International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1.Identification and Variation of Sutural Bones in Indian Dry Cranium
Indira CK, G. Vennila, K. Santhini Arunselvi
Background: Sutural bones are supranumary bones occurring along the sutures and completely surrounded by sutures of the skull. Their number, morphology and location in skull vary in skulls. The knowledge of these bones is imperative in surgery, medicolegal cases involving child abuse or fracture of skulls and for anthropologic identification of human populations. Also, the prior knowledge about the Wormian bones is important because they are present in normal individuals as well as in various disorders such as osteogenesis imperfect, rickets, etc. Very few studies have been undertaken to study the anatomical aspects of sutural bones in dry human cranium. Objective: The current study aimed to estimate the presence and variations of sutural bones in dry human cranium. Materials and Methods: This retrospective, observational and single-center study carried out in the J. K. K. Nattraja Dental College, Kumarapalayam, Namakkal district and Vinayaka Missions Medical College, Karaikal from August 2021 to December 2021. A total of 110 dry cranium of unknown sex was collected from above institutions. All the dry cranium was observed carefully for sutural bones. Presence of sutural bones was noticed in unilateral and bilateral location and shape of sutural bones was identified. Data was entered in Microsoft Excel® and statistical analysis for descriptive variables was performed in IBM SPSS (Version 16.0). Results: Out of 110 dry crania, sutural bones were found in 69 crania (62.72%) with highest number of sutural bones found at lambdoid suture and asterion part of dry cranium, whereas 9-12 sutural bones were present in three cranium at lambdoid suture and finally, 3-5 sutural bones were recorded at asterion in five bones. Among the unilateral and bilateral occurrence of sutural bones, this study noted lambdoid (60/54.54) and asterion (48 /43.63) areas with more sutural bones than at other sites. Pterion was another common site of sutural bones that showed higher frequency than the bones of parietal notch. At the parietal notch, this study recorded 2-3 sutural bones. Also, this study reported (6/ 5.45) sutural bones in lateral wall of orbit between zygomatic bone and greater wing of sphenoid. Conclusion: Anatomical knowledge of sutural bones is clinically important, because their presence refers mainly to bone dysplasia like craniosynostosis and imperfect osteogenesis and used as a useful marker of some congenital disorders.

2.Comparative Analysis of Fentanyl and Fentanyl Plus Lidocaine on Attenuation of Hemodynamic Responses to Tracheal Intubation in Controlled Hypertensive Patients Undergoing General Anaesthesia
Neha Goyal, Swati Ojha, Manju, Sweta Bharadiya, V.B. Rupakar
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, B. J. Medical College, Civil Hospital from Dec-2015 to Dec-2017 at Ahmedabad, Gujrat 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.

3.COVID-19 Pandemic and its Impact on Blood Transfusion Services at A Tertiary Care Hospital Blood Bank in Northern India
Manjari Kumari, Prashant Bhardwaj, Sadiq Wadood Siddiqui
Introduction: COVID-19 was a public health emergency and declared it as a pandemic by WHO. During this pandemic every branch of health care delivery system was negatively affected including Blood Transfusion Services (BTS).  The main objective of this study is to compare the blood donations, issued and wasted units of blood and their components during pre-COVID and COVID period. Materials and Methods: It was a retrospective cross-sectional study and data of all voluntary and replacement donations, issue and wastage of blood and blood components were collected from 1st April 2019 to 31st March 2021. This duration was divided into pre COVID period from April 2019 to March 2020 and COVID period from April 2020 to March 2021 for this study purpose. Results: During the study period total 2818 blood donation were observed. Out of this 1818 donations were in pre COVID and 1000 donation occurred in COVID period. The mean with SD of collected blood units per month in pre COVID was 151.5±73.46, while during COVID 19 it was 83.33±36.79 (p value 0.0088).  A total 4036 units of blood and blood products were issued during study period. In pre COVID period 2592 units (mean/month 216±108.46) were issued, and 1444 units (mean/month 120.33±57.97) were issued during COVID period (p value 0.0132). Conclusion: To maintain stable reserve and ensure availability of safe blood to the patients an emergency preparedness plan is necessary and blood banks must follow the guidelines given by national and international authorities.

4.A Study to Assess Diagnostic Accuracy of CT Scan and USG in the Diagnosis of Acute Appendicitis in Tertiary Care Centre
Kamal Nayan Gangey, Ujjwal Sourav
Introduction: Preoperative imaging is critical in detecting appendicitis and lowering the likelihood of failed appendectomy (NAR). Contrast-enhanced CT is the first-line imaging test for detecting appendicitis in adults, according to the American College of Radiology Appropriateness Criteria. CT is extremely accurate, with sensitivities ranging from 85.7 to 100 percent, specificities from 94.8 to 100 percent, and NARs from 1.7 to 7.7%. Using histopathological findings as the gold standard, sensitivity, specificity, positive predictive value, and negative predictive value for both CT and USG were determined. Methodology: From June 2021 to April 2022, a prospective observational study was done at Varun Arjun Medical College in Shahjahanpur on patients who were hospitalised to the emergency department with symptoms of acute pain in abdomen and clinical findings strongly suspected of appendicitis. The main criterion was to include individuals who have undergone both CT and USG imaging modalities. Result: The following is the outcome of our current research on the diagnosis of acute appendicitis. The sensitivity of the USG was 91.21, the specificity was 77.78, the PPV was 87.65, the NPV was 46.67, and the accuracy was 90 percent. The sensitivity of the CT scan was 96.70, the specificity was 88.89 percent, the PPV was 98.88 percent, the NPV was 72.73 percent, and the accuracy was 96 percent. Conclusion: While CT is the gold standard imaging method for diagnosing AA, there are several advantages to using US, including the fact that it is non-invasive and has a short acquisition time. It is reasonably inexpensive, does not require an iodinized contrast agent or oral preparation, does not expose patients to radiation, and can be conducted on children.

5.A Comparative Study of Maternal and Perinatal Outcome Between Normal Pregnant Women and Women with First Trimester Vaginal Bleeding
Neha Singh, Chanchala Kumari, Chandni Singh
Introduction: First trimester bleeding may indicate an underlying placental dysfunction, which may manifest later in pregnancy causing adverse outcomes such as increased risk of pre-eclamptic toxemias, preterm delivery, prelabour rupture of membranes (PROM), and IUGR. It is also known that maternal age, systemic diseases such as diabetes mellitus, hypothyroidism, infertility treatment, thrombophilia, maternal weight, and uterine structural anomalies increase the risk of abortus imminens. Aim and objective: To establish the relation between first trimester vaginal bleeding and its effect on maternal and fetal outcome. Material and methods: This study is a comparative cohort study. I included 100 women aged between 18-45 years with first trimester vaginal bleeding as case group, who met the inclusion and exclusion criteria and 100 normal pregnant women without first trimester vaginal bleeding as control. All the women in the study group were followed from the first visit till delivery. The characteristics of all the patients related to their age, gravidity, period of gestation, duration of bleed, ultrasound results, duration of hospital stay, treatment modalities and final fetal and maternal outcome were determined, and data were collected on the basis of proforma. Result: In our study 21% patients had abortion in cases group whereas, 9% had abortion in control group, 62% had Full term vaginal delivery in cases whereas, 80% had full term vaginal delivery in control group 17% delivered preterm in case group as compared to 11% in control group. These differences were statistically significant with p value <0.02. There was statistically significant difference between cases and control for the mode of delivery. Majority of patients, about 64% in cases and 71% in control had vaginal delivery whereas 15% of cases and 20% of control had caesarean section. Conclusion: First trimester vaginal bleeding can be a predicting factor for adverse outcome of mother and infant. It is necessary to increase the knowledge of pregnant women in this regard for observation. Also, because the clinical intervention of attentive obstetrician has important role in not only, the continuation of pregnancy but also decreasing fetal complications in these high-risk pregnancies.

6.Assessment of Risk Factors for COVID-19 in Medical Interns at a Dedicated COVID-19 Hospital: A Case Control Study
Varsha Singh, Sanjay Kumar, Shivani Sinha, Shefali Kuntal
Background/Justification: In spite of considerable efficacy, breakthrough infection after covishield vaccine is not uncommon. This study was conducted to see the risk factors for infection among medical interns   after covid vaccination and factors associated with it, so that corrective measures could be taken to further reduce the transmission.  Objective: To observe the risk factors for covid -19 infection among the medical interns in a dedicated covid-19 hospital after vaccination. Secondary objective: To observe the correct and consistent use of PPE among interns doing covid duty, to observe overcrowding at the place of work/stay, to observe that whether they are using any kind of preventive measures in terms of breathing exercise or vitamin supplement. Method: Data collection was done using online questionnaire administration and telephonic discussion. A hospital-based case control study was done. Results: Rate of covid 19 infection was 11% among the medical interns.  Inconsistent use of PPE, overcrowding at the place of work were associated with infection. Other than PPE and covid appropriated behaviour breathing exercise/ pranayam did show some protective effect.

7.Management of Avascular Necrosis of the Femoral Head by Bipolar Hemiarthroplasty: A Prospective Study
Ramesh Ramineni, Rajesh Kurapati, Yugandhar Polepaka
Bipolar hemiarthroplasty (BHA) remains the effective surgical option for avascular necrosis (AVN) of femoral head, that claiming satisfactory and unsatisfactory surgical outcomes.  The current study was designed to evaluate the functional outcome of bipolar hemiarthroplasty in cases with avascular necrosis in femoral head. This prospective study consists of 20 cases with avascular necrosis of femoral head attending outpatient department of Orthopedics, ≥40 years of age. Regular follow-ups were conducted postoperatively at 3months and end of one year. During each follow-up, cases were radiologically assessed and clinically evaluated by using Harris hip score. At 3rd month follow up, 10% had excellent results, 60% had good results and 30% reported poor results. At one year of follow-up, 40% had excellent results and 60% reported good results. None of the cases reported poor outcome at one year of follow up. Bipolar hemiarthroplasty has a definite role in the management of patient with disabling disorders. It was effective in relieving pain and restoration of function.

8.Comparative Study of Dexmedetomidine and Dexamethasone as Adjuvant to Bupivacaine in Evaluation of Motor Sensory Blockade and Duration of Analgesia
Rashim Vachhani, Babita Agrawal
Background: To evaluate Motor Sensory Blockade and Duration of Analgesia with Dexmedetomidine and Dexamethasone as Adjuvant to Bupivacaine. Material and Methods: This randomized study was conducted in the department of Anesthesiology from September 2021 to May 2022.Total 400 patients were included in this study. These patients were divided in to two groups having 200 patients in each group. Group A received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 50μg of dexmedetomidine and group B received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 8mg of dexamethasone. Results: Onset and duration of sensory and motor block, quality and duration of intraoperative analgesia were recorded. In our study we revealed similar onset of sensory block in group A and B. While Group A showed early onset and longer duration of motor block compared to group B. Hemodynamic were similar in both groups during intraoperative periods. Conclusion: We concluded that dexmedetomidine as adjuvant to bupivacaine increases the duration of block and postoperative analgesia as compared to dexamethasone with minimal or negligible adverse events.

9.The Incidence and Risk Factors Associated with Surgical Site Infections
Inuganti Gopal, Bhabani Patnaik, Sumita Tripathy
Background:  Surgical Site Infections (SSI) is considered to be one of the leading healthcare associated infections in developing nations. However, there is a significant improvement in surgical techniques, but SSI is one of the main causes of hospital acquired infections. The key factors that are associated with SSI include age, gender, immunity level, obesity, diabetes, and alcohol use.  In addition to this, the factors like hyperglycaemia, pre-existing remote body site infection and tobacco consumption is having a significant impact on improvement of risk related to SSI. In the current scenario, the risks like BMI, smoking, blood transfusion and pre-existing chronic disease are also increasing the risk of SSI. The prevention approach for SSI is requiring bundle action which systematic attention to multiple risk factors to improve the patient’s defence by minimizing the bacterial contamination. Aim:  To determine the incidence and risk factors associated with SSI in hospitals. Method: The study is based on the non-concurrent cohort and conducted at SLN Medical College and Hospital, from January 2021 to December 2021. The medical college is offering specialised services for patients and performing the actions against the infection surveillance. The data that has been collected from the sources of hospital is stored in the excel sheet and exported to SPSS version 26.0 software that has helped to analyze the desired outcome for the study.  Moreover, the prior approval was taken from the hospital authority for access the database. Data was analyzed applying independent t-test, ANOVA and logistic regression. Results: There were 70.6% female and mean age of the patients was 54.3 years. Moreover, the mean duration of the surgery was 1.6 hours. 568 patients were diagnosed with SSI with incidences of 3.4%.  Moreover, infection culture was performed on 177 patients and Staphyloccocus aureus and Escherichia coli were found to be the main microorganisms causing SSI. Moreover, the multivariate analysis has suggested the significance of 5%. Conclusion: The study has analyzed different culture, and most prevalent microorganism factors were Staphyloccocus aureus and Escherichia. The study concluded that it is essential to analyze the risk of developing SSI in patients undergoing general surgery and implementation of the measures to minimize the infection.

10.Higher Rate of Mature Senile Cataract in Tribal Population of Dadra and Nagar Haveli: Major Cause of Blindness in Tribal Population
Riddhi Oza, Pramod Wartha, Komal Parikh, V.K. Das
Aim: The purpose of the study to report the higher rate of mature senile cataract in tribal population of Dadra and Nagar Haveli due to lack of awareness and negligence. Materials and Methods: Case records of mature senile cataract seen from July 2016 to November 2018 were reviewed retrospectively. Data regarding the patients’ age, sex, demographic data, type of cataract, and treatment were analyzed. Results: A total of 250 records were reviewed. Type of cataract was matured among all the patients Mean age of presentation was 65. Lack of awareness and negligence was seen in almost all patients. Conclusion: Our study revealed that in this era of medical science there were higher cases of matured cataract seen in tribal community, the most common cause of it is negligence. Visual outcomes remained good after surgical intervention and during the course of follow-up. The findings of present study highlight the need for primary prevention, education of community, and control measures.

11.Caterpillar Hair Induced Ophthalmic Lesions
Riddhi Oza, Pramod Wartha, Komal Parikh, V.K. Das, Deepa Sonavane
Aim: The purpose of the study is to report the ocular lesions Following the entry of caterpillar setae into the eye. Materials and Methods: Report of fifty-two patients with caterpillar hair induced ophthalmic lesions were retrospectively reviewed for clinical characteristics, anatomical location of lodgement of caterpillar hair, demographic risk factors, treatment methods and outcomes. These include catarrhal conjunctivitis, keratoconjunctivitis, conjunctival nodules, keratitis, iridocyclitis, iris nodules, vitritis, papillitis, or chorioretinopathy. This can occur due to the mechanical effect of the setae and their penetration or a direct toxic effect. Ocular injury is graded according to CADERA classification. Results: Visible hairs were removed from all patients. Majority of patients were found to be with type 1 and 2 involvements. Conclusion: Association of demographic risk factors and ophthalmic injury.

12.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 was 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.

13.Study of Acceptability of Postpartum Intrauterine Contraceptive Device (PPIUCD) in a Tertiary Care Hospital; Unmasking the Hole and Corner
Nina Mishra, Susanta Kumar Behera, Rudra Prasad Bag
Introduction: The Intrauterine contraceptive device(IUCD) is one of the safest, effective, long acting and cost-effective method of contraception and reverts fertility as soon as withdrawn; fertility is not impaired at all. Despite of increasing institutional delivery and provision of incentive to PPIUCD provider, patients and ASHAs, the acceptability of PPIUCD is low. The present study was designed to evaluate the acceptability, factors affecting acceptability and side effects of PPIUCD. Aims and Objectives :(a) To study the proportion of women accepting PPIUCD. (b) To study the factors associated with acceptability of PPIUCD in women according to their socio-demographic and obstetrics characteristics, and future pregnancy desire. (c) To study side effects and complications of PPIUCD. Materials and Methods:  This study was conducted at Department of Obstetrics and Gynecology, MKCG Medical College and Hospital, Berhampur, Odisha; India for a period of 2 years from September 2019 to August 2021. During this period 24007 women following vaginal delivery (VD) and Lower Segment Caesarian Section (LSCS) were counseled for PPIUCD insertion and only 4657 women agreed and were included in this study. At the end of the study collected data were tabulated and analyzed. Results: Out of 4657 cases 807 cases (17.32 %) were given PPIUCD following vaginal delivery (post placental) and 3850 cases (82.63 %) were given during caesarean section (intra caesarian). The acceptance rate according to mode of delivery were as follows; out of 12860 cases of vaginal delivery counseled, 807 cases (6.3%)  taken PPIUCD and out of 11147 cases of caesarian section, 3850 cases (34.5%) accepted PPIUCD. Out of 24007 cases of delivery counseled, 4657 cases accepted PPIUCD. So the overall acceptance rate was 19.03%. Spontaneous expulsion occurred in 75 cases (31.1%) of vaginal delivery and 166 cases (68.9%) of caesarian delivery out of 241 cases. The overall expulsion rate was 8.7 %. On follow up at six months it was found that 241 cases (8.68%) had IUCD expelled spontaneously, 233 cases (8.4%) had IUCD removed for different reasons and 2301 cases (82.92%) were continuing IUCD. The continuation rate of PPIUCD was 82.92 %. Conclusion: The acceptance rate following caesarean section was higher as compared to vaginal delivery due to adequate counseling during antenatal period favors motivation of women to accept PPIUCD following CS. Most of the acceptors had some knowledge about PPIUCD prior to delivery. Minimal expulsion rate of 8.68% and removal rate of 8.4% was observed in our study. The most common cause of removal was menorrhagia. PPIUCD is relatively safe method of contraception as it has low rates of expulsion, minimal bleeding disturbances and negligible rates of infection. IUCD has the benefit of compliance and long-term reversible contraception.

14.Correlation of Endometrial Thickness and Histopathological Study in Patients of Abnormal Uterine Bleeding (AUB) in Perimenopausal Age
Susanta Kumar Behera, Luzoo Prachishree, Samarpita Swain
Introduction: Menstrual irregularity and abnormal heavy menstruation accounts for up to 35% of women attending Gynecology department. The histopathological evaluation of endometrial curettage yields various results ranging from physiological to pathological lesions and helps for an early diagnosis of endometrial carcinoma which carries a risk of 5-10% in perimenopausal women. Aims and Objectives:  To assess the correlation of endometrial thickness and histopathological study in abnormal uterine bleeding of perimenopausal women and its contribution in the clinical diagnosis and management. Materials and Methods: This cross-sectional study was conducted at the M.K.C.G. Medical College Hospital Berhampur (Odisha), India from September 2019 to September 2021. Perimenopausal women with AUB were first examined clinically to rule out other gynecological abnormalities and followed by relevant hematological investigations. TVS was done in all patients for measuring endometrial thickness followed by endometrial biopsy for HP study and hysterectomy was done if required. Analysis was done by MS-Excel sheet after results were tabulated. Results: Out of 250 women, 33.2% women were found to have adenomyosis as commonest pathology, 38% presented as heavy menstrual bleeding as the commonest form of AUB. Endometrial thickness (ET) was more than 8 mm in majority of women (55.6%) who were subjected to endometrial biopsy. Biopsy revealed 32% had proliferative pattern as commonest form and 13.6% had endometrial hyperplasia. Out of the 145 women, who had undergone hysterectomy adenomyosis came out as the commonest pathology (42.8%) and 4.1% as carcinoma endometrium. Conclusion: ET more than 8 mm is most often associated with abnormal histopathology. Endometrial biopsy should be employed whenever indicated to obtain a tissue diagnosis to exclude endometrial cancer.

15.Profile of Patients Undergoing Peripartum Hysterectomy in a Tertiary Care Hospital
Luzoo Prachishree, Susanta Kumar Behera, Sushree Samparna
Introduction: The worldwide rate of emergency obstetric hysterectomy or peripartum hysterectomy is around 1 per 1000 deliveries, being higher in developing countries. Uterine rupture is the leading indication of peripartum hysterectomy in developing countries ranging from 11 to 45 %. It is associated with severe blood loss, risk of transfusion, intraoperative complications and significant postoperative morbidity and mortality. Aims and Objectives: To find the indications of peripartum hysterectomy along with complications related to maternal morbidity and mortality. Materials and Methods:  It is a cross sectional study conducted over 39 cases of peripartum hysterectomy in the Department of Obstetrics and Gynaecology, M.K.C.G. Medical College, Berhampur, Odisha; India from October 2019 to October 2021. Results:  Majority of cases, 16 cases (41%) belonged to the age group of 25-31 yrs and mostly multipara in 32 cases (82%). Overall, rate of peripartum hysterectomy was 0.14%. Rupture uterus was the major cause of peripartum hysterectomy in 21 cases (53.84%), followed by abnormal placentation in 12 cases (30.76%). Subtotal hysterectomy was done for 27 no of cases (69.23%). Haemorrhage (35.89%) and pyrexia (30.76%) were the most common intra operative and postoperative complication respectively. Maternal mortality occurred in 4 cases (10.25%) while still born seen in 23 cases (58.97%). Conclusion: Identification of risk factors in the antenatal period, proper intra partum management of labour with partogram and careful trial labour of patient with history of scarred uterus can reduce the incidence of peripartum hysterectomy and maternal mortality.

16.A Comparative Study of Two Doses of Clonidineas an Epidural Adjuvant in Combined Spinal Anaesthesia
Md. Imdad Ali, Dinbandhu Prasad, Prabhanjan Chaudhary
Background: This study was done to compare the effects of two different doses of Clonidine as a sole epidural adjuvant in CSE on SAB with 0.5% Hyperbaric Bupivacaine, on the onset and duration of sensory and motor blockade, duration of analgesia, level of sedation and hemodynamic changes. Methods: A total number of 90 ASA I and II patients, between 18-60 years of height between 150-180 cm and of weight 40-80 kgs., undergoing infraumbilical surgeries, were randomized in three groups of 30 patients each; viz. Group G150, G300 and GNS. Group G150 received 150 μg Clonidine, G300 received 300 µg Clonidine and GNS received 0.9% Normal Saline (NS) through epidural route as a sole epidural adjuvant. Conclusion: Our study showed that when Clonidine used as a sole epidural adjuvant in dose of 300 µg or 150 µg, for infraumbilical surgeries, has significantly faster onset of sensory and motor block with prolonged duration of analgesia and motor blockade and no significant side effects on a conventional SAB performed with 0.5% Hyperbaric Bupivacaine.

17.The Association of Antiphospholipid Antibodies in Women with Bad Obstetric History
Priti Kumari, Sudha Kumari, Shashikar
Background: APL antibodies are the most important autoimmune cause of recurrent fetal loss. These pregnancies can be saved if diagnosed and treated adequately. This can be done by routine screening for the APLA in a pregnant woman with a bad obstetric history (BOH) and unexplained fetal loss. Material and methods: The present study is a prospective study carried out in department of Obstetrics and Gynecology in, JLNMCH, Bhagalpur. It was conducted over a period of One and half years. 6 among the women with h/o previous >2 abortions, intrauterine deaths, early neonatal deaths, still births, patients with h/o early onset pre-eclampsia, intrauterine growth restrictions. Patients underwent screening for APLA i.e Lupus Anticoagulant (LA), Anticardiolipin (ACL) and Anti Beta2 glycoprotein(β2-GP1) 1 IgG/IgM. If tested positive, patient underwent a repeat test 12 weeks later. Conclusion: It is a proved fact that APLA interfere with the normal development of the uteroplacental circulation to cause early and late neonatal pregnancy loss. Hence screening for APLA in patients with BOH will help in identifying the cause of recurrent fetal loss and improve the obstetric outcome.

18.A Prospective Study to Evaluate the Association between Electrocardiographic Findings and Severity of Chronic Obstructive Pulmonary Disease Severity
Rakesh Kumar Shahi, Rajendra Rai, Kshitiz Shahi
Background: Electrocardiographic evaluation is crucial for assessing cardiac abnormalities in chronic obstructive pulmonary disease (COPD) patients. Aims and Objectives: To evaluate the electrocardiographic findings in patients with COPD and distribute them based on COPD severity. Material and Methods: Hundred COPD patients confirmed using clinical radiology of chest and pulmonary function tests were studied in the Department of Medicine, BRD Medical College, Gorakhpur, from February 2020 to July 2021. Patients were divided based on the severity of COPD based on forced expiratory volume in one second (FEV1) values into mild (60-79), moderate (40-59), and severe (<40). Two-dimension trans-thoracic Doppler and M-mode echocardiography were performed, and findings were compared with COPD severity. Result: The majority were males (87%). The mean age of the study cohort was 61.45±11.27 years. COPD was more prevalent in patients in the fifth to the seventh decade of their age. Mean FEV1 was 36.78 ± 11.56 %, as predicted. The majority of the patients had severe COPD (65%). The most common symptoms of COPD were breathlessness (100%) followed by cough with sputum (96%). In echocardiographic evaluation majority had pulmonary hypertension (62%), 58% had corpulmonale, 52% had right ventricular dilatation, and 34% had right ventricular hypertrophy. Among the patients with mild COPD, only 2 patients had evidence of pulmonary hypertension. Among the patients with moderate COPD, 31% had echocardiography evidence of pulmonary hypertension, and 28% had evidence of corpulmonale. In contrast, in the severe COPD, group75% had pulmonary hypertension, and 82% had echocardiographic evidence of corpulmonale. Conclusion: We found a high prevalence of pulmonary hypertension, corpulmonale, and left ventricular dysfunction complicating COPD, more so with more severe COPD. We recommend screening all COPD patients for cardiac complications.

19.Role of Fluoroquinolones in Sputum Culture Conversion in MDR-TB Patients
Prasanta Kumar De, Saibal Mondal
Background: Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis with a high incidence rate in India. In recent times, reducing the emergence of multi drug resistant TB (MDR-TB) poses a great challenge. Aims and objectives: To study the 3rd & 6th month sputum culture status, after starting Category IV regimen and factors responsible for culture conversion of MDR-TB patients. Material and Methods: We enrolled a total of 200 patients. Out of these, 3 patients were baseline XDR-TB, so excluded and 176 patients completed the study. All MDR/rifampicin resistant pulmonary TB patients >14 years of age receiving category IV regimen & willing to give consent for participation were included in the study. Patients with extrapulmonary TB were excluded. Majority of the patients (89.20%) patients remained negative at 3rd and 6th month. Results: We found a significant association between delayed culture conversion and former smokers with >20 pack year smoking history compared to early convertors with persistent culture negative at 6 months. At baseline, fluoroquinolone resistance was independently found to be significantly associated with adverse effect on culture conversion in the first 6 months. Also, there was significant association (p = 0.02) in patients showing culture positivity at 6th month following early negative cultures and current alcohol intake (within the last 6months) as well as with HIV positivity and cough > 2month.  Female gender, conversion of sputum culture from positive to negative and radiological improvement was found to be positive predictors of a successful treatment outcome. While smoking habit and alcohol consumption was negative predictors of successful treatment outcome. Thirty five (26%) patients developed ADRs that required withdrawal of causal drug. Conclusion: This study presented with the various factors associated with early and delayed culture conversion and culture reversion of MDR-TB patients.

20.Prevalence of Bronchiectasis in Moderate and Severe Chronic Obstructive Pulmonary Disease
Saibal Mondal, Prasanta Kumar De
Introduction: Patients of COPD are prone to exacerbations, which account for significant morbidity and mortality and is a key determinant of health-related quality of life. Bronchiectasis and COPD commonly present as chronic cough, fixed airflow limitation. Bronchiectasis is present in many patients with COPD prevalence varies from 27% to 50% in various studies. Lower airway bacterial colonization is an independent stimulus to airway inflammation. Objective: To study prevalence of bronchiectasis in COPD as well as correlation between degree of airflow obstruction, presence of potential pathogenic organism in sputum and exacerbations. Material and Methods: This study was conducted at Dept of Respiratory Medicine, NRSMCH, Kolkata with patients diagnosed to have COPD in stable condition in the Dept. of Respiratory Medicine, NRSMCH, Kolkata during April 2014 – March 2015 (One Year). The pre-decided sample size of the study was 54 patients. This was an institution based observational case control study. Various parameters like basic demographic profile and baseline physical examinations were recorded for the patients enrolled. Apart from that sputum samples were collected for gram as well as AFB stain, chest x ray, pulse oximetry, post bronchodilator FEV1 & FVC were also recorded. Results: In the present study, 54 COPD patients were selected. Among these patients, 24 had bronchiectasis. Out of 24 COPD-Bronchiectasis patients 19 male, mean age 61.5 yr. Presence of COPD-Bronchiectasis is associated with increased PPM colonization in lower respiratory tract, more severe airflow obstruction and increased number hospital admission. There was a statistically significant correlation between the severities of COPD and the scoring of associated bronchiectasis (p<0.001). Conclusion: This study concluded that, there exists a significant correlation between bronchiectasis and COPD.

21.A Study of Associated Factors of Low Birth Weight Babies in a Secondary Care Center
Richa Nigam, Neha Bhaskar, Akanksha Jain, Sanjay S Agarwal, Sanjay Khare
Background: Low birth weight is one of the major determinants of prenatal survival, infant morbidity and mortality as well as risk of developmental disability and illness in future. Objectives: The objectives of present study are to determine the proportion of low-birth-weight deliveries and its associated maternal sociodemographic and biological factors in a secondary care hospital. Methods: A hospital based cross sectional study was conducted among 295 post-natal mothers who delivered the babies in a secondary care hospital of Madhya Pradesh during the study period of 2 months and 12 days from July 2019 to September 2019.The data was collected by conducting face to face interview by using the pretested questionnaire and then the data was analysed using the Microsoft excel. Results: Among 295 respondents 72 (24.4 %) mothers delivered low birth weight babies, 50 (16.95 %) mothers had preterm delivery and history of abortion was found in 85(28.81%) respondents. Among low birth weight delivery the dietary intake (p<0.0001), family income (p = .01). period of gestation (p<0.0001) and history of abortion (p = .002) were found to be statistically significant when compared with normal birth weight deliveries. Conclusion: Socioeconomic status, maternal nutrition, preterm labor and previous history of abortion are associated with occurrence of low birth weight deliveries. Awareness regarding nutrition, selfcare, is important in prevention of low birth weight babies. There is a need to strengthen the existing maternal services at the basic level of community.

22.A Comparative, Randomized Controlled, Double Blind Trial of Extrafascial and Intrafascial Injection for Interscalene Brachial Plexux Block in Reduction of Hemidiphragmatic Paresis
Ramvelash Meena, Manish Jha, Ajit Singh Baghela, Manish Singh Chauhan
Aim: comparative analysis of extrafascial and intrafascial injection for interscalene brachial plexux block in reduction of hemidiphragmatic paresis. Methodology: This prospective Randomized Controlled, Double-Blind study was conducted in the Department of Anaesthesiology, MDM Hospital and MG hospital both affiliated to Dr. S.N. Medical College, Jodhpur, at Rajasthan after getting approval from ethical committee 50 patients 25 in each group. aged between 18 – 85 years of either sex belonging to ASA class I- III posted for elective surgeries of shoulder and upper humerus at our institute were randomly selected for the study. Study population (50 patients) were randomly divided by computer generated numbers into 2 groups with 25 patients in each group. Group-E: Extrafascial Injection Group. Group-I: Intrafascial Injection Group. Results: The rate of hemidiaphragmatic paresis was significantly reduced in the extrafascial injection group (28%) compared with the conventional injection group (100%]; P<0.0001) There was no significant difference in hemidiaphragmatic paresis and pulmonary function test at 30 minutes and at the end of surgery in both groups. All respiratory outcomes were significantly preserved in the extrafascial injection group. A conventional injection was associated with a faster onset and longer duration of post op analgesia.

23.Association between Nighttime-Daytime Sleep Patterns and Chronic Diseases: A Community-Based Cross-Sectional Study
Arohi Abhinav Jayaswal, Ashish Kumar Gupta
Background: The goal of this study was to see if there was a link between distinct nighttime-daytime sleep patterns and the frequency of various chronic diseases among the elderly. Methods: A community-based cross-sectional research of 209 elderly people with an average age of 72.5±3.2 years was done. The study collected sleep-related characteristics (nighttime sleep duration, daytime napping, and its duration) as well as chronic illness status, such as diabetes, cardiovascular diseases (CVD), dyslipidemia, cancer, and arthritis. Results: More than 80% of people had one or more chronic illnesses. The most common disease was cardiovascular disease (54.8%), followed by dyslipidemia (26.6%), diabetes (19%), arthritis (15.1%), and cancer (4.3 percent). The average nightly sleep duration and all-day-long total sleep duration for the overall study population were 6.65 h and 7.40 h, respectively, and the average daytime napping duration was 49.22 min, with 54 percent of the study subjects napping regularly. Conclusion: Elderly people with chronic conditions exhibited varied night-day sleep patterns, and understanding these associations may help guide chronic disease management.

24.Role of Low Molecular Weight Heparin and Aspirin in Women with Recurrent Pregnancy Loss
Shivcharan Meena, Praveen Kumar Choudhary
Background: Recurrent miscarriage is one of them that affecting the health of the women. The term recurrent miscarriage refers to two or more consecutive pregnancy losses before 20 weeks of gestation. These kinds of issues are reported among 5% of women at reproductive age and the etiology of 68% of recurrent abortions. Enoxaparin is the most commonly used agent in the existing trials. Tinzaparin sodium is also a LMWH and, its biochemical and pharmacokinetic differences from enoxaparin may have clinically important effects. The data about the administration of tinzaparin during pregnancy is limited. However, LMWH alone throughout the pregnancy in patients with URM has not been sufficiently investigated and also, there is a lack of evidence for comparing LMWH molecules in these patients. Aim: The study aims to analyze the role of low molecular weight heparin and aspirin in women with recurrent pregnancy loss. Method: This was a prospective observational study conducted on 100 pregnant women with history of recurrent pregnancy loss admitted to Department of Obstetrics and Gynecology at Govt Medical Center & attached Bangur Hospital, Pali, Rajasthan, during the period March 2019 to December 2021. The inclusion criteria for the study involve age- 18-40 yrs, history of unexplained spontaneous recurrent abortion (2 or more), Antiphospholipid antibody positive, current pregnancy and cardiac activity confirmed by USG report. Apart from this, exclusion criteria were involving the known case of aneuploidy, anomaly, ectopic pregnancy, multiple pregnancies. Women with Cardiovascular disease, bleeding diathesis, previous thromboembolic phenomena, diabetes mellitus and other contraindication to LMWH. Results: For the current study, 27% of the patients belonged to 21-25 years of age group following which 37% of the patients belonged to 26-30 years of age group. 19% of the patients belonged to 31-35 years of age group while the remaining 17% of the patients belonged to 36-40 years of age group. Moreover, 96% of the patients’ belonged to normal BMI range while the remaining 4% of the patients belonged to overweight BMI range. Hypertensive Disorders (i.e. BP ≥ 140/90). 15% of the patients were detected with Precious Pregnancy/Precious Pregnancy with CRN, 6% of the patients were detected with Fetal Distress, 3% of the patients were detected with Oligo, 5% of the patients were detected with IUGR, 8% of the patients were detected with Pre-eclampsia/Pre-eclampsia with IUGR. Conclusion: From the study, it has been concluded that LMWH resulted in an improved live-birth rate in patient with 2 or more consecutive unexplained recurrent pregnancy loss. Nevertheless these findings need to be confirmed in larger randomized trials. Tinzaparin sodium is also a LMWH.

25.A Randomized Control Trial of Three Intravenous Dexmedetomidine Doses for Procedural Sedation in Patients Undergoing Minor Gynecological Surgery
Shivcharan Meena, Raghvendra Singh
Background: Minor surgery, despite its short duration, is associated with significant pain and discomfort. Several anaesthetic techniques and pharmacological agents have been used to reduce patient discomfort and facilitate surgical performance. However, procedural sedation and analgesia (PSA) is still preferred over general anaesthesia during short gynaecological procedures. Most analgesics/sedative drugs, such as midazolam, propofol, and fentanyl, which are commonly used for PSA, can potentially prolong sedation and cause respiratory depression and adverse hemodynamic effects, which may result in increased morbidity and unplanned hospitalization as most cases are done as day-care surgery. Dexmedetomidine, a known sedative and analgesic sparing drug that acts on α2 adrenoceptor, reduces heart rate, blood pressure, and anaesthetic drug requirements in response to any stress. Dexmedetomidine is extensively used as a sedative and analgesic agent in various surgeries, but the optimum dose of dexmedetomidine in these procedures is still unknown. Aim: The study aims to analyze a randomized control trial of three intravenous dexmedetomidine doses for procedural sedation in patients undergoing minor gynecological surgery. Method: The study was a randomized control trial conducted at Govt Medical Center & attached Bangur Hospital, Pali, Rajasthan, during the period March 2019 to December 2021. The study population consisted of ASA grade I and II patients aged 18-45 years who were scheduled to undergo short gynecological surgery (20-40 min) under intravenous sedation and analgesia. The study included hysteroscopic copper T removal, dilatation and curettage, hysteroscopic biopsy, and Bartholin cyst excision in the short gynecological surgery. The data was compiled, tabulated, and statistically analyzed using Statistical Product and Service Solutions (SPSS) version 17 (IBM Corp., Armonk, NY). Analysis of variance was used for the analysis of mean difference among groups and Chi-square test for grading of sedation, recovery, and discharge. Result: all patients had a Ramsay Sedation Score of 3 or more. In half of the patients in group A and in one-fourth of the patients in group B, ketamine was required as a rescue drug. None of the patients in group C required any drug supplementation. Moreover, the Modified Aldrete Score (≥8) was 21.14 ± 9.99 min and was almost doubled in groups B (39.68 ± 18.39 min) and C (45.38 ± 29.90 min). This difference was statistically significant in the A versus B group and the A versus C group (p = 0.000). However, it was comparable between groups B and C (p > 0.05). Patients in group A achieved PADSS score (≥9) earlier (148.64 ± 23.56 min) than in group B (177.10 ± 16.16 min) and group C (200.25 ± 18.47 min). Conclusion: Dexmedetomidine at a dose of 0.6 µg/kg/hr provides efficient sedation and analgesia but is associated with significant hemodynamic compromise, whereas dexmedetomidine at a dose of 0.4 µg/kg/hr requires ketamine supplementation at 0.3 mg/kg to achieve adequate analgesia and sedation without hemodynamic complications.

26.A Retrospective Study of Inflammatory Biomarkers in COVID-19 Patients
Dharmesh Gamit, Bhavita Patel, Hardik Gandhi, Brahmareddy Malapati
Objective: Covid-19 has impacted the health of the people and 20% of the patients were critical and hospitalized with the need for ventilation and intensive care unit (ICU) support. This study aimed to study the association of inflammatory biomarkers with severity of COVID-19 infection. Material & Method: For this study, 545 Covid-19 infected patients admitted in New Civil hospital, Bharuch were selected. The infection related to Covid-19 was confirmed using the Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR) test. Pearson correlation was used to assess the correlation between inflammatory markers and laboratory indicators. A p-value of <0.05 was used as a cut-off value for significance. Results: The inflammatory markers and WBC count was significantly elevated in the critical COVID-19 patients. Moreover, patients with lower absolute lymphocyte count (ALC) were significantly associated with severe to critical COVID-19 infection compared to the mild to moderate form that showed higher lymphocyte count (P<0.0001). Moreover, patients with evidence of acute cardiac injury showed a significantly lower ALC (1.08±0.628× 103 cells/μL) compared to (1.38±0.72× 103 cells/μL) (P<0.0001). Conclusion: From the study, it can be concluded that there is a significant association between different inflammatory markers, clinical as well as the laboratory profile of the Covid-19 patients affecting the recovery.

27.Ducted a Clinical Assessment of Risk Variables in Patients with Post-Partum Haemorrhage
Baljeet Kaur Bhatia, Shrikrishna Kumar Agrawal, Rekha Ratnani
Background: In both industrialized and developing nations, post-partum haemorrhage can occur in 1-5 percent of deliveries, and it is still the leading cause of maternal morbidity and mortality. Clinicians must be aware of PPH risk factors and should consider them when counseling females about where to birth. Aims & objectives: The goal of this research was to look at risk variables in tertiary hospital patients with post-partum haemorrhage. Material and Methods: The current investigation was a prospective, observational research undertaken in pregnant females over the age of 18 who were delivered at our hospital and had been diagnosed with post-partum haemorrhage. Results: During the four-year research period, 9784 births were performed at our hospital, with 172 patients (1.76%) suffering from post-partum haemorrhage. The majority of the patients were aged 21-24 years (37.21%), followed by the 25-29 years age group (31.4 % ). The research group’s average age was 23.26 3.46 years. Severe anemia (Hb 7 gm%) (36.05 percent), previous LSCS (26.74 %), hypertensive disorders of pregnancy (22.09 %), premature rupture of membranes (17.44 percent), hypothyroidism (17.44 %), abruptio placentae (17.44 %), prolonged labor (15.12 %), and placenta previa were all common risk factors in the current research (15.12 % ). Other than more than 2 uterotonics (100.00%) and > 2 PCV blood transfusions (84.88%), bilateral uterine artery ligation (45.35%), bilateral uterine artery ligation + bilateral internal iliac artery ligation (9.30%), obstetric hysterectomy (15.12%), and perineal tear repair (15.12%) were the commonest interventions (9.30 percent ). Twelve patients died (atonic PPH– six instances, mixed PPH– four cases, placenta accreta spectrum– two cases). Conclusion: 21-24 years of age, primiparity, severe anemia (Hb 7 gm%), previous LSCS, hypertensive disorders of pregnancy, preterm rupture of membranes, hypothyroidism, abruptio placentae, prolonged labor, and placenta previa were all significant risk factors for post-partum haemorrhage in this research.

28.Assessment of the Salivary Interleukin-2 Levels Among the Patients Diagnosed with Recurrent Aphthous Stomatitis: An Original Study
Praveena Adusumilli, Mary Oshin, Syed Ali Abedi, Siya K, Suhas R Nayak, Fousiya Ali
Aim: The goal of this study was to calculate and compare salivary interleukin-2 (IL-2) levels in patients with recurrent aphthous stomatitis and healthy controls, as well as their fluctuation with age and gender. Design of the Study: Saliva was collected from 100 individuals between the ages of 15 and 50, including 50 patients with recurrent aphthous stomatitis (27 females and 23 men) and 50 healthy control subjects (28 Females and 22 Males). The enzyme linked immunosorbent test was used to estimate IL-2 in both groups (ELISA). The data was statistically analyzed using the Independent ‘t’ test. Results: showed that patients with recurrent aphthous stomatitis had higher salivary IL-2 levels than healthy controls. In comparison to other age groups, IL-2 levels were also higher in patients aged 15 to 30 years. In female patients, a rise in IL-2 was also seen. Conclusion: Changes in IL-2 levels in recurrent aphthous stomatitis patients were shown to be age and sex related.

29.Role of Cartridge Based Nucleic Acid Amplification Test in Paediatric
Shweta Wali, Sachin Bandichhode, Siddhi Gawhale, Shakira Savaskar
Introduction: Tuberculosis (TB) is a major public health problem in India and hence early diagnosis and treatment is important to prevent further complications and spread. Diagnosing in children is challenging because the easily available diagnostic tools like radiological screen which is subjective, mantoux test is a marker of exposure, not disease and due to the paucibacillary nature of mycobacterium in children. Hence there is a need of a relatively rapid and confirmative diagnostic tool.  Implementation of cartridge‐based nucleic acid amplification tests (CBNAAT) has augmented the detection rates and this was studied in our research in comparison with fluorescent microscopy, mantoux test and chest xray findings. Material and Method: The present study was conducted in Government Medical College, Solapur, 200 study subjects were analyzed, pulmonary and extrapulmonary cases were tested on CBNAAT, fluorescent microscopy, mantoux test and chest xray were used in diagnosing cases. Results: Study showed most cases were from age group 5-10years, gender distribution showed male predominance. 17.5 % cases had history of TB contact. 61.00% cases had BCG scar and most common specimen found in the study was gastric aspirate in 73.00% cases. Cases diagnosed as TB in which TB positive were 20.00% and TB negative were 80.00%. CBNAAT reported 62.50%sensitivity and 62.50% specificity. Conclusion: CBNAAT was advantageous as it could detect cases which are missed by other conventional methods, it is a quick and requires minimal technical training to run the test. Gene Xpert MTB/RIF is a reliable technique for diagnosing extra pulmonary tuberculosis with high sensitivity and specificity.

30.A Study on Correlation between Clinical Profile and CD4 Count among HIV Patients
M. Nishanth, Mohammad Imran Kazmi, Mallikarjuna Shetty, M. Nageswar Rao
Background: Though India has low prevalence of HIV but it is the world’s third largest population suffering from HIV. HIV infection selectively infects and kills CD4 cells. As HIV infection progresses CD4 cell count progressively falls over a period of time. Aim and Objectives:  The aim the study was to know clinical profile of HIV and its correlation with CD4 count. Materials and Method: This is an Observational Prospective study conducted in the Department of General Medicine, Nizams Institute of Medical Sciences, Punjagutta, Hyderabad during the period of January 2018 to September 2018. We have undertaken sample size of 85 after getting informed consent, ethical approval from the institute. We have considered the patients those who have fulfilled the inclusion and exclusion criteria. Mean difference between the CD4 cell counts were analysed with the help of paired t-test. P-value<0.05 were considered as statistically significant. Analysis was done with help of software SPSS version 25. Results: Among 85 patients maximum number of the patients were observed in the age group of 30-50 years of age, male is female ratio was 1.7:1, hypertension was commonest comorbid condition followed by diabetes mellitus, respiratory system is the most common system involved. Tuberculosis is most common opportunistic infection we found in the study. Conclusion: CD4 count is the best marker to know about severity of HIV infection at diagnosis, during treatment and follow-up, the CD4 counts are low among most of the HIV positive patients which describes that advanced disease at presentation and after treatment It balanced too normal.

31.Utility of Sofa and ∆ Sofa in Predicting Outcomes in Patients Presenting with Sepsis with Acute Febrile Illness in a Tertiary Care Hospital in Rural Rajasthan
Maninder Patni, Tasha Purohit, Vijay Kumar, Nilesh Kumar Patira
Introduction: SOFA SCORE has been used to predict outcomes in patients with sepsis. The present study aims to assess utility of SOFA in predicting outcomes in septic patients at a tertiary care hospital in rural Rajasthan. Literature available on assessing the utility of SOFA SCORE in predicting outcomes in septic patients from rural background is very scanty. The study intends to assess the utility of SOFA SCORE in predicting outcomes in patients in an ICU in a tertiary care hospital in rural Rajasthan. Aim: The objective was to determine the utility of Sequential Organ Failure Assessment (SOFA) score to predict outcome of patients in Intensive Care Unit (ICU) of a tertiary care hospital in rural Rajasthan. Material and Methods: This was an observational prospective study performed in an ICU of a medical college in rural Rajasthan from August 01,2021 till November 30, 2021. 79 patients admitted in MICU with diagnosis of sepsis were studied and their SOFA score was calculated on day of admission and 72 hours after admission. Change in SOFA score (∆ SOFA) at 72 hours was also calculated. Data was analysed using Chi-square test and an independent t- test. To assess the performance of SOFA and ∆ SOFA sensitivity and specificity was calculated. Result: A total of 79 patients were included with mean age of 46.3 out of which 58 were men and remaining were women. Mean SOFA score at admission amongst survivors was 7.49± 4.16 and amongst non survivors was 11.90±4.134. Mean SOFA score at 72 hours among survivors was 4.60±4.089 and among non survivors was 9.33±5.972. The difference in SOFA score at admission and at 72 hours between survivors and non survivors was significant (p < 0.05). Area under the curve for SOFA on day 1 and day 3 predicting mortality in sepsis was 0.744 and 0.743. Area under ROC curve for ∆ SOFA was 0.651. Conclusion: Sofa score at time of admission, after 72 hours of admission have at best only moderate accuracy in predicting outcomes in patients with sepsis in a rural population where majority of infections are vector borne.

32.Study of Magnitude and Outcome of Hepato-Biliary Dysfunction in Neonatal Septicemia
Nipun Sharma, Saket Yadav, Priya Marwah, Munish Kumar Kakkar, Madhu Mathur, Gaurav Agrawal, Shalin Parmar
Background: Hepatobiliary dysfunction is one of the most usual clinical conditions manifesting in neonatal medicine. The huge majority of cases of unconjugated hyperbilirubinemia entail non pathological causal factors, whereas cholestatic jaundice generally reflects underlying pathologies which can be very serious. Few cases of neonatal cholestasis need quick, specific medical or surgical treatment, so it is rapidly vital to recognize the cause and treat the specific pathology. Material & Methods: The study was carried out in all out born and inborn newborns having blood culture positive sepsis. Investigations done in this study were complete blood count (CBC), C- Reactive Protein (CRP), Peripheral blood films, blood culture sensitivity, liver function test (LFT) which includes SGOT, SGPT, serum bilirubin (total, direct and indirect), serum total protein, serum albumin, serum alkaline phosphatase, PT/INR and USG abdomen. Blood levels for estimation of total and direct bilirubin, serum alkaline phosphatase, SGOT, SGPT, serum proteins, prothrombin time were taken after 72 hours of clinical suspicion of sepsis. These investigations (LFTs) were repeated between days 10 to 14. Results: In our study Hepatobiliary dysfunction was found to be present in 61.67% Conjugated Hyperbilirubinemia was seen in 11.67%. Significant association was observed between Hepatobiliary Dysfunction with Elevated SGPT (P<0.001S). Significant difference was observed between the Hepatobiliary Dysfunction with SGPT and SGOT. Conclusion: Neonatal Sepsis is an important cause of hepato-biliary dysfunction in newborns. Septicemia must be ruled out by necessary investigations in newborns with cholestasis at the earliest before planning for other investigations and work up as it is(NNS) treatable by appropriate antibiotics and supportive treatment.

33.Pulmonary Thrombus in Covid 19: A Case Series
Maninder Patni, Tasha Purohit, Ravindra Singh Chouhan, Vijay Kumar
Coronavirus disease 19 (COVID-19) increases the risk of thromboembolism by creating a prothrombotic state. COVID-19 and pulmonary embolism, both are associated with tachypnoea, hypoxemia, dyspnoea and increased D- dimer. Diagnosing pulmonary embolism in a patient with COVID-19 compared to a patient without it using conventional clinical and biochemical evidence is challenging. In this study, we report 8 cases affected by COVID-19 admitted to Medical Intensive Care Unit of a tertiary care centre in Udaipur. All the patients presented with fever, cough, shortness of breath. All the patients were hypoxic at the time of admission. Computed Tomographic Pulmonary Angiography (CTPA) was done in all of them when their hypoxia worsened, and D-dimer levels increased. All the patients were on therapeutic or prophylactic anticoagulation, yet they all developed pulmonary thrombus. Further studies are required to define the role of prophylactic and therapeutic anticoagulants in patients with COVID-19 infection.

34.Glycosylated Hemoglobin (HbA1c) Levels and Wound Healing in Diabetic Foot Ulcers–An Observational Study
Priyanka Hegde, Seema V. Kamaraddi, Basavaraj M. Kajagar
Background: Altered glycemic levels (HbA1c) can influence the healing process of diabetic foot ulcers (DFU), prevalent among type-2 Diabetes Mellitus (DM) patients. The objective of this study was to assess the rate of wound healing in DFU corresponding to HbA1c levels in type 2 diabetes individuals. Methodology: The present observational study was conducted in 90 DFU patients with single Wagner grades 1 or 2 foot ulcer. Depending on the HbA1c levels; Group 1:  < 7%, Group 2: 7-8% and Group 3:  > 8%. Photographs were taken using the Tissue Analytics software interface installed on an android smartphone, on day 0 and day 14. The software then calculated and yielded the length, width, and area of the ulcer. Culture and antibiotic sensitiviy of foot ulcer was done. Chi-square test was used for group comparisons and p<0.05 was considered significant. Results: The mean HbA1c level was 8.76±2.75% and the duration of DM was 118.87±83.52 months in all the subjects. The range of DM duration was 0.08 to 30 years (Confidence Interval: 8.45 to 11.36). Among the subjects, 44.44% had ulcers for 1-4 weeks. A significant negative correlation (rho= -0.55) between HbA1c and rate of wound healing (p<0.0001) was observed using Spearman rank correlation. Wagner grade was significantly associated with group (p=0.001). Neuropathy, Peripheral Vascular Disease (PVD) and bacterial infection at the site was seen in 44.40%, 31.10% and 53.1% patients. Conclusion: The duration required for wound healing increased with rise in HbA1c.

35.Do the Advantages Overweight the Disadvantages of Online Teaching: Student’s Point of View?
Kusum Singla, Munish Kumar, ManjuChenicherri, Sameena Khan
Objectives: To evaluate the advantages as well as disadvantages of online teaching. To determine whether the advantages overweight the disadvantages of online teaching. Material and methods: This survey was conducted at the Army College of Medical Sciences, Delhi Cantt, New Delhi, India. As the online teaching especially for medical students took heights during the pandemic in 2020 for the first time so, all 100 students of first professional MBBS (2019 batch) were included in the study. A cross-sectional survey using an anonymous self-administered online questionnaire was issued as the tool for the study. Results: A total of 92 students submitted the answers. Out of 92 participants 44 (47.8%) were males and 48 (52.2%) were females. 81 students were using mobile phones for attending their online classes whereas only 11 students used laptops as their mode of communication. 47 students considered online studies more flexible in comparison to offline studies and 43 respondents considered those classes more convenient. More than 75% students found offline learning better that online teaching. Conclusion: Though online teaching was salutary in pandemic time but to some extent it may not contend with offline in certain angles. In present survey student’s point of view considered offline classes better than online classes.

36.Medical Students’ Feedback Regarding Sheet Plastinated Kidney Section Versus Formalin Fixed Kidney Section
Bharat Gujar, Sanjay Vikani, Ashish Khokhariya, Mayankkumar Javia, Ashok Nirvan
Background: In Human Anatomy subject, dissection of cadaver has been the main source of learning macro-anatomy or gross anatomy. Plastination is an innovative technique to preserve the body or body parts, first developed by Gunther von Hagens in 1977. Students’ feedback is having pivotal role in reviewing the effectiveness of any newer teaching learning methods. Materials and Method: Feedback was obtained from 157 medical students of 2nd semester of Phase I MBBS regarding the formalin fixed kidney specimen as well as plastinated kidney specimen (questionnaires prepared based on 5 point Likert scale) after taking due permission from Institutional Ethics Committee as well as after taking consent from all the participants by conducting these four sessions in the dissection hall: Demonstration and self-study of coronal section of formalin fixed kidney specimen, Distribution of questionnaire based on formalin fixed kidney specimen, Demonstration and self-study of sheet plastinated kidney specimen, Distribution of questionnaire based on sheet plastinated kidney specimen. Results & Conclusion: Most of the students agreed that the sheet plastinated specimen is more clearly seen, aesthetic, easy to handle, internal structure of the organ understood better, and it can be studied for several times. Further they stated that the sheet plastinated specimen may replace the wet cadaveric specimen in the future learning of anatomy and they would prefer to use these sheet plastinated specimens in day-to-day demonstration classes. Plastination has a great future in all fields of teaching and research. Natural appearance of the specimens makes the plastination a boon for anatomy learners.

37.Effect of Esmolol, Dexmedetomide & Propofol on Haemodynamic Response During Tracheal Extubation among Hypertensive Patients – A Comparative Study
Nisarg B Patel, Beena Parikh, Punit Patel, Chintan K Dasharatha, Bina Butala, Prachi Kadam
Background: Emergence from general anaesthesia and tracheal extubation is often accompanied with tachycardia and hypertension which may produce myocardial ischemia or infarction in susceptible patients. Propofol, Dexmedetomidine and Esmolol have been studied individually in attenuating pressure response during extubation, quality of extubation and postoperative sedation in normotensive patients but these three drugs have been compared rarely in hypertensive patients so. Objective: This study was carried out with objective of to compare hemodynamic changes (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial blood pressure) during tracheal extubation after general anaesthesia among three groups. Materials and Methods: Prospective observational comparative study was carried out at IKDRC-ITS, Civil Hospital, Ahmedabad between July 2017 to October 2019. Results: It can effectively be concluded that Esmolol (1 mg/kg) bolus and Propofol (0.5 mg/kg) 2 min prior to extubation and Dexmedetomidine (0.5µg/kg) infusion 10 min before extubation all three are safe and efficacious in attenuating the hemodynamic stress response during extubation. Conclusion: Dexmedetomidine is better at controlling HR, DBP, MAP than Esmolol and Propofol. Thus, Dexmedetomidine is an effective and safe drug to provide stable haemodynamics and protects against the stress response to extubation.

38.A Study of Vitamin D Estimation in Rheumatoid Arthritis Patients
Himanshu Patel, Ashish Patel, Harshal N Damor, Dharmesh Gamit, Punit Patel
Background: Vitamin D interacts with the immune system. Vitamin D deficiency is related with increase susceptibility and severity of autoimmune diseases like type 1 diabetes mellitus, multiple sclerosis, inflammatory bowel disease, systemic lupus erythematous (SLE) and rheumatoid arthritis. Objectives: 1) To study the role of vitamin D deficiency in rheumatoid arthritis patient 2) To study the demographic profile in in rheumatoid arthritis patients. Material & Method: In the present case control study, vitamin D was estimated in 70 patients of Rheumatoid arthritis and 70 healthy controls. Result: Mean Serum Vitamin D level was 21.78 ng/ml in rheumatoid arthritis patient’s case group, while 25.54 ng/ml in control group. Although Vitamin D deficiency or insufficiency was common in RA group of patients, the difference was not statistically significant (p>0.05) Prevalence of RA is higher among females as compared to males. Mean age in case group was 43.86 ± 12.017 years, while 40.57 ± 13.53 years in control group and maximum disease prevalence is between third and fourth decades. Conclusion: In this study we found that in RA patients, vitamin D deficiency is quite common, but not more common than in age and sex matched controls representative of the general population. Given the evidence regarding the role of vitamin D in overall health, clinicians should consider screening of RA patients to identify and address suboptimal vitamin D levels.

39.Association of Haemoglobin and Glycated Haemoglobin Level among Iron Deficient versus Non-Iron Deficient Non Diabetic Patients in a Tertiary Care Centre of Gujarat
Amrutbhai P Zala, Komal Bharti Singla, Ashish Patel, Bhoomikaben A Patel, Punit Patel
Background: Iron deficiency Anaemia (IDA) is characterised by reduction in the number of Red Blood Cells (RBCs) or Hb. concentration due to incomplete Hb synthesis. Glycated Haemoglobin (HbA1c) is person’s average blood glucose (sugar) levels for the last two to three months. Patients with haemolytic disease or other conditions with shortened RBC survival exhibit a substantial reduction in HbA1c. Similarly, individuals with recent significant blood loss have falsely low values owing to a higher fraction of young erythrocytes. Some studies have reported iron depletion is related to increased Glycation of Hb. resulting in false high values of HbA1c. Objectives: This study was conducted with objective of to compare the effect of Hb% and HbA1c level among iron deficient and non-iron deficient nondiabetic patients. Material and Methods: This cross-sectional and comparative study was conducted in the Department of Biochemistry, Pathology and Medicine of tertiary care hospital of Gujarat. Total 184 non-diabetic patients with confirmed diagnosis of IDA were included as cases. Another 184 healthy individuals without IDA and diabetes were included as control. Statistical analysis was done by student’s t-test (unpaired t-test) after testing for homogeneity of variance and p-value was calculated (p-value <0.05 significant). Result: Mean HbA1c in group A was more as compared to group B and this difference was highly significant (p<0.0001). It shows that iron deficient patients had higher value of HbA1c as compared to non-iron deficient subjects. Conclusion: Our study concluded that iron deficiency leads to increase in HbA1c. Using HbA1c as a common diagnostic tool for diabetes we must keep in mind the IDA status for better endocrinological profile and medication of patients. HbA1c should always be interpreted cautiously in anaemic patients.

40.Drug Utilization Pattern of Antimicrobial Agents in the Medical and Surgical Intensive Care Unit: A Study from Western Gujarat
Arun R Keshwala, Arun Hebbar JN, Hiren R Trivedi
Background: Drug utilization research plays an important role in clinical practice as it forms the basis for amendments in the drug dispensing policies at local and national levels. Objective: To study the drug utilization pattern of antimicrobial agents among patients attending the medical and surgical Intensive care units of a tertiary care teaching hospital. Material and Method: A longitudinal, prospective and observational study was carried out to determine the utilization pattern of antimicrobial agents in 16 bedded medical and surgical ICUs at tertiary care hospitals from June 2017 to May 2018 over 12 months. Individual case papers with antimicrobial prescriptions were studied, and the prescribing pattern was analyzed using the World Health Organization (WHO) basic drug indicators. Results: A total of 622 patients with a mean age group of 46 years were analyzed, out of which 391(62.8%) were male, and 231(37.1%) were female. The mean duration of stay was 4.2 days. The most common cause of admission was post-operative (23.9%), followed by accidental trauma (13.8%) and organophosphorus poisoning (9.8%). The average number of drugs per encounter was 2.3 in our study. In our study, 39.4% of patients were expired, while 54.5% were shifted to a ward. The most common drug prescribed was metronidazole (22.4%), followed by ceftriaxone (20.6%), while the most common class of antimicrobial agents was cephalosporin drugs (27.5%). In a single drug prescription, cefotaxime was the most commonly prescribed drug (7.7%), followed by ceftriaxone (6.6%). In this study, 63.9% of drugs were prescribed by generic names and 36.1% by brand names. About 98.1% of drugs were prescribed via the parenteral route followed by the oral route (1.9%). In our study average, antimicrobial drug cost per patient was Rs. 2091.54, and the most common FDC prescribed was amoxicillin with clavulanic acid (12.6%), followed by piperacillin with tazobactam (4.21%). Conclusion: The present study in medical and surgical ICUs can provide a framework for continuous prescription audits in ICUs at the regional and national levels. This will provide the database to predict future trends and cost-effective use of existing antimicrobial agents. This will help develop standard operating procedures (SOPs) for ICU clinicians to rationalize prescribing antimicrobial agents.

41.Study of Clinical Profile of Scorpion Sting in Children at Tertiary Care Center
Pooja Prashant Deshmukh, Nilofer Bhori, Shakira Savaskar
Background: In several parts of the globe, scorpion stings are common emergency activities. The estimated annual global incidence, based on national health data, is about 1.5 million envenomings involving 2600 deaths. The incidence of scorpion stings, however, is under-researched, while mortality in most countries appears to have decreased because of adequate management. Material and Methods: This Prospective, observational study conducted in Dr. Vaishampayan Memorial Government medical college, Solapur, Maharashtra from July 2018 – August 2020 on 60 patients of scorpion stings in study period whose guardian would voluntarily agree to sign informed consent form after coming to tertiary care centre. Results: Out of total cases admitted and cases with scorpion, sting came out to as 0.025% in study period. Maximum number of children were between age group 9-11 years. Out of total 60 patients, number of males were 44 i.e. 73.33%. Scorpion sting happened mostly on night-time i.e. 46 (76.67%). Mainly scorpion sting found in this study to be happened in monsoon i.e. 32 (53.33%) followed by summer i.e. 30.00% respectively. Based on ECG changes in patients with Scorpion sting, in 26 patients ECG was normal (43.33%), 30 patients had tachycardia (50%), 04 patients had bradycardia (6.66%), 03 patients had Tall T waves (5%). Out of all patients, shock was most common complication and PICU stay maximum up to 3 days were 19 cases i.e. 31.67% and no PICU stay in 36 cases i.e. 60.00%. Based on outcome, out of 60 patients, 59 patients recovered and 1 patient expired (01.67%). Conclusion: Time intervened between sting and admission is probably a key factor for better outcome. There is now professional confidence for successful management of scorpion sting in India. Scorpion sting envenomation is a common medical emergency among children. Judicious use of inotropes like Dobutamine for management of shock and alpha-receptor blocker Prazosin has been found to be very useful and beneficial in decreasing morbidity and mortality of scorpion sting cases.

42.Demographic Comparison of the First and the Second Waves of Covid-19 Disease: A Study in a Tertiary Care Hospital of North India
Bashir Ahmad Fomda, Sadaf Guldin, Shagufta Roohi, Iqra Majid, Insha Altaf
Introduction: The new corona virus, also known as COVID-19, is a virus that causes respiratory disease. It was discovered in December 2019 in Wuhan, China, and has spread to other countries. Corona viruses are large, enveloped, positive-stranded RNA viruses. On March 11, 2020, the World Health Organization (WHO) designated the viral outbreak a worldwide pandemic. As of September 15, 2021, the virus has infected over 226672138 individuals and killed over 4663045 infected ones. India accounts for 14.7% of infections (more than 33 million) and 9.5% of fatalities (more than 4 million). Aim and Objectives: This hospital-based, retrospective study was conducted in the Department of Microbiology, SKIMS Soura, Srinagar. We designed this study with the following primary objectives: 1. To estimate and analyze SARS- CoV-2 infection positive rate during first and second covid-19 waveforms. 2. Estimate the pattern of 1st and 2nd Covid-19 waveform. Material and Methods: All pertinent clinical, demographic, and epidemiological data were collected during peak months of COVID-Wave I (Sep-Dec 2020) & COVID-Wave II (April-July 2021).The samples obtained from patients visiting Covid-19 clinic (OPD) and IPD were processed in the bio safety level II lab. A real-time RT-PCR test was utilized in line with the manufacturer’s instructions to detect ribonucleic acid (RNA) of SARS-CoV-2 from VTM’s containing NP/OP swabs from patients suspected of COVID-19. A positive result on a realtime RT-PCR assay of nasopharyngeal and/or oropharyngeal swab specimens were defined as a confirmed case of Covid-19. Results: A total of 27851 patients were included in our study in peak months of the1st wave (September to December 2020) of COVID-19 and 31871 patients in the 2nd wave (April to July 2021). The findings of this study demonstrate that during the first and the second-wave, hospitalized patients were majority males, younger in the age group of 19-30 years. The majority of patients during the first wave of COVID-19 reported in the out-patient department, while during the second wave, patients reported through the In-patient department of the hospital. Also, the total number of cases reported and positivity rate during the COVID-19 first wave was less than the second wave. Conclusion: We compared the baseline characteristics of wave II with that of Wave I, in which we found that in COVID wave II more individuals were affected, the younger population was infected, more patients were admitted. We also found that the pattern of the two waves does not show any seasonality. Our data could be used to inform Kashmiri population about the epidemiology and demography of Covid-19 waves so that people understand the nature of the situation and follow all the COVID-19 appropriate behaviours more strictly.

43. Investigation of Utility of Sonography in Early Management of Knee Pain Due to Traumatic Events
Pankaj Agarwal, Alok Tripathi
Background: Knee pain and related symptoms may come as a result of damage to one or more of the soft tissue structures that stabilize and cushion the knee joint. Trauma to the knee is the second most common occupational accident. Ultrasound has a significant role in patients presenting with knee joint trauma as sonography can detect haemarthrosis, tendon and muscle injuries. Methods: A descriptive observational study was conducted amongst 17 patients who underwent ultrasound imaging of the knee when they presented with knee pain following a traumatic episode at a tertiary care hospital in Delhi, NCR from July 2017 to March 2020. Ultrasound was performed using the technique described by Von Holsbeeck. Bilateral scans were taken for each patient for comparison. Examination was done with the patient supine, left and right lateral and prone positions. Results: A majority (65%) of the cases in our study were male, while six patients recruited were female. Sport-related knee injuries were the most common type, encountered in 12 patients (70.5%) while traffic and occupational-related knee injuries were encountered in the remaining 5 patients (29.5%). In the present study, the most frequent knee injuries were 8 ligamentous (47.0%), followed by 7 meniscal (41.1%), 2 osseous (11.7%), 1 tendinous (5.8%) and all patients had effusions. Among patients presenting with post-traumatic joint effusion, fluid was echogenic in twelve patients. Meniscal injury is seen in seven patients, while one case of quadriceps tendinosis seen secondary to repeated minor trauma seen as echogenic focus of calcification with acoustic shadowing. Two cases of fracture were diagnosed by the ultrasound. Conclusion: Sonography of the painful knee joint can diagnose all tendinous, bursal and synovial lesions. Most of meniscal and ligamentous lesions can be accurately depicted it.

44. Association Between Glycated Hemoglobin (HbA1c) and the Lipid Profile in Patients with Type 2 Diabetes Mellitus at a Tertiary Care Hospital: A Retrospective Study
Shiv Prakash Rathore, Kusum Bala Jain, Gulab Kanwar, Mohd Shakeel
Background: HbA1C is not only a glycemic index but can also be used as a marker of dyslipidemia and thus can be used as a preventive measure for the development of CVD in patients with T2DM. Methods: This retrospective cross-sectional study was conducted during the year 2012-13.  Venous blood samples were collected from 300 type 2 diabetic patients. The sera were analyzed for HbA1c, fasting blood glucose (FBG) and lipid profile panel test. Dyslipidemia was defined as per the National Cholesterol Education Programme (NCEP) Adult Treatment Panel (ATP) III guidelines. Diabetes was defined as per American diabetes association criteria. The statistical analysis was done on Microsoft excel and Epi info-6 software. Result: In our present study 95(81.89%) females out of 116 and 151 (82.06 %) males out of 184 were dyslipidemic. HbA1c demonstrated positive and significant correlations with total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipopro-tein cholesterol (HDL-C) and LDL-C. Patients with HbA1c value > 7.0% had significantly higher value of TC, Triacylglycerol (TAG), LDL-C, HDL-C as compared to the patients with HbA1c ≤ 7.0%. HbA1c can be used as a biomarker for predicting dyslipidemia in type 2 diabetic patients in addition to glycemic control.

45. Problems and Prospects of Online Mode of Medical Education During COVID-19 Pandemic: A Student – Teacher Perceptive
Dilip Kumar L, Nitesh Mangal, Mehul Patel, Matariswa Samanta, K. A. Varghese, Mansi Sharma
Introduction: Consequent upon continued nationwide lockdown to check the spread of COVID -19 pandemic, online teaching and learning has emerged as a new mode to continue the regular educational programs in India. It is vital to assess the perception of this new method by various stakeholders of educational sector. Objectives: The objectives included identification of the problems and benefits felt by medical students and college teachers about online classes and to assess its effectiveness on attendance and academic performance of students. Methods: The cross-sectional study was conducted during March-October 2021 among 150 first MBBS students admitted in 2020 in a medical college at Udaipur, Rajasthan. The participants who gave informed consent and attended three online and offline monthly tests were included and the rest were excluded. The quantitative techniques included frequency tables, mean, standard deviation and ‘t- test’. Results: Among 100 respondents, 48% were male and 52% were female. The major problems faced by students included lack of space at home to attend class (71%), interrupted internet connectivity (42%), missing interaction with stakeholders (>70%) and mismatch in theory and practicals (69%). The benefits included homemade food, family care, risk minimization of COVID-19 and regular parental monitoring. The major advantages felt by teachers included continued teaching (90.90%) and saving time (100%) in taking attendance in online mode. The average attendance for online classes was significantly higher over offline classes (p<0.0001), whereas the average retention of knowledge level as evidenced by average marks was significantly lower for online class tests compared to offline class tests (p<0.0001). Conclusion: The higher attendance does not reveal higher knowledge retention during online mode of classes.

46. A Study on Tubercular Manifestations in Ear, Nose, Throat and Head & Neck Region
Sanjit Kumar Mishra, Mamata Sahu, Santosh Kumar Mishra, Nandini Divakaran
Background: The intent of the present study was to study in detail the ear, nose , throat and head and neck manifestations of tuberculosis in relation to its prevalence as per OPD & IPD registration, age distribution, sex distribution, socio-economic status, dietary habits, residential status, sites and presenting symptoms, and  diagnostic tools, like sputum AFB, AFB in swabs from local lesion, Mantoux test, Fine Needle Aspiration Cytology, association with pulmonary tuberculosis and association with HIV infection. Materials and Methods: This was a prospective study carried out in Dept. of E.N.T & Head and Neck surgery of M.K.C.G. Medical College, Berhampur conducted between October-2019 to October-2021. Written informed consent was obtained from all study participants. Results: The most common site of TB of head and neck was found to be lymph nodes, next being larynx, hoarseness and cough being common presentations of laryngeal TB. It was more common in males than in females, and in patients of lower socio-economic status due to overcrowding, lack of awareness and low protein diet. FNAC is a reliable & very easy method to diagnose tuberculosis. Conclusion: With high degree of suspicion, an early diagnosis can be made with the help of simple investigations & successful outcome depends on appropriate antitubercular therapy & timely surgical interventions whenever necessary.

47. Evaluation of Pregnancy Outcomes in Gestational Diabetes Mellitus
Anuradha Mishra, Mamata Oram, Bibekananada Rath, Prativa Sahu
Background: In this study we wanted to evaluate the risk factors associated with GDM and assess the maternal and fetal outcomes in pregnancy with gestational diabetes mellitus. Methods: This is a prospective observational study conducted in the Department of Obstetrics and Gynaecology, Department of Endocrinology and Department of Paediatrics, MKCG Medical College, Berhampur from October 2019 to September 2021 among pregnant women of gestational age between 24-40 weeks who attended antenatal care in OPD and labor room and met inclusion criteria and diagnosed case of GDM in dept. of Obstetrics and Gynaecology, MKCG Medical College and Hospital. Results: The incidence of caesarean deliveries (56.6%), pre-eclampsia (32%), PROM (7.3%) and PPH (6%) are higher among women with GDM. This indicates GDM can result a higher maternal mortality. 11.3% had preterm labor. Requirement of insulin treatment(n=27) is more as compared to MNT alone(n=13) in GDM associated with pre-eclampsia. GDM pregnancies had significantly higher frequency of LGA (30.8%) and mean average birth weight was 2889±587gm. Incidence of neonatal complications such as hyperbilirubinemia (12.6%) and respiratory distress (11.3%) had increased the chances of NICU (18%) admission. Conclusion: A short-term intensive care gives a long term pay off in the primary prevention of obesity, impaired glucose tolerance and diabetes in the offspring as preventive medicine starts before birth.

48. Comparison of Intracuff Pressure Changes Using Air Versus 2% Lidocainein the Cuff of the Endotracheal Tube
Nagaraja Kokila, Mathikere Boregowda Sudarshan, Velagalaburre Yalappa Srinivas, Anand Shalini, Sindhu Suresh
Background: Use of nitrous oxide during general endotracheal anaesthesia is associated with increase in cuff pressure and its consequences. Our aim is to study the cuff pressure changes when lidocaine is used as cuff inflating agent and emergence phenomena following general endotracheal anaesthesia using nitrous oxide. Materials and methods: Sixty adult participants of ASA 1 and 2 undergoing elective surgeries under general endotracheal anaesthesialasting more than 90 min were included in this prospective randomised study. All patients were premedicated with IV dexamethasone 8 mg.  They were divided into 2 groups of 30 patients each. Group A – endotracheal tube cuff was inflated with air and Group L – endotracheal tube cuff was inflated with 2 % preservative free plain lidocaine till the cuff pressure was 20 cm H2O. Endotracheal tube cuff pressure was recorded by cuff manometer at cuff inflation, 5 min, 15 min and then at every 15 min interval till the completion of surgery. Emergence phenomena like sore throat, coughing, hoarseness, nausea/vomiting, dysphasia and dysphagia were noted at extubation and at 1 hr., 6 hr. and 24 hrs. postoperatively. Results: The mean cuff pressure in group A was 26.81±4.04 cm H2O and in group L was 18.67 ± 0.81 cm H2O at the end of 90 mins of anaesthesia which was statistically highly significant. At 1 hour 33.3% of patients had sorethroatin group A, 10% in group L. At 6 hours and 24 hours, 16.6% and 20% of subjects had sorethroat in group A and 6.67 % subjects in group L at 6 and 24 hours. Incidence of coughing and hoarseness of voice were also more in group A than in group L. Incidence of nausea and vomiting was almost same in both the groups. Conclusion: Minimal cuff pressure changes and fewer incidences of sorethroat, hoarseness and coughing were noted when cuff of the endotracheal tube was inflated with lidocaine than with air during endotracheal anaesthesia using nitrous oxide. Adding prophylactic dexamethasone intravenously as a premedicant further reduces the incidence and severity of post-intubation morbidities in both the groups.

49. Prospective Comparative Study of Epidural Ropivacaine Vs Epidural Levobupivacaine on the Duration of Analgesia in Adult Patients Undergoing Subumbilical Surgeries
Bhagyasree Gopinath, Santhosh Surendran
Background: Epidural anesthesia can be used as a sole anesthetic technique for surgical procedures, and it can also be used for post operative pain management. The aim of this study was to compare the efficacy of Ropivacaine and Levobupivacaine in epidural neuraxial blockade regarding duration of analgesia and adverse effects. Materials and Methods: This study was done among two group of patients belonging to ASA 1 and 2, who underwent subumbilical surgeries. Both the groups of patients were comparable with regard to age, height and weight. They were allocated into two groups using computer generated randomization. Group A received 12 ml of 0.5 % Ropivacaine and Group B received 12 ml of 0.5 % Levobupivacaine. Results: The mean duration of analgesia in group A was 195 minutes and in group B was 200 minutes. Since the p value was > 0.05, there was no statistically significant difference in the duration of analgesia between the two drugs. Incidence of adverse effects like hypotension, nausea, vomiting was comparable in both the groups and found to be statistically insignificant. There were no incidence of bradycardia, headache or dizziness in both the groups. Conclusion: Since the duration of analgesia and adverse effects were comparable in both the drugs, it was concluded that they can be used with equal efficacy in subumbilical surgeries.

50. Safety and Efficacy of Manual Vacuum Aspiration and Uterine Curettage for Treatment of First Trimester Incomplete Abortion: A Prospective Observational Study
Smita Rai, Sarita Saxena, Ujjwal Sourav
Background: Uteine evacuation is the removal of products of conception. There are many ways of performing this in the first trimester such as vacuum aspiration, surgical methods and pharmacological methods. Within these categories there are several different methods that can be employed. These depend upon the experience and training of the staff available, and the equipment and materials provided at the time. Objectives: To assess the safety and efficacy of MVA with EVA in pregnancy termination upto 10 weeks with regards to procedure time, blood loss, pain complications and duration of hospital stay. Methods: A prospective randomized comparative study of 200 patients with a history of less than or equal to 10 weeks gestation seeking MTP, attending Obstet and Gynae OPD of Dr Ram Manohar Lohia Combined Hospital, Lucknow. Statistical analysis consists of (chi)2 test, student ‘t’ test and z – test. Result: The time taken, blood loss, pain, complications and duration of hospital stay was significantly less in MVA group as compared to EVA group (p < 0.05). Conclusion: MVA is safe & effective with less complications, less bleeding, and needing less resources.

51. Prevalence and Types of Pterygium in a Tertiary Hospital in Karbi Anglong – A Descriptive Cross Sectional Study
Kabindra Deva Sarma, Saura Kamal Dutta, Pranami Basyach
Introduction: A pterygium is a triangular degenerative fibrovascular subepithelial growth of bulbar conjunctival tissue that has invaded the superficial cornea. It may cause visual impairment in some cases. Objectives: To study the prevalence and types of pterygium in patients in a tertiary hospital in Karbi Anglong, Assam. Materials and Methods: A descriptive cross-sectional study was done for a period of 6 months, in the Department of Ophthalmology. The clinical records of the patients with pterygium were retrieved and analysed. Results: The results depict that females were more affected than the males and nasal pterygium was more common than the temporal pterygium. It was also found that unilateral pterygium is more common than bilateral pterygium and progressive pterygium is more common than atrophic or recurrent types. Conclusion: The prevalence of pterygium increased with increasing age and long-term exposure to sunlight. It can be decreased by using protective measures.

52. Prevalence Miliary Tuberculosis During Pregnancy- A Cross Sectional Study in a Tertiary Hospital
Abdul Samad MV, Shivakumar
Background: The incidence of Tuberculosis during Pregnancy has increased markedly in the present-day consultations of a Pulmonologist. The clinical features of Miliary tuberculosis in pregnant patients were analyzed in this study. Aim of the study: To observe, analyze the clinical presentation and laboratory diagnosis of Miliary tuberculosis in pregnancy as per guidelines of WHO to recommend better practices of treatment in the Hospital. Methods: A Prospective study to analyze the clinical presentations and laboratory diagnosis of Miliary tuberculosis occurring in various semesters of pregnancy was conducted. Demography, epidemiology, investigative procedures adopted, treatment executed, and prognosis were studied. Results: There were 37 pregnant women with Miliary tuberculosis registered for the study. 23 (62.16%) were primi-Para, 14 (37.83%) women were multi-Para. The mean age of gestation was 28.54±2.65 weeks. The mean duration of clinical presentation was 39.50±4.32 days. Symptoms were cough, loss of appetite, fever, pain in the abdomen and pain in the chest. Acute respiratory failure was observed in 08 (21.62%) women and ARDS was observed in 06 (16.21%) women.  X-Ray chest showing diffuse, small, multiple nodules in all patients. 08 patients treated with ventilator support; 02 patients underwent extracorporeal membrane oxygenation. Conclusions: Tuberculosis of Miliary type could occur in pregnant patients; Symptoms appeared in all the trimesters of pregnancy. The common clinical symptoms were fever, breathlessness and cough. Sputum for AFB, TBNAT test, sputum for culture of TB bacilli, Monteux test, arterial blood gas analysis, pulmonary function tests, complete blood picture were significant statistically to help the diagnosis.

53. A Long-Term Study on Effectiveness and Safety of Ivabradine Versus Metoprolol on Heart Rate and LVEF in Post Myocardial Infarction Patients- A Tertiary Hospital Based Study
Midhun M, Venkatesh Bhat K, P K Surendran, Abseer K S
Background: Tachycardia and heart failure are a major concern in post myocardial infarction (PMI) patients and a therapeutic challenge. Beta blockers, the first-choice drugs used have certain disadvantages. Ivabradine known to reduce heart rate was compared with Metoprolol for their benefits and side effects. Aim of the study: To analyze the effects of Ivabradine on heart rate and LVEF in comparison with Metoprolol at fixed doses over a period of 12 months from the time of discharge. Materials: 278 MI patients were grouped and observed for 12 months for the effect of Ivabradine and Metoprolol drugs on their heart rate (HR) and LVEF values. Patients with acute inferior wall STEMI, HR above 70/minute were included. All patients were on treatment for 12 months. Patients likely to develop cardio-pulmonary complications excluded. MI was confirmed on ECG and serial CK-MB/ troponin T measurements and 2D ECHO.  Patients were with Holter monitors. Results: 278 patients were grouped as Ivabradine group wherein 138 patients (Ivabradine 5mg twice daily) and Metoprolol group 140 patients (Metoprolol 25 mg twice daily). All the risk factors were similar in both the groups. The mean HR and LVEF values were similar in both the groups. The range of HR was 64 to 86 beats per minute in all patients. The symptomatologies among the patients of both the groups were also similar.  Reduction of HR was from 76.43±7.3 to 62.55±1.05 and in Metoprolol group from 77.51±4.50 to 61.45±2.35 beats per minute 13 (09.24%) patients from Ivabradine group and 19 (13.57%) patients from Metoprolol group showed a heart rate less than 60/bpm, others had heart beats > 60/mt. Conclusions: Ivabradine was a competitive bradycardic drug in comparison to Metoprolol in early Post MI patients. It had similar action on LVEF as Metoprolol. It could be potentially used an alternative anti-tachycardia drug with no other cardiovascular side effects and wherever β-blockers are contraindicated.

54. Comparative Study to Estimate the Prevalence of Ocular Morbidities among School Children in Bihar
Ashutosh Kumar Anand, Arjun Choudhary
Aim: To estimate the prevalence of ocular morbidities among school children in Bihar. Material & Methods: This comparative study was designed to estimate the prevalence of ocular morbidities among school children in Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India, over a period of one year. Children who were not able to bring back the signed consent form from parents or were absent on the day of screening were excluded from the study. For the analysis, children were divided into 2 groups, Group 1 (5-10 years) and Group 2 (11-15 years), based on age. Results: Myopia was the major contributor, as it was higher in children from urban school compared to the ones studying in rural setting (P = 0.001). The statistical difference was mainly contributed by red-green color deficiency (P = 0.537) and conjunctival disorders (P = 0.631). