International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1.A Comparative Study of Sensory Nerve Conduction Indices in Hypothyroid Patients and Healthy Volunteers
Komal Sharma, Jyotsna Shukla, Abhishek Saini, Praveen Choudhary
Introduction: Thyroid hormone is important for neuronal cell integrity and cytoskeletal stability operating via regulation of various stress response intracellular signalling and target molecules. Alteration in thyroid hormone signalling in nerve and other tissues underlie observed manifestations like neuropathy and aberrant nerve conduction. The neurological complications are well established in hypothyroidism, however the exact pathophysiological events culminating in development of these complications are still obscure. Aim and Objective: In view of the same, the present study was aimed towards exploring the possible missing links by assessing and comparing the extent of peripheral sensory neuropathy and its relation to disease duration among hypothyroids and matched controls. Materials and methods: Nerve conduction parameters were recorded from 32 hypothyroid patients and 32 age and sex matched healthy control subjects. Sensory nerve study (SNS) of bilateral median nerve and bilateral sural nerve were recorded and compared. Results: Significant changes were observed in the form of reduction in sensory nerve conduction velocity (SNCV) (p<0.05) in both examined nerves in hypothyroid patients in comparison to healthy control subjects. We also found significantly reduced amplitude (p<0.05) and prolonged sensory latencies (p<0.05) among hypothyroid patients as compared to healthy control subjects. Also, significantly reduced sensory amplitude of median nerve and sural nerve were observed in hypothyroid patients who suffered from the disease for a period of 5 years or more. Conclusion: The present study proffered that the sensory polyneuropathy associated with hypothyroidism was largely of mixed type (demyelinating as well as axonal type). Also, the present study recommends performance of nerve conduction studies in cases of hypothyroidism early in the course of the disease for timely detection and management of peripheral nerve dysfunctions.

2.Analysis of Diagnostic Value of Gram Stain in Comparison to Culture of Sputum Samples at A Tertiary Care Hospital
Esha Singhal, Manjari Kumari, Prashant Bhardwaj
Introduction: Sputum Gram stain and culture are routinely done to determine the causative organism in case of lower respiratory tract infections. Sputum culture takes much more time to give results as compared to Gram stain that’s why Gram stain is valuable in guiding empirical treatment for the patients but Gram stain report alone is not always reliable. Aim: Aim of this study was to analyze the diagnostic performance of Gram staining in comparison to sputum culture results for lower respiratory tract infections. Materials and methods: Study was performed in a 690-bed, tertiary-care hospital of northern India. A total of 477 expectorated sputum samples which were collected in sterile containers were included in this study. Results: A total 311(65%) samples were identified as a good sample, and the count of fair and poor samples were 109(23%) and 57(12%) respectively. Poor sputum samples gave positive Gram stain results and negative cultures more frequently as compared to good & fair samples (p<.05) whereas good quality sputum samples more frequently gave Gram stain results that were compliant with the culture results either positive or negative (p<.05). In good quality sputum samples (311) number of culture positive and Gram stain positive or true positive were 172(55%). The sensitivity, specificity, positive predictive value and negative predictive value for Gram staining in good grade samples were 95.03%, 28.46%, 64.91% and 80.43% respectively (p <0.00001). Conclusion: Consistent interpretation of Gram stain results can be challenging. Correct interpretation of Gram stain results by the physician can improve the choice of antibiotics and thus can greatly reduce morbidity and mortality in critically ill patients.

3.Alobar Holoprosencephaly: A Rare Case Report
Samira Kumar Behera, Lipika Behera, Swetambari Acharya, Dipika Mishra, Chaitali Pattnaik, Shushruta Mohanty
Holoprosencephaly (HPE) is a rare congenital anomaly that occurs due to failure of prosencephalon to develop into two cerebral hemispheres. It results in brain malformation associated with multiple midline facial defects that occurs usually in 4th to 8th week of gestation. Most affected fetuses do not survive; severely affected children typically do not survive beyond early infancy, while a significant proportion of more mildly affected children survive past 12 months. We here in discuss a case of alobar holoprosencephaly in a fetus with midline facial defects that was detected clinically on USG scan. We received a dead fetus of about 21 weeks gestational age for autopsy. On external examination it had deformed facial structure like single eyeball(cyclopia) placed beneath tubular nose (Proboscis). A detail perinatal autopsy was conducted according to protocol which revealed alobar forebrain and dialated ventricles. Other visceras were normal externally and microscopically.

4.Satisfaction Level of Cancer Patients using Ramosetron and Ondansetron: A Comparative Study
Kauser Sayedda, Quazi Shahir Ahmed, Pankaj Kumar Verma, Deepak Chopra, Abdul Shaheer Umar
Background: To compare level of satisfaction of the patients receiving Ramosetron and ondansetron in prevention of acute and delayed nausea and vomiting associated with chemotherapy. Methods: 60 patients were recruited in the study and were allocated to two groups (Ondansetron and Ramosetron group). Patients were initially screened and then study visits included clinic visits on day 8, day 9 and day 14. Patient diaries were used to record patients’ satisfaction which was based on severity of nausea and vomiting using visual analogue scale (VAS). Results: VAS score was significantly lower in Ramosetron group as compared to Ondansetron group in acute phase of nausea and vomiting indicating level of satisfaction higher in Ramosetron group. Similarly, in delayed and overall phase Ramosetron group experienced lower range of scoring on VAS scale as compared to Ondansetron group. The difference was statistically significant (p<0.01). Conclusions: Level of overall satisfaction of the patients in Ramosetron group was significantly higher as compared to Ondansetron group in patients receiving the two drugs for prevention of nausea and vomiting caused by cisplatin chemotherapy in head and neck cancer patients.

5.The Incidence of Tuberculosis Among Children, Adolescents and Young Adults: An Observational, Hospital Based, Single-Center Study
Minali Raja, Tanvi Singh, Rashmi Singla, Shashi Upreti
Background: Historical data show that the risk of tuberculosis increases dramatically during adolescence, and young people face unique challenges in terms of case detection and effective treatment. However, little is known about the burden of tuberculosis among young people in the modern era. This study aimed to assess the regional incidence of tuberculosis among children, adolescents and young adults aged upto 40 years. Objective: This observational, hospital based, single-center study aimed to assess the incidence of tuberculosis among children, adolescents and young adults. Materials and Methods: This study was carried out in the Department of pathology, Himalayan Institute of Hospital trust, University, Swami Ram Nagar, Dehradun with 284 patients over a period of 12 months between March-2008 to March-2009. The data was entered; tabulated and statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS 24.0) and Graph Pad Prism Version 5. A value of p<0.05 was considered significant. Result: In this study, the maximum cases 30.28% (n=86) were seen in the third decade followed by fourth decade 19.36 % (n=55). The youngest patient recored in our study was of only 2 years old while the oldest patient recored in our study was of 40 years old. Incidence of tuberculosis was highest in the third decade whereas lowest in 1st decade of life. In females, 04 cases each were recorded between 21-40 years for tuberculosis of the Female Genital Tract and Breast, whereas no cases were recorded between 0-20 years for tuberculosis of the Female Genital Tract and Breast. In males, 04 cases recorded between 11-30 years for tuberculosis of the Urogenital Tract, whereas no cases were recorded for 0-10 and 31-40 years for tuberculosis of the Urogenital Tract. Conclusion: The current study highlighted the agewise distribution of regional incidence of tuberculosis cases in the study patients.

6.Association of Serum Ferritin in Type 2 Diabetes Mellitus Patients- An Observational Study
Sarin S M, Sarosh Kumar K K, Binulal V Bhaskar, Balakrishnan Valliyot
Introduction: Serum ferritin and iron load are proposed to be having significant role in etiopathogenesis of type 2 diabetes mellitus. Our study intends to determine the association of serum ferritin levels in type 2 diabetics of South Indian origin. Methodology: Consecutive type 2 diabetic patients attending medicine op department of a tertiary care centre between the age group of 40 to 70 years are included in the study. The data regarding clinical history, physical investigation and relevant biochemical investigations including HbA1c, Serum Ferritin, Fasting blood sugars were collected of the study population using pre validated questionnaire. Results: 150 patients were studied with mean duration of diabetes of 6.69 ± 3.63 years were included in the study. Mean HbA1c and serum ferritin levels of study population were 8.84 ± 1.68 and 159.40 ± 84.72 respectively. HbA1c, fasting blood sugar and serum triglyceride values had statistically significant correction with serum ferritin levels whereas there was no significant correlation noted with duration of diabetes. A simple linear regression showed that patients’ average HbA1c level increased 0.01 % for every 1ng/ml rise in serum ferritin value. Conclusion: Study shows that serum ferritin is having strong correlation with HbA1c levels and is a good marker of overall diabetic control.

7.A Prospective Clinical Association of Glaucoma with Systemic Hypertension and its Effect on Visual Morbidity
Archana Kumari, Govind Kumar Mandal, Uma Shankar Singh
Aim: To evaluate the association between hypertension and occurrence of glaucoma. Methodology: A prospective study was conducted over a period of 1.5 years in the Department of Ophthalmology, JLNMCH, Bhagalpur, Bihar, India including 100 patients between the age groups of 30 to 70 years diagnosed with hypertension. Patients with other systemic diseases or vascular pathologies were excluded from the study. All the patients were followed up for at-least 6 months and the need for regular review visits was explained to them. During the first visit and each follow up opinions regarding the progress of hypertension was obtained from departments of cardiology and internal medicine. The oral hypertensive medication taken by patients were categorized into 5 groups as calcium channel blockers (CCB), diuretics, angiotensin converting enzyme inhibitors (ACE), angiotensin receptor blockers and beta blockers. A detailed history of age, sex, duration of hypertension, history of other co-morbidities and treatment were collected. The participants then underwent a detailed ophthalmological evaluation. IOP measurement was done by applanation tonometry with Goldman Applanation Tonometer. The same procedure was repeated in the other eye. Phasing technique of repeating recordings was done and the average IOP was used in the study. Visual field assessment was done using Humphrey’s Automated Perimeter. Results: Among the 100 hypertension patients involved in the study, 58% patients were found to have glaucoma. 52% patients were female, and 48% patients were male. Age group affected was 11% between 30-40 years, 14% between 41 to 50 years, 26% between 51 to 60 years and 49% between 61 to 70 years. 35.8% patients taking CCB, 44% taking ACE inhibitors, and 42.2% taking ARB, 60% taking beta blockers, and 42.8% taking diuretics had reduced IOP. The range of IOP in the treated population was between 10-16mmHg and this difference in those on hypertension medications was statistically significant. Conclusion: It can be concluded from this study that there is a correlation between higher systemic blood pressure and higher intraocular pressure, and this also produces effects to be regarded as risk factors for glaucoma.

8.A Prospective Cross–Study to Determine the Prevalence of Refractive Errors among the School Going Children in Bihar
Govind Kumar Mandal, Archana Kumari, Uma Shankar Singh
Aim: The objective of this study is to find out the prevalence of refractive errors among school children. Methodology: The study was conducted by the Department of Ophthalmology, JLNMCH, Bhagalpur, Bihar, India from a period of 1 year. There was a random selection of 500 children from eight schools of Bhagalpur, Bihar region aged 5-15 years studying in Class 1 to Class 10. All subjects were brought to the Outpatient Department of Ophthalmology at JLNMCH, Bihar. It was a prospective study, cross–sectional in design. Written informed consent was obtained from each study participant. Confidentiality was maintained at all levels of the study. Patients who were found to have ocular complaint and refractive error were referred for further investigations and management. Results: A total of 500 children participated in the study. Out of 500 children, 242 (48.4%) were boys and 258 (51.6%) were girls. The most frequently reported ocular problem was eye pain (24.6%) followed by watering from eye (23.6) while reading or watching TV/mobile (23.6%) and headache while reading (19.6%), Blackboard not seen properly (14.4%), difficulty in reading books (12.2%). Also, (5.6%) of the students reported difficulty in seeing at night. Overall, 19.6% children were suffering from refractive errors, out of which 9% were previously diagnosed and 10.6% were newly diagnosed. Conclusion: Refractive error among children is a common problem and needs to be assessed regularly for early intervention. The present study indicates that the school age represents high risk group for refractive errors. Screening of the children for vision at the time of school admission and periodical eye examination of the children is recommended for early rectification of impaired vision.

9.Prospective Case Control Assessment of the Maternal Fetal Outcome in Multiple versus Singleton Pregnancies Delivered PMCH, Patna, Bihar
Priyanka Shahi, Neena Agrawal, Geeta Sinha
Aim: To compare the maternal and fetal outcome in multiple versus singleton pregnancies in PMCH, Patna, Bihar. Material & Method: This was a prospective case control study between twin deliveries (cases) beyond 24 gestational weeks and demographically matched singleton deliveries (controls) immediately following those twin births, were carried out in the Department of Obstetrics and Gynecology, PMCH, Patna, Bihar, India from October 2021 to February 2022. Results: There were 2901 births during the study period, among them 60 were twin births, which were compared with 60 singleton births. Mean parity for twin and singleton deliveries were 3.7±1.8 and 1.88±0.8, mean gestational age were 37.8±3.7 weeks and 39.6±2.7 weeks respectively. Anemia complicated 5 times more often in twin pregnancies than singleton pregnancies (OR: 6.528, CI: 0.92-25.62), similarly hypertension complicated 3.2 times more often than controls (OR; 3.819, CI: 0.86-11.2). Conclusion: Despite improvement in antenatal and neonatal care, twins pose a higher threat to MCH outcome. Hence, thorough counselling, patient awareness, more vigilance at interpretation of antenatal tests, intrapartum monitoring and bridging the gap between demand and supply at NICU facility can improve maternal and neonatal outcome; as well as can help parents cope with the psychological stress.

10.Ectopic Pregnancy: Assessing the Incidence, Risk Factors, Clinical Characteristics, Diagnosis, Treatment, and Maternal Outcome in Tertiary Care Hospital
Anupam Kumar Chaurasia, Girija Kumari
Aim: The present study aims at determining the incidence, risk factors, clinical features, diagnosis, management and outcome of ectopic pregnancies. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India in opd and ipd from April 2019 to February 2022 antinatal check-up. Total 120 cases were diagnosed with ectopic pregnancy. Results: The incidence of ectopic pregnancy (0.029%) or 2.9 per 1000 antinatal up to 20 weeks. The most common site of ectopic pregnancy was fallopian tube 102(89.17%). Ampulla was the commonest site 90 (75%) for ectopic implantation in the fallopian tube. Heterotopic pregnancy is rare where pregnancy is seen in the uterus and tube at the same time. In our study, there were 3 (2.5%) cases of heterotopic pregnancies. The most common risk factor was pelvic inflammatory disease 55(45.83%) followed by H/o previous abortion 25(20.83%) and H/o previous abdominopelvic surgery including tubal ligation, LSCS and appendicectomy 32(26.67%). In our study, 17(14.17 %) patients were using copper IUCD. 67.5% of the patients had bleeding or spotting per vaginum. Urine pregnancy test was positive in 113(94.17%) of patients. Culdocentesis was positive in 53(44.17%) of patients. Ultrasound was able to diagnose 99(82.5 %) of cases. USG findings suggestive of ectopic pregnancy were extra-uterine gestational sac 15(12.5%), haemoperitoneum 71(59.17%) and adnexal mass 91(75.83%). The incidence of ruptured ectopic pregnancy was 88%. 97.5% of the patients received one or more units of blood transfusion intra operatively and/or post operatively. All the patients with ectopic pregnancy were managed surgically. 95% patients underwent laparotomy and 5 % patients had laparoscopic treatment. 95% patients underwent unilateral or bilateral salpingectomy or salpingoophrectomy. Milking of tube was performed in 2.5% of patients. Concurrent dilatation and curettage were performed in the patients who had heterotopic pregnancy 3 (2.5%). There was no maternal mortality in the present study. Conclusion: Early diagnosis, timely referral, improved access to health care, aggressive management and improvement of blood bank facilities can reduce the maternal morbidity and mortality associated with ectopic pregnancy.

11.Analysis of Maternal Morbidity and Mortality in Hepatitis E Virus Infection in Pregnant Women
Shikha Jain, Shammi Kumar Jain, Preeti Nigotia, Gorav Jain
Aim: To analyses of maternal morbidity and mortality in hepatitis E virus infection in pregnant women. Method: A prospective study was conducted over a period of 1 year in a tertiary care hospital of Delhi. Total of 48 HEV positive patients confirmed by anti IgM test were included .Demographic profile along with antenatal and postnatal complications of patients were studied. Result: The mean age of women was 23.5year.The mean gestational age of women was 32 week. Mean gravidity was of the total 48 pregnant women; 38 delivered and 10 undelivered. Of these 35 was vaginal delivery (72.9%) (27 preterm, 08term) and 03 (6.25%) underwent caesarean section. Maternal morbidity were studied in terms of admission in intensive care unit 15 (31.25%) coagulopathy 04 (8.3%), postpartum haemorrhage 04 (8.3%), intrauterine growth retardation 03(6.25%), and sepsis 01(2.08%). Maternal mortality was occurred in 12 out of 48 cases (25%).While all 12 mortality reported in postnatal period, no mortality found in antenatal period. Most of postnatal death occurred due to hepatic encephalopathy (n=8) after 1 week of delivery. All these patients had hepatic encephalopathy at the time of admission. 34 babies were born alive, among them 20 (41.6%) were shifted to newborn intensive care unit (NICU). Conclusion: Maternal prognosis is poor in HEV positive patient particularly in postnatal period. HEV infection can be prevented by good sanitation measures while development of encephalopathy can be prevented by earlier and careful evaluation of mental status .By doing this we can reduce the burden of maternal mortality to some extent.

12.Comparison of two Suture Techniques on Postoperative Healing of third Molar: An Original Study
Bhupinder Kumar, Debasis Sahu, Sarada Challa, Praveena Adusumilli, Shiny Mounica Penumudi, Madhur Arora, Afroz Kalmee
Introduction: Minimizing post-operative complications following lower third molar surgery is a key component of patient care. Modification of the wound closure technique is one of these simple measures which have a crucial effect on the post-operative course, in patients undergoing lower third molar surgery. This study aims to determine which of the two secondary closure techniques assessed is superior in improving wound healing, and reducing post-operative complications, following lower third molar surgery. Material & Methods: A prospective, randomized clinical study was conducted to compare partial closure using one suture to the suture- less technique. Surgical sites were divided into two groups, Group A: one suture, and Group B: suture-less. Each patient received both treatments at the same time. During the first post-operative week, all patients were asked to daily assess pain, trismus & facial swelling using subjective self-assessment scales. Results: Our study showed that the age interval ranged from 20-40 years with an average age of 26.2 years. The results demonstrated that post- operative pain and wound healing are influenced by the type of the closure technique used by the surgeon. Conclusion: It can be concluded that that the placement of one suture, distal to the lower second molar, after raising a small buccal envelope flap for lower third molar surgery, is superior to the suture-less technique, in decreasing postoperative pain and enhancing wound healing.

13.Odontogenic Infection: A Review
Debasis Sahu, M. Martha Florence, Shiny Mounica Penumudi, Sarada Challa, Surapaneni keerthi Sai, Madhur Arora, Afroz Kalmee
Odontogenic infections are frequently seen in the dental practice, being dental caries its main etiology; therefore, dentists should be familiarized with its presentation and management as it can spread rapidly and have serious consequences. The purpose of this article is to provide essential knowledge on the pathogenesis, diagnosis, possible complications and treatment of odontogenic infections.

14.A Study of Anti-inflammatory Activity of Nigella Sativa in Experimental Models of Acute & Subacute Inflammation
Tripathi A, Mishra S, Bist A, Sayedda K, Ahmed QS, Chopra D, Gupta P
Aims and objectives: To evaluate antiinflammatory activity of Nigella sativa seeds in acute & sub-acute models of inflammation in rats & to compare it with control & indomethacin. Materials & Methods: Male wistar rats of weight 100-150 gram were used in the study. Ethanolic extract of N.sativa was used to evaluate antiinflammatory activity by carrageenan induced hind paw edema, kaolin induced paw edema & cotton pellet granuloma by oral gavage method. Institutional Ethical Committee approval was taken before start of study. Results: In model of acute inflammation i.e. carrageenan induced paw edema in rats, N sativa in graded doses & indomethacin exhibited antiinflammatory activity which was statistically significant as compared to control (p<0.05). Anti-inflammatory activity with 500 mg/kg & 1000 mg/kg Nigella sativa were not significantly different (p>0.05) to those of Indomethacin at all-time intervals tested. In kaolin induced paw edema, similar results were obtained as that of carrageenan induced paw edema. In cotton pellet granuloma method, N. sativa significantly decreased the formation of granuloma tissue as compared to control. There was a significant (P< 0.05) decrease in weight of cotton pellet at day 14 in all the groups treated with graded doses of N. sativa and Indomethacin in comparison to control group. Weight reduction of granuloma in N. sativa 1000mg was not significantly different (p>0.05) from Indomethacin group. Conclusion: The results suggest that N. sativa has significant anti-inflammatory activity that is comparable to that of indomethacin at 500mg/kg & 1000mg/kg.

15.Establishing Cephalometric Norms of Yen, W and Beta Angles with Evaluation of Sagittal Jaw Relationship in Guntur District Population: An Original Study
Sreelekha S, Debasis Sahu, Meesala Neeraja, Ramya Alla, Shaik Asma Sultana, Afroz Kalmee Syed
Aim: The purpose of this study was to assess the validity of the Yen, W, and Beta angles, as well as to compare them to other regularly used sagittal measurements in the South Indian population. Methodology: A total of 200 Andhra subjects (Dravidian) were considered for the study. ANB, Wit’s appraisal, Beta angle, W angle, and YEN angle were all traced on the lateral cephalograms. With the patient in Natural Head Position, sitting Condyle, and Passive Lips, a Lateral Cephalometric Head film was taken. The cephalograms were then traced by the same operator, resulting in the study’s Cephalometric database. The study’s final results were compared between males and females to ensure that they met acceptable standards. Results: There was no statistically significant difference between the genders. As a result, a single normative range for both genders might be provided. The findings suggest that all five skeletal cephalometric sagittal studies, namely the ANB angle Wit’s analysis, BETA angle, YEN angle, and W angle, are reliable and may be utilized in diverse populations without producing significant differences in the results. Conclusion: Based on the findings of this study, no statistically significant differences in any of the parameters were discovered between the subjects of the Local population, as well as between males and females. ANB angle, Wit’s analysis, BETA angle, YEN angle, and W angle can be employed based on the above assertion because they are dependable.

