade 3 fundoscopic changes and all of them were having Hb1Ac level more than 6.5%. This Fundoscopic finding was not statistically associated when compared with Hb1Ac. (Pearson Chi-Square- 1.854 with df 2 and p value is 0.396). Conclusion: Fundoscopic changes in patients was not found associated with glycosylated haemoglobin as p <0.3.

6.Incidence of Helicobacter pylori infections among perforated peptic ulcer patients of Garhwal region of Uttarakhand, India
Shwetabh Pradhan, Biant Singh, Srijan Srivastav
Abstract
Objectives: This present study was to evaluate the incidence of helicobacter pylori infections in various age group of population among perforated peptic ulcer patients. Methods: A complete assessment (general and systemic examinations) and relevant investigations were performed to all patients. Blood sample specimen was allowed to clot at room temperature and centrifuged at 2500 rpm for 5 minutes in a REMI centrifuge after separating the clot from the upper wall of the test tube with sterile loop. The serum was separated and frozen until they tested as per the instruction of the manufacturer. Serological examination was performed by ELISA test. The biopsy specimens were subjected to rapid urease test. Giemsa staining was performed for the typical morphology of stained H. pylori organisms. Results: Most of the cases 16(32%) were in age group of 31-40 years. 12(24%), 9(18%) and 6(12%) cases were in age group of 41-50, 51-60 and 61-70 years respectively. The ratio of male and female ratio was 3:2. Among all 50 patients, Giemsa staining and rapid urease test were positive in 27(54%) patients and both the tests were negative in 23(46%) of the patients. Rapid urease test was alone positive in 28(56%) of the cases. Among all the 50 perforated peptic ulcer cases both Giemsa staining and Serology were positive in 26(52%) of the cases and both were negative in 22(44%) of the patients. Giemsa staining was alone positive in 27(54%) of the patients. Conclusions: We have found the preponderance of peptic ulcers in middle aged male population, pre-pyloric region being the commonest site of perforation. There has been a higher prevalence of H-pylori infection in patients with perforated peptic ulcers in our study.

7.Prevalence of Soft Tissue Tumors (Both Benign and Malignant) Presenting in A Tertiary Care Hospital on Central India
Aparajita Tomar, Parul Nema, Hemlata Bamoriya, Ram Pratap Singh Chouhan
Abstract
Background: Soft tissue tumors are mesenchymal proliferations that arise in non-epithelial extra skeletal tissue of the body, excluding the visceral organs. Both benign and malignant tumors typically appear as a lump without causing any discomfort. Most soft-tissue masses can be diagnosed by a core biopsy, excisional biopsy, or incisional biopsy. Aims and objectives: To determine the prevalence of various benign and malignant soft tissue tumors in the hospital population and the relationship between clinical manifestations and the histological characteristics of these lesions. Materials and Methods: This observational study was undertaken with attending patients at a tertiary care hospital. Clinical data were collected in detail, such as the patient’s history, clinical examination findings, and radiological findings. The lesion site defines soft tissue tumors as head and neck, trunk, and upper and lower extremities. Results:  As a result of our research, benign lesions comprise 90% of all instances, while malignant lesions include just 10%. Our study found that lipoma was the most common soft tissue tumor, followed by haemangioma, fibroma, and schwannoma. High-grade sarcoma is the most prevalent malignant soft-tissue tumor in our study, with a propensity for those ages 41-60 years. Conclusion: Even though soft tissue sarcomas are uncommon and typically present as an asymptomatic tumor, early detection is critical for the best possible treatment. More large-scale, multicentre prospective studies are required to grasp better how these tumors behave and progress in the general population.

8.Estimation of the Clinico-Radiological Outcome of Intertrochanteric Fracture Fixation by Using the Proximal Femoral Nail in Adults
Prithviraj Deshmukh, Ankesh Goyal, Rajkumar Prasad
Abstract
Introduction & Aim: Intertrochanteric fractures are common in old age group, but it is not uncommon in younger age group. The proposed study aims to estimate the clinico-radiological outcome of the intertrochanteric fracture fixation by using the PFN in adults. Materials and methods: The clinical and radiographs outcomes were prospectively analyzed following treatment of 51 cases of unstable intertrochanteric fractures by initial debridement and Proximal Femoral Nail fixation over an eighteen-month period. The functional outcome including time to partial and complete weight bearing in fractures treated by PFN was determined. They were followed up for a mean period of 6 months and evaluated at follow ups at 6 weeks, 3 months and 6 months using SWS and RUSH score. Results: In our series of 51 cases there were 30 male and 21 female, and mean age of 58.7 yrs. 42 cases (82%) had SWS scores above 20 points at 6 months (20/40).1 case had RUSH scores below 18 at 6 months predicting a probable radiographic nonunion. The majority of the cases (98%) had RUSH scores above 18. Conclusion: The conclusion drawn from this sample study is that proximal femoral nail can be considered as an excellent choice of implant for the treatment of intertrochanteric fractures after proper training.

9.Prevalence of Plantar Fasciitis Among Post Graduate Medical Students
Dhruv Sharma, Sudhir K Rawat, Smit Vadher,  Cheraventhan Mani, Fenil Shah
Abstract
Background: One of the Commonest cause of heel pain is Plantar fasciitis. Prevalence of which is less studied. Through this study, we want estimate the prevalence of plantar fasciitis among postgraduate residents in Dhiraj hospital and compared it with the general population. Methods: Observational study in which medical students were examined clinically and preformed questionnaire was given to them comprising of questions regarding routine day- to- day activities which were answered by the postgraduate students. Also they were asked to use an application in their mobile phones to track their number of steps; which was later analyzed. Results: In our study post-graduate medical students were found to have slightly higher  prevalence of plantar fasciitis i. e. 12.08%. As compared to general population as stated in previous studies. Surgical students had a higher rate as compared to non- Surgical students.

10.Prevalence of Hearing Impairment in School Children in A Rural area of Lucknow- A Cross Sectional Study
Pankaj Kumar Verma, Deepak Chopra, Mariyam Khwaja, Nidhi Jauhari
Abstract
Background: Hearing loss in school going children causes behavioral complications and also it causes impact on childrens’ academic achievement. It largely remains undetected; the aim of this study is to ascertain the prevalence of hearing impaired children in a school in a rural area of Lucknow district. Methods: A Cross-sectional study was conducted to calculate the prevalence of hearing impairment in school children aged 6 years to 17 years in a school in a rural area in district Lucknow during month of July 2018 to December 2018. The students aural examination and audiological tests were performed by qualified Otolaryngologist and Audiologist respectively. Results: This study was conducted among 597 school children of age group of 6 to 17 years. 95(15.9%) children were suffering from hearing impairment. Maximum 67 (70.5%) individuals had Wax, followed by 20 (21.0%) individuals had Chronic Otitis media, 7 (8.2%) individuals had Serous Otitis media and minimum number of individuals belongs to Post operative case of MRM (Modified Radical Mastoidectomy). Conclusions: The hearing loss could lead to delay in the development in speech and language which leads to learning problems which in turn leads to poor academic achievements. As inference drawn from the present study that school screening is the most effective method of diagnosing deafness in school age children, this program should be extended to all school in all the areas to know the disease burden in society and early measure can be taken to avoid any disability.

11.A Comparative Study of Intravenous Dexmedetomidine and Intravenous Tramadol for Post Spinal Anaesthesia Shivering
Deepak Choudhary, Jagdish Prashad, Virendra Sharma
Abstract
Introduction: Shivering is a natural protective mechanism. The main causes of intra/post-operative shivering are temperature loss, increased sympathetic tone, pain, and systemic release of pyrogens. Spinal anaesthesia significantly impairs the thermoregulation system by inhibiting tonic vasoconstriction, which plays a significant role in temperature regulation. Several drugs have been studied for the prophylaxis as well as treatment of shivering. Tramadol, an opioid receptor agonist, has also proved to be effective in the treatment of shivering after general anesthesia, On the other hand Dexmedetomidine, a congener of clonidine, has been used as a sedative agent and is known to reduce the shivering threshold. The aim of the study was to compare the efficacy of dexmedetomidine and tramadol in the treatment of post-spinal anesthesia shivering as well as their side-effect profile. Materials and methods: The present study was carried out in the Department of Anaesthesiology and Critical Care, PDUMC, Churu, Rajasthan from Jan-21 to Aug-21. This is a Prospective Randomized Comparative Study. Patients aged 18-60 years, American Society of Anesthesiologists I & II and scheduled to undergo elective surgeries under spinal anesthesia and developing shivering grade 3 or grade 4 were included in the study. We made two groups of cases i.e. Group T (TRAMADOL) and Group D (DEXMEDETOMIDINE). Sample size was 64, which was divided into two groups of 32 each. Standard protocol followed to administering spinal anaesthesia. On occurrence of shivering its intensity graded using a four point scale as per Wrench. All data were collected and analysed with the help of suitable statistical parameters. Results: Our study concluded that dexmedetomidine is more effective than tramadol  for treatment of postspinal anaesthesia shivering.

12.Menopause Related Quality of Life among Females of Urban Field Practice Area of a Tertiary Care Centre in Jaipur City
Gahlot N, Singhal M, Paliwal A, Sharma N
Abstract
Background: Almost all women at the time of menopause irrespective of their cultural background and health conditions begin to experience physical, psychological and emotional disturbances. Objectives: 1. To determine the prevalence of poor quality of life (QOL) among postmenopausal women.2. To assess the risk factors associated with poor quality of life among postmenopausal women. Methods: A community based cross sectional observational study was carried out among 110 postmenopausal females aged between 40-60 years of age. The standardized Menopause-Specific Quality of Life Questionnaire (MENQOL) and the International Physical Activity Questionnaire (IPAQ) were used. Results-Among the study participants, the most common symptoms in the physical domain were “decrease in physical strength” (86%), “decrease in stamina” (80%), and “feeling tired and worn out” (80%). Urinary incontinence was seen in 23% of women. In the psychosocial domain, “the feeling of having the ability to accomplish less than previously” was the predominant one (80%). Among the symptoms of sexual domain, “decrease in sexual desire” was the most common complaint (63%). Among vasomotor symptoms, hot flashes were present in only 37% of participants. Those having low physical activity were exposed to more postmenopausal symptoms as compared to those having moderate and severe physical activity. Conclusion: Menopause is associated with decrease in QOL. Awareness regarding menopausal symptoms will lead to improvement in QOL by early recognition.

13.Internet Addiction: Pattern of Smart Phone and Internet Usage Among Students of Professional Courses
Mayank Jain, Manish Jain, Vinod Kumar, Ravi Shekhawat
Abstract
Background: Rapid expansion and proliferation of the internet has provided better opportunities for communication, information and social interaction although mobile phone usage has both pros and cons. The excessive, undisciplined, uncontrollable and damaging use by individuals has led to the emergence of the concept of internet addiction. Objectives: to estimate the pattern of smart phone and internet usage among professional courses students and to assess level of addiction among them. Method: A cross sectional study was conducted on the professional course students of MBBS, Nursing and Bachelor of Engineering (B.E) between 18 to 25 years age group in Jhalawar City, Rajasthan. Young’s scale of Internet Addiction was used for evaluation of internet addiction. Chi-square test was used for analysing categorical variables and student t test for quantitative variables. P-value < 0.05 was considered as significant. Result: Out of the 408 students, 142 (34.8%) having mild internet addiction, 36 (8.83%) moderate internet addiction and 07 (1.71%) having severe internet addiction. Young students ≤20 years were more addicted to internet. Most common causes of internet use were assessing of social sites (98.3%), movies & music (87.9%), games (86.3%) and search of academic related material (51.9%). Addiction to internet was more in boys and BE students. 227 (55.6%) reported that excessive use of internet affect their academic performance. Conclusion: Use of internet is widespread among professional students.  Certain degree of internet addiction (mild to severe) was found among 45.3% of students and more commonly among younger age.

