International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1.A Comparative Study of Lipid Profile in Pre and Postmenopausal Women
Kusum Bala Jain, Shiv Prakash Rathore, Surekha Kirad, Dileep Singh Nirwan, Surendra Jinger, Mohd shakeel
Introduction: The risk of coronary artery disease increases in women after menopause. This increased risk may be associated with alterations in the lipid profile characterized by changes in low density lipoprotein particle size. This has been attributed in part to adverse changes in plasma lipids and lipoprotein levels due to reduced estrogen levels. Deposition of fatty plaques on arterial walls (arteriosclerosis) is a predisposing factor for CHD. Our previous study was aimed at comparing lipid profile between premenopausal and postmenopausal women done in 2013-14 with sample size of 100 pre- and post menopausal women. So, we did the same study with increase sample size by 10 times (1000 samples) to rule out the effect of small sample size on previous results and find out the difference in lipid profile between pre-and postmenopausal women. Material & Method: The study was conducted in dept. of Biochemistry, GMC, Kota. The present study comprised of 1000 subjects, out of which 500 were premenopausal and 500 postmenopausal women. Samples were analyzed for lipid profile on autoanalyzer Transasia EM 360. Data was collected from the period of   June 2013 to May 2014 and analyzed in 2021-22. Result: data was summarized in the form of MEAN ± SD and differences in means of both the groups was analyzed using student ‘t’ test. Observations shows significant difference in Lipid profile parameters between pre- and postmenopausal women. Conclusion: Study concluded that there is significant alteration in lipoprotein levels after menopause. So, postmenopausal women should be shifted in diet changes and if needed then lipid lowering drugs should be added to decrease the cardiovascular disease.

2.Malignant Otitis Externa or Diabetic Ear- A Challange Disease
Mahesh Kumar, Naresh Kumar, Dharmendra Kumar
Malignant otitis externa is a rare but potentially fatal disease of the external auditory canal seen mostly among elderly, diabetic or immune compromised patient. The causative organism is mainly Pseudomonas aeruginosa. The disease spreads rapidly, invading surrounding soft tissues, cartilage and bones causing necrosis and even spreading to the cranial nerves. The disease can be fatal if treatment is not started aggressively and timely, especially if spreads outside the external auditory canal with involvement of the cranial nerves. Treatment is mainly medical with antipseudomonal drugs and local debridement. With aggressive treatment the mortality rate of this disease which was 50% in the past has now been reduced to 10-20%. We are our management and results are presented.

3.Establishment of Reference Interval of Blood Glucose and HbA1c in Tertiary Care Hospital of Anand District
Chhatriwala Mitul N, Sodavadiya Kiran Kumar B, Patel Dharmik S, Saiyad Taskin H
Background: Health of an individual is conceptually different in different countries, in the same country at different times and in same individuals at different ages. The reference range varies considerably from one laboratory to another and is decedent on the population diet. Methodology, selection of reference group needs of the clinical. The clinical laboratory standard institute (CLSI, formerly known as NCCLS) recommended nonparametric (IFCC) recommends both nonparametric method and parametric method for the determination of reference ranges. Material and Methods: Present study was carried out in Central diagnostic laboratory of tertiary care hospital of Anand district over the period of one year. This cross-sectional study includes total 500 blood reports of RBS, FBS, PP2BS and HbA1c of all the individual who attended the routine health Checkup, outpatient department attending the hospital. All the data were expressed a Mean±2SD. Data analysis was done by using Statistical Software (SPSS-17). Kolmogorov-Smirnov (Z-test) was applied for all the parameters. Results and Discussion: Mean and SD values of random blood glucose, fasting blood glucose, postprandial blood glucose and HbA1c for male are 112.80±23.65 mg/dL, 99.02±9.99 mg/dL, 106.09±18.82 mg/dL, 5.59±0.38% respectively, and for female are 109.74±36.06 mg/dL, 100.51±10 mg/dL, 104.77±13 mg/dL, 5.65±0.38% respectively. Conclusion: Hence, from this study we conclude that the reference range obtained for biochemical parameters of glucose observed in defined population in a city is different from the values provided by the diagnostic kits. But we found the reference range of HbA1c is similar to available reference range.

4.Effects of Modified-release Trimetazidine as an Adjunct to Standard Treatment in Dilated Cardiomyopathy
Goutam Kumar, Pawan Kumar Singh, Ravi Vishnu Prasad, B.P. Singh, Nirav Kumar, Chandra Bhanu Chandan
Background: Several clinical studies have reported numerous benefits of trimetazidine, an anti-ischemic agent, in ameliorating symptoms associated with cardiac dysfunction. Our study determined efficacy of trimetazidine as an adjunct to standard medical treatment in a population of Indian patients with dilated cardiomyopathy. Methods: Forty-five patients with ischemic dilated cardiomyopathy with previous history of acute myocardial infarction and/or documented coronary artery disease were enrolled in the study. Patients were included if the dilated left ventricular internal dimension-diastole (LVIDd) was >57 mm and the left ventricular ejection fraction (LVEF) was ≤30%. All patients received trimetazidine 35 mg modified-release formulation twice-daily and standard medical therapy for 24 weeks. Results: After 6 months, there was a significant increase in mean LVEF values by 7.1% (29.78 ± 05.11 vs. 31.89 ± 04.56, P=0.002) compared with pre-treatment values. Moreover, there was a significant increase in mean six-minute walk test scores by 7.9% (314.55 ± 65.72 vs. 339.40 ± 76.94, P=0.001). Furthermore, a significant decrease was noted in mean plasma brain natriuretic peptide levels (pro-BNP) by 16.9% from pre-treatment levels (1010.09 ± 589.03 vs. 839.55 ± 611.01, P=0.001). In addition, a nonsignificant decrease (0.4%) was observed in mean LVIDd values compared with pre-treatment values. Conclusion: Trimetazidine is beneficial in Indian patients with ischemic dilated cardiomyopathy with significant improvements in symptoms (LVEF), functional status (6-minute walk test), and inflammation (pro-BNP levels).

5.A Study to Evaluate the Effects of Visual Stimuli on Cardiac Autonomic Activity Using HRV in Middle Aged Males: A Prospective Study
Amrita Narayan, Sarbil Kumari
Objective: To test the effect of visual stimuli on HRV in middle aged males. Materials and Methods: The present 1 year prospective study was conducted in the Department of Physiology, Vardhman Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. The effects of visual stimuli on cardiac autonomic activity using HRV were studied in 50 healthy middle aged males. Beat to beat R-R intervals were continuously recorded under closed eye condition and the open eye condition. Results: The mean value of HF nu for under CEC was significantly greater (<0.05 level) when compared to OEC. The values of LF nu and LF/HF under CEC appear to be smaller than those OEC. Conclusion: When compared to the open eye condition, when the eyes are closed state of the eyes. Closing your eyes for a few moments could benefit your heart by enhancing the parasympathetic component of cardiac autonomic activity. The cardiac autonomic activity component increased.

6.A Cross Sectional Hospital Based Assessment of the Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) Viral Seropositive Among the Patients Posted for Cataract Surgery
Archana Kumari
Aim: To study the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) viral seropositive among the patients posted for cataract surgery at a tertiary care center in Bihar Region. Material & Method: This was a cross sectional hospital based study done in the Department of Ophthalmology, Patna Medical College & Hospital, Patna, Bihar, India over a period of two years. All the patients planned for elective cataract surgery were tested for HBsAg, HCV, and HIV. Results: There was a significant association with the mean age in the patients with HIV (P < 0.001) and HBsAg seropositive (P < 0.001). There was a significant association between HIV and male gender (P = 0.012). There was no association between gender and HBsAg and HCV positivity. Conclusion: The prevalence of viral seropositivity was high among patients scheduled for cataract surgery. For the benefit of the patient and their caregivers, eye care physicians might recommend these patients for counselling and additional management.

7.A Prospective Assessment of the Role of Operative Versus Non-Operative Treatment for Acute Undisplaced or Minimally Displaced Scaphoid Fractures in Adults
Mujtaba Ahmad, Pradyumna Chakraverty, Harsh Vardhan Binaykia, Bimalendu Bikash Hazra, Jayanta Mukherjee
Aim: To evaluate the effects of operative versus non-operative treatment for acute undisplaced or minimally displaced scaphoid fractures in adults. Material & Method: A prospective cohort study of all patients presenting to our OPD/ Casualty with a suspected or confirmed injury to the scaphoid was conducted over a period of 2 years. The initial radiologic examination of the wrist included poster anterior, lateral view, scaphoid view, oblique (45 deg. Pronation) view of the wrist. If the radiology reveals no fracture, wrist was immobilized with below elbow slab & was instructed to review after 15 days. Results: A total of 50 cases of acute scaphoid fracture (</= 3 weeks) were seen in a period of 2 years. The average age was 34 years. Most common location of fracture was waist fracture (11 cases) followed by distal oblique fracture (8 cases). All fractures managed by operative procedure (ORIF/per cut. Screw or k-wire fixation) united eventually. But there were 7 cases of non-union with conservative management. Conclusion: Surgical treatment is favourable for acute non-displaced and minimally displaced scaphoid fractures with regard to functional outcome and time off work; however, surgical treatment engenders more complications. Thus, the long-term risks and short-term benefits of surgery should be carefully weighed in clinical decision-making.

8.An Observational Study to Examine the Potentiality of Escherichia Coli as Probiotic Against Shigella
Nilesh Kumar
Aim: Isolation, identification and functional characterization of Escherichia coli as probiotic against Shigella in Bihar, India. Materials and Methods: This observational study was carried out in the Department of Microbiology, Madhubani Medical College Madhubani, Bihar, India, for 1 year. This study focused on poor hygienic regions firstly for the isolation of E. coli as probiotic strains against common pathogenic organism and secondly to evaluate misuse of antibiotics in a vastly populated city of Bihar. One of the hypothesis of this study presume that in the unhygienic areas E. coli from human sources might has the capacity to inhibit pathogenic organism like Shigella by which most of the people remain protected though their living and sanitation condition is very poor. Results: First Gram staining experiment were done for each selected isolate. Gram staining result revealed that all the isolates were Gram negative. Five biochemical tests were carried out for the identification of selected E. coli. All of them found positive to Indole test, Methyl red test, Catalase test and negative to Voges-Proskauer test, Citrate utilization test. Molecular identification E. coli as a bacteria, coliform and faecal coliform was done by amplifying 16srDNA, lacZ and  A gene, respectively. The PCR analysis of these genes resulted in 100% positive for all the eight selected isolates. These were identified by observing the band size with respect to DNA marker on 1.5% agarose gel on the basis of 800 bp, 874 bp and 147bp for the genes 16srDNA, LacZ and uidA. The antagonism of E. coli for Shigella was perceived by co- culturing Shigella with E. coli and observing their growth on the same plate. The result showed that in the co-culture E. coli effectively decreased the number of Shigella colony. On MacConkey agar plates, all the isolates of E. coli except Ec-AKS6 inhibited Shigella growth in co-culture. Shigella and E. coli colonies were also counted separately on MacConkey agar plates for comparison as control to evaluate culture condition. Conclusion: This study demonstrated that E. coli strains from environmental source can act as a potent antagonist against enteric pathogen Shigella.

9.A Prospective Observational Study to Assess the Diagnostic Efficacy of total TLC, CRP and Total Bilirubin in Acute Appendicitis
Nitish Kumar
Aim: To study the diagnostic value of total leucocytes count, C-reactive protein and total bilirubin in acute appendicitis: a prospective study. Methods: This study was performed on 45 patients who have clinically and radiologically diagnosed of having acute appendicitis. All patients fulfilled all the inclusion criteria like all clinically and radiologically diagnosed cases of acute appendicitis and its complications will be included in present study and Patients with hepatic disorders, a history of alcohol intake with AST/ALT >2, A history of hepatotoxic drug intake, HBsAg positive and or those with a past history of jaundice, concomitant conditions where CRP/leukocyte count/neutrophil count is elevated in acute appendicitis patients with associated diseases like rheumatoid arthritis, SLE, glomerular nephritis and gout were excluded from present study. Results: The results for comparison of (Mean±SD) of predictive markers like TLC, CRP and total serum bilirubin levels between normal appendix and different type of appendicitis were done by using one way analysis of variance with post hoc analysis according to Tukey-HSD. As compared to those with a normal appendix patients with any appendicitis were older, mostly females and had higher TLC, CRP and total serum bilirubin levels. Patients with perforated appendicitis had higher total bilirubin, TLC and CRP levels as compared to patients with normal and inflamed appendix (p<0.001) or a normal appendix (p<0.001). Conclusion: A combination of elevated levels of TLC, CRP and serum total bilirubin has high sensitivity and specificity to find out different types of appendicitis.

10.Prospective Observational Assessment of the Outcome and Efficacy of Short-Segment Pedicle Screw Fixation in Patients with Unstable Thoracolumbar Spine Fractures
Asif Ahmad Khan, Pankaj Kumar, Ramnandan Suman
Aim: To evaluate the outcome and efficacy of short-segment pedicle screw fixation in patients with unstable thoracolumbar spine fractures. Methodology: A prospective observational study of 40 patients of 15-65 years of age, was carried out in the Department of Orthopedics, Vardhman Institute of Medical Science, Pawapuri, Nalanda, Bihar, India. Detailed history, clinical examination, an x-ray of the thoracolumbar spine, CT scan, or MRI (if required) of the thoracolumbar spine was done pre-operatively and post-operatively in all cases. The neurological status and improvement of pain were documented at the time of admission, discharge, and every subsequent follow-up visit. Neurological status was assessed using the Frankel grading scale for spinal cord injury. Pain assessment was measured by Denis pain scale. Results: Out of 40 patients, 21 (52.5%) were females and 19 (47.5%) were males with a mean age of 36.65 ± 16.74 years (range 20-63). Most of the cases had fall injury (82.3%), while 17.5% had road traffic accidents. The majority of cases (42.5%) had L1 vertebral fracture followed by T12 and L2 fractures (22.5% and 20% respectively). Preoperatively the mean preoperative kyphotic angle was 17.42 ± 9.23 (range 7-30) degrees which also improved to 2.05 ± 1.34 (range 1-3) degrees after 6 months of postoperative period. Preoperatively 60% of cases had Frankel type E injury which improved to 82.5% at 6 months. Preoperatively the mean Denis pain scale was 4.72 ± 1.42 (range 2-5) that also improved to 1.24 ± 0.83 (range 1-3) at 6 months. Conclusion: This study suggest a favorable outcome for short-segment fixation with transpedicular screws in traumatic thoracolumbar spine fractures with excellent functional outcomes and less complications.

11.Hospital Based, Prospective Study to Identify Various Etiological Factors Involved in the Causation of Pediatric Ocular Injuries
Rakesh Kumar, Mukta Prasad
Aim: To identify various etiological factors involved in the causation of pediatric ocular injuries, implementation of preventive measures in the population, and the visual outcomes in pediatric ocular trauma. Methodology: This hospital based, prospective, interventional, study was conducted over 1 year. 100 consecutive patients at the Department of Paediatric Surgery, Mahavir Vaatsalya Aspatal, Patna, Bihar, India. Cases of ocular trauma in children aged 16 years or younger were evaluated. The patients who required admission were admitted and appropriate treatment was given the rest were managed on an outpatient department (OPD) basis. Patients were followed up on an OPD basis one week, four weeks, eight weeks and till six months. Data were analyzed by using descriptive statistics (SPSS 17). Results: A total of 100 patients were included in this study. Among the patients 67 were male and rest 33 females in all age groups. Most of ocular injuries were in the age group > 5 – 10 years (45%) followed by 0 – 5 years (36%). Majority of the patients were from rural (43%) and semi urban (28%) background. Parents of 34% subjects had no formal education while parents with only primary education constituted 38% of the sample and secondary education 13%. Regarding location of injury it was observed that in our study most of the injuries occurred inside home (36%), followed by injury in play grounds (23%). Injuries in streets / road and schools accounted for 22% and 19%, respectively. Mechanical injuries were the leading cause for pediatric ocular trauma accounting for 74% cases, followed by 14% thermal/ firework injuries, and 12% chemical injuries. 36% of patients presented with 6/18 or better visual acuity while 28 % had visual acuity up to 3/60. Rest had no perception of light or poor than 3/60 visual acuity at presentation. After appropriate treatment 47% patients had 6/18 or better acuity. Conclusion: Our study concludes that ocular injuries are a major cause of pediatric blindness in the Bihar region. Timely referral and management can help to prevent blindness originating from ocular trauma. Follow-ups of children are important for treating complications in the long term. It is very essential to educate children, parents, and teachers regarding ocular health and hygiene in order to minimize eye injuries.

12.Pregnancy Related Complications of Women with and without Polycystic Ovary Syndrome (PCOS): A Comparative Study
Rakhi Kumari, Seema Kumari, Indu Kumari
Aim: To study the pregnancy-related complications of women with and without PCOS in a tertiary care hospital in Patna. Materials & Methods: The study population consists of two groups Test group (Pregnant woman with polycystic ovarian syndrome) and Control group (Pregnant woman without polycystic ovarian syndrome). The sample size for the study was calculated to be 140 (70 in each group), using the software N Master Version 2.0. Results: The participants with overweight/obesity were 35.0% among the women with PCOS when compared to 25.0% among the women without PCOS (p=0.392). Even after adjusting for confounders like age, BMI and parity, there was 2.60 times higher risk among women with PCOS to have pre-eclampsia. Preterm delivery and LSCS was more among women without PCOS. Conclusion: Women with polycystic ovary syndrome are at increased risk of adverse pregnancy and birth outcomes that cannot be explained by assisted reproductive technology. These women may need increased surveillance during pregnancy and parturition.

13.Prospective Observational Study to Evaluate the Etiology, Clinical Features and Management of Unilateral Proptosis
Rashmi Kumari, Amit Prakash, Ashish Kumar, Prakash Kumar
Aim: To study the etiology, clinical features, histopathology, and management of proptosis and its outcome. Material & method: This was a two-year prospective study conducted after taking institutional ethical board clearance. All patients with unilateral proptosis that presented to the Department of Opthalmology, Narayan Medical College & Hospital, Jamuhar, Sasaram. Results: This study includes a total of 50 patients with unilateral proptosis. Headache (96%) and protrusion of eye (100%) were the commonest presented complains in these patients. Conclusion: Proptosis necessitates a complete ENT evaluation. A tiny number of instances may go unnoticed, but cancer must be ruled out in proptosis, regardless of how little the protrusion is. Malignancy was found to be the most common cause in prior investigations, while ours revealed an inflammatory genesis.

14.A Retrospective Study to Evaluate the Outcomes of Patients Admitted in the ICU with Regard to Pregnancy Status, Source of Admission and Comorbidities Leading to Admission to ICU
Rabindra Kumar, Sushil Kumar
Aim: To evaluate the outcomes of patients admitted in the ICU with regard to pregnancy status, source of admission, and comorbidities leading to admission to ICU in a tertiary care in Bihar region. Methodology: A retrospective study was undertaken for all obstetric patients admitted to the ICU of DMCH, Darbhanga, Bihar, India for 1 year. The admission criteria for the ICU included patient’s need for respiratory support, intensive therapy, or monitoring. The decision for admission is made by joint consultation from critical care team, anesthesiologist, and primary team. Inclusion criteria: All obstetric patients defined as pregnant at time of admission to ICU or delivered within 6 weeks prior to admission. The data were reviewed thorough ICU log sheet, electronic medical records, and online laboratory data. The data collected included patient demographics, pregnancy status at the admission to critical care (whether antenatal or post natal period), mode of admission (either through emergency or from within the hospital), length of stay in the critical care, laboratory investigation at the time of admission in ICU, type of disease responsible for admission in the ICU, and outcomes in terms of death or survival. Results: Data were collected for a period of 1 year During this period, 50 patients admitted to ICU were pregnant at the time of admission or delivered within 6 weeks prior to admission. Median age was 31 years with a range of 24-37 years. All the patients stayed in ICU for 1-3 days with a median of 2 days. There were 84% (42/50) of patients who required ventilator support; of them, 6 (12%) patients expired and 44 (88%) survived. There were more patients admitted in the ICU in the postnatal period when compared with the antenatal period; however, there was no statistical difference in their outcome. A difference in the outcome was observed for patients admitted through emergency compared with those admitted from within the hospital, with a statistically significant (P = 0.0005) increase in the mortality rate of patients admitted through emergency. There was no statistically significant difference in the mortality rate of patients with different presenting   illnesses.   A majority (48%) of the ICU admission were due to hemorrhagic/hematological causes followed by cardiovascular causes (32%). Conclusion:Awareness should be created among the population regarding the importance of adequate antenatal care, detection of danger signs of various obstetric complications and need for contacting medical facilities in case of emergency situations. Obstetric ICU dedicated for the management of only obstetric patients should be constructed in order to compensate for heavy burden critically ill women.

15. Single Blind, Prospective, Comparative Assessment of the Efficacy of Chloroquine Phosphate 0.03% and Sodium Carboxymethyl Cellulose 1% in Dry Eye
Sanjay Kumar Singh, Mukta Prasad
Aim: To compare the efficacy of chloroquine phosphate 0.03% (CQP) eye drops with sodium carboxymethyl cellulose 1% (CMC) eye drops in the management of DED. Material & Method: A single blind, prospective, comparative study was done in Department of Ophthalmology, Patna Medical College & Hospital, Patna, Bihar, India for the duration of 1 year. 100 patients of either gender, between the age of 30 to 70 years diagnosed with DED were included. Results: In all follow-up visits, the mean TBUT recorded in group 1 was better than that recorded in group 2 (p0.001). Group 1 demonstrated statistically significant improvement in the quality of the Marginal Tear Strip (MTS), indicating a delayed initiation of CMC action. In group 2 , the FS improved significantly from pre-treatment value to 4 weeks and from 8 weeks to 12 weeks (p=0.003, p<0.001) indicating an early and sustained improvement in FS in group 2. Conclusion: On ocular surface staining tests and Schirmer’s test, both CQP and CMC were found to be similarly effective in treating DED. However, CQP had a faster onset of action.

16. Role of Platelet Rich Plasma in the Treatment of Tennis Elbow: A Prospective Study
Shankar Niwas, Shashi Kant Kumar Singh, Kumar Satyam
Aim: To evaluate efficacy of tennis elbow treatment with platelet rich plasma. Methodology: The study was conducted at Department of Orthopaedics, SB Medical College & Hospital, Hazaribagh, Jharkhand, India during the period of 1 year. Patients between 20-50 years of age who had positive clinical tests (Thomson’s and Cozen’s test) were included in the study. About 30 ml of the patient’s blood was collected. The blood sample is placed in a centrifuge to separate the PRP from the other components of whole blood. PRP was injected into the site of the maximum tenderness. The primary analysis included VAS [21] for measuring pain inpatients, local tenderness, pain on extension of the wrist, grip strength, elbow swelling was clinically assessed at different interval of follow-up, clinical and functional outcome were evaluated at final follow-up with statistical analysis. Patients were assessed after 1 week, 1 month, 6 months, and 12 months. Results: This study included 100 patients out of which 73 were males and 27 were females with age range from 20 to 50 years. The average follow-up was 8 months. 47% belonged to 21-30 years of age group, 31% belonged to 31-40 years, and 22% belonged to 41-50 years of age group. Results were excellent in 81%, good in 16%, fair in 2% and poor in 1%. The mean VAS decreased continuously and significantly up to 8 months. Conclusion: Based on this study, it can be recommended to treat patients with PRP before considering surgical intervention primarily because it provides a similar rate of success with lower cost and less risk. More scientific studies need to do on large scale to prove these results.

17. A Prospective Study to Assess the Impact of the Prophylactic Use of Antibiotic Coated Intramedullary Nail in Treatment of Open Tibia Fractures
Mujtaba Ahmad, Anirban Paul, Pankaj Kumar Kushwaha, Abhishek Poddar, Gopal Gosh
Aim: To estimate the impact in the clinical setting, this study models whether the use of Gentamicin-coated implants is one of the methods which provide mechanical stability, effectively prevent infection and promote bony union by simple one stage procedure. Material & Method: This prospective study was conducted in the Department of Orthopaedics, where a total of 50 patients were treated over a period of 15 months with gentamicin coated tibia interlocking nail after taking written and informed consent. Results: The most common cause of injury was found to be road traffic accident and accounted for 87% of cases. Fibula fracture was associated with 91% of patients. Time taken in wound healing in majority of patients was less than 5 weeks (52%). Majority of patents (58%) had RUST score 8 at six months of duration. Conclusion: At six months, the antibiotic-coated nail had a satisfactory clinical and radiological outcome, and early findings suggest the use of antibiotic-coated implants as a novel possible therapeutic option for infection prevention in open tibia fractures.

18.Prospective Hospital Based Assessment of the Serum Ferritin Level as A Marker of Preterm Labor
Seema Kumari, Rakhi Kumari, Usha Kumari
Aim of the study: To evaluate the value of serum ferritin level as predictors in preterm labor. Patients and Method: This is a prospective study, conducted at the Department of Obstetrics & Gynecology, Nalanda Medical College & Hospital, Patna, Bihar, India, over a period of 7 months. The sample collected from the pregnant ladies who visited the outpatient clinic. Results: The mean level of iron in preterm was (72.0±24.9) and (70.5±27.4) for full-term women with no significant differences (P=0.5). S. ferritin were highly significant decrease in full term than that in preterm (P<0.001) the level of the serum ferritin declined with progression of the gestational age in preterm labor, and the mean gestational age at delivery time was below the 36 weeks. Conclusion: The findings of the present study showed that serum ferritin level can be used to find patients at risk of preterm delivery.

19.Osteosynthesis of Fracture Neck Femur in the Sixth and Seventh Decades of Life by Dynamic Hip Screw (DHS) and Antirotation Screw
Pankaj Kumar, Asif Ahmad Khan, Ramnandan Suman
Aim: To assess the results of internal fixation of fracture neck femur in the sixth and seventh decades of life by dynamic hip screw (DHS) and antirotation screw. Material & Method:  46 patients with displaced fracture neck femur were treated in  Department of Orthopedics, Vardhman Institute of Medical Science, Pawapuri, Nalanda, Bihar, India for 12 months by closed reduction and internal fixation by DHS and antirotation screw. Results: The time elapsed between trauma and surgery ranged from few hours to 7 days with an average of 3 days. Bone union was achieved in all patients except five. The time to bone union ranged from 3 to 7 month with an average of 6 months. The time to full weight bearing ranged from 3 to 7 months with an average of 5 months. The reduction in the horizontal offsets ranged from 2 mm to 6 mm with an average of 3 mm. This reduction in neck length and horizontal offset was found statistically to be significant (p value < 0.05). Conclusion: Internal fixation of fracture neck femur in the sixth and early seventh decades of life by DHS and antirotation screw has the advantages of short operative time and early weight bearing with high union rate. It is a hip preserving surgery and if non union or avascular necrosis had occurred, hip arthroplasty could be done without major difficulties. Patients above the age of 65 years and patients with Garden type IV fractures carry the risk of poor results.

20.This Randomized Prospective Study to Evaluate the Anatomic and Functional Changes of the Corneal Endothelium in Cataract Patients Undergoing Phacoemulsification and MSICS
Mukta Prasad, Sanjay Kumar Singh
Aim: To compare the effect of Phacoemulsification and Manual small incision cataract surgery (MSICS) on the corneal endothelium and to assess its impact on visual acuity and induced astigmatism. Material & Method: This randomized prospective study was conducted on140 cataract patients visiting Department of Ophthalmology, Patna Medical College & Hospital, Patna, Bihar, India. Patients were randomly divided into two groups by lottery method, comprising 70 patients each who underwent phacoemulsification (group 1) and manual small incision cataract surgery (group 2). Grading of the cataract was not taken into consideration while allotment of the patient‘s to either of the two surgical techniques. Results: The difference in postoperative mean central corneal thickness was statistically not significant at all intervals in both groups. The difference in postoperative best corrected visual acuity at 6 weeks was not statistically significant (p value = 1.0) The difference was statistically significant between two groups (p value = 0.030). The mean postoperative astigmatism was less in Group 1 compared with Group 2 at 6 weeks. Conclusion: As the Manual small incision cataract surgery does not depend upon advanced technology and is more cost effective, it may be a favorable surgical procedure in those areas where high cost phacoemulsification techniques are still not accessible.

21.A Case Control Comparison of Retinal Nerve Fiber Layer (RNFL), Ganglion Cell Layer (GCL), and Optic Nerve Head (ONH) Morphological Parameters Using Spectral Domain Optical Coherence Tomography (SDOCT) in OSA Patients
Sanjay Kumar Singh, Archana Kumari
Aim: To compare the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and optic nerve head (ONH) morphological parameters between obstructive sleep apnea (OSA) patients and age-matched controls using spectral domain optical coherence tomography (SD‑OCT). Material & Method: This case control study was conducted in the Department of Ophthalmology, Patna Medical College & Hospital, Patna, Bihar, India for 1 year. Epworth Sleepiness Scale (ESS) was employed to measure daytime sleepiness and rule out OSA while choosing control population. A scale of zero–four was chosen by the patient for eight different situations. Results: RNFL analysis in OSA patients showed statistically significant decrease of the mean Superior RNFL, Inferior RNFL, and Average RNFL. Ganglion cell analysis also showed a decrease in all six sectors of ganglion cell layer, average, and minimal ganglion cell layer‑inner plexiform layer thickness in OSA patients when compared to controls; the difference was statistically significant (P < 0.05). Conclusion: OSA patients even with clinically normal optic disc showed significant decrease in the RNFL thickness, GCL thickness, and rim area when compared to age‑matched controls. Hence, these patients constitute a high‑risk population who need to be regularly screened and followed up for ocular co‑morbidities.

22.A Clinico-Radiological Outcome Assessment of Diaphyseal Humerus Fracture Treated Using Minimal Invasive Plate Osteosynthesis (MIPO)
Shashi Kant Kumar Singh, Shankar Niwas, Kumar Satyam
Aim: To assess the clinico-radiological and functional outcome in management of humerus diaphyseal fracture by MIPO technique. Methodology: This study was conducted in the Department of Orthopaedics, SB Medical College & Hospital, Hazaribagh, Jharkhand, India in the duration of 1 year It included 50 diaphyseal fractures of humerus treated with MIPO technique. The cases were followed up for a minimum period of 1 year. 18-65 years patients having closed and Gustilo Anderson grade 1 diaphyseal fracture of humerus were included in this study. The type of fracture was evaluated and reported in accordance with the AO19 classification system after obtaining a ski gram– anteroposterior (AP) and a lateral view of the affected Arm. These radiographs were also used to decide the appropriate length of metal implant and for planning the surgery. Results: 50 patients of diaphyseal fracture of humerus were included and treated by Anterior Bridge Plating by MIPO technique. Out of 50 patients, 32 (64%) were males and 18 (36%) were females. The mean age of patients was 39.71±13.18 (Range = 18-65) years respectively. The mean surgery time was 99.52±13.50 minutes (Range = 80-120). There was a significant difference in mean UCLA and MEPS between 6 weeks, at 3 months, at 6 months and at 9 months. Callus was reported among significant (p<0.005) cases 34 (64%) at 6 weeks, 42 (84%) at 3 months, at 6 months and at 9 months. Angulation (>15°) was reported among 2 (4%) at 6 weeks, 5 (10%) at 3 months and 5 (10%) at 6 months in our study (p<0.001). Screw back out was reported among 2 (4%) at 3 months and 2 (4%) at 6 months due to infection. Roundening of Margins was reported among 4 (10%) at 6 months and sclerosis was reported among 3 (6%) at 6 months in our study. Infection was reported among 2 (4%), Non- Union among 4 (8%) and Radial Nerve Palsy among 7 (14%) cases. Conclusion: This study demonstrates that the minimally invasive plate osteosynthesis technique (MIPO) for treatment of humeral shaft fractures presents newer, effective, and acceptable modality of treatment for such fractures.

23.Assessment of the Incidence and Associated Co-Morbidities Which Influence the Surgical Site Wound Infection: An Observational Study
Nilesh Kumar
Aim: To assess the incidence and associated co-morbidities which influence the surgical site wound infection Methods: This study was carried out in the Department of Microbiology, Madhubani medical college Madhubani, Bihar, India, for 1 year. All patients who underwent various surgeries namely appendicectomy, hernia operation, laparotomy, mastectomy, amputation, cholecystectomy and nephrectomy were included in this study. For the study of risk factors and risk indices necessary information was collected including age, Diabetes, preoperative hospital stay, ASA score, nature of surgery, type of anaesthesia, duration of surgery and surgical technique. Swabs were obtained from wounds and were processed without delay using standard microbiological methods. Results: Out of 200 patients, 32 patients developed surgical site infections (16%). Out of 32 infected cases, 28 cases were culture positive (87.5%, 28/32), while 4 cases were culture negative (12.5%, 4/32). The pathogens isolated were Escherichia coli (10 isolates, 35.7%), Klebsiella spp (6 isolates, 21.4%), Coagulase negative Staphylococci (4 isolates, 14.3%),    Pseudomonas   aeruginosa   (4    isolates, 14.3%), Staphylococcus aureus (2 isolate, 7.1%) and Proteus mirabilis (2 isolate, 7.1%). The rate of SSI increased with increase in NNIS risk index from 0 to 3 with highest rate reported in ≥2 (52.5%, 21/40) . In present study out of 22 patients with Diabetes Mellitus, 8 patients had SSI. The rate of SSI was 36.4% (8/22) in patients with Diabetes Mellitus compared to rate of  SSI  in  patients  without diabetes mellitus, which was 13.5% (24/178). Conclusion: The risk indices, like the NNIS risk index provide information about potential risk factors for development of SSI.

24.A Cross Sectional Assessment of the Proportion of Colonic Carcinoma in Cases Presenting with Acute Intestinal Obstruction
Nitish Kumar
Aim: To find the proportion of colonic carcinoma in cases presenting as acute intestinal obstruction. Methodology: The study was a cross sectional study conducted in patients who attended the surgery casualty/outpatient department of the Department of General Surgery, ICARE Institute of Medical Sciences and Research and Dr.Bidhan Chandra Roy Hospital, Haldia, West Bengal, India with acute intestinal obstruction. It was conducted for a period one year . The patients presented with acute onset of vomiting, constipation and abdominal distension were taken into study. Diagnosis of intestinal obstruction was made based on clinical examination, history, image evidence in x ray and ultrasonogram. The diagnosis of colonic carcinoma was based on follow up of all patients by contrast enhanced CT abdomen, biopsy following laparotomy and CEA levels. Data was coded and entered in MS excel spreadsheet and Statistical package for social sciences (SPSS) for windows were used for analysis. Results: In this study, 100 patients were enrolled having intestinal obstruction. Out of which, 30% cases had carcinoma colon. The age of the participants ranged from 18 to 90 years. The mean (SD) of the participants was 48.37 (19.32) years. The average age of patients diagnosed with carcinoma colon was 55.85 years. Majority of the participants (89%) were having non vegetarian diet. In total (33%) patients had history of previous laparotomy. The most common diagnosis was obstructive hernia (31%), followed by adhesion obstruction (23%) and Carcinoma colon (16%). There was higher prevalence of Carcinoma Colon among females compared to males (20.6% vs 13.6%) which was statistically significant with p value of 0.05. Conclusion: There is a need for better screening and evaluation programs specifically aimed at detecting colon cancer at early stages. This implies more frequent colonoscopic evaluation for the high-risk population. With improved education of physicians resulting in effective and appropriate implementation of screening colonoscopy guidelines, and with improved technology, equipment, and training, this preventable, lethal disease should be virtually eradicated.

25.A Descriptive Study on Determining Prevalence, Pattern and Outcome of Trauma Patients
Vikas Kumar, Harpreet Singh, Navdeep Singh, Ravi Prakash Choudhary
Background: Trauma is one of the leading cause of deaths in the young population. The burden of trauma tends to range from physiological to economic causes, which could have a significant adverse impact on people. This is especially true for people living in developed countries. Current study focused on assessing the prevalence, pattern and outcome of trauma. Aim: Aim of the current study is to assess the prevalence, pattern and outcomes of trauma patients. Methods: The current study was conducted in the Trauma Centre at Healing Touch Hospital Ambala. A total of 10,200 trauma cases reported to emergency department of the hospital between 2015 and 2018 were considered in the current study. The trauma patients were from varying age groups. To perform analysis of the data, researcher developed a trauma profile on basis of consultation of an expert from the Trauma Surgery. In addition, demographic statistics was used to perform an analysis of the data sets. Results: During the study it was found that majority of the patients had road traffic accident. Further, almost 90% of the patients had suffered a blunt injury, but the condition of 64% of the patients was stable, with 86.9% of patients having systolic blood pressure between the range of 90-119mmHg. 72% patients admitted to the emergency department had normal pulse. Conclusion: The incidences of trauma were found to be more among the male patients than female patients. The young people are often involved in accidents that lead to trauma. Due to this reason, it can be said that the younger generation is at the most risk of trauma. The trauma patients tend to get pre-hospital care, i.e., care provided to them before they reach the hospital. One of the reasons could be that majority of the patients came to the emergency department in an ambulance, which is well equipped to provide pre-hospital care.

26.Can Immunohistochemical Exhibition of Galectin-3 help solve Conundrums of Thyroid?
Prasanta Kumar Das, Phalgunee Priyadarshini, Meenakshi Mohapatro
Background: Belonging to a family of lectins, Galectin-3 has garnered a lot of attention for its active part in the cancerous metamorphosis of various organs including thyroid gland. Aim: To use immunohistochemical expression of Galectin-3 to discern carcinomas from benign nodules of thyroid in histological samples. Materials and methods: Immunohistochemical staining of galectin-3 was observed in a spectrum of benign as well as malignant neoplasms of thyroid. These included 20 specimens of follicular adenoma, 25 of papillary Carcinoma, 3 of follicular Carcinoma & 2 of medullary Carcinoma. Results: Malignant thyroid carcinomas presented with significantly higher galectin-3 immunoreactivity as compared to benign neoplasms(p<0.05). It presented with a sensitivity of 83.3%, specificity of 90%, positive predictive value of 92.6% and negative predictive value of 78.3% in distinguishing malignant from benign tumours. Conclusion: Immunochemical staining for galectin-3 helps in discerning benign lesions from malignant carcinomas. It could help in recognition of tumours of thyroid with ambiguous morphologic attributes.

27.Effect of Biomass Fuel use on Pulmonary Functions in Non-smoking Healthy Women
Silvi Banerjee, Bhupendra Buda, Karuna Dash
Background: Several studies have been done in developing countries that established varying associations between biomass fuel use and pulmonary functions in young healthy non-smoking women. This study is a first of its kind conducted in Taladanda Canalside slum of Ranihat, Cuttack, Odisha to determine the effects of biomass fuel use on pulmonary functions in non-smoking healthy women. Objective: This study was done with an objective to determine the effects of Biomass fuel use on pulmonary functions in non-smoking healthy women and its comparison with LPG users. Methodology: The study was conducted for 1 year and 6 months from November 2014 to April 2016 including 160 non-smoking healthy women [Biomas Group(n=80) and LPG Group(n=80)]. Computerized Spirometry was done to determine the pulmonary functions of all subjects. Results: Baseline parameters of the two groups were similar except for number of persons sleeping per room, socio-economic status. Biomass Group had a significantly lower FEV1, FEV1/FVC% without any significant change in FVC as compared to LPG Group. Conclusion: A significantly lower FEV1, FEV1/FVC% without any significant change in FVC in the Biomass fuel user group is indicative of Obstructive Lung disease. This can be attributed to the adverse effects of indoor air pollutants generated due to the incomplete combustion of biomass fuel in indigenous Chulhas.

28.MRI Evaluation of Cases of Mucormycosis after Covid-19
Ravi Soni, Suhail Khan, Bharat Jain, Iqbal Khan, Shrinidhi R Kulkarni
Introduction: COVID-19 spread was due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Even today, COVID cases are being continually recorded. On this basis, it can be said that there is still the danger of COVID-19 cases getting increased at a rapid rate. There is no way of distinguishing the clinical findings and radiological findings of secondary fungal infection from that of COVID-19 pneumonitis and pneumonia. Aim: To Assess the MRI Evaluation of Cases of Mucormycosis after COVID-19”. Material and Methods: In the current study, the researcher conducted an observational study at Pacific Medical College, Udaipur, Rajasthan, India. Data for all the confirmed mucormycosis cases among patients with and without COVID-19 reported from September 2020 to December 2020, for the current study was collected. The researcher used SPSS Statistics 21.0 for performing an analysis of the data obtained from the health care centre. The descriptive statistics were measured and analysed using frequencies, mean, standard deviations, and median. Results: Out of the 286 cases, 65% (N = 185) had CAM (COVID-19 Associated Mucormycosis), with the mean age of 52 (SD = 16) years. Furthermore, 75% (N = 214) of the entire study population was male; and the remaining 25% (N = 72) were female. The prevalence of CAM was 0.28% and the range was 0.04% to 0.60%; on the other hand, CAM prevalence in ICU patients was determined to be 1.9% and the range was o.68% to 2%. Conclusion: From the current results, it can be concluded that Uncontrolled Diabetes Mellitus, found to be among 63% of the participants, was one of the common diseases in both CAM as well as non-CAM groups. In addition, the rhino-orbital area was among the most well-known sites of mucormycosis, with 58% participants, followed by rhino-orbital-cerebral, pneumonic, and other such areas.

29.A Retrospective Observational Study to Compare Surgical and Non-surgical Treatment of Lateral Clavicle Fractures
Gopabandhu Patra, Sidhartha Nayak,  Sambit Ku Panda,  Rabi Narayan Dhar,  Prabhat Kusum Mohapatra
Background: As per Craig’s (1990) modified Neer classification system, lateral clavicle fractures accounts for approximately 30% of all clavicle factures. The physical examination of the lateral clavicle injury involves identification of pain, deformity, vascular, neurological, and respiratory as well as mediastinal contents. In addition to this, the radiographic assessment for the injury involves X-rays, CT scan, EMG, and nerve condition studies. The surgical treatment approaches are used for the type 2 lateral clavicle fracture that have higher rate of non-union compared to type 1 and 3. The surgical treatment process involves open reduction internal fixation (ORIF) with plate and screws. Aim: To compare surgical and nonsurgical treatment of lateral clavicle fractures on the basis of functional outcomes and compare patient-reported outcome measures (PROMs). Method: All clavicle fractures in patients older than 15 years, treated at Department of Orthopaedics, B.B Medical College, Bolangir, Odisha, India, between April 2018 and March 2020 were evaluated for fracture location (n = 593). All 150 lateral clavicle fractures were further reviewed for inclusion. 25 lateral clavicle factures were excluded after which 125 lateral clavicle fractures remained. The surgical procedure was performed under general anaesthesia in the beach chair position with image intensifier control, as a day case. The skin was typically incised horizontally, after administration of antibiotic prophylaxis Results: A total of 26 patients got surgical treatment and 99 underwent non-surgical treatment. As per results, 24 patients from surgical treatment group had type 2 or 5 injury due to fall and transportation accident. Similarly, 40 patients from nonsurgical group had type 2 or 5 facture. Dash score showed more disability among the surgical group as compared to non-surgical group. Further, results of the PROM subgroup show patients treated surgically had poor constant score with infraclavicular sensory deficits, and thus were less satisfied with the cosmetic results as compared to the patients treated non-surgically. Conclusion: From the study it can be concluded that many patients from surgical group had to reoperated whereas few patients from the non-surgical group had to went for delayed surgery. It suggests that patient with surgical patients with lateral clavicle fractures should prefer non-surgical treatment over surgical treatment.

30.A Retrospective Analysis of Effect of COVID-19 on Revision Total Knee and Hip Arthroplasty
Saroj Kumar Parida, Sanjay Kumar Behera, Sambit Kumar Panda
Background: The SARS-CoV-2 (Covid-19) has significantly impacted the health of the people around the globe. Primary Total Hip arthroplasty (THA) and Total Knee arthroplasty (TKA) were significantly affected in the pandemic time. The canceled surgeries of THA and TKA were rescheduled as majority of the beds in the hospitals were occupied by COVID patients. Due to this, patients for such surgery accumulated and many patients faced serious health issues. In addition to THA and TKA, Covid-19 pandemic also significantly impacted Total Joint arthroplasty (TJA) volume. According to analysis, the annual volume of the TKA and THA for 2020 was around 128,000 and 66,000 respectively. Aim: To analyze the effect of COVID-19 on revision total knee and hip arthroplasty. Methods: For the study, the data was collected from the institutional registry for TJA and pending revisions for the TKA and THA patients. Approximately 465 inpatient beds between April 2019 and March 2020 considered for the study. Procedures were conducted for 12 months prior to the initial shutdown of elective surgery (April 19 – March 20). The percentage changes for urgent revisions for TJA were compared focusing on pre and post-Covid TKA and THA. Results: Two groups were defined as pre-Covid patients (n = 190) and post-Covid patients (n= 160). The mean age of the patient in pre-Covid group was 75.3 years (SD = 1.01) and post-Covid group was 68.9 years (SD = 11.52). For TKA revision, in pre-covid group, 33.3% of the patients had Aseptic loosening and 22.2% had Periprosthetic joint infection, and 16.6% required Urgent revision. On the other hand, in post-Covid group, 33.3% of the patients had Aseptic loosening and 21.2% had Periprosthetic joint infection, and 18.1% required Urgent revision. Post-Covid cases of THA were also increased as out of 94 patients, 15.9% required Urgent revision. There was no significant difference between the groups for TKA revision (p>0.05). Similarly, apart from Aseptic loosening (p<0.05), there was no significant difference between the groups for THA revision (p>0.05). Conclusion: It has been carried out that revision of TKA and THA decreased in health care system during Covid-19 pandemic compared to pre-Covid. The numbers of urgent cases were increased in both groups such as the numbers of urgent cases for THA were 15.9% and TKA was 18.1% post-Covid and these are creating the backlog for the care professionals to provide the better treatment and recovery of the patients.

31. Comparing Clinical and Radiological Outcome of Long Proximal Femur Nail (PFN) and Subtrochanteric Fracture Femur fixed by Dynamic Condylar Screw (DCS)
Sidhartha Nayak, Gopabandhu Patra, Sambit Kumar Panda, Rabi Narayan Dhar, Prabhat Kusum Mohapatra
Background: There are different kinds of injuries that have a significant impact on the physical health of the people. One of them is Subtrochanteric Fracture that includes those injuries that caused by severe high energy trauma in the younger population. These kinds of fractures are usually associated with the femoral head and having the high impact as dislocation of hip. There are many treatments available, but the Dynamic Condylar Screw (DCS) and Proximal Femur Nail (PFN) are mostly considered for better recovery of the patients. Aim:  To compare Clinical and Radiological Outcome of Long Proximal Femur Nail (PFN) and Subtrochanteric Fracture Femur fixed by Dynamic Condylar Screw (DCS). Method: For the investigation of the fracture and treatment process and recovery the study has involved total 35 patients. The randomized sampling technique was considered for including the patient treated with PFN 15 patients and DCS techniques 20 patients. The study period was from December 2020 to December 2021.The patients that were involved in the study had subtrochanteric femur fractures within two weeks. Result: The study has involved people from different age groups and most number of patients (37.14%) was aged between 51-60 years and least number of patients (8.57%) were in age group of 20-30 years. There were 65.71% male and 34.28% were female patients and 42.85% of there were treated using PFN approach and 57.14% were treated using DCS approach.  According to analysis, 25.71% patients were categorised type 2, 45.71% were categorised type 3, 17.14% were considered type 4 and 11.42% were type 5 categories. Conclusion: From the analysis of clinical outcome of PFN and DCS groups, it has been carried out the PFN was the better surgical intervention compared to DCS as it has shorter period for treatment and helped to full recovery of the patients.

32. A Randomized Control Trial Comparing Operative and Non-operative Treatment of Acute Displaced Distal Clavicle Fractures
Saroj Kumar Parida, Sanjay Kumar Behera, Sambit Kumar Panda
Background: The clavicle fractures are most common in children and young adults which majorly occur in person younger than 25 years. In addition to this, the treatment through surgical approach is considered when patients have high potential for non-union with more than 15-20 mm clavicle shortening. The exercise and proper monitoring of the complications is helping to understand the recovery and improvement in the physical health of the individual. However, the high impact on the bones and lack of care during the non-surgical approach for treatment is leading the patients to surgical process. The surgical process is involving open reduction and internal fixation. The process is including the plates and screws to align the bones. Additionally, surgical treatment is involving pins and screws that also used for holding the fracture bone in good position and put it back in right place. Aim: The study aims to understand a randomized control trial comparing operative and non-operative Treatment of Acute Displaced Distal Clavicle Fractures. Method: For the study randomized controlled trail process was used at SCB Medical College between August 2019 to October 2021. The study was completed under the instruction of the ethical committee and approved. For the study 18-60 years population was considered who has the issues related to completely displaced, closed, Neer type II distal third clavicle fracture. Moreover, the demographic were calculated focusing the mean, SD and percentage. Results: The number of non-operative patients was 33 and mean value of age and BMI was 42.1 and 24. Here female patients were 12.2% and male was 87.8%. The most numbers of mechanisms of injury among non-operative patients was cycling and sports both were 36.6%. For the operative patients, the mean value for age and BMI was 42 and 23.8. There were 22.2% women and 77.7% were men. The highest mechanism of injury among operative patients was cycling 40.7% and fall 25.9%. There was no significant difference was found in DASH score. There was no significant difference found in VAS score for pain between the surgical and non-surgical (mean=13.0) groups for study. At 1 year (p =0.54). Conclusion: The outcome of study has failed to identify the difference in functional outcome between surgical and non-surgical as the non-operative functions lead to more complications including the moderate rate of non-union. Moreover, the non-surgical patients were not satisfied with the treatment and recovery.

33. A Comprehensive Study on Leg Ulcers in Southern Odisha
Debabrata Patra, Laxmi Dhar Padhy, R. R. Mund
Background: An ulcer is an injury that could influence the health of the people. It can be understood as wound with a full thickness and depth. This is having slow tendency of healing that affect the physical activities of an individual. The slow healing of ulcers is a major issue with the people as it cannot be analyzed and understood through depth and size. However, it can be understood by identifying the pathologic fact that needed to be removing to improve the healing. In this situation the leg itself create the problem and increase the risk and lead to surgery.  This kind of problem is common among the elder people due to changes in the etiology and underlying the various diseases Aim: To study the clinical features of various types of leg ulcers and effectively manage the condition. Methods: The design of study was Prospective study and conducted at Post Graduate Department of General Surgery, M.K.C.G Medical College & Hospital, Berhampur. For the current study 197 patients who presented with various leg ulcers admitted to the General Surgery Department of MKCG Medical College and Hospital, Berhampur, Odisha from July 2018 to June 2020 including a three month of follow up period. Results: The venous ulcers occurred more commonly in the gaiter zone (75%), least in the foot (4%). Diabetic ulcer was not found in the gaiter zone whereas arterial ulcer was exclusively found in the foot. Moreover, the association of various systemic diseases with different leg ulcers. Anaemia is associated in 8% cases, peripheral arterial disease in 4%, TAO in 4%, Varicose Veins in 12%, DVT in 2%, Malignancy in 5%, Leprosy in 3% and Diabetics in 51%. It can be seen that Diabetes Mellitus is the most common followed by vascular ulcers associated disease for leg ulcers.

34. A Comparative Study of 2% Lidocaine Plus 0.5% Ropivacaine Versus 2% Lidocaine Plus 0.5% Bupivacaine for Peribulbar Anaesthesia in Cataract Surgeries
Susajit Kumar Pradhan, Susanta Kumar Pujahari, Bhupendra Buda, Supriya Pradhan, Smruti Ranjan Muduli
Background: Generally, to perform the Peribulbar anaesthesia, different mixtures of local anaesthetics are used, the most common of which are lidocaine and bupivacaine. It was observed that overdose of bupivacaine proves to be serious because of its cardiotoxic effects. Even more it responded poorly to the traditional resuscitation methods. This study evaluated the efficacy of bupivacaine and ropivacaine. To assess the efficacy hyaluronidase and lidocaine were used to combine the two. Here, for the patients of cataract surgery, two-point injection technique was used for peribulbar anaesthesia. Aim: To assess bupivacaine’s and ropivacaine’s efficacy each of which were combined with hyaluronidase and lidocaine. Material and Methods: It was a randomized double-blind study performed at the Department of Anaesthesia and Critical Care at the Srirama Chandra Bhanja Medical College & Hospital in Cuttack during the period of October 2014-16 on sixty patients admitted for cataract surgery in the peribulbar division. Group A of 30 patients received 3ml of 0.5% ropivacaine plus 4ml of 2% lidocaine plus 22.5 International Unit (IU) of Hyaluronidase, and Group B of 30 patients received 3ml of 0.5% bupivacaine plus 4ml of 2% lidocaine plus 22.5 International Unit (IU) of Hyaluronidase. Results: The study found significant difference in Onset of akinesia (mins) between two groups (p<0.001). Further, in Group A, there was no highly significant change in intraocular pressure after peribulbar anaesthesia, whereas highly significant increase in intra ocular pressure was observed when compared to preoperative value in Group B. The intraocular pressure and duration of akinesia was significant in the Group B than in Group A. The study further recorded a significant difference in the onset of analgesia between Group A and Group B (p<0.00). Conclusion: On basis of the study, it was concluded that bupivacaine + lignocaine is an inferior alternative to ropivacaine + lignocaine for treating patients with peribulbar anaesthesia to be used in cataract surgeries. This was because of the reason that it has better efficacy without any type of cardiovascular toxicity.

35. External Versus Endonasal Dacryocystorhinostomy: A hospital Based Comparative Study
Shweta Sharma, Sheeba Rana, Vicky Bakshi, Prateek Koul
Objectives: This study was to compare the surgical outcome, quality of life and patients satisfaction of external versus endonasal dacryocystorhinostomy surgical procedure of patients with nasolacrimal duct obstruction in a tertiary care centre. Methods: The external DCR surgery was performed by the standard technique. The mechanical endoscopic endonasal approach included enlargement of the bony ostium using a diamond burr, full length opening of the lacrimal sac and approximation of nasal and lacrimal sac mucosal edges. No sutures were used. Silicone intubation with internal silicone bolster was performed in all external and endonasal DCR cases. All surgical procedures were performed under general anesthesia. Data was recorded in prescribed performa. Results: Average surgical time of external DCR and endonasal DCR were 57 minutes and 49 minutes respectively. Average score of symptomatic relief of external DCR and endonasal DCR were 3.49 and 3.46 respectively. Fluorescein in nose (functional success) was seen in 91% external DCR and 91.6% cases of endonasal DCR. Intraoperative hemorrhage was seen in 19% cases of external DCR and 91.6% cases of endonasal DCR. Post operative hamorrhage was seen in 7.8% cases of external DCR and 7.2% patients of endonasal DCR. Infection was seen in 4.7% patients of external DCR. Average duration of follow up of external DCR  patients was 9.1 months and endonasal DCR was 9.4 months.  Average 3.3 months Silicon intubation was performed for external DCR patients and 3.4 moths for endonasal DCR patients. Patient satisfaction was greater in endonasal DCR (average score: 9.2 out of 10) as compared to external DCR (average score: 8.7). Conclusions: Both surgical procedures (external DCR and endonasal DCR) have a high degree of success. But the endonasal DCR surgical procedure is the most common choice of the patients due to its minimally invasive nature, high patient satisfaction and high success rates.

36. Factor Associated with Atopic Dermatitis and Allergic Rhinitis in Patients Attending in Tertiary Care Center Pauri, Uttarakhand, India: A Hospital Based Retrospective Study
Ratan Singh, Pooja Sharma, Sumit Kumar, Arjun Singh Doshad
Objectives: This present study was to evaluate the various factors associated with atopic dermatitis and allergic rhinitis in patients attending in tertiary care center Pauri, Uttarakhand, India. Methods: Random sampling methods was used for data collection. We adapted a questionnaire from the Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC) Standard Questionnaire for children, and we were developed a self-developed questionnaire for adults. We were interviewed   the patients about the general items such as age, gender, and type of residence, and details of allergic diseases such as allergic rhinitis, atopic dermatitis, and details of other factors likely to be associated with allergic diseases. Results: A total of 200 cases were enrolled in this study. Among them, 75(37.5%) patients were of atopic dermatitis and 125(62.5%) cases were of allergic rhinitis. 108(54%) most of the patients were males. 128(64%) patients were belonged in <18 years of age. And 72(36%) were belonged in ≥18 years of age. 108(54%) cases were lived in normal house and 92(46%) were lived in apartment. 115(57.5%) patients had family history of allergy. Conclusions: This present study concluded that allergic rhinitis was more condition as compared to atopic dermatitis in Garhwal region of Uttarakhand, India. Atopic dermatitis was commonly seen in female gender as compared to allergic rhinitis. Most common associated factor of atopic dermatitis was age <18 years, normal housing, family history of allergy and low socio-economic status. While, most common associated factor of allergic rhinitis was age ≥18 years, apartment, family history of allergy and high socio-economic status.

37. Sexual Dysfunction in Male Patients with Alcohol Dependence Syndrome – A Clinical Study
Sumit Kumar Singh, Bhakta Bandhu Das, Sarada Prasanna Swami, Susajit Kumar Pradhan, Bhupendra Buda
Introduction: Sexual dysfunctions are defined as disorders which are heterogenous in nature and are mostly characterised in the form of clinical disturbance in the ability of an individual to respond to sexual experiences and pleasures (DSM5). Alcohol dependence syndrome is characterized by strong desire to take alcohol, impaired control over drinking behaviour, tolerance’s evidence, harmful use of alcohol, physiological withdrawal state, preoccupation with substance use. This association between sexual dysfunction and consumption of alcohol is complicated in nature. In this regard, it can be said that almost all aspects of sexual response by a human being are significantly influenced due to alcohol consumption. Methods: Our study included 60 participants (30 Cases and 30 Controls).  Cases were patients from De-addiction ward, and controls from relatives of patients. All 60 participants were subjected to Socio-demographic profile matching and assessed for the prevalence and pattern of sexual dysfunction among patients with alcohol dependence syndrome, in comparison with non-alcoholics by administering different questionnaires and inventories. Result: There is no statistical difference among the case and control group was found with domain of IIEF. But, on the other hand, researcher found a statistically significant difference in the domains of Intercourse satisfaction (IS), Sexual Desire (SD), Orgasmic Function (OF), and Overall Satisfaction (OS) among the case and control groups. From the analysis, it can be said that intercourse satisfaction, sexual desire, overall satisfaction, and orgasmic function are significantly lower among the patients with alcohol dependence syndrome, as compared with the people who do not drink alcohol. Conclusion: As sexual functioning is significantly affected by alcohol, proper screening for sexual functioning of all patients with alcohol dependence syndrome can result in better prognosis and quality of life of those patients.

38. Microbiological Profile and Antibiotic Susceptibility Pattern of CSOM Cases in Garhwal (Uttarakhand) Community Presents at Tertiary Care Center, Pauri
Arjun Singh Doshad, Sumit Kumar, Ratan Singh, Pooja Sharma, Ravindra Bisht
Objectives: This present study was to evaluate the microbiological profile and antibiotic susceptibility pattern of CSOM patients at tertiary care center Pauri, Uttarakhand, India.  Methods: Two swabs were taken in each patient. One swab was used for making smears on clean glass slides for the microscopy using grams’ staining. The other swab was used for culture for the isolation of aerobic bacteria and was inoculated onto Blood agar, Chocolate agar and MacConkey’s agar. Blood agar and Chocolate agar were incubated at 370C with 3-5% CO2 (in candle extinction jar) and MacConkey’s agar was incubated at 370C.The agar plates were examined after 24 and 48 h. The plates showing no growth at 48 h were discarded and labelled as negative. The plates showing bacterial growth were identified by standard techniques based on morphological, cultural and biochemical characteristics. Antibiotic sensibility testing was performed by using Kirby–Bauer disc diffusion method. Interpretation of the sensitivity pattern was done according to CLSI (Clinical Laboratory Standards Institute) guidelines. Results: Out of 100 CSOM patients, 59(59%) patients were female. Unilateral infection (68.24%) was more common than bilateral (27.34%). 89(89%) cultures were positive for the growth of organism and 11(11%) were sterile cultures.  Most common organisms isolated were Staphylococcus aureus 43(41.75%) and Pseudomonas aeruginosa 31(30.09%. Conclusions: CSOM was more preponderance in female gender. Staphylococcus aureus was the most common organism isolated followed by Pseudomonas aeruginosa. Ofloxacin was the highest antibiotic susceptibility rate. Hence, antibiotic susceptibility pattern of the CSOM causing organisms keeps changing according to time and geographical region. So that, routine antibiotic susceptibility testing should be done at certain interval to guide empirical treatment.

39. Comparison of 1% Chloroprocaine Alone to 1% Chloroprocaine with Clonidine During Daycare Surgeries under Spinal Anesthesia
Babita Agrawal, Parvez Akhtar, Anjan Kumar Panda
Background: Bupivacaine was associated with delayed movements and urinary retention owing to the prolonged residual blockade, whereas, lignocaine shows transient neurological symptoms limiting their use during daycare surgeries under spinal anesthesia. 1% Chloroprocaine being free of preservatives can be used as an alternative to lignocaine in daycare surgeries. Aim: The present study was conducted to compare the efficacy of 1% Chloroprocaine alone to 1% Chloroprocaine with Clonidine during daycare surgeries under Spinal anesthesia. Methods: The present study included 58 subjects divided into two groups of 29 subjects each where Group I subject underwent day care surgery under spinal anesthesia using 1% Chloroprocaine and Group II subjects using Chloroprocaine with Clonidine. The parameters assessed were first mobilization, analgesia duration, peak level dermatome, motor, and sensory block duration, and onset time.  Results: First mobilization time was significantly higher in Group 1 (210+-17.77) where chloroprocaine was used as compared to Group2 (120.5±14.72) where the combination of clonidine with chloroprocaine was used (p<0.0001). Higher analgesia duration was seen in Group II (193.65±12.03) compared to Group I (100.3±15.21). This was statistically significant with p<0.0001. The duration of the motor block was higher in Group II with 76.39±9.46 minutes compared to Group I, where the duration was 69.95±7.64 minutes. Onset time for the motor block was significantly lesser for group II where chloroprocaine was used with clonidine was 9.75±1.74 mins compared to Group I where only chloroprocaine was used as 11.33±2.92 mins. This was statistically significant with p=0.01. Also, sensory block onset time was significantly lesser for Group II (7.76±2.06) mins compared to Group I where it was 9.5±2.84 mins with p=0.01. Conclusion: The present study concludes that using clonidine with Chloroprocaine in low dose provides prolonged analgesia, better anesthesia quality, and increases the duration of motor and sensory block compared to Chloroprocaine alone.

40. Pattern of Congenital Malformations and Associated Risk Factors During Pregnancy at A Tertiary Care Centre
Krishna Patel, Shabdika Kulshreshtha, Anupama Hada, Triguna Rupalal
Background: Congenital malformations include structural or functional anomalies that occur during intrauterine development and represent a major cause of perinatal morbidity and mortality. Aim: To identify and study the maternal risk factors, the various patterns of congenital anomalies in the fetus of ≥ 16 weeks of gestation by USG and in neonates. Methods: A prospective follow-up study was conducted at Geetanjali Medical College and Hospital, Udaipur from Jan 2020 to June 2021. 53 pregnant patients after 16 weeks of gestation with anomalous foetus and malformed neonate detected at the time of birth were included in the study. They all underwent a fetal anomaly scan at 18-20 weeks of gestation. Results: 43.3% patients were above 30 years of age. Maternal exposure to radiation, smoking, drugs and alcohol was seen in 32.3 % patients giving birth to CM neonate. CNS was the most common system involved in 34% CMs. More than half of the patients (56.6%) delivered at less than 28 weeks of gestation. Majority of the neonates (67.6%) expired due to fatal congenital malformations of CNS/ CVS. All the live neonates were admitted in NICU. Conclusion: This study explores the possible causes and effects of congenital malformations. The result of this study supports that history of consanguinity is the most important risk factor seen in more than half of the patients. The booked antenatal cases have lesser chances of carrying a CM fetus till the term.

41. To Assess the Sedative Effects with Midazolam on Arterial Oxygen Saturation during Spinal Anaesthesia in Infraumbilical Surgery
Madhusmita Sahu, Debasis Sahoo, Swapna Kabiraj
Background: For managing and completing the surgical process, there are different types of drugs and approaches are used. The use of anaesthesia is one of the major things that considered for managing the surgical process without pain. The spinal anaesthesia is commonalty used by the care professionals for maintaining the surgical process carefully and better recovery of the patients. Nowadays local anaesthetics along with spinal anaesthesia are broadly applied especially for ambulatory surgery. Sedation has been used for improving the acceptance of the patient for regional anesthesia and help to improve the wellbeing of the patient during the surgery. There are different types of anesthesia’s are used but midazolam is one of the common anesthesia that used by the medical experts since 1978. Aim: To assess the sedative effects with midazolam on arterial oxygen saturation during spinal anaesthesia in infraumbilical surgery. Method: The study is being conducted using the randomized controlled clinical study between July 2016 and August 2017 at KM Medical College and Hospital focusing on the patients at operation theater and post operative room. To complete the study, 100 ASA grade 1 and 2 patients both male and female between the age of 20 to 50 years involved. These patients had lower abdominal surgery that completed in ninety minutes. Results: The outcome of the study shows that there were five types of operations performed. Commonest operation was inguinal herniorraphy (29%), next being vaginal hysterectomy (27%). Least number of patients came from orthopedics department (10%). Two means of midazolam of group A & B (2.71-2.75=0.04) is not greater than the SE of 2 means i.e.2X 0.093. There is no statistically significant difference between the initial doses of Midazolam between two groups. But the total doses of Midazolam are statistically different, i.e. the second group needed more Midazolam than the first group. The actual difference between two means of doses of Bupivacaine (2.94-2.96=0.0.02) is not greater than twice the value of SE between the means is not statistically significant difference in doses of Bupivacaine between two groups. Conclusion: Respiratory rate remained unchanged, the fall of SpO2 in group B patients could be attributed to the diminution of tidal volume and so hypoventilation was found to be the major cause of fall of SpO2 in this group of patients. The lower limit for alarm should be set at 85% because severe hypoxaemia defined as a saturation of oxygen at 85% or less.

42. Study and Correlation of Anthropometric Indices & Lipid Profile in 300 Patients of Type 2 Diabetes Mellitus with Obesity at Tertiary Care Hospital
Tejas Shah, Nanda Jagrit, Usha Patel, Pratik Modi, Trupti Patel
Background: Diabetes is globally a fast-growing public health concern with its effect on individuals, healthcare system and economy of nations. Central or abdominal obesity is associated with metabolic disorders. Aims and Objective:  To correlation of BMI, WHR & lipid profile in obese type 2 Diabetic patients. Methods: Cross-sectional observational study, comprised 300 confirmed cases of type 2 diabetes obese were assessed clinically from November 2017 to October 2019 for BMI and WHR and investigated for Total Cholesterol, Triglyceride and LDL. Results: Out of 300 patients of Type 2 diabetic and obese, 174 were male and 126 were female. Most commonly affected age group in male patients were 5th decade of life (35%) and in female patients’ 4th decade of life (33%). 179 out of 205 class1 obese patient in which 96(32%) were male and83(27.7%) female patients,65 out of 75class 2 obese patient in which 45(15%) were male and 20(6.67%) were female patients and 18 out of 20 class 3 obese patient in which 12(4%) were male and 6(2%) were females; have abnormal WHR. There is statistically positive correlation between abnormal levels of Total cholesterol, TG, LDL and WHR in all class obesity patients. Conclusion: Dyslipidemia is quite prevalent in type 2 diabetic obese patients. This study showed that the atherogenic markers such as increased LDL-c and Triglycerides correlated more strongly and significantly with WHR than with BMI. So WHR can be good anthropometric indices than BMI to predict cardio metabolic risk in type 2 Diabetic obese patients.

43. A Study on Diagnostic Modalities of Acute Exacerbation of Bronchial Asthma, Chronic Obstructive Pulmonary Disease at Government General and Chest Hospital, Hyderabad
Venu Gopala Chary. K, Suresh Kumar Reddy. Yenna, G. Sowjanya
Background: Chronic Obstructive Pulmonary Disease (COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients. Aim and Objectives: 1. To observe the prevalence of infection with Mycoplasma pnemoniae, Chlamydia pneumoniae, Legionella pneumophilia in diagnosed patients of Acute Exacerbation of Bronchial Asthma, Chronic Obstructive Pulmonary Disease. 2. To subject sputum samples to sanger sequencing. Material and Methods: It was an observational study conducted at Government General & Chest Hospital, Erragadda, Hyderabad Between March 2015 to March 2016. Total 60 Patients with Acute exacerbation of Chronic Obstructive Pulmonary Disease, Acute exacerbation of Bronchial asthma with age 16 to 65 years and Patients presenting with symptoms and signs of fever, cough, dyspnoea and extrapulmonary symptoms were included in the study. No exacerbation in the month prior to enrolment (Bronchial Asthma & COPD). Bronchiectasis, Interstitial lung disease and Pulmonary Tuberculosis were excluded from the study. Results: Most (30%) Bronchial asthma cases were seen in younger age groups i.e, 16-26 years whereas later ages saw almost equal distribution was observed. On the contrary old ages i.e, 47 years and above acute exacerbation observed. Majority 63.33% cases of males had Acute exacerbation of Bronchial Asthma. Only males had Acute Exacerbation of COPD. Majority (83.3%) had mucoid sputum, 16.7% had Mucopurulent Sputum. Conclusion: Sanger sequencing can be used as a useful tool to substantiate the evidence of infection by atypical organisms when used along with IgM ELISA. Hence, it is useful in identification of bacteria at species and strain level and could be used when affordable.

44. A Comparative study of Glibenclamide with Insulin in Gestational Diabetes Mellitus
Gade Rama, B. Sweethi, R Padma Latha, Jyothi Tippoji
Background: Gestational Diabetes Mellitus (GDM) is a very common disease that is detected among the pregnant women. The incidence is on the rise and the effective control of blood glucose levels helps to reduce the associated maternal and neonatal morbidities to a great extent. Insulin has been the gold standard in the management of GDM because of its efficacy and also its safety as it does not cross the placenta but has many demerits as far as patient acceptance and compliance are concerned. Thus, we have undertaken a study to compare the efficacy of glibenclamide and insulin to attain adequate glycaemic control. Material and Methods: This is an Observational comparative study conducted in the department of Obstetrics and Gynaecology, Chalmeda Anand Rao Institute of Medical Sciences, Kariminagar, during the period from February 2021 to August 2021. About 150 patients attending the antenatal clinic were included in screening for Gestational diabetes mellitus, belonged to gestational age between 11 to 33 weeks. Results: Demographic profiles of the patients were comparable between both the groups. There was no significant difference observed in mean distribution of plasma sugar between the groups at fasting and 2 hours after mean during screening, treatment and before discharge. We have not observed any significant difference in HbA1C between the groups before treatment and after treatment. Conclusion: Though we have not with significant difference between glibenclamide and insulin, but Glibenclamide may be a safe and efficient alternative therapy to Insulin in the treatment of gestational diabetes mellitus.

45. Effect of H1 Blocker and Ganglion Blocker on Histamine Induced Response in Proximal and Distal Segment of Neonatal Rectum of ARM
Shilpa Tiwari, Amrish Tiwari, M. B. Mandal, A. N. Gangopadhyay
Objectives: The present study was undertaken to assess the effect of H1 blocker and ganglion blocker on Histamine induced response of proximal & distal segments of high type of anorectal malformations (ARM) from neonates, for better understanding of functional status of rectum in ARM patient. Methods: Present study was conducted on surgically excised segments of fresh specimens of fifteen cases of anorectal malformations, that have been collected from Department of Paediatrics Surgery, IMS, BHU. After that muscle strips were prepared for assessing in vitro contractile activity of the tissue.  We assessed in vitro contractile activity with Chemical used were histamine and their antagonists as well as hexamethonium (ganglion blocker) in an organ bath filled with physiological solution. Force transducer and computerised data acquisition system were used to assess the activity. Result: Histamine (0.1-100 µM) evoked contractions were significantly (p < 0.05) greater in proximal segment as compared to distal segment. Responses of histamine were significantly (p < 0.05) blocked by pre-application of H1 blocker pheniramine (90%) and hexamethonium (50%). Conclusion: There is significant loss of spontaneous activity in anorectal malformation high type cases. Also, distal segment was affected more as compared to proximal segment as evidenced by Histamine application response. This study will help paediatric surgeons in managing ARM cases for better outcome.

46. A Study of Contractile Status of Proximal and Distal Segment of Neonatal Rectum in Anorectal Malformations
Shilpa Tiwari, Amrish Tiwari, M. B. Mandal, A. N. Gangopadhyay
Objectives: The present study was undertaken to assess the contractile status of proximal & distal segments of high type of anorectal malformations (ARM) from neonates, for better understanding of colorectal motility problems in these patients. Methods: Circular muscle strips were prepared from freshly excised specimens of high ARM (n= 17) obtained directly from paediatric surgery operation theatre. The in vitro contractile activity of the tissue was assessed initially without any chemical interventions and thereafter with application of acetylcholine,) in an organ bath filled with physiological solution. The isometric contractile activity was recorded with the help of force transducer and computerised data acquisition system. Result: Spontaneous contractions were recorded only in the proximal segment of 18 % of ARM cases. Acetylcholine (0.1-100 µM) evoked contractions were significantly (p < 0.05) greater in proximal segment as compared to distal segment. Conclusion: Largely absence of spontaneous activity in ARM cases indicated that the tissue is functionally abnormal. Further, as compared to the proximal segment, the distal segment of ARM was badly affected as evidenced by severely impaired contractility in this segment. Thus, the result of this study may help formulation of better surgical management strategies.

47. Establishment of Biological Reference Interval for Liver Function Test in Tertiary Care Hospital in the Rural Area of Anand District
Patel Dharmik S, Chhatriwala Mitul N, Sodavadiya Kirankumar B, Patel Jainita
Background: The concept of reference intervals was introduced by the international federation of clinical chemistry IFCC to avoid the problems with normal values and values obtained from an individual under clinical investigation. In India, the reference value of LFT used in laboratories has been adopted from those reported for the western population. The reference range varies considerably from one laboratory to another and is dependent on the population diet, methodology, and selection of reference group needs of the clinicians. Aims and Objectives: To establish reference intervals of LFT which include alkaline phosphatase, bilirubin (total, direct, indirect), total protein, albumin, globulin, A/G ratio, SGPT, SGOT in healthy individuals attending routine health checkups at rural tertiary care hospital of Gujarat. Materials and Method: The posterior sampling was done over the period September 2018 to July 2019. The study was done at the clinical biochemistry department of tertiary care hospital in a rural area. In our study, we took 901 individuals who came to the hospital for their routine health check-ups after applying Inclusion & Exclusion criteria. The partitioning was done according to age (18-30, 31-40, 41-50, 51-60, 61-70, 70 and above years) and sex. Analysis was performed using the commercially available statistical software Stata for each analyte. Results: We compared the reference range derived with the biological reference interval being used currently in the laboratory. Values compared for ALP (u/l), Bilirubin Total (mg/dl), Bilirubin Direct (mg/dl), Bilirubin Indirect (mg/dl), Total protein (g/dl), Albumin (g/dl), A/G Ratio (g/dl), SGPT (u/l), SGOT (u/l). Values derived in our study for Males: – 54.07-87.70, 0.34-0.88, 0.08-0.22, 0.22-0.70, 6.91-7.81, 3.54-4.12, 0.91-1.27, 23.90-45.32, 17.41-30.39 and for Females: – 54.64-93.45, 0.28-0.70, 0.05-0.21, 0.17-0.53, 6.97-7.85, 3.45-4.01, 0.87-1.17, 20.44- 40.94, 16.15- 30.25 respectively. Conclusion: It was seen that the reference range of most liver function test parameters varies when compared with other reference ranges and reference ranges being used in the laboratory. The reason for the same was that the liver function test may vary according to age groups, epidemiological areas, and ethnicity.

48. To Evaluate the Oral Health Hygiene Among High School Children’s in Rajasthan, India
Sandeep Sidhu, Navneet Singh Kathuria, Jaskirat Sidhu, Gagandeep Kaur Sidhu, Vandana Katoch, Bela Mahajan
Aim: To evaluate the oral health hygiene among high school children’s in   Rajasthan, India. Methods: A cross-sectional research was conducted. Data was collected in various private high schools using the population probability sampling approach until the appropriate sample size was reached. The research included adolescent students in the eighth through tenth grades. Students who wore orthodontic brackets were barred from participating. They were inspected for oral health, the presence of cavities, lost, filled, or missing teeth, and so on. A semi-structured, indigenous, interviewer-based questionnaire was used to gather data on brushing frequency, toothbrush replacement, usage of tongue cleaner, mouth wash, and so on. Confidentiality was upheld. Results: The respondents’ average age was 13.9+0.77 years. The majority of the girls claimed they clean their teeth once a day (75%), 37% were unclear of the sort of toothbrush they used, and 35% of the youngsters indicated they use a medium toothbrush. Only a few students (15%) used fluoride toothpaste, whereas 72 percent were uninformed of the presence or lack of fluoride in their paste. Approximately 70% of the females brush their teeth horizontally, which is considered a harmful form of brushing. Only 23% of those polled clean their tongues, and only 21% use mouthwash. After eating a meal, the majority of students (45%) rinse their mouth. According to 35% and 23% of the students, they perceive bleeding from the gums and a bad odour from the mouth, respectively. In this study, we discovered that nearly half of the participants (45%) had dental caries, with a mean DMFT score of 2.61. When questioned about toothache in the previous six months, 35% of students indicated they had it occasionally, while 31% said they had it frequently. About half of the respondents (55%) stated they only see the dentist when they have a problem, and toothache (45%) was the most prevalent reason for their most recent dental visit. Conclusion: The research population’s oral health hygiene practices were inadequate and need to be addressed. Pupils’ awareness of the need of keeping excellent oral health can be increased by incorporating school instructors, who are viewed as role models by the students.

49. Determination of the Mechanism of Causation of Various Types of Injuries Due to Road Traffic Accidents: A Descriptive and Single Center Study
Dipu Mohan, Bindu Samuel, Smitha S
Background: Road traffic injury (RTI) has assumed major public health importance world-wide, and the burden is heavier on the health-care infrastructure of developing countries like India. In India, RTI is the leading cause of trauma related morbidity and mortality. While there are some published epidemiological reports on RTI in the region, studies on the mechanism of causation of road traffic crashes (RTC) are not available. The current study aimed to determine the mechanism of causation of various types of injuries and to submit suggestions to the planners to reduce the incidence of road traffic accidents and to reduce the morbidity and mortality due to it and thereby reducing the economic loss to nation. Materials and Methods: This descriptive and single center study carried out in the Department of Forensic Medicine, Government Medical College Hospital, Thiruvananthapuram, Kerala from 1st March 2012 to 31st March 2013 was aimed to determine the mechanism of causation of various types of injuries and to submit suggestions to the planners to reduce the incidence of road traffic accidents and to reduce the morbidity and mortality due to it and thereby reducing the economic loss to nation. Study variables under assessment included Occupation of the study participant involved in the crash, hearing impairment, drug intake, alcohol intake, nature of road, road lighting, incidence of rain and road repair work going on. Data collected from this study using the appended proforma were entered in Microsoft Excel and its analysis was carried out in SPSS software version 16.0. Result: Maximum set (26.86%) of crash victims belonged to business, followed by students (22%). The least number of crash victims belonged to driver profession. Only 1, 54 and 16 crash victims suffered from hearing impairment, or had drug and alcohol intake, respectively. The curve nature of road inflicted the maximum crash (83.71%) among the victims, followed by a road junction (12.86%). No availability of road lightning caused crash in 33.43% of crash victims. Rain was also a causative factor for only 9 cases and road repair work caused crash in only 5 cases. Conclusion: this paper has elucidated the mechanisms involved in causation of RTIs and submitted the suggestions to the planners to reduce the incidence of road traffic accidents.

50. Histopathological Study of Lesions of Nose and Paranasal Sinuses
Dharmendra Kumar, Sarita Kumari, Deepak Kumar
Introduction: A variety of non-neoplastic and neoplastic lesions of nasal cavity, paranasal sinuses and nasopharynx are commonly encountered in clinical practice. The aim of this study was to study clinical and histopathological profile of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx in a J.L.N.M.C.H Bhagalpur over the period of August 2021 to March 2022. Material and Methods: This was a prospective study of 60 cases of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx over the period of 6 months. All tissues after fixation in 10% buffered formalin, processed and then stained with Hematoxylin & Eosin to study various histopathological patterns. Results:  Among 60 cases, 49 were non-neoplastic and 11 were neoplastic. The commonest site was NC, followed by PNS. They occur commonly in second and third decades with predominance in males. Amongst the non-inflammatory lesion, nasal polyp is the commonest lesion followed by rhinoscleroma and rhinosporidiosis. The common age group is second and third decades, with male predominance. Amongst benign neoplastic lesions capillary haemangioma was common followed by inverted papilloma.

51. The Physiological Significance of Thyroid Stimulating Hormone and Thyroid Hormones with Hemoglobin A1C level
Ezmat Jalil, Pawan Vishwakarma, Rajmangal Choudhary
Introduction: Hypothyroidism causes many metabolic abnormalities as well as multiple clinical symptoms. Some studies suggest that blood sugar may be affected in hypothyroidism and levels may increase. Indeed, it has been noted that patients with diabetes who also have hypothyroidism may have higher levels of Hemoglobin A1C (HbA1C). The HBA1c test reveals the average level of blood sugar over past 2-3 months. It is also called as glycatedhemoglobin test and glycohemoglobin. Aims and Objectives: To find out the correlation of the serum level of Hemoglobin A1C (HbA1c) with that of thyroid hormones and TSH. Materials and Methods: The study design is cross sectional which has included 215 healthy participants. The blood sample was taken from each participant. 5 ml of blood was drawn HbA1c was determined by modified ELISA. Auto analyzer was employed for analysing Fasting Blood Sugar or FBS. Serum level of TSH, T4 and T3 were determined by using centrifugation at 5500 rpm for 5 minutes. Results: The study found that there is a significant negative correlation between glycosylated hemoglobin with T3 (P=0.004) and glycosylated hemoglobin with T4 (<0.001). But the level of TSH has statistically positive variation with HbA1c. Conclusion: The study concluded that T3 and T4 has negative correlation with the serum level of HbA1c while TSH has positive correlation with HbA1c. Hence the patients of hypothyroidism may show increased level of glycosylated hemoglobin.

52. Seroprevalance of Hepatitis C in Govt. Medical College Thiruvananthapuram-Cross Sectional Study
Fazeela P, Preetha Rajan, Ramani Bai JT
Introduction: There are around 70 million people living with hepatitis C Virus (HCV) infection around the world and are at risk of developing liver cirrhosis, progressing to end stage liver disease and liver cancer (hepatocellular carcinoma). Overall HCV prevalence in India is estimated to be 1%, which is also around the global average. However, as India’s population is 1.3 billion, the country contains approximately 10 million people living with HCV. Aim of the Study: To estimate the seroprevalence of Hepatitis C in Govt. Medical College Thiruvananthapuram. Objectives:1. To estimate the age and sex distribution among the Hepatitis C seropositives. 2.To estimate the seropositive among chronic liver disease patients. Conclusion: A total of 7318 including both OP and IP in Govt. Medical College Thiruvananthapuram were tested forAnti HCV. The mean age for the study is 43.2+- 19.8 years. The study population have 58% males and 42% females with maximum number of patients coming under the age group 41 to 50. Out of 7318 samples tested 69 were Anti HCV reactive thus showing seroprevalence to be 0.9% (95% CI: 0.706 to 1.094).

53. A Prospective Study of Functional and Radiolaogical Outcome of High Tibial Osteotomy in Active Indian Population
Jayanta Mukherjee, Mujtaba Ahmad, Rabiul Haque, SK Sariful Rahaman, Bhuban Kumar Pramanik, Vibhash Chandra
Aim: High tibial osteotomy is an accepted surgical technique for treatment of primary or secondary medial compartment degenerative arthritis of knee in younger and active patients. Hence this study was done to assess the functional & radiological outcome in patients undergoing High Tibial Osteotomy using knee society score (pain score, Functional score and total knee score) & femorotibial angle respectively. Methods: This is a prospective, single centre interventional study done on 26 patients who were clinically and radiologically diagnosed as medial compartment knee osteoarthritis with varus deformity. After proper preoperative assessment, patient underwent high tibial osteotomy. The clinical outcome was evaluated with knee society knee scoring system. The patients were followed up at regular intervals during 6th week 3rd, 6th and at 12th month. Results: The preoperative mean pain score and the mean total knee society score of the patients before surgery were 17.31 and 94.88 respectively. The postoperative mean knee score and functional score at 12 months was 40.75 and 177 respectively. So the preoperative and postoperative comparison score showed statistically significant improvement in both the pain score and total knee score. Mean preoperative FT angle (varus) was 6.23 1.5 and post operative FT angle (valgus) was 6.1 1.7 at 1 Yr. Conclusion: In this study, there was significant increase in the knee society knee score, pain score and FT angle after high tibial osteotomy for the patients of medial compartment knee osteoarthritis with Varus deformity. Therefore, High tibial osteotomy should be recommended for the treatment of degenerative arthritis of the knee in young, active patient and even in elderly physiologically young patients in India for symptomatic improvement and maintenance of activity level.

54. An Observational Assessment of the Primary Reasons and Pattern of Obstetric Cases Referred to A Tertiary Care Center and Management of Its Complications
Anupama Kumari, Jayshree Shandilya, Meena Mehta
Aim: This study is aimed at reviewing the primary reasons and pattern of obstetric cases referred to a tertiary care center and management of its complications. Material & Methods: The study was a prospective observational study conducted in the Department of Obstetrics and Gynecology, RIMS, Ranchi, Jharkhand, India. Study population of 100 obstetric cases over a period of one year was analyzed. Results: The mean age of patients admitted was 25.22±2.47 years. 63% of the patients belonged to the agegroup between 20-25years. The Obstetric causes accounted for 81% of the admissions in ICU and non-obstetric causes was 19%. Amongst the medical causes rheumatic heart disease, cardiomyopathy and anemia leading to heart failure accounted for 12% of total admissions. Conclusion: The multi-disciplinary team approach in intensive care units, close monitoring, symptomatic treatment, prompt surgical intervention and safe motherhood initiative would reduce the current Maternal Mortality Rate. Development of standard referral protocol, availability of tertiary care, proper training in this regard is much needed.

55. Descriptive Observational Assessment of the Clinico-Pathological Profile of Pediatric Patients with Thalassemia Major
Pawan Kumar, Rajeeva Mishra
Aim: To study the clinical profile and laboratory parameters of Thalassemia major patients between the age group 1-14 years. Material & Methods: It was a Descriptive- Observational study carried out in the Department of Pediatrics & Neonatology, RIMS, Ranchi, Jharkhand, over a period of one year. This study was conducted on 160 children with β-Thalassemia major patients aged between 1-14 year. Results: Serum Phosphorus values with majority (68) of children showed decreased level. Majority of participants belongs to 1-5 years (N=48) which shows statistical significance (0.0002). Conclusions: Thalassemia needs greater public awareness and prevention strategies in our country. Some communities are at high risk as compared to others. Education programs and compulsory antenatal screening appear to be the order of the day.

56. Prospective Observational Study of Emergency Peripartum Hysterectomy in Modern Obstetrics
Vandana Kumari, Nitish Kumar Ranjan
Aim: To study about emergency peripartum hysterectomy in modern obstetrics in a tertiary care hospital in Bihar. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna, Bihar, India for a duration of 5 months from October 2021 to February 2022. Age, parity, traumatic or atonic PPH, risk factors, complications were all studied in detail and analysed.  Results: 40 women underwent peripartum hysterectomy, accounting to an incidence of 0.10%. Incidence of subtotal hysterectomy after caesarean delivery was higher as compared to vaginal deliveries. The common indications were uterine atony (47.5%), uterine rupture of scarred and unscarred uterus (40%), placenta previa of major degree (22.5%). Post-operatively patients developed DIC (37.5%), 6 patients developed febrile illness (15%), 4 patients of ruptured uterus experienced injury to the bladder (10%). Maternal mortality in this study was 12.5%. Conclusions: Hysterectomy is a lifesaving procedure to control postpartum hemorrhage but is associated with significant maternal morbidity and mortality. Uterine atony, uterine ruptures, also due to prior caesarean delivery, placenta previa were identified as risk factors.

57. Hospital Based Cross-Sectional Assessment of the Association of Measles Antibody Titres with Nutritional Status in Pediatric Population
Pawan Kumar, Sunanda Jha
Aim: To find out any association of measles antibody titres with nutritional status in children 1 to 12 years. Material & Methods: This hospital based cross-sectional study was conducted over a period of two years on1-12-year-old children attending the Pediatrics & Neonatology, RIMS, Ranchi, Jharkhand with the objective of finding out the seroprevalence and anti-measles antibody levels, and studying their association with age, gender, as well as nutritional status of these children. Results: Majority (69.7%) of the total subjects had been vaccinated against measles. No statistically significant difference was observed in the baseline characteristics of vaccinated and unvaccinated group except for mean weight for age Z score which was significantly lower in the unvaccinated group (p = 0.022). A statistically significant relationship (p=0.027) was observed between height for age Z scores and seropositivity, with higher seropositivity being noted in children with higher height for age z scores. Conclusion: Nutritional status of children has an association with measles antibody titres as well GMT of measles specific IgG antibody, with those with better nutritional status having higher measles antibody titres.

58. A Prospective Study of Clinicopathological Correlation in Patients with Chronic Suppurative Otitis Media in Vindhya Region
Yasmeen Siddiqui, Pallavi Indurkar, Surendra Singh Maupachi, Arshi Ishteyaq
Background: Chronic suppurative otitis media (CSOM) is characterized by permanent perforation in the tympanic membrane and ear discharge, the most common reason for preventable hearing loss.  Histopathological changes in the middle ear and mastoid can assist the physicians in deciding the surgical procedure and outcome of the disease. Aims and objectives: To evaluate the relationship between clinical features and the histopathological findings of CSOM and determine the treatment protocol. Materials and Methods: Hundred patients diagnosed with CSOM were studied at the ENT Outpatient Department of SSMC, Rewa, Madhya Pradesh.  A histopathological examination was performed on the mucosa of the middle ear.  Patients undergoing surgery were followed up every week for six months.  Any post-operative aural discharge and graft condition was assessed, and PTA for hearing evaluation was done after a month. Results: In most cases, histopathological examination showed changes that correspond to chronic inflammation with lymphoplasmacytic infiltrations in the majority.  Few cases showed granulation tissue which is associated with mucopurulent discharge.  Ossicular necrosis is common in patients with granulation tissue. Conclusion: There is a need for comprehensive management of CSOM.  Various clinical and pathological features should be considered when deciding the management strategies.  The size of perforation is associated with the amount of hearing loss.  Understanding the clinical and pathological course of CSOM helps rationalize the treatment protocol and plan surgical procedures, which improves patient outcomes.

59. Immunization Coverage: Role of Sociodemographic Variables
Neeta Singh, Yusuf Ahmed, Vijay Kumar Gupta, Amit Patidar
Background Children are considered fully immunized if they receive one dose of BCG, three doses of DPT and polio vaccine each, and one measles vaccine. In India, only 44% of children aged 12–23 months are fully vaccinated and about 5% have not received any vaccination at all. Even if national immunization coverage levels are sufficiently high to block disease transmission, pockets of susceptibility may act as potential reservoirs of infection. Aims and objectives This study was done to assess the immunization coverage in and around tertiary care center and determine various sociodemographic variables affecting the same. Methods: Hospital based descriptive cross-sectional study. A total of 500 children aged between 1-5 years, admitted in Department of Pediatrics were asked to participate in this study. Information regarding vaccination, socio-demographic factors was collected from their parents and care takers. Accuracy and validity of information were confirmed by immunization card in possible situation and inspection for BCG scar. Result: 51.2% children were fully immunized,45.6% were partially immunized and 3.2%  children were unimmunized as per National immunization schedule. Percentage of completely immunized children was almost similar among males (53.1%) and females (48.3%) in the study population. Coverage of BCG was found to be the highest (95.1%) while that of measles was the lowest. P value <0.001, indicates significant relation between socio-economic status and immunization status. The main reason for noncompliance was given as child’s illness at the time of scheduled vaccination followed by lack of knowledge regarding importance of immunization. Low education status of mother, high birth order, and place of delivery were found to be positively associated with low vaccination coverage. Conclusion: Regular IEC activities (group talks, role plays, posters, pamphlets, and competitions) should be conducted in the community to ensure that immunization will become a “felt need” of the mothers in the community.

60. Study of the Effectiveness of Tutorials with Advanced Planning as a Method of Teaching Undergraduate Medical Students
Sachin M Pawar, Vinod S Shende, Satish N Waghmare, Sunita J Vagha
Background: Tutorials are small group teaching learning method with the central core of discussion. Most of current teaching techniques are didactic involving very less student participation and the knowledge is imposed on them. Tutorials with advanced planning may be the solution to this problem as being very interactive and active form of teaching learning tool. The present study was undertaken to study the effectiveness of tutorials with advanced planning as a method of teaching undergraduate medical students. Methods: Present observational study was conducted on 50 medical undergraduate students after taking their written informed consent. They undergone pre-test on same set questionnaire based on the topic already taught in didactic lecture and post test was conducted after taking tutorial with advanced planning and traditional tutorial teaching. Feedback was also taken based on set questionnaire on Likert scale. Results: Statistically significant difference was observed between the mean score of pre-test and post- test in the group where tutorial with advanced planning was conducted (p <0.01). Mean score in post -test was found to be significantly increased compared to pre-test. Post –test mean score in tutorial with advanced planning group was significantly greater than the post –test mean score in traditional tutorial teaching group (p < 0.01). Conclusion: Tutorial with advanced planning can be effective method of teaching learning process. Group interaction and better understanding of the topic especially a difficult topic was perceived to be high among the students with this method. Therefore, tutorial with advanced planning should be included as a part of regular teaching schedule for undergraduate medical students.

61. Long Term Functional and Clinical Outcome of Mini-Open Rotator Cuff Repair: A Study in Retrospect
Dhruv Sharma, Mohit Tolani, Krunal Patel, Jigar Parmar, Mohit Pabari, Hemant Soni
Introduction : Rotator cuff tear is one of the common aliment encountered in orthopedics leading shoulder pain and dysfunction. In recent times arthroscopic repair has taken precedence over mini open repair however many surgeons still prefer mini open technique over arthroscopy due to lack of infrastructure, skill or by choice. Mini open technique still seems to give satisfactory functional results. The purpose of this study was to evaluate the results of mini open rotator cuff repair. Material and methods:- This was a retrospective observational single center multi surgeon operated study done at Shree Krishna hospital Karamsad. On the basis of the clinical records obtained from MRD (medical records department) patients who were treated surgically with mini-open technique, from February 2018 through August 2021 were called upon in the OPD and were assessed according to VAS(visual analog score) and Quick DASH(disability arm shoulder and hand) score and results were evaluated. Inclusion criteria: All patients operated with mini open rotator cuff repair technique before 6 months. Exclusion criteria: Patients above 70 yrs of age, patients with shoulder lesions other than rotator cuff tear and revision rotator cuff repair. Results: The mean Quick DASH score was and VAS score was at average follow of. Discussion: There is a significant improvement in VAS and Quick DASH score after surgery with mini open rotator cuff repair.

62. Role of MRI in Evaluation of Knee Lesions
Amit Pendore, Chetan S Ravi, Hemant Gore, Vivek A Chowdhary
Background and Aim: MRI is currently the imaging modality of choice for nearly all clinical indications concerning the knee. The acutely injured knee is readily imaged for the detection of meniscal and ligamentous injury. In the evaluation of chronic knee pain, MRI can obviate the need for multiple imaging procedures simultaneously evaluating the structures of the knee, marrow space, synovium and periartucular soft tissues concerning the knee. Present study was done with an aim to describe the MRI feature in various types of traumatic and non traumatic lesions of knee joint. Material and Methods: The study population included 70 patients who underwent MR imaging of the knee when they presented with knee joint complaints (pain or swelling) in Tertiary Hospital from December 2014 to December 2016. MR imaging was performed with a MRI Scanner 1.5 TESLA (SIEMENS –MAGNETOM AVANTO TIM + DOT MRI SYSTEM) Once a patient satisfied the inclusion criteria for this study, he or she was administered the study proforma.MR findings were correlated with clinical and arthroscopic findings wherever possible. Results: Of the 70 patients evaluated with MRI of the knee, 26 patients (37%) had 32 meniscal tears. Of the 32meniscal tears, 21 (66 %) involved the medial meniscus alone, 4 (12%) involved the lateral meniscus and 7 (22%) involved the medial as well as lateral meniscus. Ligament tears were seen in 38 patients on evaluation of MR images of knee out of 70 patients included in the study. Of the 38 patients with ligament tears, 31 patients (81.57%) had ACL tears, 2 patients (5.2%) had PCL tears, 14 patients (36.84%) had medial collateral ligament tears and 9 patients (22.68%) had lateral collateral ligament tears. Conclusion: MRI is the examination of choice in the evaluation of internal joint structures of the knee like menisci, cruciate ligaments and articular cartilage. The diagnostic accuracy of MRI, although variable for different individual structures, is good enough, especially when using the concept of composite knee injury, to appropriately identify patients who require arthroscopic therapy.

63. Polycythemia Rubra Vera Presenting as Acute Coronary Syndromewith Incidental Finding of Left Renal Artery Occlusion
Jenny Koshy, Justina Koshy, Jeetendra Singh, Steffi Thomas
Introduction: Polycythemia rubra vera (PRV) is a Philadelphia chromosome (BCR-ABL) negative myeloproliferative neoplasm characterized by clonal stem proliferation of WBCs, RBCs and platelets. Men have a higher preponderance than female with approximately 2.8 per 1,00,000 men and 1.3 per 1,00,000 women being involved with PRV with the typical age at diagnosis being between 60-65 years of age. Case Report: A 65 year female, hypertensive since 1 year was admitted with complaints of left sided chest pain radiating to the back and left arm not associated with palpitations or diaphoresis. Patient also gave history of dyspnoea on exertion since last few days. On examination the patient had pulse of 78 beats per minute, BP was 150/100 mmHg. There were no other positive findings like pedal oedema, pulmonary crepitations or hepato-splenomegaly. ECG was taken, which showed ST-T changes and T wave inversions in leads I, aVL,V5 and V6. Discussion: This case report outlines the investigations and management of a patient who developed ischemic heart disease and renal artery occlusion secondary to the thrombotic events associated with PRV. Conclusion: Thus, from the case report it is evident that it is necessary to keep rare causes of acute coronary syndrome (ACS) like polycythemia rubra vera as differentials, in the treatment of ACS.

64. To Evaluate the Attitude, Knowledge and Practice Regarding Pharmacovigilance in Undergraduate Students & Postgraduate Residents at a Tertiary Healthcare Centre – A Questionnaire Based Study
Kumar Sneha, Amruta Pingale, Dikkar Vaishnavi
Introduction: Spontaneous reporting of Adverse Drug Reaction is a method of monitoring the safety of drugs and is the basic strategy for the post marketing surveillance of the drugs. Despite its importance there is a very little reporting of ADRs by the healthcare professionals. The present study evaluates the knowledge, attitude, practice about ADR reporting in undergraduate & postgraduate students at a tertiary care centre. Materials and methods: A questionnaire based cross sectional study containing 20 questions to assess knowledge, attitude and practice regarding Pharmacovigilance and ADR reporting was circulated to Undergraduates and Postgraduates in a tertiary care hospital. Students who were willing to participate and gave their consent were included in the study. Result: A total of 141 students participated in the study. Of which 78% of students gave correct response regarding the definition of Pharmacovigilance. 80.9% were aware of National Pharmacovigilance program of India (PvPI). 98.6% agreed that both doctors and patients are benefitted by ADR reporting. 63.8% have seen an Adverse drug reaction before but, only 28.4% had played the role of reporting an Adverse drug reaction because of under sensitisation about Pharmacovigilance and ADR reporting among undergraduates. 63.1% could recall when asked about the training in Adverse drug reaction reporting. 98.6% agreed that workspace environment should encourage ADR reporting. Conclusion: This study demonstrated that knowledge and attitude towards Pharmacovigilance and ADR reporting is increasing among Undergraduate Medical students and Postgraduate Residents but practice towards the same is still deficient.

65. Intrathecal Butorphanol as Adjuvant to 0.5% Hyperbaric Bupivacaine to Enhance the Duration of Subarachnoid Blockade with Postoperative Analgesia during Orthopaedic Surgeries-A Randomized Study
Vikas Kumar, Vijayant Kumar Pandey, Navdeep Singh, Dinesh Kumar Sardana
Background: There are various anaesthesia techniques used considering the health of the patient and type of the surgery. The current study will focus on Neuraxial anaesthesia that is provided during the lower orthopaedics surgery of the patients. This is helping in blocking nociceptive impulse from the operative site of the patient and minimizes the loss of the blood. Moreover, it is helping in minimizing the incidence of deep vein thrombosis and instability. The utilization of this approach is having a significant impact on the reduction in the dosage of both drugs and support in reducing the side effects and helps in improving the perioperative analgesia particularly in comparatively prolonged orthopaedic procedures. In fact, sometimes in cases of unplanned extended surgical duration we were able to avoid conversion of regional anaesthesia to general anaesthesia due to intrathecal additive Butorphanol. According to analysis, the butorphanol is considered as synthetic lipophilic opioid analgesic that is applied for balancing the anaesthesia approach for managing the perioperative health of the patient and maintaining the stability. Aim: To compare the efficacy and safety of intrathecal butorphanol as adjuvants to 0.5% hyperbaric bupivacaine in patients scheduled for orthopaedic surgeries. Method: Ninety-four adult consented patients of both gender of ASA physical status I and II scheduled for elective orthopaedic surgeries under subarachnoid blockade, were analysed. All enrolled patients were divided into two groups of 47 patients each to receive either 3 ml of 0.5% hyperbaric bupivacaine (Group A) or a similar amount of bupivacaine with 0.1 ml/ 0.1 mg of butorphanol (Group B). Patients were compared for duration of sensory and motor blockade, intraoperative hemodynamic changes, time to first rescue analgesia and side effects by using Analysis of variance (ANOVA), Mann Whitney U test and chi-square test. Results: The mean age of group A and B was 58.6 and 57.9 years and gender ratio was 28:19 and 26:21 respectively. Further, the duration of the surgery for A and B group was 149.68 mins and 158.89 mins respectively. Noticeably the time taken for total regression of sensory block at S1(min) was higher in Group B (322.8 ± 33.75 mins) than Group A (221.7 ± 19.6 mins) and statistically significant. In addition to this, the duration of motor block was 201.36 mins for group A and it was comparatively low against the group B which was 299.58 mins and statistically significant. Moreover, the VAS>3 was also observed significantly earlier among the patients of group A. The mean time for motor block up focusing on the bromage scale 3 was 14.13 mins for the patient of group A and 13.18 mins for the group B. There was no significant difference identified among these variables. Conclusion: Butorphanol is a useful adjuvant to intrathecal hyperbaric bupivacaine and can be considered as a standard practice for subarachnoid blockade during orthopaedic surgeries.

66. Graves’ Disease and Hashimoto’s Thyroiditis: Genetic and Non-genetic Perspective
Anil Pandey, Arvind Kumar Pal, Dinesh Bure, Govind Singh
In graves’ disease genetic factors mainly plays a part in genesis of disorder. Although it is seen that infection and environmental factors due play a part as well. Graves disease is characterized by antibody response to the thyroid gland (characterized by lymphocytic infiltrations), thyroid stimulating hormone receptor (TSHR) and different thyroid antigens. Graves’ disease is an autoimmune disorder in which host own immune system attacks self-antigens. The other autoimmune disorder of thyroid gland is Hashimoto disorder which also have a genetic basis.
Many gene are responsible for graves’ disease like CD40, PTPN22 and thyroid-specific genes. CD40 gene is an essential immunomodulatory component for follicular cells in the thyroid gland. CD40, PTPN22 and thyroid-specific genes are immunomodulating genes for the TSH receptor and thyroglobulin molecule. CD40 used to be associated with Graves’s disease as principal candidate on the basis of gene linkage study, connecting with 20q11 genome chromosomal region. The PTPN22 gene gives rise to a substantial risk of specific autoimmune and disease mechanisms. Although genetic factor is principal mechanism but infections also have been implicated in the pathogenesis of Graves’ disease that include microorganism like Coxsackie virus, Yersinia enterocolitica, Borrelia burgdorferi, Helicobacter pylori and retroviruses (HTLV-1, HFV, HIV and SV40). Infectious hepatitis C agents are also having affiliation with Auto Immune Thyroid Disease (viz graves diseases and Hashimoto disease). Some environmental triggers have also been reported like iodine, certain drugs, smoking and perhaps stress. Autoimmune disease-causing novel genes can be identified by recent molecular techniques involving gene expression studies namely, quantitative Real Time-PCR and microarray.

67. Study of Dermatoglyphics and Salivary Bacterial Culture in Dental Carries in Age group of 3-16 years
Anil Pandey, Amit Kumar Singh, Sandeep Dabral, C P Bhaisora, Manisha Pandey
Introduction: The entire human body is clothed with the skin which happens to be the largest and most important organ of the body. It performs many vital functions in the life of an individual, viz. it protects and safe guards the body from the vagaries of the weather, maintains the body temperature and saves the internal organs of body from the injuries. Objective: Plamar dermtoglyphics has been and is being studied in many diseases and alterations in normal patterns have been noted. It has been an accepted fact that genetics plays an important role in determination of palmar dermatoglyphic patterns. Conclusion: Result of our study showed that there in a significant role of genetic and environmental factors in causation of dental caries. Subjects in caries group had more number of whorls on their fingertips while subjects from control group had more number of loops on their finger tips and number of streptococcus mutans was more in caries groups which in directly proportional to the number of caries in individuals.

68. A Kap Study to Evaluate Stress Management among Undergraduate Medical Students at Jlnmch, Bihar
Piyush Anand, Asha Alka, Jeetendra Kumar
Aim: The present study was conducted upon knowledge, attitude and practice of stress management among undergraduate MBBS students at JLNMCH, Bihar, India. Methodology: This was a cross-sectional, questionnaire-based study, which was conducted in the department of pharmacology at JLNMCH, Bihar, India for 1 year. A total of 300 undergraduate students of first year, second year, third year, and final year of MBBS were included. Written informed consents were obtained from those who were willing to participate in the study. The questionnaire consisted of age, study year and gender of the participating students which was followed by 12 questions regarding knowledge, attitude and practice on stress management. Out of 12 questions, 4 questions were of knowledge, 3 of attitude and 5 of practice regarding stress management among medical undergraduates. Results: Out of 300 total undergraduates, 25.3%, 32.3%, 21% and 21.3% of students were of first, second, third and final year MBBS, respectively. There were 49% male and 51% female students.  32% could give a relevant definition of stress. The most common condition related to stress is depression (59.7%), followed by anxiety (30.3%). Most common stressors were vast syllabus and tough topics of MBBS curriculum (25.3%), followed by procrastination (24.7%) and less study time (19.3%).11.7% of students strongly agreed and 45.3% of students fairly agreed that they have faced difficulties in adapting to the new environment and away from home, these observations were particularly founded in first-year students. Socio behavioral problem was the most common non-academic cause of stress faced by 40.7% of students. 64.6% students of all years (except fourth year) of MBBS had confronted stress because of study performance-based anxiety among colleagues. Conclusion: There was significant level of perceived stress among majority of medical undergraduates owing to various stressors such as academic, environmental, psychological and socio-economic factors.

69. Influence of Diabetes Mellitus on the Uropathogens and Antibiotic Sensitivity Pattern in Patients with UTI: A Comparative Study
Rakesh Roshan, Sajjad Ahsan
Aim: To study the influence of diabetes mellitus on the uropathogens and antibiotic sensitivity pattern in patients with UTI. Material & Method: This was a prospective study conducted at the Department of General medicine, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, India. The study was carried out over a period of one year. The study included 350 diabetic (167 males and 183 females) and 200 non-diabetic patients (78 males and 122 females) with culture positive UTIs. Results: There was no significant statistical difference in clinical symptoms between diabetic and non-diabetic subjects. The most common organism isolated being E. coli. Aminoglycosides showed a better sensitivity profile than cefoperazone-sulbactum in both diabetics and non diabetics. Conclusion: The host factors found to be associated with UTI are female sex, presence of diabetes, poor glycemic control, presence of fever. No correlation was noted with age, duration of diabetes and type of treatment for diabetes. An elevated HBA1C correlates with occurrence of UTI. Escherichia coli (E. coli) was the most frequent uropathogen. The resistance of uropathogens to antibiotics are similar in patients with and without diabetes and non-diabetes.

70. Assessment of the Efficacy of Laparoscopic Appendectomy as Well as Conversion Rate of Laparoscopic Appendectomy to Open Appendectomy
Md. Sarfraz Alam, Shahid Ahmed
Aim: To study the efficacy of laparoscopic appendectomy as well as conversion rate of laparoscopic appendectomy to open appendectomy. Methodology: A Hospital based retrospective study of 100 patients who had undergone laparoscopic appendectomy at emergency theatre of JIMSH, Kolkata for 1 year were included for this study. The files of the patients were collected from the medical record section of hospital and studied. Sample size was not based on any standard sample calculation technique as all the patients who had undergone laparoscopic appendectomy at emergency theatre of JIMSH were recruited for this study. Categorical variables were presented as frequency. Ethical approval was approved by department research unit, department of surgery, JIMSH, Kolkata. Results: Out of 100 patients, Majority (61%) were between 20 years to 40 years of age followed by <20 and > 40 years of age (28% and 11% respectively). Most of the patients (64%) were presented with complains of pain localized in lower abdomen associated commonly with vomiting. Only 23% patients had post-operative complications, most common being pain at surgical site. The duration of hospital stay was shorter as 3 days for most of the patients (43%). Conversion rate from laparoscopic appendectomy to open appendectomy was only 10% with cause being uncontrolled bleeding, perforation of base of appendix and appendicular lump during period of this study. Conclusion:Laparoscopic appendectomy in patients with acute appendicitis can be considered a safe procedure. There is no significant difference in postoperative complications between patients who undergo laparoscopic and open appendectomy. Although the duration of the laparoscopic operation is longer, the hospital stay is shorter, with earlier recovery.

71. Efficacy of Epidural Infusion 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:  Quality of Sensory & Motor Block
Ankita Singh
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- quality of sensory and motor block. 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 Mean sensory block remained comparable for 24 hrs and difference was not statistically significant. So the quality of sensory block in both the groups was same. The median value was also zero. Both the groups were comparable with respect to VAS Static at all-time intervals. Conclusion: The quality of sensory block as assessed by Hollmen score, was comparable baseline and also throughout the study period. Three patients in Elastomeric group and two patients in Electronic group had higher degree of sensory block. Motor blockade was seen in 7.5% of patients in Elastomeric group and 5% of patients in Electronic group. At the end of 24 hours, percentage of motor blockade in both groups were comparable and the difference was statistically insignificant.

72. Prospective Observational Assessment of the Diagnostic Role of CSF C-Reactive Protein Quantitatively in Acute Meningitis and Differentiating Pyogenic Meningitis from Non-Pyogenic Meningitis
Chandan Kumar Mishra
Aim: To assess the diagnostic role of CSF C-reactive protein quantitatively in acute meningitis and to evaluate the efficacy of CSF C-reactive protein in differentiating pyogenic meningitis from non-pyogenic meningitis. Material and Methods: It is a prospective observational study of total 102 children with suspected meningitis allocated into three groups based on initial investigations; group- I Pyogenic meningitis, group-II Non-Pyogenic meningitis and group-III No meningitis (Control group). Quantitative CSF C-reactive protein was detected by the latex agglutination method. Data were analyzed to establish the diagnostic role of CSF-CRP and to evaluate the efficacy of CSF-CRP in differentiating pyogenic meningitis from non-pyogenic meningitis. Results: The age distribution among pyogenic meningitis (79) shows the maximum of 31 cases (39.2%) in the age group 1 month to 1 year. The mean value of the total count of WBC/mm3 in CSF, in pyogenic meningitis was 921.28 + 829.01, in Non-Pyogenic meningitis was 166.2 + 146.8 and in the case of normal CSF was 2.71 + 1.8. CSF culture was positive only in 17% of patients and common bacteria were grown in CSF culture were Streptococcus pneumonia (7.59%), Staphylococcus aureus (5.06%) and H. influenza (2.53%) and E.Coli (1.27). Conclusion: Detection of CSF-CRP provides a new dimension to establish the diagnosis of pyogenic meningitis. It is a rapid, reliable and sensitive diagnostic test. From this study it is concluded that CSF-CRP can be used to differentiate pyogenic from non-pyogenic meningitis. Early, accurate and appropriate therapy can ameliorate the morbidity and mortality rates in such cases.

73. A Cross-Sectional Assessment of the Efficacy and Safety of High Flow Nasal Cannula Therapy (HFNC) as Primary Mode of Treatment for Children with Respiratory Distress
Vivek Kumar, Jeetendra Mahato, Gopal Shankar Sahni
Objective: To assess efficacy and safety of High flow nasal cannula therapy (HFNC) as primary mode of treatment for children with respiratory distress. Material & Methods: This cross-sectional study was undertaken at Department of Pediatrics, SKMCH, Muzaffarpur, Bihar, India over a period of one year. Consecutive patients with respiratory distress necessitating admission to PICU, in the age group of 1 month to 16 years of age were included. Children requiring immediate noninvasive (NIV) or invasive ventilation and those with contraindications to HFNC, altered sensorium (GCS<12), apnea and catecholamine resistant shock were excluded. Results: A total of 220 (100 girls) children were commenced on HFNC therapy. HFNC failure occurred in 20 (9.0%) children at a median (IQR) time of 2 (1.43-21) hours. Conclusion: HFNC is an effective and safe primary mode of respiratory support in children with respiratory distress. Children who succeed on HFNC show a favorable clinical response within first few hours.

74. Efficacy of Epidural Infusion 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: Haemodynamic Parameters
Ankita Singh
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- Haemodynamic Parameters. 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: There was no statistically significant difference in the heart rate between the two groups throughout the duration of study. Throughout the duration of study, there was a steady fall in the SBP in both the groups, though the values were within normal range.Overall the Mean SBP remained stable throughout the postoperative period and the difference between both the groups was statistically insignificant. Conclusion: Haemodynamic stability was maintained throughout the infusion in both the groups. In our study the baseline hemodynamic parameters, which included heart rate, systolic blood pressure and diastolic blood pressure were comparable, and difference was statistically insignificant. Overall, the hemodynamic parameters remained stable throughout the postoperative period in both the groups. The mean drug delivered over 24 hours was comparable in both the groups and the difference was statistically insignificant.

75. A Retrospective Assessment of the Effectiveness of Surgical Management of Malignant Glaucoma in Phakic Eyes
Kundan Kumar Singh
Aim: Effectiveness of surgical management of malignant glaucoma in phakic eyes. Methods: The retrospective study was conducted in the Department of Opthalmology, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India for 15 months, patients who underwent core vitrectomy-phacoemulsification-intraocular lens (IOL) implantation-capsulo-hyaloidotomy at least 1mo after the onset of malignant glaucoma. Malignant glaucoma was defined as uniform shallowing to flattening of the central and peripheral anterior chambers, and with intraocular pressure (IOP) over 22 mm Hg. Patients were excluded if they had: 1) a suprachoroidal effusion or hemorrhage, 2) pupillary block, or 3) lens subluxation. Results: This retrospective study reviewed 10 consecutive malignant glaucoma patients who underwent core vitrectomy, phacoemulsification, IOL implantation, and capsulo- hyaloidotomy. All eyes had been diagnosed with primary angle-closure glaucoma (PACG); 9 eyes (90%) developed the condition after trabeculectomy. The mean onset to surgery interval was 7.1 month. Significant preoperative and postoperative differences were detected in the IOP (P=0.048), number of IOP- lowering medications used (P=0.003), and ACD (P=0.005). Complete success, qualified success, and anatomical success was achieved in 40%, 80%, and 100% of the eyes, respectively. Conclusion: The present study indicated that core vitrectomy- phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective treatment for malignant glaucoma patients with long time intervals between malignant glaucoma onset and surgery, achieved a high rate of anatomical success and low rate of postoperative complications.

76. Differential Patterns of Cough and Sputum in Patients with Asthma and COPD in Tertiary Care Hospital of Central India
Parag Sharma, Piyush Gupta, Prerna Sharma, Nishant Shrivastava
Introduction: The evolution of knowledge concerning COPD and its components Emphysema, Chronic bronchitis, and Asthmatic bronchitis take us long back in to the history over 200 years. Since then there not a single terminology have been established to clearly demarcate difference between these components. Confusion still persists between chronic bronchitis and Emphysema. In this study, we aim to assess using the preexisting clinical, pathological, and radiological knowledge, whether these phenotypes can be distinguished or not. Material methods: The present study is a prospective, observational, hospital based study conducted on 110 pre diagnosed patients on basis of complete clinical evaluation including a detailed preformatted directed history, detailed and thorough clinical examination were considered. Results: 31 of asthma patients (100%) had episodic cough, while 29 (76.3%) of Emphysema patients and 18 (94.7%) of chronic bronchitis patients had constant cough. Our study showed that 30(96.8%) asthma had worsening at night time, while 13(34.1%) of Emphysema patients and 13(68.4%) of chronic bronchitis patients had worsening at both day and night. Cough was aggravated by dust, pollen and cold in 25(80.7%) of asthma patients. All chronic bronchitis patients19 (100%) had sticky sputum, whereas non sticky sputum was present in majority of Emphysema31 (93.9) and asthma 30(100%) patients. Sputum cytology in majority of asthma patients 26(83.9%) showed predominant eosinophils, whereas 18(94.8%) patients of chronic bronchitis and 18(50 %) patients of Emphysema had predominant neutrophils. Conclusion:Thus a clear demarcating pictures of COPD and asthma can be found over coughing and sputum patterns of the patients.

77. Comparison of Dentinal Tubule in Primary and Permanent Molar under Transmitted Light, Polarised Light and Scanning Electron Microscope: An in-Vitro Study
Nitin Sharma, Neha Bhargava, Milind Agrawal, Rajendra Yadav, Annanya Rajshree Dutta, Sadef Naqvi
Background: Dentin is considered as a fundamental substrate of restorative dentistry and its physical, chemical & histological properties and characteristics are key determinants of nearly all restorative, preventive and disease processes of the teeth. It is dentinal tubules intrinsic permeability that is responsible for permitting bacterial or chemical substances to diffuse across the dentin and irritate the pulpal and periradicular tissues in both primary & permanent tooth dentin. There is a need for improved understanding of the dentin structure and nature which will have important consequences for today’s dental procedures. The aims of the study were to observe the direction of dentinal tubule in primary & permanent molar. Aims: The aims of the study were to observe the direction of dentinal tubules. Methods and Material: Present in vitro study was carried out in the Department of Oral and Maxillofacial Pathology, Rajasthan Dental College and Hospital, Jaipur and Material Research Center, Malviya National Institute of Technology, Jaipur following clearance from the ethical committee of the institution. A total of 20 teeth (10 primary and 10 permanent molars), unrestored, noncarious, hypoplastic extracted molars were ground sectioned & used in the present study. All the data was entered on the Proforma & subjected to statistical analysis using Fisher’s exact test. Results: Examination of ground sections of the primary teeth dentin showed “s”-shaped curvature in none (0 %) specimens and a straight course of dentinal tubules in all 10 (100%) specimens out of 10 teeth examined whereas in permanent teeth, 7 (70%) specimens showed an “s”-shaped curvature and 3 (30%) specimens out of 10 specimens examined. These results are statistically significant (P < 0.003). Conclusions: Dentinal tubules followed an “s”-shaped course in 7 (70%) permanent molars and in none (0 %) primary molars & the results were significant.

78. To Study the Effect of Non-Surgical Periodontal Therapy in Type-2 Diabetes Patients with Chronic Periodontitis with Evaluation of Hba1c- in Vivo Study
Neha Waman Dhadse, Pradeep Kumar, Rohan Gupta, Sonia Godara, Rajendra Yadav, Mayank Gupta
Background: This study was performed to study the effect of non-surgical periodontal therapy in type-2 diabetes patients with chronic periodontitis with evaluation of hba1c. Materials and Methods:  The study planned on  50 subjects with type 2 diabetes mellitus (HbA1c values 6-8%)  within a period of 7 years with moderate to severe periodontitis were selected. Medical records and data regarding HbA1c level, type of medications, and changes in medication or dosages was collected. The clinical parameters (PI,GI,SBI) and HbA1c were recorded at baseline & as well as 6 months post periodontal treatment. Data was analysed using SPSS software version 22. Descriptive frequencies for gender and age were calculated. The comparison between values of all the clinical and metabolic parameters at the baseline and 6 months was done by Z-test. The correlation between the clinical parameters with HbA1c at the baseline and 6 months was done by Karl Pearson coefficient test. The correlation between the differences in mean values of PI, GI, and SBI with HbA1c from the baseline to 6 months was done by t-test. Results: Reduction in all the clinical parameters were observed and were found to be statistically significant. The mean HbA1c value at baseline was 8.146 ± 1.75, which reduced to 7.11 ± 1.80 at 6 months. The mean percentage difference was 12.8%. Conclusion: The study showed that the Periodontal Therapy significantly contributed to glycemic control in T2DM patients.

79. Evaluation of Regeneration in Mandibular Grade II Furcation Defects Treated with Autologous Platelet Rich Fibrin and its Comparison with Heliguide and DFDBA: A Randomized Controlled Clinical Trial
Shreya Joshi, Pradeep Kumar, Rohan Gupta, Sonia Godara, Rajendra Yadav, Garima
Background: To evaluate periodontal regeneration in Mandibular grade II furcation defects following treatment with Platelet rich fibrin compared to demineralized freeze- dried bone allograft and GTR membrane. Materials And Methods: A total of 20 systemically healthy patients undergoing periodontal therapy will be included and with bilateral buccal grade II furcation defect in the mandibular molars, participated in the study. The following clinical measurements were recorded at baseline as well as 6 months post-surgery: (1) Plaque Index, (2) Sulcus bleeding index (SBI), (3) Probing depth from the gingival margin, relative vertical clinical attachment level (RVCAL). Paired student’s t-test was done to test the significance of changes overtime from baseline to 6 months. The unpaired t-test was utilized to compare intergroup changes in parameters. Comparison were also drawn between the test and the control groups by applying the Paired “t’’ test, unpaired “t” test and Chi-square test. Results: The mean gain in relative clinical attachment levels in the test and control groups, at the end of six months, the mean gain in the vertical clinical attachment level was 1.30 ± 0.67 mm (Test group) & 1.70 ± 0.67 mm (control group). The mean gain in the horizontal clinical attachment level was 1.80 ± 3.35 mm (Test group) & 1.60 ± 1.5mm (control group). The mean probing pocket depth for the control group at baseline was 5.50 ± 0.52 mm whereas values after 6 months post-surgery was 2.60 ± 0.51 mm. Conclusion: Both treatment modalities demonstrated a significant improvement in the probing depth, vertical and horizontal relative attachment level as well as radiographic bone density at 6 months surgery. There was no significant difference in the result obtained from the use of both the treatment modalities. Hence further long-term studies are requiring substantiating the efficacy of cost effective PRF in the treatment of mandibular grade II furcation defects over other GTR membranes which are presently being used.

80. Evaluation of Adnexal Masses and its Diagnostic Value of Clinical Findings, Ultrasonography and its Correlation with Histopathological Diagnosis
Vijayalaxmi Davalagi, Poolan Devi. K, Swapna Kabiraj, Madhusmita Sahu
Objective: Adnexal masses is a common clinical presentation in gynaecological practice and can be of gynaecological or non- gynecologic origin. it includes masses arising from ovaries, fallopian tubes, broad ligament and structures within broad ligament that are developed from the embryonic nests. the term adnexal mass is most often used for masses involving the ovary because of high propensity of the ovary for neoplasia. Therefore, gynecologist must evaluate these masses using clinical and radiological information and the balance the risk of surgical intervention for a benign vs malignant process. the objective of this study is to find out the diagnostic value of the clinical findings, ultrasonography and its correlation with histopathological diagnosis in adnexal masses. Methods: This is a prospective study undertaken in the department of obstetrics and gynaecology Mysore medical College and research institute Mysore from 7/12/2020 to 11/12/2021, All patients with clinical diagnosis all of adnexal masses where included. After a detailed history, complete general physical examination and bimanual examination a provisional diagnosis was made. The patient was then subjected to an ultrasound examination consisting of at the trans vaginal or transabdominal routes with colour Doppler in selective cases. Biochemical investigations like CA 125 where done. Risk of malignancy index (RMI) for each tumor was calculated. Following surgery, specimen was sent for histopathological examination and the report were collected with preoperative clinical and imaging findings. Results: The incidence of undergoing surgical intervention was 5.26 %. The incidence of ovarian masses was 93%. 84% were neoplastic and 16% non-neoplastic. The incidence of malignancy was 9.5%. The mean age of presentation of adnexal masses was 38.11 years with majority of tumors occurring in the age group of 41-50 years. There were highly significant differences amount tumor types (benign, malignant) and menstrual status with malignancy being more prevalent in postmenopausal group. Sensitivity and specificity of clinical diagnosis in discriminating benign and malignant ovarian tumor were 87.5% and 93.47% respectively with an accuracy of 93 %. Sensitivity and specificity of ultrasound examination were 87.5% and 95.65% respectively with an accuracy of 95% which was slightly better than clinical diagnosis. When both clinical and sonological diagnosis were combined the overall sensitivity, specificity, positive and negative predictive value for diagnosis and discriminating benign neoplasm where 87.5%, 96.7%, 70% and 98.8 8% with a false positive rate of 39% and false negative rate of 1.11 %. Their combined accuracy was 96%. CA 125 as a laboratory test showed a sensitivity of 62.5%, specificity of 84.25% and an accuracy of 82.14%. Risk of malignancy index (RMI) more than 200 showed a sensitivity of 62.5%, specificity of 95.65% and an accuracy of 93 %. Surface epithelial tumor- serous type, was the most common histological finding followed by mucinous type among both benign and malignant neoplasms. Conclusion: Ovarian masses contribute to a majority of adnexal masses and are a common site for neoplasia. Clinical findings, sonography with Doppler correlates positively with histopathology in early detection of malignancy and its appropriate management.

81. Comparative Evaluation of Microtensile Bond Strength of Different Restorative Materials on Silver Diamine Fluoride Treated Carious Primary Teeth- an in Vitro Study
Nitin Sharma, Neha Bhargava, Rajendra Yadav, Sadef Naqvi, Milind Agarwal, Annanya Rajshree Dutta
Aim: To compare the micro tensile bond strength of three restorative materials after SDF treatment to primary carious teeth and evaluate the mode of restoration failure. Methods and Material: this is a Cross-sectional study. 60 extracted carious primary molars were sectioned in two halves through the carious lesions and randomly allocated to three different groups. All groups were treated with SDF and stored in artificial saliva. The samples were restored with conventional glass ionomer cement, light cure glass ionomer cement, and composite. After 24 hours in artificial saliva, the specimens were prepared for micro tensile bond strength testing and stressed with tension at 1mm/min until failure. Mean bond strengths were compared using the One-way ANOVA test with post hoc Tukey HSD test and failure mode was recorded. Results: The mean micro tensile bond strength was highest in the light-cure glass ionomer cement followed by conventional glass ionomer cement and composite. The most common failure mode was the adhesive failure in all groups. Conclusions: Resin-modified glass-ionomer cement is better material for SDF-treated carious primary teeth.

82. Comparison of Neuromuscular Blockade, Intubation Condition and Reversal between Cisatracurium and Rocuronium with 3×Ed95 Doses
Malini S, Poolan Devi K, Manjunath H G, Greeshma N Murdeshwar, Bhavya K
Background:  Optimum relaxation done via non depolarising muscle relaxants (NDMR) is expected to be associated with hemodynamic stabilisation, shorter action and proper reversibility. Cisatracurium and rocuronium are newer NDMR belonging to aminosteroid and benzylisoquinolinium groups respectively with different elimination pathway. Limited studies are available to assess difference of 3×ED95 doses. Aim:  The primary objective of the present study is to assess difference in the onset time and intubation condition with 3×ED95 with both the drugs whereas the secondary objective is to assess the duration of action and reversal conditions. Materials and methods:  60 patients posted for the general anesthesia were randomly divided into two groups. Group C received cisatracurium and group R received rocuronium. Train of four (TOF) was used via accelerometer. Time to intubate, duration of action and reversibility were noted. Also intubation condition was recorded. ANOVA and Student’s unpaired t-test was used for means of quantitative data and Fisher’s chi square tests was used for qualitative data. Results:  Onset of action was significantly shorter with rocuronium compared to cisatracurium with excellent intubation condition with both the drugs. Also there was no significant difference between the duration of action, duration between first TOF response and head lift for 5 seconds and to extubate. Conclusion:  In this comparative study, for 3×ED95 doses of cisatracurium and rocuronium, the onset of action is faster with rocuronium and both the drugs having good intubation condition. The duration of action and reversal condition were same with both the drugs.

83. To Evaluate the Posterior Segment of the Eye in Patients with Ocular Trauma & Analyze Ocular Trauma Patients with or Without Opaque Media
Sarika Chouhan, Yogita Chaurasia
Purpose: To visualize the status of the posterior segment with the diagnostic tool of B-scan ultrasound in patients with ocular trauma. Background & Method: This was a prospective diagnostic study that was confined to the assessment of posterior segment lesions in ocular trauma patients with or without opaque media. Both open and closed globe injuries were included. Diagnostic B-SCAN ultrasound was done in 166 traumatized eyes of 150 patients attending ophthalmology OPD during the academic session Jan 2020-Jan 2022 in Upgraded Department of Ophthalmology, Bundelkhand Medical College Sagar (M.P). Results: Ocular pathologies were seen in120 eyes (72.29%). The most frequent finding was that of a Vitreous hemorrhage seen in more than one-third (37.9%) of eyes. Retinal detachment was seen in 13 eyes whereas a globe rupture was documented in 6 patients. An intraocular foreign body was diagnosed by ultrasound examination in 4 patients. Conclusion: B-Scan can be used widely for the diagnosis of different posterior segment disorders of the eye. The simplicity, reliability, and ease from the patient’s point of view, of the ultrasonic examination of the eye, emphasize that it can be used as a routine technique in the investigations of ophthalmic lesions. The main indications for the ultrasonography are opaque light-conducting media, intraocular pathologies suspected on fundus examination, suspected mass, and trauma to the eye.

84. Recent Trends and Prescribing Patterns of Antimicrobial Agents in Patients Admitted in Tertiary Care Hospital During Covid-19 Period
Balvir Singh, Yasmeen Siddhiqui, Taruna Singh, Ankita Dixit, Prabhakar Singh, Bhupendra Raj
Introduction: Antibiotics are widely used medicines to treat life threatening infections and improving survival. Antibiotic resistance among bacteria is becoming more and more serious Global problem. There is very high prevalence of antimicrobial utilisation in the community. Aim & objective: To determine the prescribing pattern of antimicrobial agents (AMA) in a tertiary care hospital. Material and methods: This is a retrospective cross-sectional study conducted in the department of Pharmacology & associated Sanjay Gandhi Memorial Hospital, Rewa, MP between Feb 2020 to Jan 2021. Total 625 treatment sheets were enrolled in the study. The data were collected by obtaining photocopy /print of patient’s treatment sheets of various departments from medical record room after getting approval from appropriate authority. Data Analysis: The data were analysed by using Microsoft word – excel version 2007. All the multiple responses were presented in terms of number and percentage. Results: Total 625 treatment sheets were enrolled; of these Maximum 130 were belonged to geriatric age group (> 68 yr) and minimum 5 were belonged to <1 (up to 12 month) year of age group. Cephalosporin was the most frequently prescribed group of drugs in various departments except in Paediatric department where Glycopeptide (61.1%) was the most frequently prescribed group. Among the groups, Ceftriaxone (42.6%) was the most frequently prescribed drug in medicine, Ceftriaxone + Sulbactam in surgery (41.1%) and Obstetric & Gynaecolog (Obs & gynae) department (76.5%) and Vancomycin (61.1 %) in Paediatric department. Conclusion: Cephalosporin was the most frequently prescribed group of drugs in various departments; among the group Ceftriaxone (42.6%) was the most frequently prescribed AMAs. There is average 5.5 drugs were prescribed per encounter which was higher than the WHO standard value of 2. Our study concludes that there is an urgent need to increase awareness among healthcare professionals to reduce unnecessary and unrequired use of antibiotics and makes AMAs Policy in Hospital settings.

85. A Morphometric Study of the Adult Human Gall Bladder in a Cadaver and its Clinical Significance in the Eastern Indian Population
Vijay Kumar Singh, Md. Zahid Hussain, Ravish Kumar, Rashmi Prasad
Background: Large gallbladder volumes observed in older individuals are predictors of impaired gallbladder motility and bile stasis which predispose one to gall stone as well as biliary sludge formation. The purpose of this research is to determine the morphology and variations of the adult human gall bladder in a cadaver, as well as its clinical significance in the Eastern Indian population and compare it with the incidence among various races in the world. Materials & Methods: The present study comprised of 48 liver with gallbladder specimens obtained from 10% formalin fixed cadavers of both genders which were available in the Departments of Anatomy, and Forensic Medicine & Toxicology of Nalanda Medical College (Patna, Bihar, India) after getting approval from the institutional ethics committee and obtaining permission for the study from the heads of the department. The study was carried out over a two-years period, from July 2019 to june 2021. The gall bladder was examined, cleansed thoroughly, dissected, and studied. The following parameters such as length, transverse diameter, shape, external variants and length of part of gall bladder below the lower border of the liver was recorded. Results: Gall bladder with length 3-7 cm was seen in 12, 7-10 cm in 28 and >10 cm in 8 cases. The mean breadth (cm) <3 was seen in 10, 3-5 cm in 30 and >5 cm in 8 cases. Shape was cylindrical in 14, pear in 22, hour glass in 10 and irregular in 2. External variants were phrygian cap in 4 and Hartmann’s pouch in 7 cases. The difference was significant (P< 0.05). Conclusion: A thorough knowledge of the various morphological and morphometric variants of the gall bladder is important for the operating surgeons neurosurgeons, radiologists. This study is also important for the teaching and acknowledgement of undergraduate and postgraduate students in anatomy as well as in surgery departments.

86. Approach to Wound Bed Preparation in Superficial Soft Tissue Infections: A Comparative Study of Methods of Debridement
Arun Kumar Pargi, Ajay Gangji
Introduction: Venous ulcers (additionally called varicose or venous stasis ulcers) are a chronic, ordinary and debilitating situation that impacts up to at least one% of the populace. The science of wound bed preparation is evolving at a pace faster than ever as advances in molecular techniques are bringing out the pathophysiology of wound healing in a better light. Today’s surgeons have an overwhelming choice of newer techniques to assist wound bed preparation from use of recombinant growth factors and genetically engineered tissues to hyperbaric oxygenation. Translating these new principles into everyday practice remains a long way off and one must not forget the importance of assessment of various local and systemic factors that may impair healing. Results: This study involves selecting hundred suffering from acute or chronic wounds, randomly distributing them to the following groups irrespective of age, sex and etiology of wounds and then treating them with different methods of debridement as denoted by the group’s name Group I Surgical debridement group, Group II Autolytic debridement group, Group III Mechanical debridement group, Group IV Enzymatic debridement group. Discussion: The term debridement comes from the French debrides, meaning to unbridle. It was probably first used as a medical term by surgeons working several hundred years ago in war zones, who recognized that grossly contaminated soft tissue wounds had a better chance of healing (and the soldier surviving) if the affected tissue was surgically removed to reveal a healthy bleeding wound surface. When necrotic or foreign material is present in a wound, sharp or surgical debridement can reduce the risk of infection and sepsis and aid wound healing. Several studies have been conducted to compare sharp debridement with enzymatic/ autolytic/ mechanical debridement as by far it has been considered the gold standard of debridement. Conclusion: Even though surgical debridement has by some distance been taken into consideration as the gold standard for casting off necrotic tissue, it could now not essentially be satisfactory. It does remove the supply of infection inside the quickest manner and promotes the levels of healing both proliferative and inflammatory and enables in accurate assessment of the wound however it also destroys the crucial new tissue. Also it can no longer be safe and has headaches like bleeding.

87. Correlation of CRP Level with Glycaemic Control in Diabetic Foot Patients and its Sequelae
Atahussain Poonawala
Background: C-reactive protein (CRP) is a sensitive physiological biomarker of sub-clinical inflammation associated with hyperglycemia, insulin resistance and type 2 diabetic patients. The present study conducted to study correlation of CRP with glycemic control in diabetic foot patients and sequelae of diabetic foot in the study population. Methods: A observational study among 100 patients with Type 2 Diabetes mellitus with diabetic foot attending outpatient department of Medical College was done during1st January 2021 and 31st June 2021. Each subject selected underwent a medical history and history regarding diabetes. The collected data was fed into an excel spreadsheet and then tabulated. SPSS for Windows version 22 software was used for statistical analysis. Results: The association of diabetic foot outcome and CRP levels showed that, patients with higher CRP levels had more chance of amputation as compared to normal CRP levels with statistical significance. The blood sugar levels showed significant positive correlation with CRP levels with statistical significance. Conclusion: There is a strong positive association between poor blood sugar control and elevated CRP levels These data can support a possible role of inflammatory biomarker in diabetogenesis.

88. Evaluate Determinant and Feto Maternal Outcome of Maternal Near Cases in Tertiary Care Hospital
Nilofer Poonawala
Background: Maternal morbidity and mortality is a major public health issue. Each year more than half a million women in the reproductive age group, die from the complications of pregnancy and childbirth. The study was conducted to evaluate determinant and feto maternal outcome of maternal near cases in Tertiary Care Hospital. Methods: The present observational study was carried among pregnant women admitted for delivery, or within 42 days of delivery or termination of pregnancy, booked at hospital or referred from elsewhere who fit into the criteria of WHO MNM during November 2019 to October 2020. Sample sizes of 100 participants were enrolled in study. The collected data were analyzed with proper statistical methods using MS excel 2016. Results: The mean age among pregnant women was 27.48± 4.03 years. Majority of cases had underlying disorder of hypertensive disorder of pregnancy followed by anemia. The delivery outcome shows that, Still born was seen in 14% and IUD 6% respectively. Conclusions: Obstetric care in tertiary hospitals has improved dramatically in developed countries. But primary care facilities and referral systems still need to be improved in developing countries.

89. Impact of Basic Life Support Training on Knowledge and Attitudes of Healthcare Persons toward Resuscitation
Varsha R. Bhivate, Manoj. R. Bhivate
Background: Basic life support (BLS), an important component of the survival chain, reduces the time between cardiac arrest and cardiopulmonary resuscitation and enhances the rate of hospital discharge. The study aimed to explore the knowledge of and attitude towards basic life support (BLS) among medical/paramedical professionals. Cardiopulmonary resuscitation (CPR) improves a person’s chances of survival after a cardiac arrest. Repeated training helps employees retain knowledge in CPR and how to utilize automated external defibrillators (AEDs). It is difficult to retain knowledge and abilities in CPR during and after training, and it necessitates systematic training with appropriate technique. Aim & objectives: To study impact of basic life support training on knowledge and attitudes of healthcare persons towards resuscitation before and after attending a BLS-training course in Terna medical college. Materials and Methods: The study was done in among the students, staff of a Terna medical college in Navi Mumbai from Jan20 – May20. Data was collected by using a validated, anonymous, self-administrated questionnaire. Observations and Results: In our study, the proportion of health-care workers who reported a positive attitude increased significantly from the pre-BLS group to the post-BLS group, showing a positive effect of BLS training 78% participants showed positive response after training about ability to work as a member of resuscitation team. Summery and Conclusion: Repeated educational programs can improve attitudes toward CPR performance and the use of AEDs. Training that addressed the concerns of health-care workers could further improve these attitudes.

90. Performance Evaluation of point-of-care (POC) Testing in Diagnosis of Urinary Tract Infections
Saqib Rishi, Nahid Nahvi, Arshid Rasool Wani, Iqra Majid, Safura Dewani
Introduction: Early detection of UTI is critical for instituting effective treatment and avoiding patient complications.  Unfortunately, the results of the culture are available after 24 hrs. .Thus point-of care rapid diagnostic tools are especially relevant in this setting. Material and methods: During this trial, 800 patient samples were taken. Direct Gram staining, wet mount preparation, and Urine dipstick chemical analysis was performed. Dipstick test provides point of care information about urinary tract infection and a positive test was later confirmed by culture of the urine specimen. Results: Nitrite test was found to have 50% sensitivity, 93% specificity,75.52% positive predictive value and 84.04%  negative predictive value .Leucocyte esterase test showed sensitivity, specificity, positive predictive value, negative predictive value of 81%, 69%, 47.73%, 91.07% respectively. Sensitivity of Leucocyte esterase test was higher than the nitrite test. The Leucocyte esterase-nitrite test combination yielded the best levels of sensitivity 81% and specificity 97% as well as positive and negative predictive values of 89%, 93% respectively when compared to culture. Conclusion: Urine culture is still the gold standard in diagnosis of UTI nevertheless it is time-consuming and expensive. pre-screening urine samples with rapid tests seem to be sensible and cost-effective approaches for identifying urinary tract infection and to decrease the workload in the laboratory in resource-limited settings, according to our research.

91. Prospective Study to Determine Post Operative Complications after Surgical Correction of Subtotal Tympanic Membrane Perforation at a Tertiary Care Hospital in Rajasthan
Shiv Shanker Kaushik, Jaideep Singh Chouhan, Imraan Khan, Baldev Singh Nathawat
Introduction: Tympanoplasty is the commonest surgical procedure performed in patients to combat ear infection and restore its function. Although anatomical outcome has been satisfactorily documented using autologous cartilage graft, the variable hearing outcome has been documented by past literature in the postoperative period. Aim: To determine complications of circumferential flaps in subtotal tympanic membrane perforations. Method: This prospective study was conducted in the Department of Otorhinolaryngology and Head and Neck surgery, RNT medical College and MB hospital, Udaipur. Patients attending the outpatient department of Otorhinolaryngology were screened and 50 patients were included in the study. Results: In our study, among the 50 patients, 5 patients were having minor complication, 2 patients (4%) were having otitis media effusion, 1 patient (2%) having retraction, 1 patient (2%) having myringitis and 1 patient (2%) having lateralization. Conclusion: Most common post operative complications was Otitis Media with effusion.

92. Estimation of Lipid Profile and Serum Lipoproteins in Polycystic Ovarian Syndrome in Tertiary Care Teaching Hospital
Lavanya Lagisetty
Background: Dyslipidaemia is the most common metabolic abnormality in Polycystic ovary syndrome (PCOS). Women with PCOS are at an increased risk for cardiovascular diseases. Lipoprotein is an independent risk factor for the development of atherosclerosis. Elevated Lipoprotein (a) along with dyslipidemia and a host of other derangements in PCOS may lead to premature atherosclerosis. We in the current study tried to evaluate the lipid profile and serum lipoprotein (a) in women diagnosed with PCOS in our tertiary care institute. Methods: This cross-sectional study was conducted in the Department of Obstetrics and gynecology and Biochemistry, Prathima Institute of Medical Sciences, Naganoor, Karimnagar, Telangana State. N=25 cases were studied during the period of the study. N=25 age-matched controls were also included in the study. The serum was isolated from a five mL peripheral venous blood sample taken by venepuncture from both patients and controls following a 12-hour overnight fast. The immunonephelometric technique was used to quantify serum Lipoprotein (a) levels. Results: The mean levels of total cholesterol in the cases were 208.56 ± 35.67 mg/dl. Taking a cutoff of < 200 mg/dl it was found that 60% of the cases in the study group were below this level and 40% were above 200 mg/dl levels the p-value (<0.001).  Serum Triglycerides (TG) among Cases and Controls have shown that 36% of the cases and 80% of the controls are in the normal range (<150 mg/dl). 48% of cases and 20% of controls were in the borderline range (150-199 mg/dl). 16% of cases were found to be having values > 200 mg/dl. Conclusion: Total cholesterol, triglycerides, low-density lipoproteins, and very-low-density lipoproteins were found to be consistently higher in PCOS patients as compared to the normal controls. Elevated Lipoprotein (a) was also found in most of the PCOS cases in the study. All these abnormalities indicate that polycystic ovarian syndrome may lead to the development of an atherogenic lipid profile and put the patient at risk for future metabolic syndrome.

93. A Hospital Based Prospective Study to Evaluate the Role of Magnesium Supplement in Laryngopharyngeal Reflux Disease
Sarika Kalra
Aim: To evaluate the association between Mg intake and the risk of reflux disease and that the addition of magnesium supplements should be considered and added to the LPRD treatment protocol for adults in accordance with the dietary reference intake (DRI). Material & Methods: This is a hospital based prospective study done over a period of 1 year conducted in the Department of ENT, MP Birla Hospital & Priyamwada Birla Cancer Research Institute, Satna (MP), India, in patients presenting with symptoms suggestive of LPR, attending the ear, nose and throat (ENT) out-patients’ department (OPD) of the age group 18-65 years. Results: In both the groups the p value was calculated to be <0.05 and was found to be statistically significant. Both the groups showed appreciable improvement in their mean RSI and RFS score at 1 month and 3 months follow-up. In both the groups the p value was calculated to be <0.05 and was found to be statistically significant. Conclusion: Addition of magnesium supplements along with the regular treatment for LPRD, can improve LPRD symptoms and should be considered in the treatment protocol of LPRD.

94. To Evaluate the Frequency and Patterns of Different Cutaneous Granulomatous Lesions: Histopathological Analysis in Darbhanga Medical College, Laheriasarai
MD Shakir Ahmad, Ranjan Kumar Rajan, Chittaranjan Dutta
Aim: To evaluate the frequency and patterns of different cutaneous granulomatous lesions. Material &Method: A total of 100 cutaneous lesion biopsies showing granuloma formation studied retrospectically in the Department of Pathology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India over a period of 2 years. Clinical findings and other related information were obtained from requisition forms of biopsies received. Results: Infectious granulomatous dermatoses were very common, only one case of sarcoidosis was found. Most cases of infectious dermatoses were noted in 21 to 30 years comprising 38% cases. Conclusion: Leprosy contribute the major cause of granulomatous dermatoses in this study. Histopathology is gold standard for diagnosis and sub classification of cutaneous granulomatous lesion with a proper history and clinical details.

95. Prospective Comparative Assessment of the Functional Outcome of Surgical Management of Proximal Humerus Fracture by Different Modalities
Ranjan Kumar Prakash, Kumar Mayank, Dilip Kumar Singh
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 Orthopedics, JLNMCH, Bhagalpur for a period of nine months. 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: In this study, a total of 100 cases who fulfilled the inclusion criteria were enrolled. 54% of cases were females and 46% were males. 53% of the cases were between 41-60 years with 37% between <18-40 years and 10% of cases >60 years of age. The age range was from 19 to 68 years with a mean age of 45.7 years. 59% of the cases sustained fracture on the left side and 41% on right side. 72% of fractures were of closed type and 28% 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 35% of cases followed in order by three part (31%), four part observed in 26% of cases. 8 cases had fracture dislocation. Road traffic injury was the most common mechanism for injury in 51% of cases and next was a history of fall in 39% 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.

96. Prospective Cross Sectional Assessment of the Various Local Causes for and Management of Epistaxis by Using Rigid Nasal Endoscope
Sarika Kalra
Aim: To evaluate the various local causes for and management of epistaxis by using rigid nasal endoscope. Material & Methods: The present prospective study was undertaken to ascertain the role of rigid nasal endoscopy in the diagnosis and management of epistaxis at Department of ENT, MP Birla Hospital & Priyamwada Birla Cancer Research Institute, Satna (MP), India over a period of one year. Results: Majority of patients were in 21-30 age group (23.33) [p value – 0.05].21 patients with bleeding point in the crevices of the lateral nasal wall (BPCLW), which accounts for 35%, 14 patients with Posterior deviation of septum with spur (PDWS), which accounts for 23.3%. [P-value 0.05]. Conclusion: Nasal endoscopy is indeed a very useful procedure which aides not only in the localization of the bleeding point, but also in detecting the pathology and in the treatment of those bleeding sites.

97. A Study to Ascertain the Current Status of Interventional Radiology in Medical Students by Assessing the Knowledge, Exposure, and Interest of Interventional Radiology among Students from Medical Colleges: A Pan India Survey
Archana Verma, Pradeep Kumar Nayak
Aim: To ascertain the current status of IR in medical students by assessing the knowledge, exposure, and interest of IR among students from medical colleges in various parts of the country. Methodology: An online questionnaire was completed by Department of Radiology, Katihar medical College and Hospital, Katihar, Bihar, India for 1 year. Different college students were contacted and requested to volunteer in disseminating the information about the survey. The students were informed about the survey and the online link to questionnaire was posted in their common WhatsApp groups and shared further to more students. Responses were received from 1,500 medical students. The survey questions were formulated based on similar studies conducted in the past [11-13]. However, questions 7 and 8 were newly introduced to know their specialty inclination and to assess the exposure to cardiology (one of the popular higher subspecialties). Survey responses were arranged on a spreadsheet, statistically analyzed and results were obtained. Results: The 1,500 respondents comprised 792 (52.8%) males and 708 (47.2%) females. The majority (56.3%) of the respondents were currently in the clinical years of their training. With regard to their inclination of a career choice, 26.9% chose medical and 23.1% chose surgical as their choice of specialty. At the same time, 20.8% responded as they have an interest in both core specialties alike while 29.1% had not decided yet. Most (58.3%) of the students had exposure to the radiology department. Interventional Radiology services were present in 46.4% of the respondent’s institutions. Regarding their interest in radiology as a career, 43% responded positively, while 57% were either unsure or negative. About 23.9% of the students responded that they would consider IR as a career. The most common reason for not choosing IR as a career is lack of awareness about the specialty (59.7%), followed by the already made decision on another specialty before exposure to IR (27.5%). Desire for a relaxed lifestyle was the reason for 10.6% of respondents. There were also reasons like lack of patient interaction, threat from artificial intelligence, health reasons (familial tremors), and lack of formal training programs, which altogether comprised less than a percent. Conclusion: This study demonstrates that medical undergraduate students in India have a poor understanding of IR due to limited exposure to the sub-specialty. An intervention, in the form of introducing IR in medical undergraduate teaching may have a positive impact on the knowledge and skills of medical students and a critical understanding of the scope of practice in IR.

98. An Observational Assessment of the in-Vitro Antibiogram of Non-Fermenting Gram Negative Bacilli in a Tertiary Care Hospital
Sunil Kumar, Ravi Kumar, Arjun Lal
Aim: To identify non-fermenting Gram negative bacilli isolated from various clinical samples up to genus and species level along with study of their antimicrobial sensitivity/ resistance pattern. Methodology: This study was carried out in the department of Microbiology, over 200 samples of clinical specimens collected from in- patients admitted to various departments of ANMMC, Gaya during a period of 1 year study. A detailed history of the patients was recorded including the current underlying disease like Diabetes or malignancy. The samples for the study were collected from patients with NFGNB infection, admitted during the period of study. NFGNB was isolated from blood, CSF and other body fluids. Patients with colonization of NFGNB with no apparent clinical infection and isolates from improperly collected samples were excluded from the study. The samples were collected from respiratory tract (RT), pus, wound, urine and blood. A preliminary (gram stain) examination was carried out for RT, pus, wound and urine samples, following which they were incubated in appropriate media. Results: Pus samples constituted majority of specimens accounting for 45.5%. Urine and Sputum samples accounted for 14% & 13% of specimens respectively. Stool, Blood, Pleural fluid, Ascitic fluid and CSF samples accounted for remaining 27.5%. In the decreasing order of frequency, the NFGNB showed 54.41% sensitivity to Carbenicillin, 45.58% to Piperacillin and Tazobactam, 29.42% to Piperacillin, 26.48% sensitivity to Ticarcillin, 23.53% sensitivity to Amoxyclav, 16.18% sensitivity to Netilmicin and 7.36% sensitivity to Penicillin. NFGNB showed a sensitivity of 52.95% to Ceftazidime, 48.53% to Cefaperazonea and 42.65% to Ceftriaxone. Maximum resistance was observed for Cefuroxime and minimum for Ceftazidime. Ps. aeruginosa showed a sensitivity of 54.16% for Cefoperazone, 60.42% sensitivity for Ceftazidime, 49.84% sensitivity for Cefepime. Conclusion: This study gives an alarming sign towards high prevalence of multi drug resistant NFGNB. It may be concluded that growth of NFGNB cannot be overlooked and should be confronted with high index of suspicion. Precise identification of these bacteria up to genus and species level, imperative clinicmicrobiological correlation and careful antibiotic prescription shall go a long way in improving clinical outcomes of patients.

99. Outcome of Perforator-Based Flap for Reconstruction of the Soft Tissue Defects of the Leg: A Hospital Based Prospective Study
Mekhla, Goutam Guha
Background: Soft tissue reconstruction of the lower limb is challenging as there are chances of poor wound healing and also scarcity of tissue for local flap coverage. Due to limited mobility and paucity of overlying skin, even small soft tissue defects of the lower limb generally need flap coverage. So, present study, was conducted to assess the outcome of perforator-based flap for reconstruction of the soft tissue defects of the leg. Methods: This prospective study was conducted between September 2020 to November 2021 among patients admitted in Department of Plastic and Reconstructive surgery with soft tissue defects over lower limb. Patient’s socio-demographic characteristics and various pre-operative, intra-operative and post-operative variables were obtained using a predesigned and pretested questionnaire. For statistical analysis data was entered into a Microsoft excel spreadsheet and then analysed by SPSS. P -value ≤ 0.05 was considered for statistically significant. Results: In present study a total of 117 study subjects were enrolled. The mean age of patients was 33.91± 12.50 years. In our study, nearly three fourth of the patients (74.4%) were males. In our study we performed procedure for 32 (27.4%) lateral supramalleolar flap, 2 (1.7%) lateral calcaneal, 1 (0.9%) lateral sural artery perforator flap, 14 (12.0%) medial plantar artery perforator flap, 23 (19.6%) medial sural artery perforator flap, 1 (0.9%) medialis pedis flap, 16 (13.6%) peroneal artery perforator flap and 28 (23.9%) posterior tibial artery perforator flap. In our study, 2 (1.7%) flaps had infection, 8 (6.8%) flaps had marginal necrosis and 12 (10.3%) flaps had partial necrosis. We found that out of 117 flaps, 95 (81.2%) flaps had no complications and the overall flap survival rate was 89.7%. Conclusion: The overall survival rate, functional and cosmetic outcome of perforator-based flaps for lower limb soft tissue reconstruction is acceptable. Therefore, whenever possible it should be considered as a reconstructive option for coverage of soft tissue defects of lower limb.

100. To Estimate Serum Lipid Peroxide, Superoxide Dismutase, Glutathione Reductase, Zinc, Magnesium and Copper in Different Psychiatric Disorders
Chaudhary Ranjeet Singh, Devi Singh
Background: Health is considered to be wealth. All of us want to be healthy. However, where absence of illness is not healthy, a healthy person has a sound body. He is happy and contented. He has the ability to face difficulties, losses and frustrations. He is capable of living in harmony with others. Not only is he happy but is able to keep others happy. He sees that others are not put into trouble because of him; he has certain moral and spiritual values. Such a person who is physically, mentally, socially and spiritually alert can be considered to be healthy. The establishment of definite link between the variability of plasma or serum lipid peroxide levels and disease link arteriosclerosis, diabetes and heart ailment, has been largely responsible for an increased interest in these biochemical parameters. In the light of the above facts the present study was undertaken to evaluate the different biochemical parameters in the patients with psychiatric disorders. Aim: To estimate serum lipid peroxide, Superoxide dismutase, Glutathione Reductase, zinc, magnesium and copper in different Psychiatric disorders. To find out the biochemical changed occurs in Psychiatric disorders. Material and Method: The present study was carried out in the Department of psychiatry. A total of 150 subjects were enrolled for the study and were divided into 4 groups. They were selected from Psychiatric Ward. Consent was obtained from the attendants of the patients. The patients were randomly selected. To assess the serum lipid peroxide, Superoxide dismutase, Glutathione Reductase, zinc, magnesium and copper in different Psychiatric disorders. Groups are divided into following types: Group I: Normal patient Group II: Manic Depressive Psychosis, Group III:  Schizophrenia, Group IV: Other Psychiatric Disorders. Results: In psychiatric disorders there were a significant decreased levels of zinc and significant increased levels of serum lipid peroxide. Therefore, there was a decreased level of superoxide dismutase in the patients suffering from psychiatric disorders. Serum zinc levels in schizophrenia were significantly lower than controls. There appears to be a deficiency state of zinc in the patients. Serum copper levels in schizophrenia were found to be elevated. This may not have direct relationship with the disorders. In psychiatric disorders serum levels of all the four trace elements were abnormal. Zinc, magnesium and copper ‘V was lower than control. The lower levels of zinc, copper and magnesium appear to reflect an impaired ability of these patients to regulate copper, zinc and magnesium metabolism as a result of sub-optional functioning of nervous and neuroendocrine system in these patients. Conclusion: In psychiatric disorders serum levels of all the four trace elements were abnormal. Zinc, magnesium and copper ‘V was lower than control. The lower levels of zinc, copper and magnesium appear to reflect an impaired ability of these patients to regulate copper, zinc and magnesium metabolism as a result of sub-optional functioning of nervous and neuroendocrine system in these patients. Further, detail and controlled studies are required before any causal relationship is to be established with the alternation in the serum levels of these trace elements along with other parameters.

101. Study of Serum Uric Acid, SGOT, SGPT, and Testistorne Level Alcoholic Smokers
Rajendra Prasad Gupta, Nitin Chauhan
Introduction: Alcohol has a physical as well as a mental effect. Even moderate drinking appears to increase a person’s chance of death from a range of causes, including cancer and some forms of cardiovascular disease. This article will explain how alcohol affects your physical health and address some often asked questions about the short- and long-term effects of alcohol on the body. Binge drinking or taking a large amount of alcohol in a short period of time, puts a lot of strain on your physique and inside tissues (and dismiss outcome in sensation a legacy succeeding a consumption sitting). Excessive alcohol consumption causes headaches, severe dehydration, nausea, vomiting, diarrhea, and gastritis. Excessive drinking, even on a single occasion, increases the risk of heart problems. Aim: Study of Serum Uric Acid, SGOT, SGPT, and Testosterone Level Alcohol and Smoking Males. Material and Method: This study included total 40 males to age 20-55 years and divided in two groups one is once in week drinks and second group 5 to 10 cigarettes smoking per day. Previous history chronic alcoholic or last how many years consumed alcohol etc. included subjects were comes from OPD. Subjects under Observe Short-course focus in the Dept. of Medicine. Result: Table on shows that Comparison between biochemical parameters alcoholic males and Smoker’s males are serum Testosterone level are normal in both groups. The valves are shows statistically significant. P < 0.0001. Conclusion: Excessive alcohol consumption in the body on a regular basis in males has been shown to raise the risk of heart illness, liver disease, and renal disease, but some studies have shown that it can also create difficulties in the reproductive system.

102. A Community Based Assessment of the Determinants of Knowledge and Practices of Postnatal Mothers on Essential Newborn Care in a Selected Area of BiharSmokers
Preeti Kumari
Aim: To assess determinants of the knowledge and practices of postnatal mothers on essential newborn care. Material & Methods: A community based cross-sectional study was conducted among 200 postnatal mothers and neonates dyads in the one of the selected Primary Health Centers (PHC) of the Intensive Field Practice Area (IFPA) of the Comprehensive Rural Health Services Project (CRHSP). Birth register at every sub-center was referred for making a list of postnatal mothers delivered during the study period. Postnatal mothers were contacted by making home visits along with ASHA (Accredited Social Health Activists) workers and enrolled using convenience sampling techniques. Results: The mean knowledge scores of postnatal mothers on ENBC was 24.72 ± 6.60. More than half of postnatal mothers (67%) had moderate knowledge. The mean practice scores of postnatal mothers on ENBC were 23.71 ± 3.52. More than two-thirds of postnatal mothers had adequate practices. Conclusion: Some gaps were observed in the adopting safe practices in the domains of thermal control, breastfeeding, cord care and eye care among the postnatal mothers; necessitating need for education, reinforcement and dispelling the cultural beliefs.

103. Impact of MgSO4 Infusion on Elective Neurosurgery Propofol Dosage Reduction
Kumar Ashim, Kumar Abhishek, Bharati, Rahul Katiyar, L.D. Mishra, Sourabh Kumar
The potential benefits of using magnesium sulphate as an adjunct to propofol-fentanyl anaesthesia were explored due to propofol’s inability to enhance neuromuscular block and the requirement for early postoperative analgesia with fentanyl. This study examines the impact of mgs04 infusion on the necessary propofol dose during elective neurosurgery procedures conducted under propofol infusion anaesthesia. The study was conducted in a hospital in Varanasi, India. Following approval from the Institutional Ethical Committee, patients were required to provide written informed consent prior to their inclusion in the study. The age range of patients in both groups is 20-60 years. The mean age in group T (MgSO4 group) is 41 years with a standard deviation of 12.21 years, while in group C (saline group) it is 37 years with a standard deviation of 10.08 years. In summary, the use of magnesium during surgery has beneficial effects such as anaesthesia, pain relief, and muscle relaxation. This results in a decreased need for anaesthesia drugs during total intravenous anaesthesia.

104. Role of Luteal Phase Serum Biomarkers in Predicting Pregnancy Outcome in ICSI Cycles: A Prospective Cohort Study
Kriti Prasad, Kumar Abhishek, Saurabh Toppo, Bharti, Kuldeep Jain, Sourabh Kumar
Introduction: Pregnancies achieved by IVF-ET cycles are at increased risk of adverse outcomes when compared with natural pregnancies or those achieved by ovum donation cycles. The aim of this study is to evaluate the prognostic value of serum biomarkers progesterone and estradiol and to determine their optimal cut-off values at seven days post ET in predicting pregnancy outcome in women undergoing ICSI cycles. Methods and analysis: This is a prospective cohort study that was conducted at KJIVF. All patients with definite indication for ICSI are included. Standard protocol and procedures were observed as per patient protocol. Inclusion criteria: All patients undergoing ICSI. Exclusion criteria: All patients undergoing FET, Embryo Donor or Egg Donor Programs. All patients received progesterone and estrogen support after ET. Serum progesterone levels and estradiol levels were measured at Day 7 post ET. Hormone assays: Serum progesterone and estradiol is measured by ELISA in units of ng/ml and pg/ml respectively. Results: AUC of E2 is .722, AUC of P4 is .784 well within 95% confidence interval which emphasizes on significance of predicting the pregnancy outcome. Conclusion: A significant correlation was found between day 7 level of progesterone and estradiol and pregnancy outcome post ET.

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