16.Assessment of Enamel Colour Variations using Different Orthodontic Adhesives: An in Vitro Study
Meesala Neeraja, Debasis Sahu, Sreelekha S, Ramya Alla, Afroz Kalmee Syed, Praveena Adusumilli
Introduction: Aesthetics is a crucial aspect of orthodontics, and color is a big part of it. The irreversible penetration of resin tags into the enamel structure at depths of up to 50 meters may cause enamel color changes. The goal of this study was to analyze enamel color changes in an in vitro investigation utilizing various orthodontic adhesives. Methodology: Forty removed human premolar teeth were collected and they were divided into four equal groups and compared for color variation caused by photo aging for the various bonding agents. ANOVA and Post hoc analysis were used to compare significance. Results: We observed a significant change in there was a significant variation in the E1 between the TRANSBOND XT, ORMCO, RELY A BOND, and BRACEPASTE. However there was no variation for the E2 and E3 between the groups. Conclusion: After debonding and finishing, Ormco Enlight demonstrated the maximum enamel color change of E2 value 2.92. Rely A bond with an E2 value of 2.80 had the least enamel color change. There is a considerable color shift in the enamel in all of the groups investigated, however it is less than the minimum threshold value of E 3.7 units.

17.To Assess the Role of to Cilizumab with or without Remdesivir in Covid-19 Diabetic Patients
Monika Gaur, Sujeet Kumar Jangid, Shefali Mehta, Ronak Jain, Aditi Mehta, Vishwa Mehta
Background: The clinical presentation of Covid-19 positive person can range from asymptomatic to severe pneumonia with acute respiratory diseases. The major impact of Covid-19 is identified on respiratory system of the human and leading to death. There are different types of treatment options available for managing the health of the people but first was remdesivir that approved by the FDA. The dexamethasone has been associated with decreased mortality in recovery of the medicine trail. Apart from this, the major benefits of interleukin 6 antagonists are still subject of debate as tocilizumab FDA approved the interleukin 6 for treatment considering the side effects too. Aim: The study aims to assess the role of tocilizumab with or without remdesivir in COVID-19 diabetic patients. Method: The current study is retrospective, single centered, observational cohort and based on the patients who were diagnosed with Covid-19 considering the PCR test and hospitalized at ESI Chitrakoot Nagar, Udaipur under RNT Medical College, Udaipur from October-20 to December-21. The study has involved the patients who were 18 years and older and had the clinical association with diabetes mellitus. Moreover, the respiratory findings also defined as infiltrates, SPO2 < 93% on room air and requirements of respiratory assistance. For the current study, the data was collected related to demographics, co-morbidities, symptom, oxygen support category, laboratory values and outcome of the therapies. The level of oxygen support was analyzed considering the ACTT-1. Results: There were total of 127 patients considered for analyzing the role of tocilizumab with or without remdesivir in COVID-19 diabetic patients. The group 1 is involving the 54 patients and group 2 has 73 covid-19 patients. According to the outcome of the analysis, the mean age of both groups were 62 and 64 years for group 1 and 2. There was significant difference identified for respiratory support received by the patients and obesity, COPD and CVD. However, there was no significant difference found for diabetes patients as the P value was more than 0.05. As per the outcome of the study focusing on the Chi Square, most of the variables have shown significant difference but Remdesivir, and low vitamin D levels have shown the no significant difference. Conclusion: From the analysis, it has been concluded that the combinations of tocilizumab and remdesivir did not have any significant difference in mortality but the patients who recovered from the covid-19 has influenced with diabetic issues. The improvement in practice and advancement in laboratory trail has helped to improve the effectiveness of these treatment options.

18.Comparative Study of Fixation versus Conservative Treatment of Posterior Malleolar Fragment in Ankle Fractures
Deependra Sonkar, Akhil Bansal, Shubham Chourasiya, Brajesh Meher, Suneet Tandon
Background: Ankle fracture involving posterior malleolus, whether to fix it or not has always been a subject of controversy for a long time. Aim of this study was to compare the outcomes of fixation vs conservative treatment of trimalleolar ankle fractures. Material and Method: A total of 30 patient with ankle fracture were taken into study. In group I Posterior malleolus fracture was fixed by means of screw or plate in 18 patients  along with medial and lateral malleolus while in group II posterior malleolus fracture was left unfixed in 12 patients .In addition to reduction quality at fracture site, pain and range of motion at ankle joint was assessed in each follow up. Results: The mean follow up was 12 month. Ankle pain and motion was assessed according to Olerud and Molander scoring system. The score was found significantly higher in group I. Conclusion:  Fixation of posterior malleolus restores the articular surface and helps in maintaining the congruity of tibial plafond. These results suggested that posterior malleolar fracture fixation has better functional and radiological outcome in an ankle fracture.

19.Study of Spinal Cord Injury in Tertiary Care Hospital of Bhopal City
Anupam Surendran, Devendra Chaudhary, A P Sharath, Sudhir Singh
Objectives: To evaluate outcome and prognosis of spinal cord injury in patients admitted in Tertiary care hospital of Bhopal from July 2019 to June 2021. Methods: Consecutive Spinal cord injury cases admitted from July 2019 to June 2021 were evaluated on a preformed proforma for demographic factors, epidemiological data and neurological status. Exclusion criterion – Patient admitted after 15 days of injury, Patient operated outside and Patients sustaining spinal column injury without cord involvement or with nerve root injury. Results: In 140 cases of Spinal cord injury, 73 were cervical and 67 had thoracolumbar injuries, with male to female ratio of 3.8:1 and 71% in the age group of 20–49 years. Around 79% patients were from rural background. Among the causes of injury, 53% patients had a road traffic accident and 28% had fall from height. Fall of heavy object overhead and back (10.7%), fall with heavy object overhead (3.0%) and fall following electric shock (4.0%) were uncommon causes. Complete paralysis was found in 20.5% cervical and 23.3% in thoracic injuries. Extremity and rib fractures (10.6%) and head injuries (7.2%) were common associated injuries. About 55% cases were initially attended at non-specialized centers. Conclusion: The present study found no significant difference in the length of stay and degree of neurological recovery between the patients treated by non-operative and operative methods. Therefore, the value of surgery in the management of spinal cord injury remains undefined and must await the performance of a rigorously controlled, randomized, prospective study.

20.A Study of Complications after Ileostomy Reversal in a Tertiary Care Center
Sulaksh Mittal, Sudhir Singh, Kunal Vaidya, Devendra Choudhary
Background: Closure of a loop ileostomy or colostomy is relatively a simple procedure although many studies have demonstrated high morbidity rates following it. Methods to reduce number of complications are investigated. The aim of this study to determine complications after ileostomy closure. Objectives: To study the incidence of complications of ileostomy reversal and also the potential risk factors leading to complications after ileostomy reversal. Study design: Prospective cohort study. Methods: Data from 108 patients who underwent closure of stoma from December 2019 to August 2021 at Hamidiya Hospital, Bhopal (MP) were collected including demographics, causes of ileostomy formation, additional diseases, time from creation to closure of stoma, duration of operation, postop complications and duration of stay after surgery. Results: Complications occurred in 55 patients at different follow up periods in total 108 patients undergoing stoma reversal of variable age. 25% (n = 14) of patients had surgical site infection, malnourishment 7.4% (n=8), incisional hernia 6.5% (n=7), diarrhoea 5.6% (n=6), bowel obstruction 4.6% (n=5), anastomotic leak 0.9% (n=1). Most common potential risk factors after complications were low Hb, critical status of the patient, sunken stoma and comorbidities. 2 patients died (1.8%). Conclusion: Meticulous care and attention to advanced techniques and methods, post operative education regarding stoma care and its resumption and multidisciplinary follow ups reduces post op stoma creation or closure complications.

21.A Study to Evaluate Hypercoagulable State in Patients of Chronic Obstructive Pulmonary Disease
Shivani Chaturvedi, Vishwas Gupta, Vikas Kumar Mishra, R.S. Chatterjee, Sourabh Jain
COPD is a multisystem disorder associated with pulmonary and systemic inflammation. This systemic inflammation contributes to various extra pulmonary manifestations of COPD. Exacerbations are associated with increased airways inflammation. In this study we studied prothrombotic state in COPD patients by analysing fibrinogen and D dimer levels. Aim and Objectives: To study the prothrombotic markers plasma D-dimer and fibrinogen levels in stable COPD patients and during exacerbation and to compare the above parameters during exacerbations of COPD on day 1 and after stabilization, and its significance if any. Material and Method: 30 patients with COPD exacerbation were studied. Blood samples were obtained for fibrinogen and D-dimer levels  on two different occasion-on day 1 of admission and at follow up when clinically stable after day 5 in exacerbation group and on entry of study in stable COPD group. Data were compared in both groups. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. Result: Most patients fall into the age group 41-70 year corresponding to the peak age group of COPD population. The sex distribution is study is 47 were male (78%) and 13 female (22%). All patients were smoker. The smoking mean was found to be 25±5.9 pack years. , the mean value of fibrinogen in COPD exacerbation group was 491±225mg% which declined to 267±89mg% after stabilization. In stable COPD group, the mean value of fibrinogen was 426.86±144.0mg%. In conclusion, we have demonstrated in the study the presence of a hypercoagulable state in COPD patients. However, the present study has the limitation of small sample size. Further studies are needed to identify the exact mechanisms underlying the hypercoagulative state in COPD, and to determine whether anticoagulant therapy is clinically useful in COPD.

22.A Clinico Histopathological Study to Identify Non Diabetic Renal Disease in PTS of Type 2 DM with Renal Involvement
Lavanya Mandli, Shamsheer Khan, SS Rama Kalyana Praveen
Background: Both diabetic nephropathy (DN) and nondiabetic renal disease (NDRD) are reported to occur in patients with type 2 diabetes mellitus (DM). The precise diagnosis of the type of nephropathy has obvious clinical, therapeutic and prognostic implication. Aim: The aim of our study was to find out the frequency of nondiabetic kidney diseases in patients of type 2 DM with renal involvement. Methodology: Sixty-five type 2 diabetic patients with renal involvement were included in the study.  Percutaneous renal biopsy was carried in these sixty-five patients after informed consent. Results: There was a preponderance of males (66.2%) and majority of the patients were in the age group of 41-60 years. Duration of diabetes ranged between 3 months to 30 years. The indications for renal biopsy were nephrotic syndrome 35 (53.8%), 8(12.3%) rapidly worsening renal functions,7(10.7%) significant renal failure with normal or insignificant proteinuria at presentation,5 (7.6%) microscopic haematuria, 10(15.3%) proteinuria in the absence of diabetic retinopathy. Renal biopsy in 65 cases revealed: isolated diabetic nephropathy   in 44(67.7%), NDRD in 7(10.8%) and 12(18.5%) patients had NDRD superimposed on diabetic nephropathy. Nondiabetic glomerular disease in our patients include Membranous glomerulonephritis, IgA Nephropathy, Endocapillary Glomerulonephritis. Interstitial Nephritis and Acute tubular injury are predominant tubulointerstial lesion in this study. Conclusion: This study demonstrates presence of both glomerular and tubulointerstitial lesions unrelated to diabetes (NDRD) in type 2 diabetic patients with renal involvement.

23.Comparative Study of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anaesthesia
Bheem Raj Singhvi, Dilip Kumar, Hans Raj Charan
Aim: Comparative analysis of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anaesthesia. Methodology: This prospective randomized observational study was conducted in the Department of Anaesthesiology, Govt. Medical College, Barmer from Jan-2021 to Dec-2021 at Rajasthan after getting approval from ethical committee 90 patients aged between 30 years to 60 years of either sex belonging to ASA class II (controlled hypertensives) posted for various elective surgeries under general anesthesia at our institute were randomly selected for the study. Study population (90 patients) were randomly divided by computer generated numbers into 3 groups with 30 patients in each group. Group A: will receive Inj Fentanyl 2 µg/kg before induction. Group B: will receive Inj. Fentanyl 2µg/kg plus inj Lignocaine 1.5mg/kg before induction. Group C: will receive normal saline before induction. Results: We found that our study suggests that combination of fentanyl and lignocaine provides more significant attenuation of heart rate, MAP, controls more effectively rise in SBP and DBP than fentanyl alone after laryngoscopy and tracheal intubation. No clinically relevant side effects were observed in all three groups. Conclusion: Fentanyl and combination of Fentanyl and lignocaine, both effectively decreased hemodynamic response to tracheal intubation. However, neither fentanyl nor fentanyl plus lignocaine could inhibit all hemodynamic responses. Fentanyl plus lignocaine was more effective in attenuating hemodynamic responses than fentanyl alone.

24.Clinical Study of Headache in Relation to Sinusitis and its Management
Ritesh Nandwani
Aim: To study relation of headache with sinusitis and its management. Methodology: Patients clinically presenting with headache were selected. Only patients with headache due to rhinogenic causes were subjected to X-ray paranasal sinuses and diagnostic nasal endoscopy and followed-up to evaluate management. Results: Majority of the patients were of age group 21-30 years, and it is more predominant in males. Majority of the patients of headache were having DNS (56.5%), acute sinusitis (34.5%) and few numbers of patients had nasal polyp (10%). Majority of the patients who underwent antral washout were not relieved, so they underwent functional endoscopic sinus surgery, which gave dramatic results in improving symptoms of patients including headache. Conclusion: To know whether the headache is sinogenic or not; firstly the patient is clinically assessed, then radiological investigations (X-ray PNS) are done. Role of FESS is huge and ultimately it is the cure for the headache due to rhinogenic causes.

25.A Comparative Study on the Effect of Isometric Hand Grip Exercise in Normotensive Offspring of Normotensive Vs Hypertensive Parents Assessed in Terms of Rate Pressure Product and Pulse Pressure
Nidhi Gupta, Kapil Gupta, Sanjay Kumar Singhal, Abhishek Saini
Introduction: Rate pressure product (RPP) is a valuable marker of cardiac function and is expressed as a product of Heart Rate (HR) and Systolic Blood Pressure (SBP) (HR*SBP/1000). Pulse Pressure (PP) is the difference between systolic and diastolic blood pressure and depends on the interplay between cardiac output and peripheral resistance. Aim: RPP and PP responses to isometric hand grip exercise (IHG) were measured and compared among offspring of normotensive and hypertensive parents to reveal the differential change in patterns of these parameters so as to objectively unearth the predisposition towards development of hypertension at a later age. Material and methods: The present study was a case control study wherein two groups namely, “Cases” and “Controls” were formed comprising 45 subjects in each, on the basis of presence or absence of hypertension in parents, respectively. While forming the groups, age, gender and Body mass index (BMI) matching was ascertained resulting in recruitment of 27 males and 18 females in each group. HR, SBP and diastolic blood pressure (DBP) were recorded at baseline, 4 minutes after starting IHG exercise (“during IHG”) and 5 minutes after the end of IHG exercise (at “5-minute post IHG”). RPP and PP were calculated secondarily from the so obtained primary parameters. Statistical analysis was performed using Paired and Unpaired t-test while comparing among same group and between the groups respectively. Results: The groups so formed, were comparable with respect to BMI. RPP and HR were found to be significantly higher in male cases in comparison to male controls in basal stage with a p value of ≤0.001. Significant increase in RPP, HR, SBP and DBP occurs in both cases and controls (in both males and females) during IHG exercise and remained significantly elevated post 5 minutes of IHG exercise only in cases (p≤0.001). No significant difference was observed in the basal PP between cases and controls (across both genders). During IHG no significant difference in PP was observed in control subjects (both male and female) as well as in male subjects enrolled under case group. However, statistically significant change in PP was observed in female subjects constituting case group during IHG exercise (p≤0.01). Both male and female subjects enrolled under the case group demonstrated statistically significant change in PP after IHG exercise (p≤0.01). Conclusion: RPP and PP are promising markers for assessment of autonomic reactivity and can serve as objective tools for deciphering the propensity of development of hypertension in normotensive individuals later in life.

26.Effectiveness of Submucosal Resection and Septoplasty in Deviated Nasal Septum: A Study from Vindhya Region
Yasmeen Siddiqui, Arshi Ishteyaq, Irfan Ahmad Siddiqui, Neelofar Shaikh
Background:  Deviated nasal septum is a commonly faced challenging surgical morbidity in outpatient’s department of otorhinolaryngologist now days. Different surgical modalities have been accepted by surgeons to treat this condition based on their clinical decision. Aims and objectives: To study submucosal resection and septoplasty to evaluate its effectiveness by comparing clinical outcome and complications. Material and methods: Eighty patients with deviated nasal septum were studied. Baseline laboratory and clinical investigations were done to rule out the other conditions. Deviated nasal septum and its type were identified by anterior rhinoscopy. Type of surgical procedure was accepted based on type of deviation. Results: Out of 80 patients 40 patients had SMR and 40 underwent septoplasty. In our study, all the 73 patients had presented with nasal obstruction (91%) followed by headache (48%), nasal discharge (22%). On endoscopy, C-shaped deviation was present in (74%) followed by S-shaped deviated nasal septum (19%), spur (9%). Post operative nasal obstruction relief was seen in 80% patients. In our study, postoperative anterior rhinoscopy and diagnostic endoscopy findings show reduced fogging (5%) and persistent septal deviation (5%). In our present study complications seen in both the group includes excessive bleeding (9%), crust formation (6%), synechiae (9%), septal haematoma (4%), septal perforation (2%), residual deviation (5%), secondary atrophic rhinitis (1%). Conclusion: Based upon analysis of data of our study we concluded that females are more affected in third decade of life to deviated nasal septum than male with the most common presenting symptoms of nasal obstruction. C-shaped deviation is a more common form of septum deviation. Both surgical modalities have similar post-surgical pain relief but after sub mucosal resection patients may have higher chances of having complications.

27.A Comparative Study between Dexmedetomidine and Fentanyl as Adjuvant with Epidural Levobupivacaine in Abdominal Hysterectomy
Anirban Kundu, Suchismita Pal, Souvik Saha, Sudipa Mandal
Background: Objective of this study was to compare epidural dexmedetomidine or fentanyl with levobupivacaine in terms of onset of sensory block, peak height of sensory block, duration of analgesia, Onset, and duration of motor block, intra operative haemodynamic stability, surgeon’s satisfaction regarding operating condition by VAS scale and untoward side effects. Methods: After the approval of the Institutional Ethics Committee this randomized, parallel group, double-blind controlled study was carried out under the Department of Anaesthesiology of a tertiary care centre in north India. Results: Dexmedetomidine (50µg) is better adjuvant that fentanyl (50µg) in terms early onset of sensory and motor block. Dexmedetomidine provides longer duration of sensory and motor block than fentanyl. Both are comparable regarding maximum level of sensory block. Regarding haemodynamic parameter (Mean BP, Heart rate) and adverse effect (bradycardia, hypotension, nausea & vomiting, pruritus) dexmedetomidine is better alternative than fentanyl, though it cause more decrease of heartrate. Dexmedetomidine provides more satisfaction among surgeon than fentanyl. Conclusions: Therefore, epidural dexmedetomidine is a feasible, safe, and more reliable adjuvant with levobupivacaine (0.5%) to provide smooth anaesthesia and analgesia with higher satisfaction to surgeon than epidural fentanyl in abdominal hysterectomy.

28.Efficacy of Oscillating Positive Expiratory Pressure (OPEP) Therapy in Patients with Bronchiectasis – A Prospective Study
Chandrasekar S., Mohamed Musthafa A., Laila K.V., Rajagopal T. P.
Background: A characteristic feature in bronchiectasis is the impairment in clearance of secretions leading to frequent colonization and recurrent infection with various pathogenic organisms. This results in a vicious cycle of purulent secretions, bronchial damage, bronchial dilation, and further impairment. Chest physiotherapy (CPT) with postural drainage is the standard treatment for mobilization and removal of airway secretions. Airway clearance can be augmented by use of devices such as oscillating positive expiratory pressure (OPEP) devices which combines positive expiratory pressure therapy with high frequency oscillations within the airways. Objectives: To study the efficacy of Oscillating Positive Expiratory Pressure (OPEP) Therapy compared with Conventional Chest Physiotherapy (CCPT) in patients with bronchiectasis in reducing exacerbations, improving lung functions, quality of daily life activity and healthy status. Methods: A Prospective cohort clinical study conducted in patients with bronchiectasis in a tertiary care setting for a period between February 2018 and July 2019.A total of 130 patients were randomized into two groups to receive either Oscillating Positive Expiratory Pressure (OPEP) therapy using Acapella device or conventional chest physiotherapy in addition to regular pharmacotherapy. All patients were reassessed every 2 months. FEV1 was measured at the beginning of study, 4th month and at the end. Comfort, well-being and adherence were assessed in the two study groups using a 5-point Likert scale at the end of the study. The Statistical software SPSS 22.0, and R environment ver.3.2.2 were used for the analysis of the data. Results: The number of exacerbations was significantly less in OPEP group compared to CCPT group and the onset of exacerbations was later in the former group. Health related quality of life, comfort and wellbeing showed improvement in OPEP group. Conclusion: The relatively lower exacerbation rates and their later onset, improvement in health-related quality of life, comfort and wellbeing in patients performing OPEP therapy compared with CCPT supports the use of OPEP therapy for airway clearance than other conventional airway clearance techniques in patients with Bronchiectasis.

29.Spectrum of Histopathological Changes in Ischemic Heart Disease: An Autopsy Study
Rashmi Gupta, Sujata Singh, Superna Ganguly, Krati Agrawal
Background: cardiovascular disease comprising of mostly ischemic heart disease and stroke are leading cause of death worldwide. WHO estimates that India accounts for just over a fifth of these deaths. A thorough autopsy under expert supervision and histomorphological examination of heart plays an essential part to confirm the cause of death. Aims and objectives: This study was conducted to study the spectrum of histopathological changes in ischemic heart disease. Material and methods: A retrospective study of 252 cases of formalin fixed heart specimen was undertaken in the Department of Pathology, Chhattisgarh Institute of Medical Sciences, Bilaspur, Chhattisgarh. Out of 252 specimen, 32 specimen of heart showed autolytic changes and hence their histomorphological findings were not included in the study. A detailed gross and microscopic examination was performed, and findings were correlated with available clinical data to establish the cause of death. Result: Atherosclerosis was the most common lesion found in 124 cases (64%) followed by medial hypertrophy in 56 cases (28%) and intimal hyperplasia in 46 cases (23%). Other frequent findings were disruption of myocardial architecture 44 cases (22%) and patchy interstitial fibrosis 47 cases (23.5%). Also seen was presence of collateral formation in 39 cases (19.5%) and recanalization in 22 cases (11%). Microthrombi in circulation was seen in 27 cases (13.5%). These cases could have been the undiagnosed covid patients. Fibromuscular dysplasia was seen in 12 cases (6%) and thickening of pericardial fat in 10 cases (5%). Fibrous cap formation was seen in 7 cases (3.5%) and transmural inflammation in 12 cases (6%). Other less common findings were presence of Lines of Zhan in 7 cases (3.5%), Giant cell arteritis in 2 cases (1%) and dissection of aorta in 2 cases (1%). Conclusion: Atherosclerosis was found out to be the most common lesion responsible for causing mortality.

30.Influence of Epidural Analgesia on Pain Relief, Progression of Labour and Neonatal Outcome: A Comparative Study
Nikita Bagdi Kapoor, Manisha Bagdi
Introduction: Developed nations have shown an increase in the use of painless labour techniques with the most commonly use of epidural Ropivacaine with Fentanyl as an adjuvant. Several research have showed minimal side effects & no increase in the incidence of cesarean sections. However, in developing nations the use of labour analgesia is minimal, claiming doubts on its efficacy and risks associated. Thus, this comparative study was undertaken to evaluate the influence of epidural analgesia on pain relief, progression of labour, neonatal outcome & overall patient satisfaction. Material & Methods: 90 nulliparous parturients with established labour, age 20-35 y, body weight < 80 kg, at least 36 completed wk of gestation (confirmed by ultrasound), single fetus in vertex presentation, cervical dilatation > 4 cm were included in the study. Epidural group-Participants were administered 0.25% Ropivacaine and 50μg fentanyl (n=45), Control Grou-Did not receive any anaesthesia(n=45). Both the groups were assessed for Duration of labour, Number of vaginal, instrumental vaginal delivery & caesarean sections, neonatal outcome, VAS Pain scores & overall patient satisfaction. Result: Both the groups were comparable with respect to demographic variables. In epidural group, mean duration of first stage of labour was statistically significantly shorter as compared to control group(p<0.05). The Epidural group showed statistically significantly prolongation of second stage of labour (p<0.05). There was no statistically significantly difference in the number of vaginal deliveries, instrumental deliveries or C section in both the groups (p >0.05). No difference in APGAR scores were observed between groups. Conclusion: Increased pain relief & patient satisfaction observed with no increase in incidences of instrumental vaginal delivery or cesarean section and similar neonatal outcomes observed with epidural analgesia. With advancements in technology , patient awareness & continued medical education the labour analgesia would prove to be a boon to alleviate the pain of delivery in developing nations.

31.A Study of Seroprevalence of  Hepatitis B, Hepatitis C and Human Immunodeficiency Virus among Pregnant Women Attending Antenatal Care Clinic of a Tertiary Care Hospital in Jaipur, Rajasthan
Anil Yadav, Manju Yadav, Ashok Kumar Yadav, Rameshwari Bithu, R.K. Maheshwari, Bharti Malhotra
Introduction: Hepatitis B Virus, Hepatitis C Virus and Human Immune -Deficiency Virus by vertical transmission are major public health problem during pregnancy as associated with high risk of maternal complications. This study aimed to estimate the seroprevalence of HBV, HCV and HIV infection and their co-occurence in antenatal screening at tertiary care hospital, Jaipur. Material and methods: This study was conducted in Department of Microbiology, Sawai Man Singh Medical College, Jaipur. 364 Pregnant females attending ANC in Obstetrics and Gynecology Department of SMS Medical College, Jaipur over a period of one year from May 2020 to April 2021 .  All the serum samples were screened for HBV, HCV and HIV. Results: In this one year study a total 364 serum samples were analysed for HBV, HCV and HIV. Seroprevalence were observed that 7 positives for HBV (1.92%), 1 was positive HCV (0.27%) and 1 was positive for HIV (0.27%). Conclusion: Pregnant women visiting ANC clinic of SMS Hospital should be screened for HBV, HCV and HIV treated necessary to reduce their viral loads and their children vaccinated at birth with the single dose hepatitis B vaccine to break the cycle of mother to child transmission.

32.Assessment of Infraorbital Levobupivacaine vs. Ropivacaine in Post Operative Analgesia Following Cleft Palate Surgery
Aastha Jindal, G. Prasanna Kumar, Pinu Ranawat
Background: Ropivacaine and levobupivacaine have been used for the peripheral block in children for surgical pain. The present study is aimed to compare the effectiveness of 0.375% levobupivacaine and 0.375% ropivacaine in the infraorbital block for cleft palate surgery. Methods: Eighty patients between the age group of 2–12 years planned for elective surgery for cleft palate were included in the study. The solution for Group L was a mixture of 0.375% levobupivacaine and the solution for Group R was a mixture of 0.375% ropivacaine. Infraorbital nerve blocks were conducted by landmark-guided technique. We used the Verbal Rating Scale (VRS) to assess the postoperative pain. Results: There was a statistically significant difference in the time interval until the first request for pain medication was made by the participants in the two groups. There were differences in pain scores calculated at regular intervals after surgery comparing the two groups. There were differences in the need for rescue analgesics comparing the two groups. Conclusion: The analgesic effects of levobupivacaine are statistically better than ropivacaine in the infraorbital block in children who underwent cleft palate surgery.

33.A Comparative Study of Intravenous Dexmedetomidine and Intravenous Tramadol for Post Spinal Anaesthesia Shivering
Dilip Kumar, Bheem Raj Singhvi, Hans Raj Charan
Introduction: Shivering is a natural protective phenomenon. The main causes of intra/post-operative shivering are temperature loss, increased sympathetic tone, pain, and systemic release of pyrogens. Spinal anaesthesia significantly impairs the thermoregulation system by inhibiting tonic vasoconstriction, which plays a significant role in temperature regulation. Several drugs have been studied for the prophylaxis as well as treatment of shivering. Tramadol, an opioid receptor agonist, has also proved to be effective in the treatment of shivering after general anesthesia, On the other hand Dexmedetomidine, a congener of clonidine, has been used as a sedative agent and is known to reduce the shivering threshold. The aim of the study was to compare the efficacy of dexmedetomidine and tramadol in the treatment of post-spinal anesthesia shivering as well as their side-effect profile. Materials and methods: The present study was conducted in the Department of Anaesthesiology, Govt. Medical College, Barmer from oct-2021 to march-2022 at Rajasthan after getting approval from ethical committee. This is a Prospective Randomized Comparative Study. Patients aged 18-65 years, American Society of Anesthesiologists I & II and scheduled to undergo elective surgeries under spinal anesthesia and developing shivering grade 3 or grade 4 were included in the study. We made two groups of cases i.e., Group T (TRAMADOL) and Group D (DEXMEDETOMIDINE). sample size was 64, which was divided into two groups of 32 each. Standard protocol followed to administering spinal anaesthesia. On occurrence of shivering its intensity graded using a four-point scale as per Wrench. All data were collected and analysed with the help of suitable statistical parameters. Results: Our study results in that dexmedetomidine are more effective in the treatment than tramadol for treatment of postspinal anaesthesia shivering.

34.Comparative Study of BIS Values Required for Insertion of Proseal Laryngeal Mask Airway or Endotracheal Intubation in Paediatric Patients Undergoing Sevoflurane Anaesthesia
Bheemraj Singhvi, Bhupendra Rathore, Hans Raj Charan
Aim: The aim of present study is comparison of BIS values required for insertion of proseal laryngeal mask airway or endotracheal intubation in paediatric patients undergoing sevoflurane anaesthesia. Methodology: This prospective randomized observational study was conducted in the Department of Anaesthesiology, from Aug-21 to Feb-22 at Government Medical College, Kota after getting approval from ethical committee. children between 2 and 14 years of ASA I and II and they were randomly allocated to Group P (proseal laryngeal mask airway insertion) and Group TI (tracheal intubation) scheduled for elective surgical procedure requiring general anaesthesia. This study was conducted on 60 patients who were randomly divided into 2 groups of 30 patients each. Results: BIS score decreased in both the groups during induction period BIS score was significantly higher 1 min after Endotracheal intubation as compared to 1 min post LMA insertion, and the difference was statistically significant. BIS score required for insertion of LMA ranges from 55-60 whereas slight deeper levels of anaesthesia of BIS range between 50-55 are required for endotracheal intubation. No clinically relevant side effects were observed in both groups. Conclusion: LMA is a better option than endotracheal intubation for short surgical procedures requiring general anaesthesia in terms of less requirement of inhalational agent, lesser induction times and BIS score is concerened.

35.Comparative Evaluation of the Treatment Planning According to the Figo Staging and MRI Staging Classification in Carcinoma Cervix
Shubhkirti Agrawal, Rahil Kumar Sharma, Aarti Sharma
Background: Cervical cancer is a major public health problem for women. Accurate staging may lead to proper management of cervical cancer. Methodology: We retrospectively reviewed all patients from 1st June 2015 to 31st March 2017 with cervical cancer who underwent pre-treatment MRI and analyzed the correlation between the FIGO clinical staging and MRI staging. Results: Correlation of overall clinical and MRI staging by percent agreement is moderate (73.9%), but the kappa coefficient showed a slight correlation. The correlation of clinical and MRI findings in the vaginal invasion, pelvic sidewall invasion, adjacent pelvic organ invasion, and spreading to distant organ also showed moderate-to-strong correlation by percent agreement (ranging from 67.6 to 91.9%) but slight correlation between clinical and MRI examinations by kappa or weighted kappa coefficient (K = 0.000–0.128w). Conclusion: In patients with cervical cancer, pretreatment MRI provides higher spatial soft tissue resolution which can define pelvic tumor extent, including a more accurate assessment of tumor size (due to multiplanar evaluation), parametrial invasion, pelvic sidewall invasion, and adjacent pelvic organ invasion. This could potentially lead to a reduction in staging morbidity by invasive investigation such as cystoscopy and proctoscopy.

36.Study of Functional Outcome of Arthroscopic ACL Reconstruction by Various Grafts
Abhishek Pathak, Deependra Sonkar, Shailandra Pandey, Himanshu Patel, Mohammad Zuber
Introduction: Anterior knee instability associated with rupture of the ACL is a disabling clinical problem. The ACL has a poor capacity for intrinsic repair. Thus, ligament reconstruction as a means of stabilizing the tibio-femoral joint and restoring high level function of the knee joint becomes destined. Therefore, present study was aimed to study the functional outcome of arthroscopic ACL reconstruction by various grafts. Materials and methods: The present Study was carried out in patients coming to a tertiary care hospital considering a total of 24 patients. Arthroscopically assisted Anterior Cruciate Ligament Reconstruction surgery was performed in patients concluding inclusion criteria. ACL repair was done by Bone patellar tendon bone (BTBP), hamstrings and Peroneus grafts were used as and when required. Results: In present study patients average age was 29.8± 7.6 years with 3 females and 21 males. Considering the mode of injury majority patients were having sports playing. Considering the mechanism of injury most of the patients reported the “valgus” posture to be the mode of injury to the knee joint. Majority of the patients were treated using hamstring and peroneus grafts (41.7%). During pre-operative evaluation, majority of the patients showed grade 3 results upon Lachman test. During post-operative evaluation, majority of the patients were observed to be at grade 0 on Lachman evaluation similar results were observed by Lysholm scoring. Conclusion:  We found that all three methods had shown equal potential however, majority of the patients were benefited by hamstring and peroneus grafts with optimistic Lachman and Lysholm scorings.

37.Early Outcome of Lumbar Instability with Accompanying Intervertebral Disc Prolapse, A Clinical and Radiological Follow-Up
Neenu Gupta, Manish Ranjan, Pranav Santhaliya, Madhukar Dayal, Rajiv Ranjan
Background: identify lumbar instability and intervertebral disc prolapse, in patients presenting to the outpatient clinic with chronic lower back ache and sciatica using functional flexion and extension radiography and MRI, and secondly, to follow up these patients undergoing posterior decompression, stabilisation and postero-lateral fusion, over a post-operative period of 6 months and assess clinical and radiological outcome and compare the pre-operative and post- operative variables. Materials and methods: The study was conducted at Nalanda medical college and Hospital, Patna. Study duration of two years. and 38 patients who fulfilled the inclusion criteria were included in the study. The pre-operative and post-operative functional status of the patient was assessed using the Japanese Orthopaedic Association (JOA) score. The patients then underwent functional radiography and MRI of the lumbosacral spine, as well as routine pre-operative blood investigations. Following this, the patients underwent surgery and were reviewed with clinical examination and repeat functional flexion- extension radiographs of the lumbosacral spine, 6 months after the surgery. The pre- and post-operative lumbar mobility was quantified on functional radiography by an independent observer. Tests of statistical significance were then applied on the data of     the variables in the study, gender, occupation, smoking status, chief complaint, end plate changes and type of instability, and the pre- and post-operative JOA scores were compared. Conclusion: Adequate decompression of the structures causing nerve root compression can be carried out through the posterior approach along with instrumentation. Reduction of any abnormal lumbar mobility in the post-op functional radiographs, is an objective method of assessing stabilisation and fusion. The type of abnormal lumbar mobility, and the presence or absence of end plate changes did not affect the outcome.

38.Paediatric Undescended Testes Management in Government General Hospital Guntur-5 years Study
Chanda Bhaskara Rao, Aralikatti Hemavathi Revanappa, Bhavana Chanda
Undescended testis one of the common problems in pediatric population. Nearly half of the undescended testis descends into scrotum within six months spontaneously. Current trend of management is to repair as early as possible within the first year of life. Late management or repair may lead to dysplastic changes in the testis and prone for higher malignancy incidence. We have collected the data of the undescended testis in pediatric surgery department of Government General Hospital and Guntur Medical College, Guntur over the period of 5 years from January 2017 to December 2021. Introduction: Cryptorchidism means hidden testes or invisible testis and other common names are undescended and maldescended testis. There are many controversies in the management and other aspects of undescended testes. Knowledge of abnormal morphogenesis, hormonal effects, molecular pathology of undescended testes very important to diagnosis as well as treatment of this very common entity. Hormonal therapy is not much useful, Orchiopexy is best successful treatment to relocate the testis into the scrotum. Successful orchiopexy may reduce but not completely prevent potential infertility and testicular malignancy. Proper counseling and regular long-term follow-up of the patient are essential to detect malignancy. Study design: Its retrospective observational study of Undescended testis in children with evaluation and management during the period of January 2017 to December 2021. Materials and Methods: Data collected during January 1st ,2017 to December 31st ,2019 regarding operated cases of undescended testis in pediatric surgery department of government General Hospital Guntur, Guntur Medical College, Guntur, Andhra Pradesh, India. Total number patients of undescended testis operated during these 5 years are 232 cases. Total number of testes operated was 275.Right side undescended testis 113 cases (48.7%), Left side undescended testis 76 cases (32.7%).  Bilateral undescended testis 43 cases (18.5%). Procedures adopted are 1 standard classical inguinal orchiopexy done 230 testes (226 orchiopexies four nubbins, two transverse testicular ectopia noted), 2. Inguinal incision with   intra-peritoneal exploration in 19 testes and orchiopexy in 16 testes, two blind ending vas, one nubbin noted, 3. laparoscopy in 26 testes, orchiopexy done in 19 testes, three testes absent,  two blind ending vas, two nubbins were noted. Total number of patients were 232. Total testes studied was 275. Results: Out of 230 inguinal explorations, 226 testes placed in scrotum (98.2%). Low intra-abdominal testes 19 explorations done,16 orchiopexies, two blind ending vas, one nubbin (84.2% orchiopexies). High intraabdominal position testes, 26 explorations done,3 absent testes,2 blind ending vas, 2 nubbins,19 orchiopexies (73%). Out of 275 exploration, 261 testes placed in scrotum (94.9%). On follow up eight testes were Atrophied (3.16%), eleven testes ascended (4.34%) six wound infections (2.18%). Conclusion: Surgical correction is main treatment for undescended testis. Successful placement of testes in scrotum is possible in almost all cases. Minimum surgical complication operatively. Follow up needed till attaining puberty. Incidence of malignancy, infertility increased if delayed orchiopexy beyond 2years age. Early orchiopexy (6months to one years) may improve the infertility, probably decrease the malignancy. Atrophy of testes, Ascended testes less common than many studies.

39.Attenuation of Stress Response during Laryngoscopy and Endotracheal Intubation using Esmolol and Fentanyl – A Comparative Study
Kavitha K., Letha J., Nanna R. Chandran
Background: Laryngoscopy and endotracheal intubation are noxious stimuli, that can evoke detrimental hemodynamic consequences in patients with coronary artery and cerebrovascular disease. Hence there is a need to suppress these hemodynamic effects. Various group of drugs are administered prior to laryngoscopy for suppression of these hemodynamic effects. Esmolol, Fentanyl, Clonidine and Lignocaine are commonly used in anaesthetic practise for stress response attenuation prior to laryngoscopy. In our study we compared the efficacy of Esmolol and Fentanyl in attenuating various hemodynamic variables during laryngoscopy, intubation and in the immediate post intubation phase. Methods: A prospective randomized comparative observational study was conducted in 100 patients belonging to ASA I and II categories during the study period from December 2018 to June 2020.They were divided into two groups containing fifty subjects each, after satisfying the inclusion and exclusion criteria and randomization. After obtaining informed consent, each group received either of the study drug 3 minutes prior to laryngoscopy, followed by induction with IV Propofol and neuromuscular blockade with IV Vecuronium. Hemodynamic variables like HR, SBP, DBP and MAP were recorded at fixed time intervals and data sheet prepared in MS excel format. Any adverse events which occurred during the study were also recorded. A p-value of less than 0.05 was considered as statistically significant. Results: Both groups were comparable in terms of demographic variables, ASA class and Mallampati grades. Tachycardia was lower in Esmolol group. Systolic BP, Diastolic BP and Mean Arterial Pressure were increased in both groups after laryngoscopy and intubation and at different time intervals. There was no significant difference in mean Systolic BP & Diastolic BP between 2 groups. There was significant difference in Rate Pressure Product between 2 groups, after drug administration to 10 minutes after intubation, with Esmolol group having lower mean Rate Pressure Product compared to Fentanyl group. There was no ST- T segment changes in both the groups. Conclusions: Esmolol was found to be a better drug in attenuating the stress response to laryngoscopy and intubation in terms of Heart rate. The blunted effect of Esmolol to laryngoscopy and intubation stress response may be due to the time lag between bolus dose and timing of intubation which requires more studies for confirmation.

40.Assessment of Chromium (Cr), Copper (Cu) & Lead (Pb) Levels in Carcinoma Breast Patients Comparative
Neeraj Singh Songara, Ajay Kumar Bhargava, Akshita Chaudhary, Laxmi Naval
Background: In breast carcinoma, the concentrations of trace elements are modified as a consequence of endogenous toxicities & unregulated their exchange during tumourogenesis. Chemotherapy treatment results in increasing or decreasing level of biochemical components of blood by affecting organ systems. Objectives: To determine & compare serum chromium (Cr), copper (Cu) & lead (Pb) concentrations between breast carcinoma patients & healthy controls. Methods: Determination & comparison of serum chromium (Cr), copper (Cu) & lead (Pb) was done between 50 breast carcinoma patients & 50 healthy controls. Trace element analysis was done using Atomic Absorption Spectrophotometry (AAS). Statistical comparison was done, results were expressed as Mean ± SD, p < 0.05was considered to be statistically significant. Results: All groups were statistically matched in age, sex and p >0.05. Serum Cr concentrations in cases and controls (0.2216 ± 0.1221 µg/L), (0.1746 ± 0.1196 µg/dL) respectively, p = 0.055. Serum Cu concentrations in cases & controls were (160.500 ± 14.41 µg/dL), (100.94 ± 18.37 µg/dL) respectively, p = < 0.0001*.  Serum Pb concentrations in cases & controls were (20.02 ± 7.09 µg/dL), (17.38 ± 6.93 µg/dL) respectively, p= 0.063. Interpretation and conclusion: Serum (Cu) showed significant increases in breast carcinoma patients as compare to healthy controls, serum (Cr) & (Pb) are insignificant.

41.Fine Needle Aspiration Cytological Study of Salivary Gland Lesions at Tertiary Care Centre
Pratibha Shekhawat, Garima Gupta, Ankur Gupta, Chandrajeet Singh Ranawat
Introduction: Salivary gland region mass usually presents a diagnostic challenge. The present study is conducted with a purpose to diagnose the non-neoplastic and neoplastic lesions of the enlarged salivary glands by FNAC and to study the spectrum of lesions with respect to age, sex and site of occurrence. FNAC is less invasive diagnostic modality with good range of sensitivity in all lesions. Materials and methods: A prospective randomized study was conducted in the Department of Pathology, SMS Medical College & Hospital from February 2018 to June 2019. A total of 120 FNACs were done on salivary gland swellings during this period. FNAC was performed with informed consent of the patient using a 23-25 G needle. Alcohol fixed smears were stained with H&E. Air-dried smears were stained with MGG stain. PAS stain was done on methanol fixed smear, if required. Results: Out of the 120 cases, 73 cases were diagnosed as non-neoplastic lesions and 47 cases as neoplastic lesions. The cytomorphological features of following lesions were studied: Sialadenitis (51), Non-neoplastic cysts (10), Benign tumors (40), Malignant tumors (11), Mesenchymal lesion (2) and Tumor-like lesions (6). The majority of the patients were in the age group of 21-30 years and were males. In the present study, the parotid gland was the commonest site involved. Pleomorphic Adenoma and Mucoepidermoid carcinoma were the commonest benign and malignant tumors respectively. Conclusion: FNAC of salivary gland lesions is an excellent method for investigating the nature of the lesions, as it is accurate, simple, rapid, inexpensive, well tolerated and harmless to the patient with high sensitivity, specificity and accuracy.