14.Comparative Evaluation of Low Dose Intrathecal Buprenorphine and Clonidine in Potentiating Post-Operative Analgesia by Subarachnoid Block for Lower Limb Orthopedic Surgery- A Randomized Double Blind Controlled Study
Namrata Natraj Sadafule, Neha Amey Panse, Merlin Elizabeth Jacob
Abstract
Introduction: In attempt to prolong post-operative analgesia by intrathecal block, it is necessary to use adjuvant with local anaesthetic agents. High doses of intrathecal adjuvant cause side effects. So to avoid this, in our study we used low doses of intrathecal buprenorphine and clonidine as adjuvant to local anaesthetics for lower limb orthopedic cases. Methods: Ninety ASA I and II patients who were scheduled for femur fracture surgeries, either open or closed reduction with implantation, were enrolled in our study and randomly divided into three groups (30 of each).Patients in Group A – received intrathecal bupivacaine 0.5% (Heavy) 2.8 cc + 0.2 cc NS, Group B –intrathecal bupivacaine 0.5% (Heavy) 2.8cc+ buprenorphine 30 mcg (0.2cc), and Group C received intrathecal bupivacaine 0.5% (Heavy) 2.8cc + Clonidine 30mcg (0.2cc).The purpose of this study was to compare Buprenorphine and Clonidine in terms of their intra- and post-operative effects, their side effects, and their effects on the onset of pain,24-hVAS, and the amount of additional analgesic required when they were added to the local anesthetics in the spinal anesthesia we administered to elective femur fracture surgery patients. Results: The duration of sensory and motor blockade and post-operative analgesia was significantly longer in both study groups when compared to the control group (group A), but significantly prolonged in buprenorphine group compared to clonidine group (group B vs. group C, P < 0.05). The total requirement of rescue analgesic was less in both study groups compared to the control group, but it was significantly lesser in buprenorphine group when compared to clonidine. Side effects such as bradycardia and hypotension were observed to be more with clonidine(n=9),10 patients in group B experienced PONV in comparison to 5 in group C, whereas sedation score of >3 was seen in 7 patients of buprenorphine group. Conclusion:We conclude that both intrathecal buprenorphine and clonidine effectively prolong the duration of post-operative analgesia, but intrathecal buprenorphine is more effective in prolonging pain free period when compared to clonidine with insignificant side effects.

15.Prevalence of Gallbladder Carcinoma According to TNM Classification
Bharat Jain, Nipa Hathila, Monica Satyam, Apurva Vohra
Abstract
Introduction: Gall Bladder Carcinoma is an aggressive malignant condition that is found mainly among the elderly population. In average, the affected population is about 65 to 70 years old which is found to comprise of 2/3rd of the biliary tract carcinoma. Due to high incidence, it is needed to be properly staged and managed. TNM classification and AJCC’s staging system can be used in this regard which is the most accepted one. Aims and Objectives: The study intended to find out the number of patients in each staging and how the staging varies with other parameters of the patients like age, BMI and etiologies. Materials and Methods: The study is retrospective design which has included patients staged according to TNM classification and their prevalence was analyzed with several parameters. Therefore, the prevalence of each staging was determined. Again, this prevalence was analyzed with several other population characteristics. Results: The study found that the mean value of the patients in this study was 58.25 ± 9.08 years old. There were 57 females while 43 males in this study. The study found that 38% of the patients had Stage IB while 32% of the patients were in Stage 0. Conclusion: The study found out that the most prevalent TNM stage in this sample is Stage IB. Also, lower BMI is more prevalent in severe TNM stages. It has been found that cholelithiasis is more prevalent with Stage IIB and Stage III.

16.Psychological and Mental Health of the Elderly during COVID-19 Pandemic
Shehnaz Shaikh, Sadiyah Shaikh
Abstract
Introduction: COVID-19 pandemic has substantially changed our lives. The negative effects of misinformation and isolation have caused panic among people. The worst hit are the elderly who are not very resilient, both physically and mentally. COVID-19 has caused a profound negative effect on the well-being of the elderly population affecting individuals and the society. This study enrolled 107 elderly patients and assessed their mental status by using 4 questionnaires, namely, General Health Questionnaire (GHQ) comprising of 12 items, Patient Health Questionnaire – 9 (PHQ-9), 15-item Geriatric Depression Scale (GDS) and Structured Clinical Interview for Depression (SCID). Methods: This study is a cross-sectional quantitative study in which the General Health Questionnaire (GHQ) comprising 12 items, Patient Health Questionnaire-9 (PHQ-9), 15-item Geriatric Depression Scale (GDS) and Structured Clinical Interview for Depression (SCID) were used for assessing mental distress and determining the psychometric characteristics, respectively. The study was conducted between July 2020 and September 2020. The study included 107 patients whose ages ranged between 65 years and 75 years. Housing complexes were surveyed after taking permission from the authorized persons. List of the elderly individuals of the respective housing societies was prepared and they were contacted on phone with a request to fill up the questionnaires for research purposes. The 4 questionnaires were dropped into their houses in an envelope. After they had completed the forms they were supposed to drop the questionnaires in a sealed box kept in the society’s office. Results: This study has summarised the results in a table for each of the questionnaires used in this study. Results of the GHQ-12 questionnaire revealed that 71.96% of the total patients had Major Depression, PHQ-9 questionnaire revealed that 83.17% of the total patients had Major Depression, GDS questionnaire revealed 87.84% of the study participants had depression while 91.58% were found to have Major Depression by the SCID questionnaire. Conclusion: The study concluded that the elderly population is vulnerable to developing major depression during a pandemic.

17.Association Between Cervical Cytological Changes and Prolonged Sexual Exposure Due to Early Marriage: An Observational Study
Ajay Kumar, Ashok Kumar
Abstract
Background: Cervical cancer is on the declining trend in India according to the population-based registries; yet it continues to be a major public health problem for women in India. Multifactorial causation, potential for prevention, and the sheer threat it poses make cervical cancer an important disease for in-depth studies, as has been attempted by this paper. Material & Methods: A total of 1205 women who have undergone Pap smear examination at the camps, 100 were adolescents, 305 were young adult’s girls and 800 were adult women. To see the effect of prolonged sexual exposure on the cytological status of cervix, these 1205 women were divided into 3 cohorts based on their ages as defined above. Results: In adolescents, clinical lesions were not so common and 18 cases of erosion cervix (18%) and 2 hypertrophied cervix (2%) were diagnosed. Conclusion: Preventing and treating cervical cancer and reducing the burden are possible by targeting resources to the areas with high prevalence.  Vaginal discharge was common in all the three groups and showed rise with increasing age.

18.Evaluation of Clinical Presentation and Various Causes of Hypertension in Young to Middle Aged Patients: An Observational Study in India
Jitendra Kodilkar, Arvind Agarwal, Rahul Baviskar, Deodatta Chafekar
Abstract
Introduction: Hypertension is the leading cause of death worldwide. It is estimated that >1 billion persons worldwide suffer from hypertension. One in five young adults in India has high blood pressure. High blood pressure (hypertension) is the leading global cause of premature death It is a major risk factor for heart attack, stroke, heart failure, atrial fibrillation, chronic kidney disease. High blood pressure hits Indians at a younger age than western populations, and first heart attacks and strokes occur a decade earlier on average. Thus, there was a need to screen and promote healthy lifestyles early to avoid the crisis India is heading for. Therefore, we conducted this study in order to evaluate the clinical profile of hypertension in young to middle aged adults which will be helpful to for early detection, diagnosis      and treatment which will help avoid complications consequences in future. Materials and Methods: Cross-sectional observational study of 116 individuals aimed to study of the clinical profile and various causes of young to middle aged hypertensive patients at a tertiary care hospital in India. All patients between age group of 18-40 years of both genders diagnosed as a      hypertensive as per the existing guidelines. Results: Renal causes (77%) was the most common etiology of young hypertension amongst study population followed by Endocrine cause (8%), Obstructive Sleep Apnea (3%). Most of the study population belongs to the age group of 35 to 40 years (39.7%) followed by 31 to 35 years (30.2%), 26 to 30 years (17.2%) and 18 to 25 years (12.9%). Conclusion: This limited sample size study has shown that renal causes, predominantly parenchymal are a dominant cause of secondary hypertension in young adult population. Headache, palpitation, epistaxis and sweating are the major symptoms in this population. Considering the rising incidence of hypertension in the younger population we need to do screening on a mass scale to detect this ailment early. A high index of suspicion in a young to middle aged hypertensive to rule out renal causes could go a long way to prevent progression of these patients to end stage renal disease. Early diagnosis and treatment is essential to prevent further co-morbities in these patients.

19.Effectiveness of Focus Echo-Cardiography in Deciding Clinical Management of Various Cardio-Pulmonary Ailments at Intensive Care Unit of A Tertiary Care Hospital
Jitendra Kodilkar, Vibusha V Bhagat, Rahul Baviskar, Neelima D Chafekar, Maduri Kirloskar, Gouri Diwan
Abstract
Introduction: FOCUS (Focused Cardiac Ultrasound) is a simplified application of echocardiography that is rapidly expanding in use in emergency and critical care medicine. It is limited, point of care cardiac ultrasound diagnostic test with goal directed approach conforming to standardized, targeted, scanning protocols. Materials and methods: The present study was carried out in the department of Medicine in medical ICU of tertiary care teaching hospital from August 2019 to August 2021. We performed FOCUS on patients presenting to the intensive care unit having chest pain, breathlessness who fulfilled our inclusion criteria prior to which clinical and laboratory assessment was done of patients. Focused echocardiography was performed by the trained medicine faculty /cardiologists using portable ultrasound machine LOGIQ V2 with 3SC-RS Adult cardiac probe in MICU in the patients as early as possible in the patients. On basis of the FOCUS diagnosis, treatment plan was decided like drug therapy, fluid therapy or intervention with the help of medical team consisting of physicians, intensivists, cardiologists and other superspecialists. Patients were reassessed and monitoring done for all for response to treatment as per the case. Those patients were clinically followed up for the outcome, either recovery or death. Result: The data scrutinized from 151 patients it was studied that maximum patients had reported IHD (58.94 %) and 17.22% patients with pulmonary thromboembolism ,10.60% had DCMP ,2.65% had LV clot, 0.66 had Infective endocarditis, 1.99% had Hypertensive heart Disease, 4.64% had Pericardial Effusion, 2.65% had valvular heart disease, 0.66 % had Aortic Dissection. In the finding maximum patients were treated with Antiplatelet drug (148), thrombolysis (86), Diuretic (89), Anticoagulation (76), Ionotropic drugs (27), Anti-arrhythmic drugs (23), Fluid resuscitation (21). In intervention study 76 patients were treated with percutaneous transluminal coronary angioplasty, 9 patients were treated with coronary artery bypass grafting & 3 patients with pericardiocentesis. The study reported significant recovery in 88 patients. The P valve reported was 0.4999 which is statistically in-significant. The observation makes clear that initial FOCUS study is beneficial for early clinical decision making at intensive care unit and to line up proper treatment to patient for quick recovery. Conclusion:The present study shows that Focused Echocardiography is clinical potential and are sensitive in the detection of different cardiovascular diseases and also for early clinical decision making in the management of patient in intensive care unit.

20.A Comparative Study of Predictive Factor for Difficult Mask Ventilation in Adult Overweight and Obese Population
Trushna Rahul Talware, Amruta Pingale, Sunita Sankalecha, Jeetendra Singh
Abstract
The incidence of DMV in obese individuals has been reported to be 1.4-24%. According to World Health Organization data, in 2019, there were more than 1.9 billion overweight adults worldwide, above the age of 18, and more than 600 million obese people. Thus, most patients requiring anesthesia for surgery will be overweight or obese.
Observations were made during the study:
-Incidence of difficult airway was observed in 16.3% obese cases as compared to none in overweight individuals.
-Mean BMI was significantly higher among cases with incidence of difficult airway (29.12 vs 26.6 Kg/m2; p<0.01).
-Mean neck circumference was significantly higher among cases with incidence of difficult airway
-Difficult mask ventilation was significantly associated with increasing obesity as seen with its positive correlation with BMI and neck circumference.

21.Ultrasound Guided Clavipectoral Fascia Plane Block with Superficial Cervical Plexus Block for Clavicle Surgeries – A Case Series
Smitha Y, Mamatha H K, Naveen Kumar C P
Abstract
The clavipectoral fascia plane block (CPB) is a novel regional anaesthesia technique that has been utilized for clavicular fracture surgeries. It involves injection of local anaesthetic in between the clavipectoral fascia and the periosteum of clavicle and it provides pain relief by blocking the terminal branches of the nerves as they pass through this plane. The cutaneous innervation of the skin above the clavicle is supplied by the supraclavicular nerve of the superficial cervical plexus (SCP). We present this case series of successful management of clavicular surgeries under ultrasound guided clavipectoral fascia plane block with superficial cervical plexus block.

22.To Study Nasal Index of Jaat Community of North Western Rajasthan
Mani R, Manchanda A, Geeta, Singh J
Abstract
Background: Nasal anthropometry deals with the measurement of size and shape of the human nose. The shape of the nose is greatly influenced by so many factors such as race, sex, culture and age. The aim of this study was to study the nasal anthropometry of the Jaat community and compare these data with the Indian and foreign study. Materials and Methods: One hundred (100) subjects were taken for the study. The selected subject’s age ranged between 18-50 years. Subjects who had undergone for any facial surgery were not taken for the study. Digital vernier caliper and spreading caliper were used for the measurement of nasal length and nasal breadth. Results: The overall average nasal index in Jaat community of north western Rajasthan was 78.10±8.19. The average mean nasal index in female of Jaat community was 78.92±7.17. The average mean nasal index in male of Jaat community was 77.02±9.36. The result showed sexual dimorphism, with the female had higher nasal dimensions as compared to the males. Conclusion: The result showed that the mean nasal index of Jaat community falls within the mesorrhine type of nose.

23.Surgically Induced Astigmatism and Posterior Corneal Curvature Changes Following 2.2 and 2.8 mm Clear Corneal Incision in Phacoemulsification: A Comparative Study
Archana Kumari
Abstract
Aim: To primarily compare surgically induced astigmatism (SIA), total and posterior corneal curvature, pachymetry, and their stabilization after 2.2 and 2.8 mm clear corneal incision in phacoemulsification. Material & Method: This was a randomized, prospective interventional study enrolling 160 patients who were distributed randomly in group 1 (operated with 2.2 mm incision) and group 2 (operated with 2.8 mm incision) with 80 patients in each group. Results: Mean SIA showed decrease from week 1 to week 6 in both the groups. The mean SIA in group 1 was lower than that in group 2 at all the follow-ups, although the difference was not statistically significant. There was no significant difference in K1 postoperatively as compared to preoperative value in both the groups’ at all follow-up visits. Conclusion: 2.2 mm incision induced a lesser amount of SIA as compared to 2.8 mm incision, although the difference was not statistically significant at all the follow-up visits.

24.Comparative Assessment of the Efficacy of CRP with Blood Culture in the Diagnosis of Neonatal Septicaemia
Nilesh Kumar
Abstract
Aim: Comparison of CRP with blood culture in the diagnosis of neonatal septicaemia. Methods: This study was carried out in the Department of Microbiology, Madhubani medical college Madhubani, Bihar, India, for 12 months. 100 patients were included in this study. 100 neonates with suspected sepsis or those coming to hospital with signs and symptoms of sepsis up to 28 days of life were included in the study. The colonies grown on blood agar and MacConkey agar were identified by conventional methods according to the standard laboratory protocol, including colony morphology, Gram staining and biochemical reactions. CRP estimation was done by Latex Agglutination Card test. CRP was reported as positive if agglutination particles were detected and negative if no particles were seen. Samples positive for CRP were further subjected to CRP estimation using Automated Clinical Chemistry Analyser. Results: In the present study, the male to female ratio was 1.5:1. The mean age of the study population was 7.25 days. Out of the total 100 neonates, 44 were blood culture positive from which 38 were positive for CRP also. Among the blood culture negative samples, 26 were CRP positive. The mean value of CRP in blood culture positive neonates was 49.1 mg/l whereas in blood culture negative neonates were 15.7mg/L. Conclusion: Early diagnosis of neonatal sepsis with the aid of biomarkers like CRP may serve as an important tool in reducing the mortality and morbidity among neonates.

25.A Prospective Comparative Study to Determine the of Midline Abdominal Wound Closure Using two Different Techniques of Wound Closure
Nilesh Kumar
Abstract
Aim: To assess the outcome of midline abdominal wound closure using two different techniques of wound closure. Material & Method: This was a prospective observational study which was conducted in the department of general surgery Shree Narayan Medical Institute & Hospital, Saharsa, Bihar, India. All patients more than 18 years of age were included in this study who underwent midline laparotomy in the emergency settings only. Results: In group I, mean suture length (SL) to wound length (WL) ratio was 4.74 and in group II, it was 5.16. The p value of the ratio of suture to wound length in two groups was <0.05 which is statistically significant SSI developed in 27 patients in group I while there were 19 patients in group II who developed SSI. When the two groups were compared and the p value was calculated, it was found to be 0.030 which was statistically significant. Conclusion: In this study, we found that the patients in group II whose midline laparotomy was closed with small tissue bites had better wound outcome postoperatively in terms of wound site infection and wound dehiscence.

26.Comparative Assessment of Quantitative Changes in Macular Thickness Using Spectral Domain OCT in Diabetic Patients Undergoing Cataract Surgery
Sanjay Kumar Singh, Mukta Prasad
Abstract
Aim: To evaluate the quantitative changes in macular thickness using spectral domain OCT in diabetic patients undergoing cataract surgery pre and post operatively and its relation with diabetic retinopathy (DR). Material & Method: This was a prospective comparative study, comprised of 100 patients conducted in the Department of Ophthalmology, Patna Medical College & Hospital, Patna, Bihar, India over a period of 15 months. Results: 31 patients had Mild NPDR followed by 12 patients had Moderate NPDR. Severe NPDR With macular edema in 5 patients and pre op macular edema is seen in 2 patients. Preoperatively 90% patients had a vision of 6/60 or lesser. Over all visual acuity improved postoperatively at 4th and 12th week after small incision cataract surgery to 6/12 and 6/9 in majority of the patients. A statistically significant increase could be detected in central subfield macular thickness though the increase was mild. (P<0.002). Conclusion: After cataract surgery, there was a statistically significant rise in CSMT, notably in individuals with preoperatively confirmed macular edema. Associated retinopathy is a risk factor as well. However, after straightforward minor incision cataract surgery, there was no statistically significant increase in mild and moderate NPDR preoperatively or in the postoperative term.

27.A Prospective Study to Assess and Compare the Functional Outcome with Different Modalities in Fixation of Proximal Humerus Shaft Fractures
Shankar Niwas, Shashi kant Kumar Singh, Kumar Satyam
Abstract
Aim: To assess and compare the functional outcome with different modalities in fixation of proximal humerus shaft fractures. Methodology: The present prospective study was conducted in the Department of Orthopaedics, SB Medical College & Hospital, Hazaribagh, Jharkhand, India for a period of one year. The study participants were informed about the study details and informed written consent was obtained from them. The history of injury of the participants, general condition and any associated soft tissue injury were evaluated. The severity of the injury was assessed to assess local injury and axillary nerve was assessed by examining any anaesthetic patch over lateral aspect of the shoulder. All the cases with proximal humerus fractures above 18 years of age and consenting for the study were included. The modality of the treatment was decided based upon the following factors: Neer’s classification [grade 2 to grade 4]; presence  of  humeral  head  dislocation  and comminution; valgus impaction, quality of bone, open or compound  fracture  and  age  of  the  patient.  Results: A total of 50 cases who fulfilled the inclusion criteria were enrolled. 52% of cases were females and 48% were males. 42% of the cases were between 41-60 years with 28% between <18-40 years and 10% of cases >60 years of age. 60% of the cases sustained fracture on the left side and 40% on right side. 74% of fractures were of closed type and 26% were open. As per Neer’s type of fracture classification, the most common type of fracture observed in our study cases was two-part fracture accounting to 36% of cases followed in order by three part (28%), four part observed in 26% of cases. 5 cases (10%) had fracture dislocation. Road traffic injury was the most common mechanism for injury in 52% of cases and next was a history of fall in 38% of cases. At the end of clinical and radiological union and full functional recovery the results were evaluated. Of the total 50 cases in the study, 74% cases had excellent results, 14% cases were satisfactory, 8% cases were unsatisfactory, and 4% cases had failure. Conclusion: To conclude, the options as to the management modality used depend on the pattern of the fracture, the quality of the bone encountered, the patient’s goals and the surgeon’s familiarity with the techniques. Principle of fixation is reconstruction of the articular surface, including the restoration of the anatomy, stable fixation, with minimal injury to the soft tissues preserving the vascular supply, should be applied.

28.A Randomized, Comparative Assessment of Functional and Radiological Outcome in Management of type IIIB Tibial Fractures by AO and Ilizarov External Fixator
Mujtaba Ahmad, Rabiul Haque, Swagatam Jash, SK. Sariful Rahaman, Jayanta Mukherjee
Abstract
Aim: To determine the comparison of radiological & functional outcome & complications of the acute open tibial fractures treated with primary ilizarov external fixator and Ao external fixator. Material & Method: This is a randomized, comparative study conducted on Patients of either sex with open tibial fractures satisfying inclusion criteria admitted in the Department of Orthopaedics, over a period of 2 years. Patients satisfying the inclusion criteria have been treated by Ilizarov technique and other patients treated by AO external fixator in the previous 2 years. Cases will be randomized by simple random sampling. Results: Subjects in our study are more affected on right side (60 %) when compared to left side (40 %). In AO group pin tract infections were seen in 42.8 % (n-15) and in Ilizarov group pin tract infections were seen in 14.2% (n- 5). Conclusion: Because the Ilizarov external fixator is a minimally invasive technique, it has a lower impact on the blood supply. The ring fixator is a safe, stable (three-dimensional stability) design that allows the patient to walk immediately after surgery and has a high union rate, even in heavily comminuted fractures.

29.One Year, Prospective Comparison of Astigmatism Induced by a Straight and Frown Incision in Manual SICS (MSICS) in Patients with Immature Pre-senile and Senile Cataract
Archana Kumari, Sanjay Kumar Singh
Abstract
Aim: To compare the astigmatism induced by a straight and frown incision in manual SICS (MSICS) in patients with Immature Pre-senile and Senile Cataract. Material & Method: This was a one-year, prospective study, comprised of 200 patients (100 patients in each group). Group A: MSICS (Frown Incision) Group B: MSICS (Straight Incision) with the patients undergoing manual SICS at the Department of Ophthalmology, Patna Medical College & Hospital, Patna, Bihar, India. Results: The patients were divided into 2 groups, that is Group A (Patients who underwent MSICS with frown incision) and Group B (Patients who underwent MSICS with straight incision). In Group A, on Day1, 50 % of the patients had 6/24 – 6/18 visual acuity, on Day 7, 71% had 6/12 – 6/6 visual acuity, on Day 70, 74% had 6/12 – 6/6 visual acuity and on Day 90, 94% had 6/12 – 6/6 visual acuity. In Group B, on Day 1, 12 %of the patients had 6/12 – 6/6 visual acuity, on Day 7, 48% had 6/12 – 6/6 visual acuity, on Day 45, 69% had 6/12 – 6/6 visual acuity and on Day 90, 88% had 6/12 – 6/6 visual acuity. Conclusion:In conclusion, frown incision is evidently better than straight incision in minimizing surgically induced astigmatism.

30.To Evaluate and Compare the Effect of Magnesium Sulfate and Dexmedetomidine as an Adjuvant to 0.5% Ropivacaine in Infraclavicular Brachial Plexus Block
Deepali Mandloi, Basant Ningawal, K.K. Arora, Pooja Vaskle
Abstract
Background & Method: This study is conducted with an aim to evaluate and compare the effect of magnesium sulfate and dexmedetomidine as an adjuvant to 0.5% ropivacaine in infraclavicular brachial plexus block, comprised of 90 patients divided into three groups of 30 each, scheduled for elective surgeries in hand, wrist and forearm. The present study was conducted in Department of Anaesthesiology, M.G.M Medical College and M.Y. Hospital, Indore. The study was explained in detail to the patient and/or his/her legally acceptable representative in their own language including the procedures, risks/benefits, complications, etc. in detail. A voluntary written informed consent was obtained from the patient and/or his/her legally acceptable representative for participation in the study. All the study related procedures were conducted after obtaining their voluntary written informed consent.Result: In Group RP, 8 (26.7%) patients were moderately satisfied, 15 (50%) were very satisfied and 7 (23.3%) were extremely satisfied. In Group RM, 5 (16.7%) patients were moderately satisfied, 15 (50%) were very satisfied and 10 (33.3%) were extremely satisfied. In Group RD, 4 (13.3%) patients were moderately satisfied, 14 (46.7%) were very satisfied and 12 (40%) were extremely satisfied. The proportion of extremely satisfied patients were in Group RD, followed by Group RM and lowest in Group RP. There was no statistically significant association between patient satisfaction and the groups (P=0.577), showing the groups are independent of the patient satisfaction. In group RP and Group RM, no adverse events. In Group RD, bradycardia was seen in 2 (6.7%) patients and hypotension in 3 (10%) patients. There was a statistically significant association between adverse events and the groups (P=0.032), showing that the groups are dependent on the adverse events. Adverse events were seen only in Group RD. Conclusion: In our study, Magnesium sulphate (2mg/kg) versus Dexmedetomidine (1mcg/kg) were compared as an adjuvant to 0.5% Ropivacaine in Infraclavicular Brachial plexus block. Based on the present clinical comparative study, following conclusions can be drawn: – As compared to Magnesium sulphate, Dexmedetomidine as an adjuvant to Ropivacaine, in Infraclavicular brachial plexus block for upper limb surgeries, fastened the onset time and prolonged the duration of sensory & motor blockade. The mean duration of analgesia was prolonged with Dexmedetomidine as compared to Magnesium sulphate causing a later requirement of first rescue analgesia.

31.Prospective Cross-Sectional Study to Evaluate the Validity of Serum Ferritin Level as a Marker of Preterm Labor
Rashmi Singh, Amrita Rai, N. K. Bariar
Abstract
Aim: To evaluate the value of serum ferritin level as predictor in preterm labor. Method: The Department of Obstetrics and Gynecology, Patna Medical College & Hospital, Patna, Bihar, India, conducted this cross-sectional study on 200 pregnant women with labour pain. They were divided into two groups i.e. group I (preterm N=100) and group II (term N=100). Results: The rate of nulli parity was substantially greater in the preterm delivery group than in the term delivery (P 0.001). With a sensitivity, specificity, and diagnostic accuracy of 75.2 percent, 65.3 percent, and 75.0 percent, respectively, a ferritin level of 36.4 ng/mL was determined as the optimum cut-off for preterm delivery when compared to term delivery. Conclusion: Considering the results of other studies, it can be stated that ferritin level can be used to detect patients at risk for preterm delivery.

32.Role of Saline Infusion Sonography (SIS) for Endometrial Cavity Evaluation for Diagnosis Focal Intra-Cavitary Lesions in Sub-Fertile Women
Bhumija
Abstract
Aim: To observe the role of Saline Infusion Sonography (SIS) for endometrial cavity evaluation for diagnosis focal intra-cavitary lesions in sub-fertile women. Materials and Methods: The present was a retrospective analysis done on the basis of record maintained in ultrasound register and case record sheets of 100 sub-fertile women who underwent infertility treatment and fulfilled the inclusion criteria for 1 year at department of reproductive medicine IGIMS, Patna, Bihar, India. Results: A total of 100 patients were included in the study who full filled the inclusion criteria. The sensitivity of SIS in identifying endometrial pathology in infertile women was better than that of TVS. Specificity remains same for both modalities. Polyps were better identified and demonstrated with SIS, however both modalities were not very efficient in identifying synachiae. The accuracy rates of TVS and SIS were 90.3% and 95.77% for the diagnosis of intracavitary space-occupying lesions, respectively. Conclusion: HSGM should be considered as an intermediate investigation after TVS to assess intracavity pathology and to confirm the diagnosis; hysteroscopy should become a therapeutic intervention.

33.Prospective, Longitudinal Study Comparative Assessment of the Impact of Single Dose versus Multidose Prophylactic Antibiotics in Elective Hernia Repair
Md. Sarfraz Alam, Shahid Ahmed
Abstract
Aim: To assess the impact of single and multiple-dose antibiotics in clean and clean contaminated elective hernia surgeries concerning surgical site infection and associated complications. Methodology: This prospective, longitudinal study was conducted for 1 year at Jagannath Gupta institute of medical sciences and Hospital, Budge Budge, Kolkata, West Bengal, India in the general surgery department. 120 suitable patients were included in this study. All the patients were randomly assigned two groups (n=60) single-dose pre-operative (SD) group and multiple- dose (MD) in each group. Master chart for Protocol of the procedure was designed along with Performa, patient identification details, and informed written consent form for all study. Both groups were homogenized in terms of age, type of hernia, and clinical findings. SD group was given amoxycillin-clavulanic acid (2 gm) intravenously at the time of induction of anesthesia. MD group was given amoxicillin-clavulanic acid (2 gm) parentally at the time of induction of anesthesia and following it up with the same antibiotic (1 gm) intravenously twice a day for two days post-operatively. Results: Data collected from both single antibiotic group I (n=60) and group II multi-dose group (n=60) who underwent elective hernia surgery. Out of 60 patients of group SD, only 8.3% of patients developed surgical site infection compared to none in group MD. Statistically, there was no appreciable difference in the incidence of SSI in both SD and MD groups with a p value of 0.273. Seroma was found in the 3rd postoperative day in 3 patients in group I, fluid aspirated, and culture turned out to be negative. Five of the SD group developed an infection, which subsided with the continuation of antibiotics. Expenditure incurred by the patient only for antibiotic analyzed of antibiotic (amoxicillin and clavulanic acid) and found the average cost of antibiotic per patient in SD group was Rs. 150 while the cost of antibiotic per patient in group II was Rs. 1200. P value is < 0.05, found to be significant. Conclusion:From this study, we can conclude that single-dose antibiotic prophylaxis is economical in uncomplicated elective surgery. A multidisciplinary and multifaceted approach to surgical site infections is absolutely necessary to continue to improve these critical outcomes of surgery.

34.Prospective Observational Assessment of Hearing Impairment in Newborns with Birth Asphyxia Admitted to Neonatal Intensive Care Unit
Gopal Shankar Sahni, Vivek Kumar, Jeetendra Mahato
Abstract
Aim: To find the prevalence of hearing impairment in inborn neonates with birth asphyxia. Methods: Prospective Observational study was conducted to assess the prevalence of hearing loss in neonates with birth asphyxia admitted to the Department of Pediatrics, SKMCH, Muzaffarpur, Bihar, India. Auditory function was examined by Otoacoustic emission (OAE) followed by auditory brainstem response (ABR) test and distortion product OAE (DPOAE). Statistical analysis, Chi-square test was used and testing data was analyzed using the SPSS software version 22. Results: A total of 100 neonates with birth asphyxia were screened with OAE for hearing impairment included in the study. In our study only 7/72 babies with moderate birth asphyxia had hearing impairment as compared to 4/13 babies with severe birth asphyxia had hearing impairment and the difference was statistically significant (P=0.0002). The statistically significant risk factors for development of hearing impairment in babies with birth asphyxia were – Hypoxic ischemic encephalopathy (P=0.005), and mechanical ventilation (P=0.0003). Conclusion: The prevalence of hearing impairment among term neonates with birth asphyxia was 11%. Two staged screening with OAE, which is a feasible screening test in resource poor set up, can be used as a screening modality for hearing impairment in babies with birth asphyxia.

35.The Cross-Sectional Assessment of the Prevalence, Possible Etiology and the Response to Treatment and Outcome in Pediatric Patients Admitted with Shock
Chandan Kumar Mishra
Abstract
Aim: To assess the prevalence of pediatric shock in children admitted to Pediatric ICU, to identify possible etiology and the response to treatment and outcome in patients admitted with shock in Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. Material & Methods: The cross-sectional study was conducted in Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India over a period of one year. A total of 1783 cases were admitted in PICU over a period of one year. Results: The total no of pediatric shock cases was 60. Among them 25 were male and 15 were females. In males it was 22/1000 and in females it was 26/1000. The difference between the two groups was not statistically significant. Conclusion: Septic shock accounts for majority of decompensated shock and poor outcome to management. Infancy decompensated shock, septic shock and those requiring ventilator support were the factors influencing the outcome of management.

36.An Online Survey to Assess Impact of COVID-19 Pandemic on Medical Education and Training of Surgical Residents
Md. Sarfraz Alam, Sekhar Chakraborty, Manju Banerjee
Abstract
Aim: To assess the effect of COVID-19 pandemic on medical education and training of surgical residents. Methodology: An online survey was conducted to assess the effect of COVID-19 on the residents in various surgical specialties in Jagannath Gupta institute of medical sciences and Hospital, Budge Budge, Kolkata, West Bengal, India during the period of 6 months. All the surgical residents were invited to participate in the survey using WhatsApp and other social platforms. The questionnaire consisted of 5 sections: Demographic details, surgical residents and COVID-19 related work, impact of COVID-19 on surgical training of residents, and academic activities during COVID-19. The data was collected and analyzed. Results: A total of 50 surgical residents completed the survey. Out of the 50 respondents, 29 (58%) were male, and 21 (42%) were female. 36% percent of respondents were in the first year of their residency, 40% in their second year, and the remaining 24% were in the final year. Residents from 8 surgical specialties participated in the survey. There was a significant reduction in working hours since the pandemic began (6.53±4.28 hours) when compared to pre-pandemic time (11.45±4.82 hours). 56% residents worked for 1-5 weeks, 38% worked for 5-10 weeks, and 06% residents worked for >10 weeks. Among them, 46 % were worried about getting infected and 42% were worried about transmitting infection to family members. 12% of residents had fear of death due to COVID-19. 42% reported poor visibility with goggles or face shield as most difficult part of working with PPE kits. Conclusion:The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns in all fields.

37.A Prospective, Cross-Sectional, Hospital-Based Assessment of the Clinico-Demographic, Biochemical and Outcome Profile of Diabetic ketoacidosis in Children with Type 1 Diabetes Mellitus
Chandan Kumar Mishra
Abstract
Aim: To study the clinical, demographic, biochemical and outcome profile of the children admitted with Diabetic ketoacidosis (DKA). Material & Methods: This was a prospective, cross-sectional, hospital-based and observational study. This study was conducted over a period of one year in the Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India. Results: The majority of the patients in this study were females (43), with a female to male ratio of2.2:1. Mean B.M.I. was 13.66 ±3.281 kg/m2. Most of the children, 60%, were from upper lower class IV socioeconomic status families as per the Modified Kuppuswamy scale. The most common presenting symptoms were nausea/vomiting in 40, pain abdomen in 31, followed by fever in 37. Conclusion: In our study, the most common precipitating factor observed for DKA was an infection. For the long-term management strategy, education of the patients and their parents regarding infection control, regular blood sugar monitoring and proper Insulin dosing appear to be promising tools.

38.Assessment of Analgesic Efficacy of Transversus Abdominis Plane Block with Local Wound Infiltration Using 0.25% Levobupivacaine for Post Cesarean Analgesia: Prospective, Single-Blind, Randomized, Comparative Study
Nikita, Shalini Sharma, Smita Bharti, B.K. Kashyap
Abstract
Aim: Comparison of analgesic efficacy of transversus abdominis plane block with local wound infiltration using 0.25% levobupivacaine for post cesarean analgesia. Material and methods: This prospective, single-blind, randomized, comparative study conducted in the Department of Anaesthesiology and Critical Care, Patna Medical College and Hospital, Patna, Bihar, India, for 6 months, after obtaining written informed consent, patients were randomly allocated using computer-generated random numbers into 2 groups of 50 patients. An opaque sealed envelope concealing the group number allocated was opened after the enrollment of the patient. Results: There was no significant difference between the two groups in the incidence of side effects including nausea, vomiting, pruritis, or any other procedure-related complications. In group I, 20% patients had a score of 1 (very satisfied), 68% patients had a score of 2 (satisfied), 12% had a score of 3 (dissatisfied). In group II, 54 had a score of 1, 26% had a score of 2 and 20% had a score of 3. (P< 0.001). Patients in the group (T) had a higher mean patient satisfaction score (1.488±0.588) compared to group I (2.098± 0.429) (P <0.001). In group I, 20% patients had a score of 1 (very satisfied), 68% patients had a score of 2 (satisfied), 12% had a score of 3 (dissatisfied). In group II, 54 had a score of 1, 26% had a score of 2 and 20% had a score of 3. (P< 0.001). There was no significant difference between the two groups in the incidence of side effects including nausea, vomiting, pruritis, or any other procedure-related complications. Conclusion: TAP provides superior quality of pain relief, decreases total analgesic requirement, and better patient satisfaction.

39.Surgical Management of Bilateral Inguinal Hernia: A Prospective Randomized Comparative Study
Alok Kumar Niranjan, Sanjeet Kumar
Abstract
Aim: A comparative study of Stoppa’s repair versus Lichtenstein technique for surgical management of bilateral inguinal hernia. Methods: This prospective, open, randomized, comparative study was carried out in the Department of General Surgery, Jannayak Karpoori Thakur Medical College and Hospital Madhepura, Bihar, India, India. Patients were randomised into two groups based on simple randomization-group 1: patients underwent Lichtenstein tension free mesh hernioplasty; and group 2: patient underwent Stoppa’s repair. Age, chief complaints and duration of inguinal hernia, other concomitant conditions such as chronic cough, chronic constipation, urinary complaints, etc., history of previous abdominal surgeries, family history, occupation, marital status, and etc. were all taken into account. A thorough physical examination was also carried out. Total 50 patients-25 patients in each group-were included in the study who were fulfilled the selection criteria. Results: The present study has included 50 patients with bilateral inguinal hernia, meeting the selection criteria. The patients were randomly assigned to one of two groups in this study. In group 1, 25 patients underwent bilateral Lichtenstein tension-free hernioplasty, while group 2 underwent Stoppa repair. As per preoperative variables-age, BMI, comorbidities, and smoking did not show a statistically significant difference between the two groups. The operative time was significantly shorter in group 2 patients (44.33±6.23 min), whereas it was 79.54±7.51 min in group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. In terms of postoperative complications, postoperative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups. Conclusion: Both procedures were capable of achieving favourable post-operative outcomes and had similar problems. The time it took for all groups to return to normal activity and work without pain was longer, most likely because the hernia procedures were bilateral.

40.Ropivacaine with Tramadol and Ropivacaine with Midazolam for Post-Operative Epidural Analgesia: Prospective, Single-Blind, Randomized Comparative Study
Smita Bharti, Nikita, Shalini Sharma, B.K. Kashyap
Abstract
Aim: To study comparative study of ropivacaine with tramadol and ropivacaine with midazolam for post-operative epidural analgesia. Methods and Materials: This prospective, single-blind, randomized, comparative study conducted in the Department of Anaesthesiology and critical care, Patna Medical College and Hospital, Patna, Bihar, India, for 12 months. The mean duration of analgesia in the tramadol group (913±315.5 min) was more than the midazolam group (769.2± 331.9). The confidence level is estimated at 95%, power of study at 80%, the minimum sample size required for the study was calculated as 100 subjects (n=50 in Group R, n=50 in Group L). Patients within 18-60 years of both the gender undergoing elective surgeries below the umbilicus under Epidural block who have given valid informed consent were included in the study. Results: Comparison of onset of sensory, motor blockade, and duration of sensory-motor blockade among the two groups showed a statistically significant difference in the onset of sensory, motor blockade, and duration of sensory blockade across the group (p<0.005). The results also showed no statistically significant difference in heart rate across the group (p>0.005). There was also no statistically significant difference in MAP (Mean arterial pressure) across the group (p>0.005). There was no statistically significant difference in spO2 across the group (p>0.005). During the comparison of VAS scores across the two groups. The result showed a statistically significant difference in VAS score at 12 hr across the group (p<0.005). Our result also revealed opioid requirement analysis across the two groups. The result showed a statistically significant difference in opioid requirement across the group (p<0.001). Conclusion: The mean duration of analgesia was more among ropivacaine with the Tramadol group.

41.Assessment of the Association between Serum Lipid Profile and Blood Glucose in Newly Diagnosed Type 2 Diabetic Patients: A Cross-Sectional Study
Rakesh Roshan, Sajjad Ahsan
Abstract
Aim: To research association between serum lipid profile and blood glucose, hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus. Material & Method: The present study will be undertaken in the Department of General medicine, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, India for 1 year. Results: 21.3% had borderline high levels (150-199mg/dl), 14% had high levels (200-499 mg/dl) and 2.6% participants had very high triglycerides (≥500 mg/dl).59.33% participants had low HDL and 40.6% participants had normal HDL. Conclusion: The study showed widespread lipid abnormalities in the course of diabetes triggered dyslipidemia as hypercholesterolemia, hypertriglyceridemia, elevated LDL and decreased HDL. This study proposes the predominance of hyperlipidemia over increased prevalence of diabetic dyslipidemia.

42.Cross Sectional Descriptive Observational Assessment of the Association of Glycosylated Hemoglobin (Hba1c) Level with Diabetic Retinopathy in Type 2 Diabetes Patients
Kundan Kumar Singh
Abstract
Aim: Association of glycosylated hemoglobin (HbA1C) level with diabetic retinopathy in type 2 diabetes patients. Methods: The present study was cross sectional descriptive observational conducted in the Department of Opthalmology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 12 months. 120 Participants diagnosed to have type 2 diabetes mellitus with retinopathy changes in the fundus are included in this study and Recent HbA1 c levels of the participants known were included in this study. Results: The present study constituted 14.17% mild NPDR, 20% moderate NPDR, 49.17% severe NPDR, 12.5% PDR and 4.17% high risk PDR. The above table reveals that there were 94.12% of mild NPDR cases, 54.17% of moderate NPDR cases and 13.56% of PDR cases in 6.5% – 8.5% range of HbA1c.Whereas in HbA1c range of 8.6 % – 10.5%, mild and moderate NPDR cases reduced to 5.88% and 29.17% respectively and severe NPDR cases increased to 55.93%. Early PDR cases raised from 40% in 6.5% – 8.5% range of HbA1c to 53.33% in 8.6 % -10.5%. And high-risk PDR cases raised from 20% to 60% when HbA1c raises from 6.5% – 8.5% to 8.6 %- 10.5%. This revealed an increasing trend of severity of retinopathy with raise in HbA1c levels. The mean of HbA1c in mild NPDR was 8.02 ± 0.53. In moderate NPDR it was 9.03 ± 1.67. In severe NPDR 10.26 ± 1.78. In Early PDR 9.23 ± 1.26 and in High risk PDR 9.70±2.37. Therefore, as the severity of retinopathy increased, the mean HbA1c for that level of severity also increased. Conclusion: The value of glycosylated haemoglobin (HbA1c) showed an increasing trend as severity of diabetic retinopathy increases. Duration of diabetes and high HbA1c levels are found to be the major predictors of diabetic retinopathy in type II diabetes mellitus.

43.An Observational Assessment of the Adherence to Medication in Patients Suffering from Hypertension
Asha Alka, Piyush Anand, Jeetendra Kumar
Abstract
Aim: Association of glycosylated hemoglobin (HbA1C) level with diabetic retinopathy in type 2 diabetes patients. Methods: The present study was cross sectional descriptive observational conducted in the Department of Opthalmology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 12 months. 120 Participants diagnosed to have type 2 diabetes mellitus with retinopathy changes in the fundus are included in this study and Recent HbA1 c levels of the participants known were included in this study. Results: The present study constituted 14.17% mild NPDR, 20% moderate NPDR, 49.17% severe NPDR, 12.5% PDR and 4.17% high risk PDR. The above table reveals that there were 94.12% of mild NPDR cases, 54.17% of moderate NPDR cases and 13.56% of PDR cases in 6.5% – 8.5% range of HbA1c.Whereas in HbA1c range of 8.6 % – 10.5%, mild and moderate NPDR cases reduced to 5.88% and 29.17% respectively and severe NPDR cases increased to 55.93%. Early PDR cases raised from 40% in 6.5% – 8.5% range of HbA1c to 53.33% in 8.6 % -10.5%. And high-risk PDR cases raised from 20% to 60% when HbA1c raises from 6.5% – 8.5% to 8.6 %- 10.5%. This revealed an increasing trend of severity of retinopathy with raise in HbA1c levels. The mean of HbA1c in mild NPDR was 8.02 ± 0.53. In moderate NPDR it was 9.03 ± 1.67. In severe NPDR 10.26 ± 1.78. In Early PDR 9.23 ± 1.26 and in High risk PDR 9.70±2.37. Therefore, as the severity of retinopathy increased, the mean HbA1c for that level of severity also increased. Conclusion: The value of glycosylated haemoglobin (HbA1c) showed an increasing trend as severity of diabetic retinopathy increases. Duration of diabetes and high HbA1c levels are found to be the major predictors of diabetic retinopathy in type II diabetes mellitus.

44.A Hospital Based Retrospective Histopathological Assessment of the Cervical Lesions
Akhalesh Kumar, Rituraj, Pradeep Kumar Singh
Abstract
Aim: To study the histopathological features of cervical lesions. Materials and Methods: A retrospective study was done in the department of Pathology at Government Medical College, Bettiah, Bihar, India, over a period for 1 year. Results: 87.7% (307/350) lesions were Non-neoplastic and majority was inflammatory in nature second most common was benign lesions 25 (7.1%). Invasive lesions occupied only 2.8% (8/350) and pre invasive about 2.2% (10/350) respectively. Conclusion:Histopathology study of cervical biopsy lesions is a valuable diagnostic procedure. Early detection of cervical lesions may provide an opportunity for appropriate interventions to prevent further complications such as progression from benign to malignant conditions. Adequate screening procedure with follow up cervical biopsies helps in early diagnosis and management of premalignant and malignant lesions.

45.An Observational, Cross-Sectional Assessment of the Adherence to Medication in Patients Suffering from Hypertension
Rajiv Ranjan Das, Sonu Kumar
Abstract
Aim: To assess the adherence to medication in patients suffering from hypertension. Material & Method: This observational, cross-sectional study was conducted in the Department of Pharmacology, RIMS, Ranchi, Jharkhand, India, for a period of 15 months. All patients suffering from hypertension and on medication were recruited in the study. Results: Based on the number of medications used by patients, they were subdivided into two groups, Group 1 had patients who were on single medication for hypertension whether it was single compound or two compounds in single medication, whereas Group 2 had patients who were taking two or more medications in combination or single compound. Conclusion: Patients’ on single medication had significantly better adherence, slightly better quality of life and better adherence correlation as compared to patients on more than two medications.

46.A Cross Sectional Study of Factors Responsible for COVID-19 Vaccine Hesitancy amongst University Students of Patna
Seema Singh, Sanjay Kumar, Setu Sinha, Rani Kumari
Abstract
Introduction: Coronavirus is a contagious disease caused by severe acute respiratory syndrome (SARS Cov-2), first known case of which was identified in Wuhan, China in December, 2019. In India, first known case was identified in Kerala on 27th January 2020. Roll out vaccination program was started on 16th January 2021 in India. Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccine services.  Keeping in mind, a college-based study will be conducted amongst University Students of Patna. Objectives: To find out the reasons responsible for vaccine hesitancy. To find out the prevalence of unvaccinated University Students of Patna. Methodology: A google form based cross- sectional study was carried out on population > 18 years of both sexes. Sample was calculated using formula 4pq/l2. 276 participants were selected by simple random sampling. IEC approval and informed consent of the participant was taken. Data was collected using predesigned, pre-tested questionnaire. Data analysis will be carried out using epi info software. Result: A total of 276 students participated in the study, with 48.9% were graduates and 51.1% were post-graduates. A majority (64.8%) of students belonged to middle socioeconomic status, with (47.1%) reporting a family monthly income of >INR 50,000. Most (65.6%) of the participants were aware that the COVID-19 virus was circulating in the community; 67.3% of the students were aware that a “COVID-19 vaccine” was being prepared. A large proportion of participants (69.5%) did not have any history of vaccine hesitancy.  In bivariate analysis, showed significant association between gender, age and family size with intention to receive COVID-19 vaccine seems (p=<0.05)). Conclusion: In this study, we found suboptimal levels of willingness to receive COVID-19 vaccines, with nearly one-third not sure or willing to receive a vaccine, indicating high levels of potential vaccine hesitancy. If the COVID-19 vaccine has lower efficacy, governments will have to introduce more strategies to persuade their population to become vaccinated. In addition, since acceptance is associated with perceived risk for COVID-19, it is also important to increase the perceived risk in communities.

47.A Cross Sectional Study of Psychological Impact of SARS Cov-2 amongst University Students of Patna
Rani Kumari, Sanjay Kumar, Sanjay Kumar Choudhary, Varsha Singh, Seema Singh
Abstract
Introduction: Coronavirus is a contagious disease caused by severe acute respiratory syndrome (SARS Cov-2), first known case of which was identified in Wuhan, China in December 2019. In India, first known Case was identified in Kerala on 27th January 2020. At the time of writing, a total of 240 countries have been identified with Covid-19 cases, exceeding a total of 362million people world-wide and a total death more than 56.3 million. Objectives: To assess the prevalence and severity of core symptoms of depression, anxiety and stress and its impact on their routine activities, domestic violence, eating habits and sleep pattern. Methods: A google form based cross-sectional study was carried out on students more than 18 years of age of both sexes.  Sample was calculated using formula 4pq/l2. 256 participants were selected by simple random sampling. IEC approval and informed consent of the participant was taken. Data will be collected using predesigned, pre-tested questionnaire. Results: In this study, 256 participants were involved, with a response rate of 96.6%. The median age of the participants was 21 years. In this study, the overall prevalence of psychological problem among college students due to COVID-19 was 18.61% (95% CI 14.1% to 22.8%), which was measured using student’s experience of all forms of psychological problems (anxiety, depression and stress disorders). Conclusion: Inadequate efforts to recognize and address college students’ mental health challenges, especially during a pandemic, could have long-term consequences on their health and education.

48.An Observational Assessment to Determine the Incidence of Pulmonary Tuberculosis and Opportunistic Respiratory Infections among the Cases of HIV
Sudhir Chandra Jha, Umesh Chandra Jha, Shreyas Rajeev Pikle
Abstract
Aim: To primarily evaluate the incidence of pulmonary tuberculosis and opportunistic respiratory infections among the cases of HIV. Material &Method: The present study was conducted at Darbhanga Medical College & Hospital, Darbhanga, Bihar, India, over a period of six months by department of General medicine. All the cases of HIV diagnosed earlier or at the time of attending the OPD of department presenting with the respiratory signs and symptoms and clinical evidence of respiratory tract infections were included in this study. Results: A total of 100 cases fulfilling the inclusion criteria with 73 males and 27 females were included in the study. Male to female ratio in the study was 2:1. Of the 100 cases in the study, 75 cases were known cases of HIV and 25 cases were diagnosed during the hospital visit. Fever was the most common presenting symptom in 90% of cases with other signs and symptoms like cough (84%). A total 51% of cases were diagnosed with bacterial pneumonia and the causative bacteria were isolated by culture and sensitivity. Conclusion: Knowledge of the pattern of pulmonary complications in patients with HIV infection in relation to CD4 count will help clinicians develop faster diagnostic and therapeutic approach to patient management. There was strong correlation between CD4 counts and number of symptoms. The type of infections, bacterial or fungal and PJP were dependent on the CD4 counts of the HIV cases.

49.Prospective Cohort Assessment of the Factors Associated with Risk of Hospitalization in Children with Community-Acquired Pneumonia (CAP)
Vivek Kumar, Jeetendra Mahato, Gopal Shankar Sahni
Abstract
Objective: To evaluate factors associated with risk of hospitalization in children with community-acquired pneumonia (CAP). Material & Methods: This was a prospective cohort study conducted over a period of two years in Department of Pediatrics, SKMCH, Muzaffarpur, Bihar, India.  A total of 300 children with pneumonia were included in the study. Results: Hospitalization was needed in 167 (55.6%) children with pneumonia including 6 patients who were initially given ambulatory treatment and were later admitted in view of deteriorating respiratory distress. Amongst children with pneumonia, reportable chest X-rays were available in 160 cases (total X-rays 176). Conclusion: Present study found SpO2 <90% at room air, serum procalcitonin level >0.5 ng/mL and lower weight for height z-score to be predictors for risk of hospitalization in under-five children presenting with community acquired pneumonia. These factors can be utilized to assess a child with CAP regarding the need of hospitalization.

50.Assessment of the Cost Difference of Various Branded and Generic Antimalarial Drugs: Cost Minimization Analysis
Sonu Kumar, Rajiv Ranjan Das
Abstract
Aim: To assess the cost difference of various branded and generic antimalarial drugs available in the Indian market. Material & Methods: The minimum and maximum cost in rupees (INR) of an antimalarial drug manufactured by different pharmaceutical companies in the same dose strength was noted among all the above sources. Results: Highest cost ratio was seen with Chloroquine 500 mg, Mefloquine 250 mg and Sulfadoxine – Pyrimethamine 500+25 mg. Lowest cost ratio was seen with Quinine 600 mg, Chloroquine 250 mg and Sulfadoxine – Pyrimethamine 750+37.5 mg. Conclusion: This study reveals the need to further improve the drug price regulatory mechanism concerning anti-malarial available in India to improve patient compliance and thus cure rates of malaria.

51.To Study Indications and Outcome of Surgical Management of Local Complications of Acute Pancreatitis
Sanjeet Kumar, Alok Kumar Niranjan
Abstract
Aim: To study Indications and outcome of surgical management of local complications of acute pancreatitis. Material and methods: This prospective observational study conducted in the Department of General Surgery, Jannayak Karpoori Thakur Medical College and Hospital, Madhepura, Bihar, India, from july 2020 to June 2021, The inclusion criteria for the study were patients who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis. Results: Among them, 50 patients had local complications due to acute pancreatitis. All patients were managed using the step-up approach, starting with conservative management and minimally invasive intervention when warranted. Twenty patients required surgical intervention due to failure of endoscopic or radiological intervention or positions of lesions being inaccessible to these techniques. Conclusion:various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains an essential modality in managing the disease.

52.Observational Prospective Assessment of the Cyto-Histopatholo gical Correlation in Thyroid Lesions
Rituraj, Akhalesh Kumar, Pradeep Kumar Singh
Abstract
Aim: To correlate cytological and histopathological finding in thyroid lesions. Material & Methods: This was an observational Prospective study was conducted in the Department of pathology, Government Medical College, Bettiah, Bihar, India, over a period of one year. Results: Total number of cytological diagnoses was 150. In the present study among 150 patients, nodular / colloid goiter was most common lesions accounting for 81 cases (54%) followed by Multinodolar goiter which were 31 cases (20.7%). Conclusion: By comparing the result of FNAC and histopathology, FNAC had higher accuracy, sensitivity of 80% and specificity 100% in the diagnosis of neoplastic thyroid lesions. FNAC is safe, inexpensive and less invasive diagnostic method with excellent patient compliance. FNAC can be used in the management of thyroid swelling to avoid unnecessary surgery on conditions like thyroiditis. FNAC with the help of imaging techniques is helpful in diagnosis of neoplastic lesion.

53. A Non-Randomized Assessment of the Effects of Acute-Intense Exercise on Visual and Auditory Reaction Time
Rajni Kant, Deepmala Sinha, Pankaj Bhushan, Bijay Krishna Prasad
Abstract
Aim: To evaluate the effects of acute-intense exercise on visual and auditory reaction time. Material & Method: This is a non-randomized study included 60 males in the age group of 18-22 years. Personal history and medical history of both groups was collected in the study proforma. After the baseline measurements, subject started to exercise on the stationary bike. Exercise task was done to achieve the goal of increase the heart rate to double that of resting heart rate (rHR). Results: Statistically significant decrease in VRT & ART after the acute exercise. There was a significant increase in heart rate & systolic BP after the exercise (p<0.05). Present study also observed significant decrease in diastolic blood pressure after exercise compared to baseline value. Conclusion: Respond to visual stimuli presented in the periphery of the visual field is vulnerable to moderate to severe exercise, as compared with the ability to respond to visual stimuli presented in the central portion of the visual field. An exercise- induced increase in arousal level and a consequent narrowing of attentional focus would explain the present results.

54. Classification and Management Variants of Nasomaxillary Hypoplasia Based on the Clinical Features: A Retrospective Study
Onkar Dev, Vidyapati Choudhary
Abstract
Objectives: To classify the variants of nasomaxillary hypoplasia based on the clinical features an advocate a logical treatment protocol for each type described. Material & Method: This was a retrospective study of 14 cases of nasomaxillary hypoplasia (Binder’s syndrome) selected from case records and photographs of 113 cases of rhinoplasties performed over a period of two years. Diagnosis of Binder’s syndrome was based on the typical features. Results: Nasal correction with loco regional autologous cartilage grafts was sufficient in mild cases. Loco-regional cartilage grafts along with costal cartilage grafts were needed for moderate and severe cases. Anterior nasal floor along with alar base augmentation was performed to achieve a proper aesthetic profile in moderate and severe cases. Post-operative results were excellent in mild and moderate cases and acceptable in severe cases. Conclusion: Most cases of nasomaxillary hypoplasia present as mild or moderate deformity, severe hypoplasia being seen in only a few cases. During surgical reconstruction, loco regional cartilage grafts (septal and conchal) can be used extensively in mild and moderate cases without having to solely depend on costal cartilage for augmentation. Augmentation of the premaxilla is necessary along with nasal augmentation and columellar lengthening with autogenous costal cartilage grafts for effective treatment. Augmentation with costal cartilage is enough to give an aesthetically pleasing facial profile in mild to moderate cases.

55. Neovascular Glaucoma: Aetiology and Staging Assessment
Kundan Kumar Singh
Abstract
Aim: To identify the most common cause and the frequent stage of presentation in patients with neovascular glaucoma. Methods: A prospective observational study was conducted in the Department of Opthalmology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 1 year. Total 130 eyes of 120 patients who underwent ophthalmological examination and diagnosed as having neovascular glaucoma were include in this study. All patients underwent thorough ocular examination i.e., visual acuity, slit lamp bio-microscopy, intraocular pressure (IOP) measurement by Goldmannapplanation tonometry, gonioscopy with Posner 4 mirror indirect gonioscope and dilated fundus examination with +90 D lens. Results: The present study was conducted in 130 eyes of 120 patients out of which 110 patients had either eye involvement and 10 patients had both eyes involvement. All Patients were aged between 15-71 years with a mean of 52.84 ± 11.9 years. Out of 120 patients, 95(79.17%) were males and 25(20.83%) were females. On gonioscopic examination, most of the cases i.e., 68(56.67%) had only rubeosisiridis without involvement of the angle, 26(20%), 16 (12.31%), 9(6.92%), 7(5.38%) had neovascularization of angle (NVA) in one, two, three and four quadrants respectively. Out of 130 eyes, 69(53.07%) had diabetic retinopathy in variable severity, 16(12.31%) had inflammatory etiology, 12(9.23%) had retinal vein occlusion and 14(10.77%) had glaucoma (PXG and absolute glaucoma). There is no statistically significant difference between the mean IOP in rubeosisiridis stage and open angle stage (P= 0.779). 77 eyes (59.23%) had IOP < 30 mm of Hg of which 68 were in rubeosisiridis stage. 53 eyes (40.77%) had IOP > 30 mm of Hg of which 39 were in angle closure stage. IOP < 30mm of Hg was found mostly in rubeosisiridis stage and> 30 mm of Hg was found in angle closure stage. Conclusion: In the present study, it was found that Proliferative diabetic retinopathy is the most common cause and rubeosisiridis is the most common stage of presentation in NVG.

56. Angiographic Profile of Acute Coronary Syndrome in Smokers and Non Smokers: A Comparative Study
Goutam Kumar, Pawan Kumar Singh, Ravi Vishnu Prasad, B.P. Singh, Nirav Kumar, Chandra Bhanu Chandan
Abstract
Aim: To study the angiographic profile of Acute Coronary Syndrome in smokers versus non-smokers and to analyses with respect to baseline characteristics. Material & Methods: This study comprised of a total of 200 cases. Study participants were allocated to two groups: Smoker’s Group and Non Smoker’s Group. Each group comprised of 100 participants. Mean age of the participants was 39:67 years. It was conducted in the Department of Cardiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, over a period of one year. Results: In the smokers group, Acute coronary syndrome was more frequently encountered in males (71% versus 29%, p<0.001) Non-smokers group, Acute coronary syndrome was often encountered in females (69% versus 31%). Conclusion: (1) Acute coronary syndrome occurred seven years earlier in smokers (2) Smokers presented with more acute infarctions and less Unstable angina (3) Single vessel disease was the most common CAG diagnosis in both smokers and non-smokers.

57. A Prospective Comparative Assessment of Astigmatic Outcomes and Incisional Integrity in Temporal Clear Corneal Incision and Superior Scleral Incision Phacoemulsification Surgery
Atul Kumar Anand, Dhananjay Prasad, Sumit Kumar, Rajesh Kumar Tiwary
Abstract
Aim: Comparative study of astigmatic outcomes and incisional integrity in temporal clear corneal incision and superior scleral incision phacoemulsification surgery. Methods: This prospective comparative study conducted in the Department of Ophthalmology, Nalanda Medical College and Hospital Patna, Bihar, India for 1 year. 100 patients were included in this study. Preoperative evaluation was done including visual acuity, intraocular pressure, sac syringing, thorough examination of anterior segment by slit lamp examination, posterior segment examination by 90D. Keratometry was done preoperatively and post operatively using automated keratometry, Axial length measured with a contact ‘A’ scan unit and the IOL power was calculated using SRK II formula. Results: Mean age of patients in category A was 65.45± 5.89 years and that in category B was 66.85 ± 6.36 years. There was no statistically significant difference between two categories regarding age. Hence, the study was age matched Category A had 31 males and 19 females and in category B were 29 males and 21 females. In our study, SIA in temporal clear corneal on 1st, 8th, 40th, 90th, 180th post-operative day were as follows 1.13 (0.61), 1.17 (0.51), 0.98 (±0.43), 0.92 (±0.45) and 0.91 (±0.47). There was a mild increase in the SIA from 1st to 8th post-operative day that decreased significantly by 40th post-operative day. There was mild further decrease in SIA by 3rd month which was not statistically significant and remained same by 6th month. In superior scleral category, SIA was 0.92 (±0.50), 0.92 (±0.41), 0.80 (±0.34), 0.77 (± 0.31) and 0.78 (±0.31) on post op day 1, 8, 40, 90 and 180. The change from 1st to 40th day was significant and there was mild decrease in SIA on postoperative day 90 and 180 but was not significant as compared to postoperative day 40. Conclusion: The study concludes that there is statistically significant post operative shift to WTR astigmatism in temporal clear corneal incision as opposed to ATR astigmatism in superior sclera incision; hence it is better to plan temporal incision as mostly elderly patients have preoperative ATR astigmatism.

58. Efficacy of Epidural Infusion in Pain Relief of 0.0625% Bupivacaine with 1μGM/CC Fentanyl for Postoperative Analgesia After Major Abdominal Surgeries Using Elastomeric Infusion Pump (Infusor Baxter Health Care USA) or Electronic (EMCO) Infusion Pump
Ankita Singh
Abstract
Aim: To evaluate the use of electronic and elastomeric infusion pumps for administration of local anesthetics for post-operative analgesia in the major abdominal surgeries with regard to – Pain relief: static & dynamic. Material & Methods: After institutional ethics committee approval, a prospective, observational, comparative study was carried out in 80 patients of either sex between ages of 18 to 65 years undergoing major abdominal surgery. The patients were into two groups of 40 patients each, elastomeric pumps (Group A) or electronic pumps (group B). Results: The age of the patients in the study ranged from 20.00 – 64.00 years.  Baseline Mean VAS at rest was 6.95 in Elastomeric group and 7.05 in Electronic pump. The median in both the groups was 7 with an IQR of 2.00. Thus the baseline was comparable and the difference was not significant.(P = 0.746) Mean VAS at dynamic state that is at mobility was 8.00 in Elastomeric group and 8.33 in Electronic group.  At the end of 24 hrs, Mean VAS was reduced significantly from baseline to 1.18 in Elastomeric group and 1.43 in Electronic group. Median and IQR was 1 and 2 in both the groups. This difference was statistically insignificant. (P = 0.330). Conclusion: Post-operative pain has many deleterious effects. Epidural analgesia is the most effective method to provide sustained pain relief. Baxter Elastomeric Pumps are non-electronic medication pumps which are said to be equally efficacious to electronic pump with respect to good pain relief.

59. To Evaluate AMH as a Predictive Marker of Ovarian Response in Assisted Reproductive Technology Outcome: An Observational Study
Amrita Rai, Rashmi Singh, Sonali Gupta, Geeta Sinha
Abstract
Objective: To evaluate AMH as a predictive marker of ovarian response in assisted reproductive technology outcome. Methods: 70 women (age 25–40 years) selected for in vitro fertilization treatment were included in this study. Analysis of day-2 serum samples was done for the AMH, FSH, Inhibin B, and LH by ELISA kit methods. USG was done for the antral follicle count (AFC) and oocytes’retrieval. Results: The mean AMH levels of all treated patients were 2.260 ± 0.417. ROC for AMH indicating poor ovarian response with sensitivity of 72 % and specificity of 70 %. A statistically significant positive correlation was observed between the number of oocytes retrieved and the AMH (r = 0.620, p = 0.0001) (Fig. 2). Significant correlation was also seen between the number of oocytes retrieved and AFC (r = 0.400, p = 0.0001). Conclusion: Our data demonstrated that AMH is an adequate predictor of both high and poor ovarian response, but it does not associate with pregnancy outcomes.

60. Pyoderma-Bacteriological Profile and its Antibiotic Sensitivity Pattern: A Retrospective Study
Ajay Kumar, Rashmi Soni, Babita, Satyendu Sagar
Abstract
Aim: To know the bacteriological profile of pyoderma in this region and to determine its antibiotic sensitivity pattern along with special reference to MRSA. Materials & Methods: Total samples collected were from 400 clinically diagnosed cases of pyoderma. A Retrospective study was conducted for a period of two years in department of Microbiology, Nalanda Medical College & Hospital, Patna, Bihar. Results: Around 53.2% of pyoderma cases were primary and 46.7% cases were secondary to contact dermatitis, scabies, skin ulcers &eczema. The major associated risk factors for causation of Pyoderma were Malnutrition (33.2%) followed by Diabetes (19.7%). Staphylococcus aureus was found to be the most common cause of Pyoderma followed by CoNS streptococcus pyogenes. Conclusion: Staphylococcus aureus was the primary pathogen causing pyodermas in this study. The antibiotic susceptibility pattern of the organisms isolated must be taken into account before starting therapeutic treatment.

61. A Hospital Based Assessment of The Prevalence and Severity of Vitamin D Deficiency in Type 2 DM As Well as to Record the Effect of Hyperglycemia on Serum Vitamin D Level
Sudhir Chandra Jha, Umesh Chandra Jha, Nehal Hyder
Abstract
Aim: To see effect of both high prevalent diseases on each other and to observe prevalence and pattern of vitamin D deficiency in diabetics. Material & Method: This study was conducted in the Department of General Medicine, Darbhanga Medical College & Hospital, Darbhanga, Bihar, India. Total 180 participants were enrolled in the study out of which 90 healthy people were enrolled as case (Group A) and 90 type 2 diabetic patients as controls (Group B). Results:  Prevalence of low vitamin D level in healthy population was present in 17 patients, while prevalence was 52 patients in Diabetic group. Patients having diabetes duration of less than 5 years, 25.01% were have insufficiency of vitamin D level and 7% had deficiency, 8.1% patients have insufficiency and 12,6% patients have deficiency of vitamin D level. It was found that all three important micro vascular complications: – diabetic retinopathy, diabetic nephropathy and peripheral neuropathy did not have any significant correlation with serum Vitamin D level as p value is greater than 0.05 for all three parameters. Conclusion: Vitamin D deficiency is highly prevalent in diabetic patients as compared to normal healthy population. All patients of type 2 Diabetes patients must have screened for serum vitamin D level and if found deficient than it should be treated promptly with vitamin D supplements for better control of hyperglycemia.

62. Study of Demography of First Thousand Patients Who Underwent Coronary Angiography-Retrospective Study
Ravi Vishnu Prasad, Nirav Kumar, Nishant Tripathi, B.P. Singh
Abstract
Background: CAD is very much prevalent in developing country. Our study is unique, first time done in province of Bihar to determine correlation between significant coronary artery disease and risk factors particularly chewable tobacco which is unique in Bihar and adjacent state. We also studied demographic features of coronary artery.it is a retrospective study done between February 2015 to July 2016 at IGIMS, Patna. Material and Method: All first 1000 patients who underwent coronary angiography systemically analyze for significant coronary artery disease, anatomical variation. These results were correlated with risk factor, which is established, also include oral tobacco. Result: among all patients 74 % were male, 29% were diabetic, 55% were hypertensive, 7% were smoker, 32% were taking tobacco chewer. 54% patient were suffering from significant coronary artery. Anomalous coronary artery was present in 2%. RCA dominance was seen in 91%, LCX in 7% and codominance in 2%. Muscle bridge was present in 1% case. Discussion: All risk factors were significantly associated with CAD but strength of association between oral chewable tobacco with CAD was more in comparison to smoking.

63. Clinical and Functional Outcome of Non-Surgical Managements of Knee Osteoarthritis in Very Elderly Patients
Mujtaba Ahmad, Rabindranath Chowdhury, A Md Atif, Samuel Lakra
Abstract
Aim: To investigate the clinical and functional outcome of non-surgical management of osteoarthritis knee in very elderly patients. Materials and Methods: The present interventional cohort study was conducted at KPC Medical college & Hospital, Kolkata during the period of Covid Pandemic. A total 50 patients were evaluated for their functional outcome, daily activities with any associated complications and thereby Performa filled for ROM, verbal pain score, WOMAC score and evaluated at the end of six months. Since the questionnaire was in English, the questions were translated to their mother tongue and the response noted. Results: The mean age of the study group was 84.5 years. There were 16 (32%) males and 34 (68%) females. The average pre consultation flexion at knee was 106.720 (106.72 ± 7.51) and it was improved to average of 117.810 (117.81 ± 7.15) at 6 month follow-up. The average pre-consultation extension at knee was 78.330 (78.33663 ± 7.51) and it was improved to average of 39.190 (39.198 ± 7.51) at 6 months follow up. The verbal pain score shows decreasing trend in subsequent follow-ups and 0 in almost every patient at 6 months follow-up. 10 out of 50 patients had persistent pain at 6 months follow up with verbal pain score of 2. There was decreasing trend in WOMAC score on subsequent follow-ups signifying better functional outcome in reference of stiffness and pain. Conclusion: Pharmacological along with ST and PrT programme is the ideal option for patients who are of very elderly age groups and in whom surgery is contraindicated.

64. Ultrasound Guided Transversus Abdominis Plane Block with Ropivacaine Versus Bupivacaine for Post Operative Analgesia in Elective Lower Segment Caesarean Section: A Prospective, Double-Blind, Randomized, Comparative Study
Shalini Sharma, Smita Bharti, Nikita, B.K. Kashyap
Abstract
Aim: To study ultrasound guided Transversus abdominis plane block with 0.25%ropivacaine versus 0.25% bupivacaine with 2mg dexamethasone as an adjuvant in both groupsfor post-operative analgesia in patients undergoing elective lower segment caesarean section deliveries. Material and methods: This prospective, double-blind, randomized, comparative study was conducted in the Department of Anaesthesiology and critical care, Patna Medical College and Hospital, Patna, Bihar, India, for 1 year. 60 American Society of Anesthesiologist’s (ASA) grade I and II patients, between 18-40 years of age posted for elective caesarean section were included in a prospective, randomized, double- blind, controlled clinical trial over a period of 1 year. Patients were randomized by computer generated random number to receive USG guided TAP block at the end of caesarean section with either Inj. bupivacaine 0.25% 15 ml + Inj. dexamethasone 2mg each side in group B (n = 25) or Inj. ropivacaine 0.25% 15 ml +Inj. dexamethasone 2mg each side in group R (n = 25). Results: Mean age was 22.90 ± 3.78 years. Demographic profile, baseline pulse, mean arterial blood pressure and duration of surgery were comparable in both groups. Baseline pulse and blood pressure was considered at the end of surgery before performing the block and there was no significant difference between the two groups. The pulse rate and mean arterial blood pressure during study interval, was higher in Group B than Group R, though it was within normal physiological range for both the groups. There was significant difference at 2 & 4 h (p<0.05). Time for rescue analgesia was earlier in Group B compared to Group R which was 6.7 h and 9.47 h respectively (p = 0.00). Conclusion:This study concludes that 0.25% Ropivacaine + 2mg dexamethasone provided a longer duration of analgesia compared to 0.25% Bupivacaine+2mg dexamethasone when used in TAP block for postoperative analgesia in lower segment caesarean section deliveries.

65. Evaluation of Surgical Profile of Patients Undergoing Appendectomy: is the Common Pathology Still of Interest?
Prabhu Dayal, Anil Kumar, Mohan Lal, Manish Choudhary
Abstract
Background: Effective health care implies careful consideration of all associated factors before the final decision. Acute appendicitis is one of the surgical emergencies and requires effective health care, early diagnosis, and rapid intervention with effective decision-making. Material & Methods: The present cross-sectional observational study was conducted at the department of surgery of our tertiary care hospital. 200 Patients with acute appendicitis were enrolled from the outdoor department and ward by simple random sampling. Institutional Ethics Committee Clearance was obtained before the start of the study and written and informed consent for the procedure was obtained from all the patients. Strict confidentiality was maintained with patient identity and data and not revealed, at any point in time. Results: Abdominal pain was reported and presented by every study participant. The next most common symptom reported by the study participants was the loss of appetite which was found in 88% of subjects followed by nausea in 84% of study participants. Fever was reported from 72% of subjects and 57% of study participants suffered from vomiting. Thus, abdominal pain was the universal finding in the present study. Right iliac fossa tenderness was also found in all subjects. Abdominal mass was not found in any patient on clinical local examination. 4% of patients were known cases of diabetes and 7% of patients had experienced episodes of acute abdominal pain in the past. The previous history of heart disease was reported from only two cases. No patient was found to have lymphadenitis. The cardiovascular and respiratory examinations were normal in all the study participants. Conclusion: The age distribution pattern was similar among both sexes, although the incidence is marginally higher in males. Acute appendicitis was more common in younger age groups. The most common presenting symptom in the present study was Abdominal pain followed by loss of appetite, nausea, fever, and vomiting. Right iliac fossa tenderness was also found in all subjects.

66. A Study of Management of Long Bones Fractures with Locking Plates
Komuravalli Varun Krishna, N Vamsi Reddy
Abstract
Background: The annual incidence of open long bone fractures is 11.5 per 100,000 people. They are more common in men, and their age distribution is bimodal. The most common type of open fracture is the tibial diaphysis, while open femoral diaphyseal, distal femoral, and proximal tibial fractures are more common among the most badly damaged individuals. Open fractures of the lower limbs are more serious than those of the upper limbs. We in the current study tried to evaluate the management of long bone fractures with locking plates. Methods: This cross-sectional interventional study was conducted in the Department of Orthopedics, Prathima Institute of Medical Sciences, Naganoor, Karimnagar, Institutional Ethical approval was obtained for the study. The common principle used for the treatment of the fracture was compression in 48% of cases followed by combination in 20% of cases and 16% each were treated with neutralization and bridging respectively. Results: In the current study 52% were closed fractures and 48% were open fractures. Grade I compound fractures were in 16% of cases followed by Grade II compound in 8% and Grade IIIA in 20% of cases and Grade IIIB in 4% of cases. The mean time of healing in closed cases n=13 was 16.5 ± 4.5 weeks. The mean healing time of Grade I compound fracture n=4 cases was 18.5 ± 2.5 weeks. Similarly, the mean healing time of grade II compound fracture n=2 cases was19.5 ± 2.5 weeks. The mean healing time for Grade IIIA compound fracture in n=5 cases was 22.5 ± 2.5 weeks. In the Grade IIIB case, the duration of the healing period was 24.0 weeks. Conclusion: Locked plating is a significant advancement in fracture treatment. In osteopenic bone and for comminuted and periarticular fractures, the locking plate improves fixing stability. Because the locking plates with screw heads thread into the plate and operate as fixed-angle devices, they provide more stability per screw than traditional nonlocking fixation.

67. Evaluation of Surgical Site Infection in Abdominal Surgeries in Abdominal Surgeries in the Department of General Surgery in a Tertiary Care Centre: An Observational Study
Bhanumati Giridharan, Pankaj Surana, Byomokesh Patro, P. Dhanasekaran, P. N. Shanmugasundaram
Abstract
Background: Surgical site infection is increasingly recognized as a measure of the quality of patient care by surgeons, the incidence of SSI in our environment is still high when compared to the developed world. Objectives: This study was conducted to evaluate the incidence, risk factors and the types of Surgical Site Infection (SSI) in postoperative abdominal surgeries. Methods: Immediate postoperative period of the patients was followed up. Wound was examined on day 2, then everyday till the day of discharge. Signs of SSI were looked for. If the Patient developed SSI in this period, then type of SSI was classified and swab culture was performed to identify the microorganism and antibiotic sensitivity pattern. CDC (Centre for disease Prevention and Control) criterion was used for diagnosis and classification of SSI. Patient was treated and discharged. All the details were recorded in the proforma. The patients were followed up every week till 30 days. Results: The SSI rate in our study was 14% and risk factors Associated with SSI in our study are smoking (p=0.001), preoperative stay of> 3days (p=0.000), ASA score (p=0.001), contaminated and dirty wound (p=0.000), duration of surgery (p=0.010) and duration of drain placement (p=0.000). Conclusion: Our study prompts us to look at the gaps in our surgical and infection control protocols which will enable policy formulation that will foster a reduction in wound infection rate. SSI can be reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies, adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use of drains and intraoperative maintenance of a sepsis and following operation theatre discipline properly.

68. Assessment of Nutritional Status of Liver Cirrhotic Patients by the Anthropometric Parameters (BMI, TSF, MAC, MAMC) and Their Correlation with Severity of the Disease
Sandhya Mishra, Vijay Laxmi Nangliya, Shyam Sunder, Anjali Sharma
Abstract
The objective of the study was to evaluate the nutritional status of liver cirrhosis patients by the   Anthropometrics measurements (Body Mass Index (BMI), Triceps Skin-fold thickness (TSF), Mid-Arm Circumference (MAC), Mid-Arm Muscle Circumference (MAMC) as an assessment method of the nutritional status. and their correlation with severity of Liver cirrhosis according to Child-Pugh classification. One hundred fifty cirrhotic subjects of either sex ranging in age from 20–70 years were included in the study, and the results were compared with 50 age- and sex-matched healthy control subjects. All cirrhotic subjects were assessed for severity of disease as mild (Child A), moderate (Child B), and severe (Child C) as per Child-Pugh classification. Among Anthropometric parameters: BMI, TSF, MAC, and MAMC were used for the assessment of Nutritional Status, measured in all the subjects. TSF, MAC, and MAMC were significantly decreased in Cirrhotic Subjects as compared to the healthy controls. Whereas BMI was not decreased significantly in Cirrhotic patients as compared to healthy control subjects. Enrolled 150 Cirrhotic patients were further segregated into three groups Child A, B & C according to the severity of their liver disease as assessed by the Child-Pugh classification. When Anthropometric parameters (BMI, TSF, MAC, and MAMC) were compared with the severity of liver cirrhosis, these measurements were decreased with the advancement of liver disease but the mean difference among Child Pugh groups was statistically not significant. However there was no significant correlation but there was a negative tendency between BMI, TSF, MAC and MAMC with the Child score. The anthropometric method used BMI, TSF, MAC and MAMC, it was observed that with increase in severity of disease severity of malnutrition also increased but the frequency of malnutrition diagnosis was less. These traditional methods under-diagnosed the nutritional depletion status of patients with cirrhosis because they are affected by edema, ascites, inter observer variation and there is no standard reference data for comparison in Indian population. Malnutrition is common in CLD patients. MAMC is efficient anthropometric  parameter and is associated with severity of disease so as one single method does not serve as the only and best parameter to diagnose malnourished patients or patients with risk for malnutrition. Though not very sensitive, body mass index BMI can be used to assess malnutrition after correcting the weight for the severity of ascites and edema. Anthropometric measurements including MAMC , TSF and MAC are simple and quick to perform with good inter- observer agreement and are probably the most practically applicable method. In addition, TSF and MAMC have demonstrated a linear relationship with mortality among cirrhotic patients.

69. Ocular Manifestations in Cases of Bell’s Palsy
Vipul Kumar Nagar, Gaurav Kataria, Yogendra Singh Dhaked
Abstract
Background: The facial nerve controls the muscles of facial expression, and in Bell’s palsy, dysfunction of facial expression is noted and the blink response dysfunction occurs due to damaged facial nerve. Lid retraction, a defective tear pump mechanism that leads to decreased tear production may also be reported. In cases of Bell’s palsy, ophthalmic signs such as lid malposition, dry eye, exposure to keratopathy, and tearing are common. Material & Methods: The present prospective study was conducted at the Department of E.N.T. and ophthalmology of our tertiary care hospital. The study duration was of one year from January 2019 to December 2019. A sample size of 50 was calculated at a 95% confidence interval at a 10% acceptable margin of error by epi info software version 7.2. Institutional Ethics Committee Clearance was obtained before the start of the study and written and informed consent for the procedure was obtained from all the patients. Strict confidentiality was maintained with patient identity and data and not revealed, at any point in time. Results:  In the present study, on the assessment of Bell’s palsy based on ophthalmic presenting signs it was found that out of total study participants, the most common presenting sign was Lagophthalmos in 96% of patients which was followed by conjunctival congestion in 42% patients, which was followed by corneal infiltrate among 34% patients, which was followed by reduced blinking among 22% patients which were followed by reduced corneal opacity among18% patients, which was followed by poor Bell’s phenomenon among 08% patients and only 1 patient was presented with a corneal ulcer. Conclusion: We concluded from the present study that Bell’s Palsy was commonly seen in young, aged patients between 20-and 30 years of age. The prevalence was more in females. The most common presenting signs were lagophthalmos, watering, and corneal infiltrate. Complete recovery occurs with medical management alone however, the rate was greater among younger than in older patients.

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