42.Evaluation of Neurological Outcome in Cervical Spinal Cord Injury and its Correlation with Initial Magnetic Resonance Imaging
Neenu Gupta, Manish Ranjan, Madhukar Dayal, Pranav Santhaliya, Rajiv Ranjan
Background: Spinal cord trauma is one of the most devastating injuries which leads to disability. Trauma to the cervical cord is even more debilitating in terms of increased morbidity and mortality. In the era of improved medical care and sophisticated diagnostic tests prompt attention to these patients is very vital. Apart from the initial resuscitation and neurological evaluation it is important to perform diagnostic tests so as to assess the extent of concealed injury to the cervical spine. Methods: Patients who sustained cervical cord injury were assessed for neurology and underwent MRI scan. Neurology was assessed based on ASIA score and cord changes on MRI were evaluated. Some patients underwent conservative treatment, and few others underwent surgical treatment. They were followed up over a period of one year in terms of their neurological status. Results: Neurological recovery of patients with less severe initial injury was better compared to the patients who had poor initial neurological score and longer extent of cord injury. The patients with higher extent of cord injury on MRI had higher mortality rate and few of them succumbed to cervical cord injury related complications. Conclusion: The primary injury to cervical cord plays a major role in deciding the final outcome in terms of neurological recovery. Patients with lesser segments cord injury and good neurological score had a better final neurological outcome. MRI plays an important role in evaluating patient with cervical cord injury. It helps to identify patients at risk of developing respiratory complications, to predict the extent of neural recovery at the end of one year and thereby plan appropriate treatment and rehabilitation. Surgical treatment does not play a major role in the management of patients with cervical cord injury.

43.A Double-Blind Randomized Sham Control Study to Assess the Effects of rTMS (Repetitive Transcranial Magnetic Stimulation) on Executive Functioning in Treatment Resistant Depression
Saadgi Jagawat, Tushar Jagawat, Savita Jagawat, Mukesh Sandu, Mausumi Sinha, Nandita Hazari
Background: Up to fifteen percent of patients with Depression eventually present with Treatment Resistant Depression (TRD). Executive functions, in general, are a part of the cognitive process which includes fluency, working memory, set-shifting ability, set maintenance, planning, response inhibition, error detection, abstraction, strategizing and organization. Cognitive impairment / executive functions have found to be associated with depression. The Food and Drug Administration (FDA) has approved Repetitive Transcranial Magnetic Stimulation (rTMS) for the treatment of both MDD (Major Depressive Disorder) and TRD in adolescent and adult populations. Aims and Objectives: To examine the effects of active and sham rTMS on executive functioning in patients of treatment resistant depression by comparing pre and post rTMS effects on mood symptoms, executive functioning for both groups (active and sham) and assessing the correlation between the effects on executive functioning and mood changes due to rTMS. Material and Methods: The study included 20 individuals (10 in each arm) of either gender, aged between 18-50years suffering from mild to moderate depression (assessed by HAM-D). The executive functioning was assessed by using NIMHANS Neuropsychological Battery (Digit Symbol Substitution Test-DSST, Digit Sequencing Test-DST, Colour Trail making B test, and Stroop test), 10 sessions of either active HF-rTMS (10Hz) or sham rTMS (allocated by random sampling) were applied to the left DLPFC over two weeks. Results: The mean age was found to be 42.62 years with 60 % males and 40 % females. On DSST Positive effects of rTMS were found for information processing speed in the active group compared to sham. On other tests, DST, CTB and Stroop test, the findings were not statistically significant. Significant positive correlation was present between HAM-D and Stroop tests scores in active group. The severity of depression reduced significantly due to rTMS treatment. Conclusion: The important finding of this study is the decrease in time on DSST after treatment with rTMS in the active group showing improvement in visuomotor coordination, attention and information processing speed in patients with TRD.

44.Types and Frequency of Ovarian Neoplasm According to Age: A 10 Year Histopathological Study
Deepak Goyal, Ankur Gupta, Garima Gupta, Sadhana Agrawal
Objectives: To find Types and frequency of Ovarian Neoplasms according to age and to compare it with other studies. Methodology: A 10-year retrospective study of ovarian Neoplasms, specimens of that were received and diagnosed in the Department of Pathology, R.N.T. Medical College, Udaipur Rajasthan. This study was conducted for a period of 10 years from Jan 2004 to Dec 2013. Results: The study was carried out on 472 specimens. Maximum tumors of the ovary (26.48%) were found in age group of 31-40 years followed by age group 21-30 years (24.78%). The maximum benign tumors (30.99%) of the ovary were found in age group of 31-40 years followed by age group 21-30 years (30.14%). Maximum malignant tumors of the ovary (25.45%) were found in age group of 51-60 years followed by age group 41-50 years (23.64%). The peak incidence of the surface epithelial tumors in the present study was in 31 to 40 years (24.14%). The peak incidence of the germ cell tumors (41.19%) in the present study was in the third decade (21 to 30 years) of life. The youngest patient in our study was a 6-year-old girl who had Benign cystic teratoma. The peak incidence of sex cord stromal tumors (48.72%) in the present study was in age group >50 years. Conclusion: Maximum tumors of the ovary (26.48%) were found in age group of 31-40 years. The maximum benign tumors (30.99%) of the ovary were found in age group of 31-40 years and maximum malignant tumors of the ovary (25.45%) were found in age group of 51-60 years.

45.A Comparative Study between Oral Melatonin and Oral Alprazolam as Premedication on Preoperative Anxiety, Sedation and Cognitive Functions in Patients Undergoing Surgeries Under General Anaesthesia
Kishore Keerthy N., Narendra Babu Chanappa, Archana G, Vinuth K. Murthy
Background: In this study we wanted to evaluate the effect of oral melatonin on pre-operative anxiety, sedation, orientation and cognitive functions, the effect of oral alprazolam on pre-operative anxiety, sedation, orientation, and cognitive functions and compare the efficacy of oral melatonin and oral alprazolam on pre-operative anxiety, sedation, orientation, and cognitive functions. Methods: This was a randomised clinical carried out in the Department of Anaesthesiology and Critical care, Kempegowda Institute of Medical Sciences, Bangalore among two groups of 50 subjects each over a period of 18 months. Simple random sampling was done. Hundred patients aged between 18 years and 60 years of physical status ASA grade 1 and ASA grade 2 undergoing elective surgeries under general anaesthesia was included in the study after ethical clearance from the college ethical committee. Results: Oral melatonin 3mg produces greater decrease in anxiety than alprazolam 0.5mg/kg at the end of 60 minutes and was statistically significant. Oral melatonin 3mg produces more sedation after administration compared to alprazolam 0.5mg thus calming and preparing the patient for induction of anaesthesia though it was statistically insignificant with p value < 0.001. Oral melatonin 3mg and oral alprazolam 0.5mg both didn’t affect the orientation of the patient after administration and postoperatively. Conclusion: Oral melatonin 3mg affects patients mental balance, attention, concentration, delayed and immediate recall, visual and verbal retention after administration due to its sedative effects but was restored postoperatively which was better compared to the effects of oral alprazolam 0.5mg after administration for smoother induction of anaesthesia. Oral melatonin 3mg and oral alprazolam 0.5mg does not cause cognitive dysfunction of the patient postoperatively. Oral melatonin 3mg and oral alprazolam 0.5mg did not produce any adverse effects.

46.Role of Plain Radiographs and Ultra Sonogra   in the Evaluation of Blunt Abdominal Trauma
Neenu Gupta, Pranav Santhaliya, Madhukar Dayal, Manish Ranjan, Rajiv Ranjan
Background: Blunt abdominal trauma is one of the commonest injuries. Blunt abdominal trauma usually occurs due to road traffic accidents; fall from height or during sports. Prevalence of intra-abdominal injuries varied widely, rapid diagnosis was essential and appropriate prioritizing diagnostic work up and treatment was critical to ensure patient survival to decrease mortality and morbidity. Methods: A prospective study was conducted over a period of two years, on 100 patients. They were evaluated with plain radiographs and Routine real-time ultrasound scanner (Philips IU22) with correlated CT (Siemens somatom 6 slice) and post operative findings in cases wherever laparotomy was performed. Conclusion: To conclude a multipronged multimodality approach employing combination of abdominal radiographs, ultrasonography in evaluating trauma cases can be fairly useful and accurate in early diagnosis and management of solid visceral injuries results from blunt abdominal trauma where limited diagnositic modalities lacking CT and ICU support with high sensitivity and high specificity resulting in reduction of mortality and morbidity.

47.Comparative Study of Placental Grading During Third Trimester in Hypertensive Disorders of Pregnancy and Normal Pregnancy
Neenu Gupta, Pranav Santhaliya, Madhukar Dayal, Rajiv Ranjan
Background: Hypertensive disorders are one of the most commonly known complications of pregnancy which are associated with a significant risk of both maternal and foetal morbidity and mortality. Obstetric ultrasound provides a cornerstone for assessing hypertensive disorders of pregnancy. Pregnancy induced hypertension is defined as blood pressure more than 140/90 mm of Hg after 20 weeks of gestation and oedema or proteinuria or both. Eclampsia, hypertension, proteinuria, peripheral edema and neurologic dysfunction, identifies an extremely high risk obstetric population. Methods: The study was done in the department of Radiodiagnosis at Nalanda medical college and Hospital Patna. Study duration of two years. The study group comprised of 80 cases which were further subdivided into 40 patients with pregnancy complicated with hypertension in the third trimester and B.P. more than 140/90 mm of Hg. The control group consists of 40 normotensive patients matched with age and parity. Results: In present study, grade III was observed in 3 cases (11.1%) of control group in <37 weeks and 8 cases (88.9%) of control group in >37 weeks gestation. In cases of PIH ie. Study group, Grade III was found in 17 cases (54.8%) of <37 weeks and 12 cases (92.3%) cases of >37 weeks gestation. Conclusion: Accelerated maturation of placenta are more common in the hypertensive group and in <37 weeks of gestation.

48.The Effect of Plantagoovata Husk on Glycemic Index and Glycemic Response of Kuttu Chapatti in Diabetic Patients and Healthy Controls
Mumtaz Jahan, Ajay Kumar Bhargava
Psyllium is a form of fiber made from the husks of the Plantagoovata plant’s seeds. Psyllium is a bulk-forming laxative and is high in both soluble fiber (70%) and insoluble fiber (30%). The beneficial effect of psyllium in the management of type II diabetes has not been totally demonstrated. The purpose of this study was to determine glycemic index of kuttu chapatti and to evaluate effect of psyllium husk on glycemic response of kuttu chapatti. Subjects were randomly selected from Jhalawar Medical College, Jhalawar to participate in a case-controlled study ninety-seven subjects were included in the study that were given diet counseling before the study. Kuttu chapattis were given in 50 grams of digestible available carbohydrates as test diet 1. Same Kuttu chapattis were given along with 5 gm of psyllium husk as test diet 2. The reference food was a solution in water (250 ml) containing 50 g glucose. In the morning, 5 times the blood was collected – on an empty stomach and 30, 60, 90 and 120 minutes after eating for both test diets and reference food for three consecutive days in healthy controls and in patients with type II diabetes. The glycemic indices of kuttu chapatti were found to be 53.1 + 6.1 and 54.1 +5.2 for healthy subjects and diabetic patients respectively, with P = 0.399 therefore the difference in Glycemic indices after Kuttu Chapatti in both groups was statistically insignificant. Glycemic indices of kuttu chapatti with psyllium husk found 47.0 + 6.2 and 48.2 +6.2 for healthy subjects and diabetic patients respectively with p – value was 0.317 therefore the difference in Glycemic indices after Kuttu Chapattiwith Psyllium Husk in both groups was also statistically insignificant. Difference in Glycemic indices of kuttu chapattis is statistically highly significant with kuttu chapattis with psyllium husk for healthy subjects (P < 0.0001) and for diabetic patients (P < 0.0001). our results demonstrate values of glycemic indices for kuttu chapatti and evaluate effect of psyllium husk on glycemic response, addition of 5 gm of psyllium husk to test diets significantly decrease the value of glycemic index in both the groups.

49.Hospital Based Case Control Study of Hs-CRP and Lipid Profile in Hypothyroid Adults at Bihar Region
Md. Israrul Haque, B.P. Singh
Aim: To analyse the thyroid profile, hs-CRP and lipid profile in newly detected hypothyroid adults in comparison to controls and also to compare the above parameters in subclinical and clinical hypothyroid cases. Material & Methods: This was a hospital-based case control study conducted at the Department of Cardiology, IGIMS, Patna, Bihar, India for 1 year. Results: BMI values in the study were higher in cases (25.48 ± 5.82 kg/m2) compared to controls (25.21 ± 5,62 kg/m2) and was statistically significant (P = 0.05). hs -CRP levels were in within reference range for 80% of cases and 92% controls whereas above the normal range was seen in 20 % cases and only 8 % controls. Conclusion: Hypothyroidism (CH & SCH) is common among females and is associated with mild dyslipidemia and low-grade inflammation. Moreover, subclinical hypothyroidism is more common than clinical hypothyroidism..

50.Prospective Clinical Functional Outcome Assessment of Fracture of Distal End of Radius Managed with Locking Compression Plates
Ranjan Kumar Prakash, Kumar Mayank, Dilip Kumar Singh
Aim: To analyse the thyroid profile, hs-CRP and lipid profile in newly detected hypothyroid adults in comparison to controls and also to compare the above parameters in subclinical and clinical hypothyroid cases. Material & Methods: This was a hospital-based case control study conducted at the Department of Cardiology, IGIMS, Patna, Bihar, India for 1 year. Results: BMI values in the study were higher in cases (25.48 ± 5.82 kg/m2) compared to controls (25.21 ± 5,62 kg/m2) and was statistically significant (P = 0.05). hs -CRP levels were in within reference range for 80% of cases and 92% controls whereas above the normal range was seen in 20 % cases and only 8 % controls. Conclusion: Hypothyroidism (CH & SCH) is common among females and is associated with mild dyslipidemia and low-grade inflammation. Moreover, subclinical hypothyroidism is more common than clinical hypothyroidism.

51.An Analytical Cross Sectional Assessment of Sensorineural Hearing Loss in Type 2 Diabetes Mellitus
Sarika Kalra
Aim: To investigate the association between diabetes and sensorineural hearing loss (SNHL). Material & Methods: In this cross-sectional study, we evaluated 100 type 2 diabetes mellitus patients coming to the Department of ENT, MP Birla Hospital & Priyamwada Birla Cancer Research Institute, Satna (MP), India. Results: Audiometry testing at 250–8,000 Hz, SRT, and SDS were significantly worse in participants in the D than ND group. The differences between groups were not significant when the models. Conclusion: We found no association between the duration of diabetes and worsening of hearing thresholds after models were adjusted for age, gender, and the presence of hypertension.

52.Prospective Cohort Study to Assess the Risk Factors for the Development of Pneumonia and Severe Pneumonia in Children in Northern Bihar
Satyendra Paswan, Shantanu Kumar, Nagenrda Kumar Gupta
Aim: To identify the risk factors for pneumonia and severe pneumonia in children. Material & Methods: This study was a prospective cohort study carried out at Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, India from October 2020 to may 2021. Results: A total of 990 children were included, and 603 (60.9) boys with ARI were enrolled. Among them, 938 (11.8%) and 772 (77.9%) had ‘pneumonia. younger age and low weight for height were considered as an independent risk factor for pneumonia. In the case of Hib vaccination, positive vaccination history increased the odds of developing community acquired pneumonia. Conclusion:Young age and under nutrition (low weight for height/length) in children are significant independent risk factors for pneumonia.

53.A Retrospective Observational Assessment of the Incidence, Leading Causes, Risk Factors and Complications of Emergency Peripartum Hysterectomy in Modern Obstetrics
Seema Kumari, Abhishek Kumar, Jyoti Kumari
Aim: To know the incidence, leading causes, risk factors and complications of EPH. Material & Method: This was a retrospective observational study conducted at the Department of Obstetrics and Gynecology, Nalanda Medical College & Hospital, Patna, Bihar, India. This study included all women undergoing hysterectomy after 22 weeks of gestational age and within 6 weeks of delivery from over a period of 1 year. Results: EPH was done for atonic PPH in 15 (42.8%), followed by uterine rupture in 10 (28.5%). A mean of 3.4 units of packed red blood cells were transfused. Intra-operative injury to the urinary bladder was seen in 6 (17.1%) of the patients. There were no other intra-operative complications. Conclusion: Uterine atony and uterine rupture continues to be the most common causes for EPH in our population. Multiparity is an important risk factor among patients with rupture uterus. Cesarean delivery and repeat cesarean deliveries are the likely risk factors for EPH.

54.To Evaluate and Compare the Efficacy of Ultrasonography and Computed Tomography in Differentiating Transudate from Exudate in Patients with Pleural Effusion
Ansary Abdul Qayyum, Mathur Rajendra Babu
Purpose: To evaluate efficacy of radiological method (USG and CT imaging) for differentiating transudative and exudative pleural effusion. Materials and methods: A retrospective data base observational study, included patients who underwent USG, CT THORAX and Thoracentesis between June 2020 to June 2021, total period of 12 months. USG appearances and CT attenuation values were compared with standard method (Light’s criteria) along with additional findings like presence of pleural thickening, pleural nodules and loculation were also evaluated. Results: 25 (30.12%) were transudates and 58 (69.88%) were exudates. Transudative effusions were always anechoic. Exudative effusion may be complex septated (60.03%), echogenic (24.14%) or complex non-septated (10.34%) on USG with very few being anechoic (5.17%). Loculations and septation were better appreciated on ultrasound while pleural thickening and nodules were better seen on CT. Mean attenuation values were significantly higher in exudates (14.65 ± 6.07; mean ± SD, range: 4.5 to 34) than transudates (4.66 ± 2.29; mean ± SD, range: 1.3 to 8.2) with a P-value <0.01. Effusions can be considered transudative if the CT attenuation value is <8, with a sensitivity of 91.8% and specificity of 82.9% with a significant P value <0.01. Pleural thickening, nodules and loculations were seen more commonly in exudates than transudates with a high specificity (92.1 %, 96.3% and 100% respectively). Conclusion: USG is a bedside non-invasive tool and very helpful in determining transudative and exudative effusions. CT attenuation values are useful in determining the etiology of pleural effusions. CT HU values are < 8 mostly indicating transudative effusions.

55.Role of Clinical Features (Including That of Current WHO Criteria), and Oxygen Saturation (SpO2) in the Diagnosis of Childhood (2-59 Months) Pneumonia in Northern Bihar
Shantanu Kumar, Satyendra Paswan, Nagenrda Kumar Gupta
Aim: To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia. Material & Methods: This prospective, cohort study was conducted in Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, India, from October 2020 to May 2021. Children aged 2-59 months with ARI (any cough and/or breathing difficulty for <2 weeks) were enrolled. Results: A total of 1100 children with ARI were enrolled in the study. According to WHO criteria, 139 (12.6%) and 988 (89.8%) of the enrolled children had pneumonia and no pneumonia (URI), respectively. Around 68% (22/32) children had pneumonia (kappa=0.4, P<0.001). Conclusion: Current WHO criteria based on rapid respiratory rate and/or chest in drawing has modest sensitivity and specificity, considering CXR abnormalities as gold standard for diagnosis of pneumonia. Addition of SpO2 of <92% to chest in drawing alone or WHO criteria increases the probability of pneumonia diagnosis and is important in the management of a child with pneumonia.

56.A Hospital Based Observational Assessment of Acute Kidney Injury of Infectious Etiology in Monsoon Spell
Vijay Shankar, Rishi Kishore
Aim: To assess the acute kidney injury of infectious etiology in monsoon season. Material & Methods: The study was planned in the Department of Nephrology, Nalanda Medical College & Hospital, Patna, Bihar, India to assess incidence, etiology, clinical profile, and outcome of AKI of infectious origin during monsoon season. Results: A total of 120 cases were recruited for the study, among which 100 were males and 20 were females. Among all the patients, 105 showed clinical feature of fever, followed by vomiting (98), oliguria (85) and High-colored urine (77). 31 cases presented with malaria as the most common diagnosis. Conclusion: Tropical AKI presents in severe stage and in significant proportion during monsoon. Malaria and AGE are still the predominant etiologies while leptospirosis and dengue are emerging etiologies causing AKI during monsoon.

57.Study of Serum Iron, Calcium and Zinc Status in Correlation to Febrile Seizure in Children Admitted to a Tertiary Care Hospital in Bihar
Subhrajyoti Tripathy, Kripa Nath Mishra, Rizwan Haider
Aim: To evaluate the correlation of serum iron, serum calcium and serum zinc levels in children with febrile seizures. Methods: This prospective case control study was conducted on 120 Children between 6 months to 5 years who were admitted to a tertiary care hospital in Bihar over a period of one and half year from April 2020 to October 2021 fulfilling the inclusion criteria. The case group consisted of 60 patients with febrile seizures and the control group included 60 febrile children without seizures. Demographic details, seizure details, nature of febrile illness, examination findings on admission and investigations were noted according to study protocol. Results: Mean age of cases and controls was 21.12 ± 15.26 and 36.9 ± 21.19 months respectively. Among cases 61.67 % were males. The mean temperature in cases was 102.12 ± 0.83°F being higher than that of controls (98.87 ± 0.2780 F: P = 0.0012). The mean values of Hb, MCV and MCH were low in cases compared to controls with statistically significant P values. Mean value of Serum Ferritin in cases and controls was 40.14 ±29.65 µg/l and 58.16±25.08 µg/l respectively (P = 0.0014) i.e., low serum ferritin was seen in cases than in controls. No significant deference in mean value of serum calcium was noted among cases and controls. Mean value of serum zinc level in cases was 49.84±38.62 μg/dL which was lower than controls (92.17± 33.5 μg/dl: P = 0.0001). Conclusion: The children having febrile illness suffer from iron deficiency and zinc deficiency can serve as reinforcing factors for febrile seizures and needs to be excluded whereas calcium deficiency is not associated with febrile seizures.

58.To Evaluate Peripheral Smears with Hypersegmented Neutrophils-an Etiological Analysis in Tertiary Care Center of North Bihar
Ranjan Kumar Rajan, MD Shakir Ahmad, Chittaranjan Dutta
Aim: To evaluate peripheral smears with hypersegmented neutrophils and classify the etiological factors. Material & Method: This is a prospective study carried out over a period of one year conducted in Department of Pathology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India. EDTA blood samples received in our hematology laboratory were analyzed for hyper segmentation of neutrophils using leishman stained peripheral smears. Results: Although major cases were contributed by macrocytic anemia, 43.7% cases were having microcytic hypochromic anemia. Out of the 42 cases with normocytic normochromic blood picture; only 12 had subnormal levels of either Vit B12 or folic acid values. Rest of the 30 cases had normal Vit B12 and folic acid levels. Conclusion: Microcytic hypochromic anemia, myelodysplastic syndromes and inflammatory conditions also can cause hypersegmented neutrophils in peripheral smears. Study also points to increased incidence thrombocytosis in pure Microcytic hypochromic anemia cases compared to other etiological factors which is still to be established with further detailed studies.

59.Prospective Randomized Comparative Clinical Assessment of the Diclofenac with Different Preparation of Paracetamol for Post-Operative Analgesia Following Laparoscopic Cholecystectomy
Ganesh Kumar, Venu Gopal
Aim: To evaluate the efficacy of postoperative pain control by diclofenac with Paracetamol 100 mL infusion (P) and diclofenac with Paracetamol 2 mL stat (PL). Material & Methods: The proposed study was carried out in the department of Surgery, JNKTCH, Madhepura, Bihar, India, over a period of one year.120 patients were included in the study. They were divided into two groups with 60 patients in each group: Group DP and Group DF. Results: The demographic data showed that the mean age group was 35 years, weight was 60.5 kg, height was 160 cm and a sex ratio of female: male=51:49 in either group. VAS taken for post-operative pain assessment was same in both the age groups over equal time interval without significant difference. Conclusion: Comparing both the formulations of these paracetamol in combination with diclofenac in laparascopic surgeries and we did not find any significant difference between these two in terms of demography, VAS, VRS and any other side effects. However, the major difference in the cost between these two formulations makes a significant impact in the economic burden.

60.Randomized Comparative Assessment of the Safety Profile of Clonidine and Dexmedetomidine in Patients Needing Short-Term Sedation of Intensive Care Unit
Mahesh Kumar, Saurabh Singh
Aim: To compare sedative, analgesic and cardiovascular effects and safety profile of two 2 agonists, clonidine, and dexmedetomidine for patients requiring short-term sedation in ICU. Material & Method: On arrival to the ICU, patients were randomly allocated into two groups, Group C and D, based on computer generated random number tables. Clonidine was supplied in 1 ml ampoules, containing 150 µg/ml and diluted with normal saline to a concentration of 3 µg/ml. Dexmedetomidine was supplied in 2 ml ampoules that contained 100 µg/ml diluted with normal saline to a concentration of 4 µg/ml. Results: Over a period of 18 months, 100 patients were enrolled in the study to receive sedation with either dexmedetomidine (n = 50) or clonidine (n = 50). These included 83 postsurgical, 10 medical and 7 polytrauma patients evenly distributed in each group. The baseline hemodynamic parameters were comparable in both groups. A significant reduction in systolic and diastolic BP from the baseline (P < 0.05) occurred after bolus infusion in Group D but in none of the patients fall was >30% from baseline. Patients receiving clonidine (Group C) had significantly lower heart rates from baseline (P < 0.05). On comparison, the hemodynamic parameters were comparable between the two groups during the study period (P > 0.05). Conclusion: Both clonidine and dexmedetomidine produced effective sedation; however, the hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients.

61.Randomized Prospective Double Blind Clinical Evaluation of Dexmedetomidine on Haemodynamic Stress Response during Laryngoscopy and Intubation
Monika Madhurima
Aim: The present study was aimed at attenuation of haemodynamic sress response to laryngoscopy and intubation in patients posted for elective surgeries under GA. Methodology: This randomized prospective double-blind study carried out in 140 patients aged 20-60 years of ASA physical status of I and II scheduled for elective surgery under general anaesthesia requiring endotracheal intubation. After detailed pre-anaesthetic evaluation, systemic examination and routine investigations were done. In pre-anesthetic preparation room, monitoring for heart rate, non-invasive blood pressure, and peripheral oxygen saturation were established and baseline vital parameters were recorded, including Ramsay sedation score. Intravenous line was secured and premedication consisting of Ondensetran 0.08 mg/kg IV and Glycopyrrolate 0.004 mg/kg IM, were given 30 minutes before induction of anesthesia. Patients were randomly divided into two groups (each of 70 patients) using random number table method. Group B, (n=70): Inj. dexmedetomidine 1mcg/kg in 100 ml NS and Group A, (n=70): 100 ml NS Intravenous infusion over 10-15 minutes, 30 minutes before induction of anesthesia. Patients were monitored for hemodynamic changes at various specific timing as per protocol, and sedation was monitored according to Ramsay Sedation Score immediately and at 5, 10, 15 and 20 minutes after drug administration. Results: 52 and 59 were ASA physical status I in group A and B respectively, and 18 and 11 were ASA physical status II in group A and B respectively. Patient characteristics in terms of age, gender and weight were comparable in both the groups. On comparing the changes in heart rate, SBP, DBP, SpO2, MAP, and sedation sore between group A and group B at various specific timing, there was significant difference between the two groups. Sedation did not cause respiratory depression in any patient. There was significant fall in heart rate in dexmedetomidine group after drug administration as compared to baseline. There was increase in heart rate at the time of laryngoscopy and intubation, but this increase was not significant. After intubation, heart rate returned below baseline value and remained so throughout the study period. While in control group, heart rate significantly increased during laryngoscopy and intubation and remained above baseline throughout the study period. In group A, 18 patients (25.7%) had tachycardia, 16 patients (22.9%) had hypertension and 4 patients (5.7%) had arrhythmia intraoperative. In group B, 6 patients (8.6%) had bradycardia and 3 patients (4.3%) had hypotension, preoperatively. Intraoperative, 5 patients (7.1%) had tachycardia and 3 patients (4.3%) had hypertension. Respiratory depression was not seen in any patient of either group. Conclusion:Dexmeditomidine given before induction effectively blunts the hemodynamic response to laryngoscopy and endotracheal intubation and provides stable hemodynamic throught the surgery and provides good and safe level of sedation without respiratory depression in routine surgery.

62.A Prospective Assessment of the Mean Hemoglobin Values for Various Blood Groups and to Find Out if There Are Any Significant Differences in the Values in Different Blood Groups
Ram Kumar Singh
Aim: The aim is to find the mean hemoglobin values for various blood groups and to find out if there are any significant differences in the values in different blood groups. Materials and Methods: Total 300 subjects were recruited from the common rural population in and around of Bihar. Apparently healthy males and females of the age group 18–45 years were included in the study.  Blood hemoglobin levels were estimated using the instrument hemo control (EKF diagnostics). The finger pricked blood was collected into a hemoglobin micro cuvette and this was fed into hemo control. The hemoglobin levels were displayed digitally. The values were recorded. Results: The randomly selected population consisted of 173 males and 127 females There was a significantly high value of hemoglobin occurring in the O+ve individuals (hemoglobin values of 15.1–16.3 g/dL) as compared to the A+ve individuals though the absolute values and mean values of the hemoglobin fall in the normal range only. Conclusion: Our study done on the rural population showed significantly higher hemoglobin values in O blood group than the A and B blood groups. Rh-negative blood groups had low hemoglobin values when compared with Rh+ve blood groups.

63.Comparative Assessment of the Hemodynamic Parameters with Low Dose Oral Clonidine (100mcg) and Placebo Group in Laparoscopic Surgeries
Venu Gopal, Ganesh Kumar
Aim: This study aims at comparing the hemodynamic variation with low dose oral clonidine (100mcg) and placebo group in laparoscopic surgeries. Material & Methods: 80 consecutive patients undergoing laparoscopic procedures of 90 to 180 minutes were enrolled into the study. Results: Of the 80 cases, 70 were laparoscopic cholecystectomies and 10 were laparoscopic hernia repair, which was comparable between the two groups. However, at 90 minutes the diastolic blood pressure was lower in the test group, but at 120 mts there was no statistically significance between the two groups (p=0.762). Conclusion: Low dose oral clonidine is a very efficient, easy to administer and cost-effective premedication drug during laparoscopic procedures.

64.Pedicled Transverse Rectus Abdominis Muscle Flap Breast Reconstruction: A Comparative Study
Sumit Raj, Roshani Prasad, Chandramauli Upadhyay, Binod kumar Jaiswal
Aim: To address concerns regarding the pedicled TRAM flap by providing a detailed and up-to-date analysis of the morbidity associated with the procedure when polypropylene mesh is used to reinforce the abdominal wall repair. Material & Methods: 100 patients underwent breast reconstruction with pedicled TRAM flaps at Department of Surgery, JLNMCH, Bhagalpur, Bihar, India. All patients played an active role in the decision-making process and were provided the option of pedicled flaps, free flaps, or implant-based reconstruction. Results: During the study period, 100 patients underwent pedicled TRAM flap breast reconstruction by the senior author (J.A.A.). Unilateral pedicled TRAM flaps were performed in 55 patients and bilateral procedures were performed on 45 patients. All of these flap complications occurred in unilateral TRAM flap patients, with a rate of 20.1% in the unilateral group vs. 0% in the bilateral group (P = 0.005). Obesity was significantly associated with donor site complications independent of other risk factor contributions (OR, 6.12; P = 0.001). Conclusions: The pedicled TRAM flap continues to be an excellent option for breast reconstruction. Complication rates for both unilateral and bilateral TRAM flaps were low in this series, with no complete flap losses and just 4.3% of patients requiring a return to the operating room secondary to morbidity.

65.A Retrospective Observational Assessment of the Emergency Peripartum Hysterectomy in Modern Obstetrics
Priyanka Shahi, Ila Priyanka, Geeta Sinha
Aim: To know the incidence, leading causes, risk factors and complications of EPH. Material & Method: This was a retrospective observational study conducted at the Department of Obstetrics and Gynecology, Patna Medical College & Hospital, Patna, Bihar, India. This study included all women undergoing hysterectomy after 22 weeks of gestational age and within 6 weeks of delivery. Results: The mean gestational age at which EPH was performed was 34.3±4.1 weeks. EPH was done for atonic PPH in 12 (40.0%), followed by uterine rupture in 8 (26.7%) and morbidly adherent placenta in 6 (20.0%). Intra-operative injury to the urinary bladder was seen in 5 (16.7%) of the patients. Conclusion: Uterine atony and uterine rupture continues to be the most common causes for EPH in our population. Multiparity is an important risk factor among patients with rupture uterus. Cesarean delivery and repeat cesarean deliveries are the likely risk factors for EPH.

66.A Case Control Assessment of the Electrocardiographic Changes in Subclinical Hypothyroidism
Ram Kumar Singh
Aim: The objectives of this study were to study the electrocardiogram (ECG) changes in a group of newly diagnosed subclinical hypothyroid females and to compare the ECG changes in subclinical hypothyroid females with normal healthy euthyroid individuals. Material & Methods: This study was conducted in the Department of Physiology, A. N. Magadh Medical College, Gaya, Bihar, India. We studied 30 patients with newly diagnosed and untreated primary SCH, outpatient department (with non-specific complaints such as fatigue, mild weight gain, dry skin, and depressive feelings but without overt symptoms and signs of thyroid hormone deficiency. Results: A total of 60 subjects (30 in the study group and 30 in the control group) were included in the study. TSH levels were significantly higher in SCH patients than controls, but fT4 and fT3 were comparable. Conclusion: ECG changes in SCH showed increase in the QTc interval as compared to controls, which predisposes to the potentially life-threatening ventricular arrhythmias. However, the other parameters of ECG such as QRS interval, PR interval, and QRS axis were similar to the controls.

67.A Cross-Sectional Descriptive Study to Evaluate the Hematological Changes in Hypothyroidism and Hyperthyroidism Patients Attending Medicine OPD in Darbhanga Medical College, Laheriasarai
MD Shakir Ahmad, Ranjan Kumar Rajan, Chittaranjan Dutta
Aim: To study the pattern of hematological changes in thyroid dysfunction and to correlate thyroid function tests with complete blood count & red cell indices findings. Material & Method: This was a cross-sectional descriptive study conducted in Department of pathology, DMCH, Darbhanga, Bihar, over a period of one year to evaluate the correlation between thyroid disease and hematological changes. For study 100 patients of hypothyroidism, 50 patients of hyperthyroidism and 50 euthyroid patients attending Medicine OPD at tertiary care center were selected. Results: Hypothyroid group showed statistically significant reduction in Mean RBC count, hemoglobin, hematocrit, MCV and MCH and increased RDW whereas hyperthyroid group showed reduction in Mean RBC count, hemoglobin, and hematocrit and increased RDW when compared with control group. There was no statistically significant difference in total leukocyte count and platelets count among hypothyroid and control as well as hyperthyroid and control group. Conclusion: Thyroid function test should be done in cases of unexplained anemia. So, periodic evaluation for probable hematological changes should be done in all the patients with hypothyroidism and hyperthyroidism.

68.A Comparative Evaluation of Premedication with Oral Gabapentin and Pregabalin in Attenuation of Pressor Response to Endotracheal Intubation under General Anaesthesia
Monisha S., Sreeraghu G. M., Vinuth K. Murthy, Sufiyan Faizi N.
Background: In this study we wanted to compare the effects of oral Pregabalin and Gabapentin in attenuating the hemodynamic response to laryngoscopy and intubation in relation to heart rate, blood pressure-systolic and diastolic and mean arterial pressure. Materials and Methods: Sixty patients belonging to ASA grade 1 and 2 were randomly divided into two groups of thirty each. Oral Gabapentin 600mg and oral Pregabalin 150 mg was given 1 hr prior to surgery. Both groups were premedicated with Glycopyrolate 0.005 mg/kg and Fentanyl 1.5μg/kg was given. They were induced with Thiopentone sodium 5 mg/kg and intubation was aided with Vecuronium 0.1 mg/kg.The hemodynamic parameters recorded were heart rate, systolic and diastolic blood pressure and the mean arterial pressure every minute upto 5 minutes and at 10 minutes, 15 minutes, 30 minutes and 45 minutes time interval in each group. Statistical analysis was done using Chi-square (χ2) test of significance and Student “t’’ test and P value obtained. Results: Both groups showed attenuation of stress response. Pregabalin and Gabapentin affected heart rate to same extent upto 5 minutes (p>0.05). In Gabapentin group, there was increase in SBP, DBP and MBP upto 3 minutes, after that it was maintained below the baseline. In Pregabalin group there was no rise in systolic and diastolic blood pressure and mean arterial blood pressure compared to the baseline from the 1st minute of intubation which is statistically significant (p<0.001). Conclusion: Both Pregabalin and Gabapentin attenuate the stress response to laryngoscopy and intubation. When both these drugs were compared. Pregabalin attenuated the stress response to laryngoscopy and intubation better than Gabapentin and afforded a good hemodynamic stability.

69.Prospective Observational Assessment of the Thyroid Profile in Patients of Thalassemia with Multiple Blood Transfusions and High Serum Ferritin
Jeetendra Mahato, Vivek Kumar, Gopal Shankar Sahni
Aim: Thyroid profile in patients of thalassemia with multiple blood transfusions and high serum ferritin. Methods: This prospective observational study was done in the department of Paediatrics, SKMCH, Muzaffarpur, Bihar, India, for the period of 1 year. 100 Children 3 to 18 years age group with proven Beta thalassemia major, Child received blood transfusions for more than 2 years and children with serum ferritin level >700(ng/ml) were included in this study. A detailed history was obtained from each patient regarding the age of diagnosis, frequency of transfusions, compliance to transfusion, and chelation was noted. 3ml of fasting blood sample from venous blood under strict aseptic precautions is taken to assess serum levels of thyroxine (T4), tri-iodo-thyroxine (T3), thyroid-stimulating hormone (TSH) and Ferritin using Chemiluminescence Immunoassay method. Results: In the study 59% were males and 41% were females. In the present study, 27% were in the age group below 5 years, 52% were in the age group 5 to 10 years and 21% were in the age group above 10 years. The mean age of subjects was 8.12 ± 3.12 years. In the study 7% were Underweight (<3rd Centile), 71% were Normal (3rd to 90th Centile), 15% were Overweight (90th – 95th) and 6.7% were Obese (>95th Centile). In the study, the mean height was 166.25± 16.87cms, and the mean weight was 21.98 ± 9.02 kgs. Mean Hb was 7.25 ± 1.87 g/dl, mean Ferritin (ng/ml) was 1300.87 ± 1022.87, mean T3(pg/ml) was 2.52 ± 1.11, mean T4(ng/dl) was 3.26 ± 2.87 and mean TSH (mIu/L) was 4.66 ± 2.32. Conclusion: Thalassemia patients have a high prevalence of endocrinological abnormalities. Several studies at different centers have demonstrated the increased prevalence of endocrinopathies in patients with thalassemia. Improvements in protocols of transfusion regime and chelating therapy should hopefully improve the care and quality of life of these patients.

70.Study of Influencing Factors on Drug Prescribing Behavior of Practitioners in an Urban City of Eastern India
Soumya Santra, Karmajeet Rath, Sudhanshu Sekhar Mishra, Kunal Sharma
Background: Physicians are entrusted with the responsibility of assessing their patients’ needs and prescribing drugs to improve their health. Rational prescribing is a significant topic that requires more attention in order to examine prescriber’s behavior in clinical settings. Three broad influencing factors for the prescribing behavior were identified such as, physician’s personal drug choice, pharmaceutical influence & patient factors. Aim & Objectives: The study was performed to determine influential factors on prescribing drugs by the practitioners. Materials & Method: A cross-sectional study was carried out among practitioners of hospital, private or dual setup based. An objective type of questionnaire was designed for them to assess their prescription. Analysis was done by using suitable statistical methods. Results: Among hospital-based practitioners (n-45), 82.3% considered company’s brand image, 88.9% notified regular promotions, 75.6% mentioned easy brand name and 68.9% accepted scientific information influenced their prescribing habits. Private practitioners (n-42) who participated in the survey enlisted common factors to be company’s image 73.8%, brand Availability 71.4%, medical representative’s rapport 61.9%, pharmaceutical promotional tools 80.9%, scientific information 66.7%, and personal drug preference 76.2%. On the contrary, dual practitioners (n-96) agreed upon their choice of drugs being affected by the company’s image 89.6%, regular promotions 81.3%, brand availability 85.4%, lower priced drugs 61.5%, medical representative’s rapport 79.2%, easy brand name 65.6%, International certifications 68.7%, pharmaceutical promotional Tools 82.3%, scientific information 76.1%, and personal experience 76.0%. The overall literacy status, behavior towards doctor and socioeconomic conditions of the patients have been enlisted as important factors of prescription pattern in 65.6%, 41.0% and 68.3% cases respectively. Conclusion: This study highlighted the differences in perception among hospital based, private and dual practitioners in regard to choose of drugs and prescribing habits. The major influencing factors were found out to be low priced drug, medical representative’s rapport, international certifications and promotional tools used by the pharmaceutical companies. Nevertheless, patient factors like namely literacy, socioeconomic status and behavior of the patients also played a vital role on physician’s selection of drugs.

71.A Single-Center, Retrospective Assessment of the Clinical Profile of Patients with Sudden Onset Sensorineural Hearing Loss
Sarika Kalra
Aim: To study clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital. Material & Methods: Present study was single-center, retrospective study, conducted in Department of ENT, MP Birla Hospital & Priyamwada Birla Cancer Research Institute, Satna (MP), India. Study approval was taken from institutional ethical committee. Case records of patients with sudden onset sensorineural hearing loss examined over a period of 10 months were considered for present study. Results: Vertigo was significant in patients without recovery (63.33%) as compared to patients with recovery (20 %) and difference was statistically significant (p<0.05). Recovery was noted in early initiation of treatment and difference was statistically significant (p<0.05). Conclusion: In patients with sudden onset sensorineural hearing loss age less than 40 years, no comorbidities, lesser degree of hearing loss, early (<14 days) initiation of treatment are factors associated with recovery.

72.Morphometric Evaluation of Variations in Shape of Coronoid Process of Adult Human Mandible: A Cross-Sectional Study
Hema Narayan, Suman Kumar, Ramji Prasad
Aim: To study clinical profile of patients with sudden onset sensorineural hearing loss at a tertiary hospital. Material & Methods: Present study was single-center, retrospective study, conducted in Department of ENT, MP Birla Hospital & Priyamwada Birla Cancer Research Institute, Satna (MP), India. Study approval was taken from institutional ethical committee. Case records of patients with sudden onset sensorineural hearing loss examined over a period of 10 months were considered for present study. Results: Vertigo was significant in patients without recovery (63.33%) as compared to patients with recovery (20 %) and difference was statistically significant (p<0.05). Recovery was noted in early initiation of treatment and difference was statistically significant (p<0.05). Conclusion: In patients with sudden onset sensorineural hearing loss age less than 40 years, no comorbidities, lesser degree of hearing loss, early (<14 days) initiation of treatment are factors associated with recovery.

73.The Present Hospital Based Prospective Assessment of the Albuminuria and Reduced Estimated GFR between First-Degree Relatives of Chronic Kidney Disease Patient
Rishi Kishore, Vijay Shankar
Aim: To assess the Albuminuria and reduced estimated glomerular filtration rate among first-degree relatives of patients with chronic kidney disease. Material & Methods: The present study was planned in the Department of Nephrology, Nalanda Medical College & Hospital, Patna, Bihar, India. Total 60 individuals were enrolled in the present study over a period of six months. Results: 60 cases were divided in two study groups as 30 cases of the first-degree relatives of CKD patients and 30 are control cases. Hypertension was seen among 10 cases followed by Diabetes mellitus (6) and chronic glomerulonephritis (4). Conclusion: Presence of hypertension serves as a modifiable independent risk factor for albuminuria while the presence of proteinuria and increasing age were found to predict reduced eGFR in first degree relatives. The prevalence of albuminuria increases with the duration of hypertension. Early screening of essential hypertensive patients for albuminuria and aggressive management of hypertension might reduce the burden of diseases due to renal damage secondary to hypertension in the community.

74.Personality Disorders in Treatment Seeking Patients with Poly Substance Dependence
Dheeraj Goya, Sushil Kherada, Pratibha Gehlawat, Suresh Gochar, Vijay Kumar Saini, Sunil Sharma
Introduction: Relationship of substance use with personality disorders have been postulated by various hypotheses. So, with the aim of to assess personality disorders in treatment seeking patients with poly substance dependence we planned a cross sectional study. Material and Method: After taking consent patients of polysubstance dependence (diagnosed as per ICD-10) were recruited. Relevant information gathered through semi structured proforma and Modified Kuppuswamy scale was applied for Socio-demographic details. Personality disordered was assessed with help of ICD-l0 international personality disorder examination (IPDE). Results: Total 45 patients were enrolled in the study. Personality disorders were absent in 46.7% patients while it was present in 48.9%. Majority of patients with polysubstance dependence were having borderline personality disorder (15.6%) followed by Dissocial personality disorder (13.3%). Discussion: Assessment of co-morbid personality disorder in above population may help in management.

75.A Comparative Study of Labetalol versus Methyldopa in the Treatment of Preeclampsia
Shubhangi Devendra Chaudhari, Devendra Chaudhari, Maya Arvikar
Introduction: A large proportion of antenatal care is devoted to the detection and management of hypertensive disorders of pregnancy because, as a group, they are the second major cause of maternal and perinatal serious illness (e.g. Stroke or preterm birth, respectively) and/or death in both low to middle income and high income countries. Pre-eclampsia/eclampsia is an unpredictable, multi-organ disorder unique to human pregnancy. With hypertension, the preeclampsia syndrome, either alone or superimposed on chronic hypertension, is the most dangerous. Treatment of this disorder remains a challenge to even the most experienced obstetrician, as the etiology is not known. Preeclampsia is development of hypertension, proteinuria, or both, after 20 weeks in women with previously normal blood pressure. Hypertension during pregnancy is common. It is estimated that preeclampsia complicates 3 to 10% of pregnancies in primigravidae and is variable and comparatively less in multiparas. Aim: To compare the efficacy and safety of labetalol with methyldopa in the management of preeclampsia. Material and Method: This study included 50 patients of females with the age group of 20-50. In оf Faculty of Pharmacology and OBGY Dept. Dr.Ulhas Patil Mediсаl Соllege and Hospital Jalgaon, Maharashtra. Result: Table: 1 Comparison between labetalol and methyldopa Systolic Blood Pressure (SBP) in first group 0 hours to after taking dose of Labetalol  and  Methyldopa systolic blood pressure are  after 72 hours more reduced to the Labetol groups compared Methyldopa to the values shows that statistically significant p-valve are P < 0.001. Conclusion: Many drugs have been used in the management of preeclampsia, labetalol is very effective and early onset of control of blood pressure is seen. With effective control of blood pressure, prevention of eclampsia and the pregnancy can be prolonged to achieve fetal maturity. To conclude, labetalol is safe, quicker control of blood pressure, advantageous than methyldopa with fewer side effects, and in prolongation of pregnancy in hypertensive disorder of pregnancy.

76.Study on Efficacy of Oral Iron in Comparison with Iv Iron Sucrose in the Treatment of Iron Deficiency Anemia in Pregnant Women in a Rural Scenario
Shubhangi Devendra Chaudhari, Devendra Chaudhari, Maya Arvikar
Introduction: In India, the maternal mortality is around 350 -450/100,000 live births, a figure similar to that found in Europe 200 years ago. Anaemia is estimated to contribute to 20 percent of all maternal deaths and nine times higher risk of perinatal mortality. The odds for low birth weight are tripled, while those for preterm delivery more than doubled in association with IDA. Anaemia and iron deficiency in pregnancy are associated with large placental weight and a high ratio of placental weight to birth weight (placental ratio).both of which are predictors of adult hypertension. A vast majority of women in rural India embark upon pregnancy with frank iron deficiency anaemia. Iron deficiency anaemia (IDA) remains the commonest medical disorder in pregnancy in the developing world, with the burden of disease impacting on both the mother and the newborn (and subsequent child and later adult). India is leading in iron-deficiency anaemia in the world. It is very common in rural population due to poverty and an inadequate diet. Aim: Study on Efficacy of Oral Iron in Comparison with Iv Iron Sucrose in the Treatment of Iron Deficiency Anemia in Pregnant Women in A Rural Scenario. Material and Method: The comparative study was conducted department of gynecology and pharmacology at Dr. Ulhas Patil Medical College and Hospital during the period of November 2021 to Aril 2022. 40 patients who fulfilled the inclusion criteria were randomized into either of the two groups, 20 to the oral are the patients who were given. study with two groups, 20 patients in IV Rx Group, and 20 patients in Oral Rx group was undertaken to study the treatment effect based on outcome such as Hemoglobin (before and after), and side effects. Result: Comparison between Before and after Sucrose oral and Iv Iron Therapy Hb, Rbc, Are Increased. In After Iv Rx group Treatment Is Statistically Significant (P value<0.0001). Conclusion: This study was attempted to analyse the safety and efficacy of oral iron in comparison to IV iron on the hematological parameters in pregnant women with iron deficiency anemia. My study confirms that IV iron caused a rapid and effective improvement in the hematological parameters when compared to oral iron. In our country, with a higher incidence of iron deficiency anemia in pregnancy, specially in a rural scenario, this type of treatment may be helpful in management of these patients in a cost-effective manner.

77.Observational Research to Assess the Prevalence and Impact of Thyroid Disorders on Maternal and Fetal Outcome
Naiyer Azam
Aim: To determine the prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome. Material & Methods: This observational study was carried out by the department of Biochemistry in collaboration with department of Obstetrics and Gynecology Venkateshwara Institute of Medical Sciences, Gajraula, Uttar Pradesh, India. A total of 360 pregnant women were selected over a period of one year, between 13 and 26 weeks of gestation were included in the study. Results: The prevalence of hypothyroidism was 5%, out of which 2.7% had overt hypothyroidism and 3.1% had subclinical hyperthyroidism in the present study. The maternal complications in different groups were adverse maternal effects in overt hypothyroidism included preeclampsia (18.1 versus 9.09%) and placental abruption (18.1 versus 2.00%, P = 0.005). Conclusion: The prevalence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome.

78.Community Based Study: Relationship Between Maternal and Children Nutritional Status
Chintan K Dasharatha, Nikulkumar R Thakkar, Mayankkumar Javia, Kalpeshkumar V Vadher, Punit Patel
Background: Maternal and child undernutrition and micronutrient deficiencies affect approximately half of the world’s population. Nutritional status of children influences their health status, which is a key determinant of human development. About 45% of deaths of children under 5 are related to malnutrition. Objective: To assess the relationship between the nutritional status of the mother and the nutritional status of the children. Materials and Methods: A community-based study was conducted on a total of 110 children and their mother. Data were collected using a pre-tested structured questionnaire and anthropometric measurements were performed using calibrated equipment and standardized techniques. Maternal nutritional status was determined by BMI using the WHO recommendation. The weights and heights of the children were converted to z-scores with WHO Anthro Software. Results: The difference of wasting among male children (20.7%) and female children (17.3%) was not significant (p>0.05). Number of wasted children were maximum (35.7%) in the age group of 6 to 12 months. The number of participants decreased as the age increased and the difference was statistically significant (p<0.05). Children whose mothers had underweight nutritional status were significantly more wasted as compared to children of mothers who had normal nutritional status. Conclusion: The interrelationship between maternal and infant nutritional status was significantly associated and highlights the importance of improving maternal nutritional status to achieve better maternal and child health outcomes.

79.Clinical Management of Eyelid Trauma in a Tertiary Care Teaching Hospital
P Swetha, V Pragna
Background: Eyelid trauma appears to be minor however, it can have serious consequences in terms of injury-related morbidity. Ocular trauma is the major cause of visual impairment worldwide. Management of lid injuries, complete eyelid function, and maintenance of the lacrimal system are important considerations. The current study aimed to assess the extent of eyelid trauma and management of eyelid trauma reported to our tertiary care teaching hospital. Methods: This cross-sectional study was conducted in the Department of Ophthalmology, Prathima Institute of Medical Sciences, Naganoor, Karimnagar. N=25 cases of eyelid trauma were included. The patients were evaluated by Visual acuity using Snellen’s acuity chart, Slit-lamp biomicroscopy of the anterior segment, Extra Ocular Movements, Intraocular pressure using Goldmann Applanation tonometer, Direct and Indirect ophthalmoscopy, Field of vision, Color vision, Diplopia Charting. Results: Full-thickness involvement of the eyelid was found in 15(60%) of cases and partial thickness was involved in 40% of cases. The margin of eye involvement was seen in 60% of cases and the margin was not involved in 40% of cases. The majority of the patients (84%) had good visual acuity ranging from 6/6 to 6/18. Visual acuity ranged from 6/24 to 6/60 in 12% of the cases, with just one instance having vision less than 6/60 due to an immature cataract in the afflicted eye. Conclusion: The eyelid injuries are common in the younger age group and affect males frequently with road traffic accidents being an important cause. lower canaliculus involvement was greater than upper canaliculus involvement because of the inferior canaliculus’s more vulnerable location to damage and the loose proximity of the lower lid to the globe medially. The time of presentation has a great impact on the outcome of the repair. The younger group has better cosmetic outcomes postoperatively.

80.Comparative Evaluation of Vancomycin Disc Diffusion Method & Vancomycin Screen Agar with Vancomycin E-Test in the Detection of Clinically Significant MRCoNS.
Sandhya Narayanan, Deepa S., Soundarya P.L.
Background and Objectives: Coagulase negative Staphylococci (CoNS) are colonizers of the skin, anterior nares, and ear canals of human beings. They have long been considered as non-pathogenic but as a result of the combination of increased use of intravascular devices and increase in the number of hospitalized immunocompromised patients, they have become one of the important nosocomial pathogens.  One of the characteristics of CoNS is their resistance to multiple antimicrobial agents. Some recent reports have pointed out high level of methicillin resistance and reduced susceptibility to vancomycin which is of utmost danger in this era of multidrug resistance. Materials and Methods: A total of 100 Coagulase negative Staphylococci isolates from various clinical samples were collected. All clinical samples were processed as per the standard protocols and CoNS were identified and further characterized Susceptibility to antibiotics were tested by Kirby Bauer’s disc diffusion method. Vancomycin screen agar was used for all MRCoNS isolates. MIC of vancomycin was performed by E-test. Results: Of 100 isolates, 17 (17%) were MSCoNS and 83 (83%) were MRCoNS.91% isolates were susceptible to vancomycin disc method. 8 isolates grew on vancomycin screen agar and one isolate showed resistance to vancomycin using E-test. Whereas one isolated showed intermediate susceptibility to vancomycin by E-test. Conclusion: In our study, we have observed emergence of vancomycin resistant strain. Higher prevalence of MRCoNS and indiscriminate use of vancomycin are the risk factors, and such strains can get disseminated in the hospital environments at an alarming rate. Hence as an alternative linezolid can be considered.

81.A Hospital Based Study on Breastfeeding Practices in Infants Aged 0-6 Months
Nawal Kapoor, Kirti Vishwakarma, Purnendu Lohia, Vipin Thakur
Objective: To study breastfeeding practices in 0–6-month babies delivered institutionally & to find barriers to standard breastfeeding practices from postnatal mothers. Methods: Hospital based cross sectional study which included all postnatal mothers who delivered a healthy neonate. Sociodemographic details regarding age of mother and father of neonate were obtained. Their residence, education, occupation, socioeconomic status, family type etc. was obtained and noted. Breastfeeding practices were assessed and time of initiation of breast feeding after delivery was noted. In case of delay, the reason of delay was assessed. All the cases were assessed for exclusive breast feeding and reason for not exclusive breastfeeding was noted. Colostrum feeding, prelacteal feeding or any other practice with respect to feeding of neonate was observed and noted. Position of breastfeeding, feeding practice during night, method of top feeding and its reason was assessed. Results: 66.1% mothers at least took four or more antenatal visits. During the antenatal visits, advice regarding diet and physical activity was received by 87% mothers whereas breast feeding advice was received by only 14.3% mothers. Only 57.8% neonates were breast fed exclusively (100% in case of NVD and only 32.7% in case of LSCS). Reason for not feeding exclusively was insufficient milk production (83.1%) in majority of cases followed by Inverted nipples (8.1%). Initiation of breast feeding was significantly earlier i.e. within 30 minutes following delivery in NVD cases (91.7%) as compare to LSCS cases (83.2% after 1 hour) (p<0.05) reason for delay in initiation of breast feeding was no milk production during initial few hours/days (87.9%), maternal illness (6.3%) and unawareness regarding timing of initiation among mothers (3.4%). Conclusion: The rate of exclusive breastfeeding is suboptimal and are significantly affected by mode of delivery. Upper middle socioeconomic status, death of child and LSCS are associated with delay in initiation of breastfeeding whereas breast feeding counselling during ANC, breast examination during ANC and vaginal delivery are associated with exclusive breastfeeding. Though IYCF recommends breast crawl immediately or within 5 minutes of delivery, it is not being practiced and must be emphasized after delivery.

82.Factors Associated with Neonatal Pneumonia: A Narrative Review
Manoj Kumar, Swati, Avinash Kumar, Anjali Kumari
The greatest risk of death from pneumonia in childhood is in the neonatal period. It is estimated that pneumonia contributes to between 750 000–1.2 million neonatal deaths annually, accounting for 10% of global child mortality. The etiology depends on time of onset. Gram negative bacilli predominate in the first week of life, and Gram-positive bacteria after that. Streptococcus pneumonia probably causes about 25% of neonatal pneumonia. Other associated risk factors are malnutrition (40% in India), Indoor air pollution, non-breast feeding, chronic pulmonary disease (obstructive), etc. Strengthening of health care delivery system for early detection and treatment and as well as minimization of preventable risk factors can avert a large proportion of death due to pneumonia. Interventions that would reduce mortality from this condition would have a large range of beneficial effects: improved maternal health, better management of other common neonatal conditions, and reduced long term childhood and adult morbidity.

83.Assessment of Uterotonics and Tranexamic Acid for the Treatment of Postpartum Hemorrhage: A Comparative Study
Sangita Kumari, Pratima Kumari
Aim: To compare anti-hemorrhagic effect of uterotonics and Tranexamic acid (TXA) for postpartum hemorrhage. Material & Method: This is a prospective observational study done over a period of two years. 260 pregnant women who were booked in this hospital and delivered vaginally and clinically diagnosed with postpartum hemorrhage were taken for the study. 130 patients received standard protocol with placebo and 130 received standard protocol with Tranexamic acid 1 gm IV. Results: Two groups are comparable with respect to delivery. P value is significant (p< 0.0001). As there is significant difference in FTND and VBAC. Mean blood loss in the control group was 750 ml +/- 100ml while that in study group was 650ml +/- 100ml. The difference between the two groups was significantly high and hence it was statistically significant (p< 0.0001). Conclusion: Tranexamic acid significantly reduces bleeding in post-partum hemorrhage. TXA is not a new drug and is generally well tolerated without any thrombogenic side effects.

84.Knowledge, Attitude, and Practice of Hand Hygiene among Medical and Nursing Students at a Tertiary Health Care Centre in Bihar, India
Kumar Saurabh, Kamlesh Rajpal, Namrata Kumari, Randhir Kumar, Richa Sinha
Aim: To assess the knowledge, attitude and practices of hand hygiene among the medical and nursing students of our college. Methodology: The present study was conducted at Indira Gandhi Institute of Medical Sciences, Patna, which is a multispecialty centre. This was a questionnaire based cross sectional study performed between August 2019 and July 2020. The medical and the nursing students willing to take part in the study were included in the study. Knowledge was assessed using 8 questions which included multiple choice and “yes” or “no” questions. Attitudes was measured using 10 statements, where the re­spondents were asked if they agree or disagree to it. Practice was assessed similarly, using 6 questions. A scoring system was used where 1 point was given for each correct re­sponse to knowledge, positive attitudes and good practices. 0 was given for incorrect knowledge, negative attitudes and poor practices. A score of more than 75% was considered “good”, 50-74% “moderate” and less than 50% “poor”. Results: Out of 210 participants, 160 (76.2%) were medical students and 50 (23.8%) were nursing students.  136 (64.8%) were females and 74 (35.2%) were males. All the participants belonged to final year. On assessing the knowledge questionnaire, 114 (54.3%) participants had good knowledge, 57 (27.1%) had moderate, while 39 (18.6%) had poor knowledge. Maximum of medical and nursing students (90.6% and 90% respectively) believed that they have sufficient knowledge about hand hygiene. 82% nursing students believed that sometimes they have more things to do than hand hygiene and only 47.5% medical students agreed to this. 90% medical students agree that wearing gloves reduce the need for hand hygiene while only 58% nursing students agree to this. Only 51.4% students agree that adhering to hand hygiene practices is easy in the current ICU setup.190 (90.5%) participants confirms that hand hygiene is an essential part of their role but 52 (24.8%) also confirmed that sometimes they miss out hand hygiene simply because they forget it and 126 (60%) agreed that it is difficult for them to attend hand hygiene courses due to time pressure. Conclusion: The students had good knowledge on hand hygiene, but attitudes and practices of medical and nursing students were unsatisfactory to that level. The study shows the need for further improvement of the existing hand hygiene training programs to address the gaps in knowledge, attitudes and practices.

85.Retrospective Observational Assessment of Seroprevalence of Hepatitis A and E Viruses in Patients of Acute Viral Hepatitis
Sunil Kumar, Manoj Kumar, Arjun Lal, Asim Mishra
Aim: In this study, we have studied the seroprevalence and co-infection of HAV and HEV infections in various age groups. Study on seasonal variation of HAV/HEV infections was also included in the study. Methodology: The present study was a retrospective observational study conducted in Department of microbiology in Anmmc, gaya Bihar for 1 year. All patients presenting to the hospital with features of AVH whose samples were received for serological testing against hepatitis A and hepatitis E in the Microbiology laboratory of the institute during the study period were included in the study. For microbiological confirmation, serological testing was done using enzyme-linked immunosorbent assay (ELISA)-based anti-HAV IgM (DiaPro Diagnostic Bioprobes, Italy) and anti-HEV IgM (DiaPro Diagnostic Bioprobes, Italy) antibody detection tests. Data were collected from the laboratory and hospital records for the study. The categorization into pediatric and adult was as per the hospital protocol for patient enrolment in the pediatrics (≤12 years) or medicine (>12 years) specialities. Results: A total of total 200 serum samples were processed for HAV and HEV IgM. In age group of < 12 years, 23.5% cases; age group of 12-40, 43% cases and age group of >40 years, 33.5% cases were studied. Among all the samples, 58% samples were of males and 42% samples were of females. Out of 200 samples, 79 samples (39.5%) were positive for HAV and/or HEV. 25 samples were only HAV IgM positive, 43 samples were only HEV IgM positive, and 12 samples were found positive for both HAV and HEV IgM. 121 samples were found negative. Conclusion: The overall prevalence of HAV and HEV infection was found 39.5%. The shift in HAV seroprevalence toward adults, along with an increasing trend of the number of cases reporting to the hospital, warrants the active community-based surveillance to assess the incidence of HAV in adults in this region.

86.A Retrospective Study to Establish How Useful Mammography and Sonography Was in Confirming the Diagnosis
Pradeep Kumar Nayak, Archana Verma
Aim: This study is done to establish how useful mammography and sonography was in confirming the diagnosis. Methodology: A retrospective study was undertaken of all patients presenting to Department of Radiology, Katihar medical College and Hospital, Katihar, Bihar, India for 1 year whose core biopsy (CB) revealed a diagnosis of fat necrosis. The presenting symptoms, including any history of trauma, were noted. The clinical examination findings were also reviewed. The interpretation of each clinical, mammographic and ultrasonic examination was prospectively classified using a four-category scale (1 ¼ normal, 2 ¼ probably benign, 3 ¼ possibly malignant and 4 ¼ probably malignant). Ultrasound findings were subgrouped into (i) depth within the breast tissues planes, (ii) purely solid lesions, (iii) purely cystic lesions, (iv) complex lesions, (v) the transmitted sound characteristics, (attenuation, enhancement), or (vi) normal examinations. Mammographic findings were categorized as (i) well or poorly defined lucencies, (ii) well or poorly defined densities, (iii) parenchymal disturbances, (iv) skin thickening, (v) related or distant calcifications and (vi) normal study. Results: All 50 patients presented with a palpable abnormality, 48 were discrete masses while 2 demonstrated generalized segmental nodularity. The patient’s age ranged from 28 to 75 years (mean 55.4 years). Only 26 (52%) of the 50 cases had a clear history of trauma or demonstrated definite signs, e.g. scar or bruising, to suggest trauma. 19 (38%), lesions were tender. 28 (56%) lesions were associated with bruising at various stages of evolution. 3 (6%) lesions had associated skin dimpling. The mean time from recalled trauma to presentation and imaging was 8.43 weeks. Mammography was performed in 100% of the patients. 27 (54%) of the mammograms were normal. The Wolfe pattern characteristic was grouped as follows: N1 type ¼ 23, P1 type ¼ 8, P2 type ¼ 19, DY type ¼ 0. All 50 ultrasound examinations revealed a visible abnormality corresponding to the site of clinical concern. The lesions were distributed within the breast tissue as follows: (i) 10 lesions (20%) within the superficial subcutaneous tissue of the skin and fatty tissue; (ii) 33 (66%) lying deeper, purely within fatty tissue; (iii) 7 (14%) lying deeper within fat and glandular tissue. The size of the lesions ranged from 5 to 21 mm, mean 13.3 mm. Conclusion: From this study, it can be concluded that when clinically fat necrosis is suspected, the mammogram and ultrasound are the most important diagnostic tools. If there are no suspicious features of malignancy on the mammogram, then USG appearances can be relied upon to give a diagnosis of early fat necrosis.

87.Evaluation of Letrozole as Suitable Ovulating Induction Agent in Patients with PCOS Induced Infertility
Pratima Kumari, Sangita Kumari
Aim: To compare the pathological nature of infertility amongst the female population in the Indian subcontinent. Material & Method: The main source of data for this study are the women with primary and secondary infertility with anovulation attending the Department of Obstetrics & Gynecology, Nalanda Medical College and Hospital, Patna, Bihar, India. This is a prospective study with a total of 200 women satisfied the inclusion and exclusion criteria of the study. The present study consists of cases of infertility due to anovulation which were thoroughly evaluated before the diagnosis of anovulation was confirmed. Results: In this study mean age of the patients were 28.0 years and mean age of husbands were 32.4 year. 105 patients underwent diagnostic hysterolaparoscopy with chromopertubation + ovarian drilling. Conclusion: Letrozole can be considered as suitable ovulating induction agent in patients with PCOS induced infertility. It is a better drug in terms of mono follicular ovulation and better endometrial thickness than other ovulation induction agents. It has high ovulation rate with significant conception rate, with only drawbacks being miscarriages.

88.Study of Adverse Drug Reactions in Inpatients of Medicine Department in a Tertiary Care Hospital: A Cross – Sectional Study
Jeenalben M. Patel, Dishaben S. Patel, Chetankumar R. Acharya, Bhargav R. Darji
Introduction: Adverse Drug Reactions (ADRs) cause considerable morbidity and mortality worldwide. Early detection, evaluation and monitoring of ADRs are essential to reduce harm to patients and thus improve public health. Spontaneous reporting system (SRS) by health care professionals is common method for reporting suspected ADRs. Chances of ADRs in medicine department are high due to various factors. ADR monitoring and evaluation are the key components of effective drug regulation systems, clinical practice and public health programmes. Aim: To determine various types, pattern, severity and preventability of ADRs. Methods: It was cross – sectional, observational study of 104 inpatients of medicine department of either gender. All patients who met study criteria and gave consent were enrolled in the study. ADRs were recorded in ADR reporting form. Documented ADRs were then assessed for causality, severity and preventability using WHO-UMC’s causality assessment scale, Naranjo’s causality assessment scale, Modified Hartwig and Siegel’s severity assessment scale, Modified Schumock and Thornton’s preventability assessment categories. Results:  Total 189 ADRs were observed in 104 patients. Predominant systems involved were gastrointestinal system (24.3%), general conditions and system disorders (22.8%). Common causative classes of drugs were antibiotics (56.9%) and steroids (23.9%). In Naranjo’s and WHO UMC’s causality assessment scale, 81.7% ADRs were possible. In Hartwig and Siegel’s severity assessment scale, 51% of the ADRs were moderate. According to modified Schumock and Thornton’s preventability assessment, 69.2% ADRs were definitely preventable. Conclusions:Most of the ADRs were possible in causality, moderate in severity and definitely preventable in preventability.

89.A Retrospective Socio-Demographic Assessment of the Aspects of Adolescent Girls Having Menstrual Problems as Well as Type of Menstrual Problems
Anupam, Mamta Singh
Aim: To evaluate the socio-demographic aspects of adolescent girls having menstrual problems as well as type of menstrual problems and its management. Material & Methods: This retrospective study was carried out at Department of Obstetrics and Gynecology, Nalanda Medical College & Hospital, Patna, Bihar, India, over a period of one year. Results: We have collected data of 100 adolescent girls, who had presented with menstrual problems at our tertiary care hospital during the study period. Menstrual problems were in the form of dysmenorrhea in 67%, menstrual irregularity in 23% and amenorrhea in 10%. Dysmenorrhea was more prevalent amongst all the menstrual problems. Conclusion: Majority of the adolescent girls in our study were anemic. Hence, prevention and management of anemia along with health education regarding normal physiology, various menstrual problems and importance of nutrition is necessary. In India attempts and success to develop adolescent friendly health services in public and private systems have met with partial success. Hence, counselling and management of menstrual problems in adolescents needs to be provided in existing health and medical care services.

90.A Comparative Study on Microbiological Profile and Antibiogram of Surface and Core Microflora in Patients with Chronic Tonsillitis
Rahul Kumar Bagla, Hitender Basista, Abhinav Srivastava, Nidhi Pal
Background: If culture of tonsillar surface is representative of bacteriology of core, then rational therapy could be directed at organisms cultured by surface swab. If not then it should be directed to the core microorganisms. As there is paucity of reports on the microbiological profile and antibiogram of chronic tonsillitis patients in the region of Western Uttar Pradesh, we intended to compare the growth pattern of organisms through surface throat swab culture in preoperative period and tonsil core culture following tonsillectomy. Methods: The present hospital descriptive cross-sectional study over a period of 12 months among patients (3 years or above) admitted for tonsillectomy for Chronic tonsillitis. The minimum sample size was calculated as 97 considering. During OPD hours or after admission, clinical history was taken and patient-specific and relevant information (age, sex, address and clinical information. Investigations for pre-anaesthesia fitness was done for all patients prior to surgery. The specimen was cultured on 5% sheep blood agar, chocolate agar and in brain heart infusion agar for anaerobic cultivation. Antibiotic susceptibility testing of the organisms was done by Kirby Bauer disk diffusion method (Donald C. Sockett DVM) in Muller Hinton agar. The chi-square test was used to find the difference between dependent (surface isolates vs core isolates) and independent variables (bacterial culture reports). Results: In present study, the aerobic bacteria in surface and core isolates (n=94) were 88.3% and 94.7%. Staphylococcus aureus were statistically more in proportion in surface isolates as compared to core isolates (p<0.05) and Streptococcus pneumoniae were statistically more in proportion in core isolates as compared to surface isolates (p<0.05). In present study, the aerobic bacteria in surface and core isolates (n=94) were 17.0% and 13.8%. In present study no statistically significant difference in antibiotic sensitivity for Amikacin, Ciprofloxacin, Cefoperazone & Sulbactam, Ceftriaxone, Azithromycin, Cefepime and Gentamycin among core and surface islolates of β haemolytic streptococci, Staphylococcus aureus, Klebsiella sp, and Streptococcus pneumoniae was observed respectively (p>0.05). Conclusion: Knowing the bacteriology does not assist us cure recurrent tonsillitis because the mechanism of infection activation is unknown. It could, however, be a first step toward determining if bacteria play a role in reactivating recurring infections.

91.Evaluation of Magnesium Sulfate as an Adjuvant to 0.5% Ropivacaine in Infraclavicular Brachial Plexus Block
Neetu Gupta, Pooja Vaskle, Deepali Valecha, K. K. Arora, Deepak Vaskle
Background: The Infraclavicular brachial plexus block is one of the common regional technique for upper limb surgeries below the elbow. But the duration of analgesia is often a limiting factor. To overcome this problem various adjuvant have been added to local anaesthetic agents for prolongation of postoperative analgesia as well as to increase the duration of sensory and motor block. Aims: The Aim of our study was to evaluate the effects of Magnesium sulfate as an adjuvant to 0.5% Ropivacaine for Infraclavicular brachial plexus block in terms of duration of postoperative analgesia and to evaluate onset and duration of sensory and motor block. Material and Method: A  Prospective, Double- blinded, Randomized Controlled study was carried out on 60 adult patients ( 30 patients in each group ) aged between 18-60 years with ASA physical status I and II undergoing elective orthopaedic surgeries of elbow, forearm, hand and wrist under infraclavicular brachial plexus block by using peripheral nerve stimulator. Patients were randomized into two groups: Group RP(n=30) received inj. 0.5% Ropivacaine 30 ml. Group RM(n=30) received inj. 0.5%  Ropivacaine + inj Magnesium sulfate 2mg/kg  total volume 30 ml. The onset and duration of sensory and motor block and duration of postoperative analgesia were assessed. Results: The mean duration of postoperative analgesia was significantly longer in Group RM (588.32±18.98) as compared to Group RP(421.66±28.20) min and mean duration of sensory and motor block was prolonged in Group RM (SB 562.00±26.10 min, MB 532.69±28.62 min) as compared to Group RP (SB 356.00±18.94 min, MB 335.01±24.30 min). Conclusion: Addition of Magnesium sulfate to Ropivacaine for Infraclavicular brachial plexus block significantly prolongs the duration of postoperative analgesia as well as duration of sensory and motor block.

92.Assessment of Prevalence of Pre-Diabetes and Cardio-Metabolic Risk Factors in First Degree Relatives of Patients with Type-II Diabetes Mellitus
Sadanand Khatnawliya, Nikita Srivastava, Gaganpreet Parashar
Background: Diabetes and cardiovascular diseases may have interlinked under lying mechanism, in addition to multiple common risk factors. The present study was conducted to assess prevalence of pre-diabetes and cardio-metabolic risk factors in first degree relatives of patients with type-II diabetes mellitus. Materials & Methods: 110 first degree relatives of patients suffering from Type 2 DM of both genders were included. Parameters such as weight (Kg) and height (cm) and BMI was measured. Waist circumference, fasting lipid profile, fasting blood sugar (FBS), post prandial blood sugar (PPBS), glycated haemoglobin (HbA1c) was performed. Results: Out of 110 patients, males were 65 and females were 45. Age group 30-34 years had prediabetics seen in 7, 35-39 years in 13, 40-44 years in 11 and 45-49 years in 9. The difference was significant (P< 0.05). Pre diabetic patients were detected with only IFG in 4, only IGT in 8 and in both IFG and IGT in 28. The difference was significant (P< 0.05). The mean value in subjects with absent   diabetes and present diabetes of BMI (kg/m2) was 23.1 and 26.8, LDL (mg/dl) was 126.2 and 146.4, HDL (mg/dl) was 44.2 and 35.2, TG (mg/dl) was 130.2 and 154.9, FBS (mg/dl) was 92.3 and 110.4 and HbA1c (%) was 5.6 and 5.7 respectively. Conclusion: First degree relatives of patients with type 2 DM patients have high prevalence of prediabetes and other cardio metabolic risk factors.

93.Neuroimaging of Mucormycosis in COVID-19 Patients: Case Series
Chetan S. Ravi, Amit Pendor, Snehal Kawale, Vivek A. Chowdhary
Recent COVID19 pandemic was evident with increase in cases of mucormycosis which primarily affects the paranasal sinuses, orbits and central nervous system. Depending on organ of involvement, Mucormycosis is further sub-classified of which rhino-orbital-cerebral mucormycosis (ROCM) is most common. In this case series of 5 patients we will see the pattern of neuroaxis involvement along with their radiological features. All patients were suffering with COVID19 confirmed by positive RT PCR results and mucormycosis with KOH mounts. First case was of right frontal abscess with pachymeningeal thickening of right cavernous sinus, right ICA thrombosis and right 5th cranial neuritis. Second case was of right temporal abscess, right ICA & cavernous sinus thrombosis. Third case was of right temporal abscess with pachymeningeal thickening of right cavernous sinus. Fourth case is of right temporal abscess with right middle cranial fossa pachymeningitis and final fifth case was with left ICA thrombosis with skull base osteomyelitis with clivus involvement of mucormycosis.  Diagnosis of neuroaxis involvement was done by Computed tomography and Magnetic resonance Imaging. Imaging is very important in diagnosing and studying the pattern of neuroaxis involvement of mucormycosis along with further treatment planning.

94.Clinicopathological Pattern and Outcome of Neonates Requiring Mechanical Ventilation in NICU
Latha S.P, S. V. Savaskar, Sachin Bandichhode, Moin Tamboli
Introduction: Neonatal period carries the highest risk of mortality in childhood.  Mechanical ventilation is an appropriate treatment for respiratory failure in sick neonates and it has drastically enhanced the final prognosis of their disease over the past two decades. The aim of the study is to find out the clinical profile and the indication of ventilation in NICU, to study the predictors of morbidity and mortality in ventilated neonates and to study the outcome of ventilated babies in NICU. Materials and methods: The present observational study was done in NICU, Dr. V.M. Government Medical College, Solapur, Maharastra, India from July 2018 – August 2020.  Sample size of the study included all ventilated neonates with gestational age > 28 weeks and birth weight >1000 grams and excluded neonates with gestational age < 28 weeks, birth weight < 1000 grams, multiple congenital anomalies and those who died within 6 hours of admission. Results: In our present study, out of 300 ventilated newborns172 (57.34%) newborns survived, and 128 (42.67%) newborns died. Proportion of survival was significantly higher. RDS was the most common indication of ventilation. And complications were noted in 125 (41.67%) ventilated newborns, Ventilator associated pneumonia being the common complication. Conclusion: In our present study, out of 300 ventilated newborns there were 173 (57.67%) male newborns and 127 (42.33%) female newborns and majority were inborn, delivered by LSCS, pre-term and had birth weight between 1.0-1.5 kg.  Majority of the ventilated neonates had respiratory distress and tachypnea and indication in majority of neonates for mechanical ventilation were respiratory distress syndrome. Most common complication during the study period was ventilator associated pneumonia. Mortality was higher among outborn, preterm male, with birth weight of 1- 1.5 kg and those with acidosis, neutropenia, positive CRP, delayed capillary refill time and bradycardia and this study showed survival rate of 57.34%.

95.A Study on Clinical Profile and Risk of Exacerbation in Patients With obstructive Airway Disease Due to Post Tuberculosis Destroyed Lung
Vishwas Gupta, Sourabh Jain, Vikas Mishra, Lokendra Dave, Nishant Shrivastava, Ankit Singh Tomar
Introduction: Neonatal period carries the highest risk of mortality in childhood.  Mechanical ventilation is an appropriate treatment for respiratory failure in sick neonates and it has drastically enhanced the final prognosis of their disease over the past two decades 6,7. The aim of the study is to find out the clinical profile and the indication of ventilation in NICU, to study the predictors of morbidity and mortality in ventilated neonates and to study the outcome of ventilated babies in NICU. Materials and methods: The present observational study was done in NICU, Dr. V.M. Government Medical College, Solapur, Maharastra, India from July 2018 – August 2020.  Sample size of the study included all ventilated neonates with gestational age > 28 weeks and birth weight >1000 grams and excluded neonates with gestational age < 28 weeks, birth weight < 1000 grams, multiple congenital anomalies and those who died within 6 hours of admission. Results: In our present study, out of 300 ventilated newborns172 (57.34%) newborns survived, and 128 (42.67%) newborns died. Proportion of survival was significantly higher. RDS was the most common indication of ventilation. And complications were noted in 125 (41.67%) ventilated newborns, Ventilator associated pneumonia being the common complication. Conclusion: In our present study, out of 300 ventilated newborns there were 173 (57.67%) male newborns and 127 (42.33%) female newborns and majority were inborn, delivered by LSCS, pre-term and had birth weight between 1.0-1.5 kg.  Majority of the ventilated neonates had respiratory distress and tachypnea and indication in majority of neonates for mechanical ventilation were respiratory distress syndrome. Most common complication during the syudy period was ventilator associated pneumonia. Mortality was higher among outborn, preterm male, with birth weight of 1- 1.5 kg and those with acidosis, neutropenia, positive CRP, delayed capillary refill time and bradycardia and this study showed survival rate of 57.34%.

96.Study of Various Treatment Modalities for Patients with Keloid : A Comparative Approach
Mohammad Imran Kazmi, V Suman Chandar Rao, Sakeena Hussain
Background: Keloid is a thick raised scar. It can occur wherever having  a skin injury but usually forms on earlobes, shoulders, cheeks or the chest. Treatment of keloids is challenging for all clinicians; no standard treatment protocol exits. Though triamcinolone has been used as gold standard since 1980’s, its efficacy is high in initial doses ranging from 50% to 90%, but recent data suggests nearly 10% to 50% of keloids tend to relapse with triamcinolone (TAC) after initial good response. Aim and Objectives: This study aimed to compare various existing and newer treatment modalities and tried to find out one ideal treatment at low cost with effectiveness and with no recurrence. Material and Methods: It was Prospective randomized open labelled clinical trial, Patients presenting with keloid to the department of DVL in our medical college, during the study period of December 2021 to April 2022 were recruited those who were fulfilled inclusion and exclusion criteria. Results:  Study comprised of 60 patients each of 20 in group 1, 2 and 3 respectively. Group 1 and 3 were more or less equally efficacious with clearance rate. 77.83% (13) of the patients had shown complete response by 18 weeks in our study in group 1. In group 2, 30% (6 out of 20) of the patients showed complete response. In group 3, 65% (13) of the patients showed complete response by 18 weeks and the median response time was found to be 12 weeks in our study. Conclusion: Prevalence of keloids was found to be equal among both sexes. The majority of keloids were seen in the 20 to 40 years, the chest was most common site observed. Among the treatment modalities Group 1 and Group 3 treatment modalities was found equally effective in our study.

97.A Research on the Use of a Partogram in the Management 0f Labor in Patients Who Had Previously LSCS
Baljeet Kaur Bhatia, Debarati Biswas, Rekha Ratnani
Background: A partogram is a valuable tool for tracking the progress of labor. Partogram can aid with intrapartum monitoring and identifying any atypical labor patterns in individuals who are having a trial of labor after a cesarean surgery. As a result, it can assure a positive feto-maternal outcome. Aim: The goal of this study was to track the progress of labor in all ANCs who had previously given their consent for vaginal birth through partogram and report the feto-maternal result. Methods: A 6-month retrospective observational research was undertaken in 50 patients who had previously had LSCS for labor trial and met the inclusion criteria. Every patient gave a detailed history of their age, parity, pregnancy length, and labor discomfort. General physical examination, abdominal examination for fundal height, position, presentation, engagement, amount of liquid, palpable uterine contraction, and fetal heart rate were all performed. For pelvic assessment and Bishop score, a pelvic examination was performed. All of the information was entered into a pre-made proforma. All of the patients’ labors were documented on a WHO-modified partograph. SPSS software was used for statistical analysis. Result: Twenty (40%) of the 50 patients delivered vaginally, whereas the other 30 (60%) needed repeat LSCS. Instrumental deliveries accounted for four of the twenty vaginal deliveries. Six patients (12%) crossed the action line, 26 (52%) were in the middle of the action and alert lines, and 18 (36%) did not cross the alert line. Fetal discomfort was detected in 20 patients (66.66 percent), scar dehiscence in four patients (13.33 percent), and non-progression of labor in six patients (20 percent). At one minute, the APGAR score was less than 7 in 10 infants and greater than 7 in 40 neonates. At 5 minutes, the APGAR score was less than 7 in 6 infants and greater than 7 in 44 neonates. Conclusion: The partogram reduced feto-maternal problems and assisted in the early detection of deviations from normal labor, allowing for prompt management. The participants who passed the partogram alert line were taken for LSCS, showing that the partogram was more effective. Maternal difficulties in patients who have had past LSCS, such as obstructed labor, protracted labor, scar dehiscence and scar rupture, as well as additional complications such as PPH, cervical tears/vaginal lacerations, can be avoided with the use of a partogram.

98.Assessing the Peritoneal Fluid Sensitivity and Culture in Subjects with Perforation Peritonitis: A Clinical Cross-Sectional Study
Nisha Singh, Sharmila S Raut, Amit A. Rangari, Pankaj Surana
Background: A partogram is a valuable tool for tracking the progress of labor. Partogram can aid with intrapartum monitoring and identifying any atypical labor patterns in individuals who are having a trial of labor after a cesarean surgery. As a result, it can assure a positive feto-maternal outcome. Aim: The goal of this study was to track the progress of labor in all ANCs who had previously given their consent for vaginal birth through partogram and report the feto-maternal result. Methods: A 6-month retrospective observational research was undertaken in 50 patients who had previously had LSCS for labor trial and met the inclusion criteria. Every patient gave a detailed history of their age, parity, pregnancy length, and labor discomfort. General physical examination, abdominal examination for fundal height, position, presentation, engagement, amount of liquid, palpable uterine contraction, and fetal heart rate were all performed. For pelvic assessment and Bishop score, a pelvic examination was performed. All of the information was entered into a pre-made proforma. All of the patients’ labors were documented on a WHO-modified partograph. SPSS software was used for statistical analysis. Result: Twenty (40%) of the 50 patients delivered vaginally, whereas the other 30 (60%) needed repeat LSCS. Instrumental deliveries accounted for four of the twenty vaginal deliveries. Six patients (12%) crossed the action line, 26 (52%) were in the middle of the action and alert lines, and 18 (36%) did not cross the alert line. Fetal discomfort was detected in 20 patients (66.66 percent), scar dehiscence in four patients (13.33 percent), and non-progression of labor in six patients (20 percent). At one minute, the APGAR score was less than 7 in 10 infants and greater than 7 in 40 neonates. At 5 minutes, the APGAR score was less than 7 in 6 infants and greater than 7 in 44 neonates. Conclusion: The partogram reduced feto-maternal problems and assisted in the early detection of deviations from normal labor, allowing for prompt management. The participants who passed the partogram alert line were taken for LSCS, showing that the partogram was more effective. Maternal difficulties in patients who have had past LSCS, such as obstructed labor, protracted labor, scar dehiscence and scar rupture, as well as additional complications such as PPH, cervical tears/vaginal lacerations, can be avoided with the use of a partogram.

99.Significance of Rotter’s Node Group Dissection in Modified Radical Mastectomy – A Study of 88 Cases
Mayank Pancholi, Himanshu Patidar, Sanjay Desai, Vinod Kumar Dhakad, Simran Behal
Aim: To identify lymph node yield in Rotter’s group (Interpectoral) tissue dissected during modified radical mastectomy for Carcinoma breast. Material and Method: The records of eighty eight patients were retrospectively reviewed from November 2019 to February 2022 who underwent modified radical mastectomy for breast cancer and had interpectoral tissue separately sent for histopathologic examination. Results: All the lymphnodes identified during histopathological examination were from levels one to three and Rotter’s tissue failed to yield any lymphnodes. Conclusion: In our study population the interpectoral tissue dissection failed to yield any nodes and hence may be omitted from standard modified radical mastectomy.

100. Comparative Study of Laparoscopic Ventral Rectopexy Versus Laparoscopic Posterior Rectopexy for Complete Rectal Prolapse
Prashant Kumar Singh, Nadeem Ahmad, Kanchan Sonelal Baitha, Shashi Singh Pawar, Prem Prakash
Background: There is no agreement about which laparoscopic rectopexy technique is best for treating complete rectal prolapse. Purpose was to compare functional outcome, the recurrence rate, and quality of life in patients treated with laparoscopic ventral rectopexy (LVR) versus the laparoscopic Wells rectopexy (LWR) for complete rectal prolapse. Material & Methods: The study was conducted in the Department of general surgery, IGIMS, Patna, Bihar, India. A sample size of 30 patients was included in the study. The records of all the patients with complete/ full thickness rectal prolapse (FRP) who were operated on with laparoscopic rectopexy without sigmoid excision during the period of study was analyzed prospectively. Results: The overall mean age of the study population was 55.4±14.5. 13 patients were females and 17 were males. There were only two conversions to open surgery in the LVR group. Mean operative time was significantly longer in LVR (121.5 – 27.8 minutes versus 105.7 – 18.7 minutes; P = .001). Conclusions: In this study, both LVR and LWR successfully and safely corrected the prolapse and prevented recurrence in patients after long-term follow-up. Operative time and hospital length of stay are significantly shorter in LWR. High incontinence scores and age >70 are potential predictors of bad continence postoperatively. LVR appears to be more suitable for patients with a high constipation score and abnormal perineal descent.

101. Descriptive Cross Sectional Study Assessment of the Socio-Demographic Correlates of Menstrual Problems among School Going Adolescent Girls
Preeti Kumari
Aim: To know the prevalence of menstrual disorders and its various determinants in rural women of Bihar Region. Material & Methods: The study was of descriptive cross-sectional study, undertaken on 360 school going adolescent girls (14-18 years) in Bihar, the field practice area attached to department of community medicine, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. Results: 27.2% were undernourished and 5.8% were overweight. 71% girls were found to be anemic. Most common menstrual abnormality was dysmenorrhea, reported in 47.8% of total study subjects followed by oligomenorrhea reported in 23.6% of adolescent girls. Conclusion: It can be concluded from the study that even though menstrual problems are widely prevalent in the adolescent girls they are not addressed properly. Moreover, there is a need to generate awareness about menstruation at school level.

102. Morphometric Assessment of the Foramen Transversarium of Cervical Vertebrae: An Observational Study
Priyanka Raj, Pallavi, Ashok Kumar Singh
Aim: To study the morphometry of foramen transversarium of the cervical vertebrae on both sides. Material & Methods: The present study was conducted in the department of Anatomy, Vardhman institute of medical sciences, Pawapuri, Nalanda, Bihar, India for three months. 400 dry human cervical vertebras of unknown age and sex were utilized for this study. Results: After intercomparison, the p-value was found to be <0.001 (p<0.05) in all cases, which was statistically significant. A significant increase in the diameter of the foramen transversarium was observed on the left side of all vertebrae studied. Conclusion: Successful surgical management in degenerative, traumatic, and neoplastic diseases of the cervical spine needs well-detailed knowledge of the anatomy of the cervical spinal column.

103. An Anatomical Evaluation of Incidence and Types of Calcaneal Facets on Talus and Co Relation between Squatting Facets and Angles of Neck
Pallavi, Priyanka Raj, Birendra Kumar Sinha
Aim: To determine incidence and types of calcaneal facets on talus and co relation between squatting facets and angles of neck. Material & Methods: Study was conducted on 130 (right-68, left-62) dry tali irrespective of sex from Department of Anatomy, Patna Medical College, Patna, Bihar, India for three months. Articular surface of talus on inferior surface is studied for various types of their incidence. Results: Lateral squatting facet was found in 46% of the bones on right side 38.4% on left side, showing no significant difference. With angle of inclination, we found there is significant co relation between angle of inclination and squatting facet with p value 0.001. Indicating those tali where squatting facet was present, angle of inclination was larger significantly. Conclusion: Incidence of calcaneal articular facet and modification on neck of talus (squatting facet with high AI) are attributed to differences in race, habitual activities, posture, gait and level of plane used for locomotion by Indian population.

104. A Prospective, Observational Assessment of Amblyopia and its Risk Factors in Selected School Going Children
Rajesh Kumar, Arun Kumar Sinha
Aim: To study the prevalence of amblyopia in school going children. Material & Methods: The present study was conducted as a prospective, observational study at the Department of Ophthalmology, Bhagwan Mahavir, Institute of Medical sciences, Pawapuri, Nalanda, Bihar, India, on 1000 school going children over a period of 1 year. Results: About 42% cases belonged to lower socio- economic background. Among 33 amblyopic cases 13 cases (76.9%) showed improvement in >2 snellens line in visual acuity. The observed association between duration of occlusion therapy and visual improvement in children with amblyopia was statistically insignificant (p>0.05). Conclusion: Amblyopia is one of the major hidden visual problems in the society which can be prevented by early identification and proper management in appropriate time. Early diagnosis and treatment can prevent and minimize risk of permanent deficit of vision in amblyopia if detected earlier especially before 10 years of age. Screening programs in school going children can detect amblyogenic factors earlier to prevent major permanent deficit in vision by amblyopia so screening of children should be done through school surveys, awareness should be spread through various campaigns among the teachers and parents of the children about amblyopia and its adverse consequences not only on visual impairment part but also functional, psychological, social, economic impact.

105. A Comparative Study of Fentanyl and Clonidine as an Adjuvant to Intrathecal Hyperbaric Bupivacaine with Fentanyl or Clonidine alone with Bupivacaine for Lower Abdominal Surgeries
Vidhi Patel, Neel Patel, Palak A Chudasama, Hardik Z Patel
Background: Lower abdominal and limb surgeries are performed under spinal anaesthesia but its main drawback is that the analgesia is of limited duration. Hence, additives which cause the prolongation of the duration of motor as well as sensory block will be beneficial in reducing the morbidity of the patients in the postoperative period. Several clinical studies have been conducted on intrathecal use of fentanyl and clonidine in various lower abdominal surgeries. Objectives: This study was conducted to compare the effect of combination of   fentanyl (25µg) and clonidine (30µg) as an adjuvant to intrathecal hyperbaric bupivacaine (15mg) to fentanyl and clonidine alone with bupivacaine for lower abdominal surgeries. Materials and Methods: Present study was conducted on 90 patients of ASA grade 1 or 2 posted for lower abdominal surgeries. All patients were randomly divided into three groups of 30 patients each. Group A: 0.5% bupivacaine heavy 3 ml (15mg) + fentanyl (25µg) + 0.9% normal saline. Group B: 0.5% bupivacaine heavy 3 ml (15mg) + clonidine (30µg) + 0.9% normal saline. Group C: 0.5% bupivacaine heavy 3 ml + fentanyl (25µg) + clonidine (30µg) + 0.9% normal saline. Perioperative complications, sedation score, time to first dose of rescue analgesic and total duration of analgesia were noted. Results: Heart rate and blood pressure was more decreased in group B and group C compared to group A. Hypotension and bradycardia were more in Group B and Group C compared to Group A. Pruritus was seen in Group A and Group C but not seen in Group B. In group A, 100% patients were awake. About 86.67% and 83.33% patients were awake in group B and group C respectively. Duration of analgesia was significantly prolonged in group C as compared to group A and group B. Conclusion: The combination of intrathecal clonidine and fentanyl with hyperbaric bupivacaine significantly prolongs duration of postoperative analgesia with good haemodynamic stability and nonsignificant adverse effects compared to fentanyl and clonidine used alone with hyperbaric bupivacaine intrathecally.

106. Comparison of Hemodynamic Responses During intubation with Superior Laryngeal and Transtracheal Nerve Block versus without Block
Hardik Z Patel, Kunal Kumar I Patel, Mehul Kumar R Patel, Nisarg B Patel
Background: Laryngoscopy and endotracheal intubation is the commonest method of securing a definitive airway for administering general anaesthesia. This noxious stimuli is associated with a transient increase in hemodynamic response. Airway anaesthesia used as blunting hemodynamic stress response, variety of technique like mucosal application of local anesthetic as a spray, viscous solutions, soaked cotton pledgets, and nebulization or as airway nerve blocks. In this study we compared the efficacy of superior laryngeal nerve block, transtracheal block along with general anaesthesia and muscle relaxant for blunting hemodynamic response to laryngoscopy and oral intubation and their side effects. Material & Methods: This was a prospective, randomized and comparative study. Study was conducted on 100 patients of ASA I and II, from age group of 30 -70 years under going planned surgery under general anaesthesia requiring oral intubation. Patients were randomly selected and allocated in to two groups (50 patients in each group). Group B (n=50) received bilateral superior laryngeal nerve block and trans tracheal block.  In Group C (n=50) no  airway block given. The cardiovascular parameters were monitored at time intervals like, Base line, Induction, Intubation, 1 min after intubation, 2 min after intubation, 4 min after intubation, 5 min after intubation, 7 min after intubation, 10 min after intubation, 15 min after intubation.  Statistical analysis was carried out using Microsoft Excel 2007 & Quickcalc Graphpad Prism 8.0 statistical software. Result: There was statistically significant increase in heamodynamic parameters like Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Pressure in Group C compare to Group B. Conclusion: Combining the bilateral block of the internal branch of superior laryngeal nerve and trans tracheal nerve block as an adjuvant to general anaesthesia was associated with stable hemodynamic response.

107. Analysis between Waist- Height Ratio with Obesity and Cardiovascular Parameters
Kusuma R, Shilpa M
Introduction: The prevalence of obesity and cardiovascular dysfunction have increased significantly from before and it has been well noted that both the conditions, obesity and cardiovascular dysfunction, are well correlated. But there is a need to find out an effective predictor which can conveniently determine or predict the status of obesity or cardiovascular function. Waist-to-height ratio (WHtR) dimensions have attracted more consideration recently as anthropometric indicators of childhood obesity and cardiovascular status. They are child-safe monitoring techniques that are simple to use, affordable, and specific to visceral fat. However, there is no clinically supported perception of the parameters pertaining to obesity and cardiovascular function that can correlated with Waist-to-height ratio. Aims and objectives: To find out the statistically significant correlation between parameters attributed to obesity and cardiovascular status, with that of WHtR. Materials and Methods: This retrospective study has derived participants’ data from health clinic centre and carried out statistical analysis to find out the objective. The parameters that were considered to be related with obesity are Body Mass Index (BMI) and percentage of body fat. Again, the parameters that were considered to be related with cardiovascular functions are pulse rate, systolic blood pressure and diastolic blood pressure. These parameters were considered for analyzing with Waist-Height ratio. Results: The study found that the WHtR is a statistically significant predictor of both obesity and cardiovascular parameters, like percentage of body fat and systolic blood pressure (p<0.05). Conclusion: The study has concluded that WHtR is a statitically significant predictor that can be used to predict the outcome of obesity and cardiovascular function.

108. The Efficacy of Chlorhexidine Gel in Managing Vaginal Infections
Varuni Sharma, Navin Shukla
Introduction: Vaginal infections are prevalent among the population. It complicates pregnancy, lactation and also deteriorates the quality of life. There are antifungal and antimicrobial medications, which are more precise in their therapy, are already available for such infections. a novel bio-adhesive vaginal gel with % chlorhexidine gluconate was recently developed using a patented technique. This formulation provides for a longer release of Chlorhexidine throughout time because of its bio-adhesive properties it is important to investigate this medication in vaginal infections. Aims and Objectives: To find the efficacy of chlorhexidine gel as compared to the existing treatment protocols in managing vaginal infections. Materials and Methods: This prospective study was conducted with the patients of vaginal infections, namely, Vulvovaginal candidiasis (VC), bacterial vaginosis (BV) and non-specific vaginitis (NSV). The confirmed diagnosis of the conditions was done by the suspected clinical features and laboratory results. The patients were given Clorhexidine vaginal gel along with Oral metronidazole for VC, Vaginal clotrimazole gel or combination of these two. for NSV. The outcomes were assessed by observing the side effects, improvement of the condition and Visual Analog Scale (VAS) score. The statistical analysis was conducted. Results: The mean score of VAS for Clorhexidine vaginal gel and Oral metronidazole in Bacterial Vaginosis were found to be 8.85±1.15 and 8.89±1.12, respectively. In Non-Specific Vaginitis, the mean score of VAS for Clorhexidine vaginal gel and combination therapy were found to be 8.63±1.25 and 8.85±1.22, respectively. The significance test revealed that each group treated with Clorhexidine vaginal gel and other drugs for each of the condition, was found to be statistically insignificant (P > 0.05). Conclusion: The study has shownt that there is satisfactory outcome in each of the condition considered for this study and it suggests that Clorhexidine vaginal gel can be used as an adjuvant drug for these conditions which should be made as guideline to the treatment of these conditions.

109. An Assessment of the Contributing Arteries in Superficial Palmar Arch Formation and Variations in its Formation
Neha Singh
Aim: To study contributing arteries in superficial palmar arch formation and variations in its formation. Material & Methods: Study was done on 20 formalin (10%) embalmed adult cadavers, 15 males & 5 females (40 sides). Decomposed, amputed, injured and specimens from children were excluded from study. Results: SPA was formed by superficial branch of ulnar artery only in 5 cases out of 40 (12.5%). SPA was formed by superficial branch of both ulnar and radial artery in 28 cases out of 40 (70%). Conclusion: The arch formation is highly variable. Knowledge of contribution to the SPA will be helpful to the reconstructive hand surgical procedures such as arterial repairs, vascular graft applications and reimplantations.

110. Determining the Anatomical Location and Variations of IOF this is Imminent for Successful Regional Anesthesia and Endoscopic Surgeries of the Maxillary Region: Morphometric Analysis
Neha Singh
Aim: To assess the anatomical location and variations of IOF this is imminent for successful regional anesthesia and endoscopic surgeries of the maxillary region. Material & Methods: The study was conducted on 60 Human skull bones of unknown gender from the Department of Anatomy Nalanda Medical College, Patna, Bihar, India. Human adult skull bones without any deformity were included in the study. Results: 60 skulls (120 sides) – both right and left were studied. Most commonly observed shape of IOF is semilunar 38 % on right side, 42% on left side. Accessory IOF were present in 6.6% of skulls bilaterally. They lie medial to the IOF with mean distance between them as 5 mm on right side & 3 mm on left side. Conclusion: Our study results will be of immense help to the surgeons and anesthetists, handling this region for operative procedures.

111. Assessment of the Oncologic Outcomes of Individuals with Non-Urothelial Bladder Cancer: An Observational Study
Md. Shadab
Aim: The aim of the present study to evaluate the oncologic outcomes in patients with nonurothelial bladder cancer in Bihar region. Methods: This was a prospective observational study conducted in the Department of General Surgery, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, India for 1 year. All 15 adult patients between 18 and 80 years of age with histologically proven NUBCs were included in the study. Patients were followed for a median duration of one year. Results: 15 patients of NUBCs were included in this study. Out of them, 9 patients had adenocarcinoma, 3 had SCC, 2 had small cell carcinoma, and 1 had inflammatory myofibroblastic cancer. The median presenting age of the patients was 52 years (range: 34-87 years), and hematuria was the commonest presenting concern, i.e., in 85% patients. Clinically, T3 was the commonest stage of presentation, and 1 patient had metastatic disease. The median follow-up duration was one year. During this period, 64% patients were diagnosed with cancer recurrence or progression, with majority, i.e., 22%, exhibiting disease at multiple sites. Furthermore, all these patients died because of the disease progression itself (10 patients), and the remaining (5 patients) died of generalized ill health and co-morbidities. On analysis, the mean DFS was 60.39 ± 7.15 months, and the overall median survival was 55.7 ± 9.69 months. Conclusion: The NUBC is a rare but aggressive disease that presents at an advanced stage in many cases. Treatment protocols are not uniform; therefore, further collaborative research is needed to improve survival outcomes.

112. A Comparative Assessment of Efficacy of Intravenous Iron Sucrose (IVIS) Versus Oral Iron in Treating Anemia among the Antenatal Mothers
Seema Singh
Aim: To evaluate the efficacy of intravenous iron sucrose (IVIS) versus oral iron in treating anemia among the antenatal mothers attending a tertiary care center. Material & Methods: This study was carried out at the Department of Obstetrics & Gynecology, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India over a period of 1year. 120 consenting women with singleton pregnancy and gestational age between 18 and 28 weeks, with iron-deficiency anemia confirmed by a peripheral smear and Hb of 7–10.9 g/dL, were included in the study. Results: There was statistical significance of difference in the mean Hb levels between the two groups at 4 and 8 weeks of treatment. A statistically significant difference was observed between the two groups after 4 weeks (P = 0.01) and 8 weeks (P = 0.01) of iron therapy. Statistical significance of difference between the two groups with respect to rise in PCV was also observed as well. Conclusion: IVIS was found to be more effective than oral iron therapy in treating antenatal anemia with no serious adverse drug reactions.

113. The effect of vitamin B12, Magnesium and Vitamin D in COVID-19 among geriatric patients
Vijay Valecha
Introduction: The pandemic hit caused a high prevalence of COVID-19 and fatalities gloablly. This disease has affected various organ systems and causing systemic inflammation, other than respiratory symptoms. The pathophysiological mechanism also shown that lower levels of vitamin B12 caused disruption in gut microbiota and increased oxidative stress. Reduced levels of vitamins and magnesium, resulted from the infection of this disease, has led to further deterioration of the health status. Aims and Objectives: This study is intended to evaluate the effect of combination therapy of vitamin D, magnesium, and vitamin B12 in COVID-19 patients by analyzing the outcomes of the disease when this combination therapy is applied. Materials and Methods: This current study is a cohort observational prospective, in which 30 patients were given a combination of cholecalciferol (vitamin D3) of 1000 IU, magnesium oxide at 150 mg dose and methylcobalamine (Vitamin B12) of 500 µg, referred to as Intervention group. Another 25 patients were taken for comparison and referred to as Control group. The baseline data was collected, and the outcomes were observed and compared between the two groups. Results:  The study also found that the duration required to run the management of COVID-19 is significantly less in Intervention group than control group (p<0.05). The study further added that the group which received the combination therapy required less oxygen therapy with or without ICU support (p<0.05). Conclusion: The study concluded that this combination therapy can improve the health status of COVID-19 patients by decreasing the probability to require oxygen therapy and ICU support. The study also concluded that this combined therapy can reduce the duration of hospitalization of COVID-19 patients.

114. A study on clinical application of High-Sensitivity Cardiac Troponin I Assay in individuals with suspected Myocardial Infarction
Vijay Valecha
Introduction: The prevalence of chest pain and its admission to emergency department is quite high and it is a need of the hour that more simpler diagnostic or prognostic index be found in prediction of acute myocardial infarction (AMI). There are many diagnostic pathways available, but the current pathway is unable to confirm AMI during the presentation and the occurrence of hospital admissions are high among the geriatric population with chest pain. In Europe and America alone, there are more than 20 million cases annually which indicate a possible occurrence of AMI but cannot diagnosed on confirmed basis. This either causes repeated admission or deaths due to lack of proper management. Aims and Objectives: This curreent study intends to find out the efficacy of quantifying high sensitivity cardiac Troponin I (hs-cTnI) to predict AMI. Materials and Methods: This current prospective study is of cohort type which has obtained medical records of the patients including the level of hs-cTnI at presentation. After 6 months of presentation, the follow-up study was conducted to predict the efficacy of having AMI. The study also analyzed the several risk factors and other baseline characteristics with the occurrence of AMI. The statistical analysis was conducted to highlight the significance. Results:  The study has found that the patients had shown significant differences in ECG characteristics, creatinine clearance and few medication history like ACE inhibitor or ARB, aspirin and statin (p<0.05) when patients with AMI and Non-AMI were compared. It was shown that the concentration of hs-cTnI is found to be significantly more (p<0.05) at the beginning of the study in those patients who finally had AMI during the follow-up study, as compared to the patients who did not show AMI during the follow-up study. Conclusion: The study concluded that the efficacy of using hs-cTnI in clinical setting can be considered to be the guideline of AMI diagnosis in the emergency department. The study also highlighted the significant characteristics which can be used as the predictor of AMI in the future.

115. A Study on Tuberculosis Screening in Urban Households with Pulmonary TB Contacts
Manish Kumar Jain
Introduction: Mycobacterium tuberculosis is the causal agent of tuberculosis and pulmonary one is the most prevalent. World Health Organization has suggested that there are issues in the national TB program undertaken by the Government of India. Issues including management related, insufficient funding, only X-ray, low cost treatment, insufficient information, lack of awareness among the population, increased hidden cases, lower treatment standard. It has been found that to increase the efficiency of the programme, there is a need to identify the hidden cases or the contacts of the current cases. The lack of awareness and interest may lead to increase of cases unknowingly. Hence, in this study, the contacts are identified and evaluated for the presence of TB and the reasons behind the failure of their screening have been analyzed. Aims and Objective: The study is intended to find the reasons behind the inefficient management of TB programme by identifying the household contacts of the patients with pulmonary TB (PTB). Also, the study intends to find out the significance of introducing contact register in the whole management of the household contacts of PTB. Materials and Methods: The records of the index cases were obtained from Tuberculosis Units and contacts were identified. They were questioned regarding their health status and underwent screening of PTB before and after implementation of contact cards. Then the findings were statistically evaluated and conclusion was drawn. Results: The study has found that the difference of confirmed cases  found in pre and post implementation stage is statistically significant (p<0.05) and the anti-TB treatment given to confirmed cases found from screening programme in pre and post implementation stage, was also statistically significant (p<0.05). The reasons behind the failure to list the contacts and the failure to provide screening to the listed contacts were also evaluated. Conclusion: The contacts cards should be made integral to the PTB screening programme and regular identification of Household contacts (HHC) must be carried out to increase the coverage of the screening.

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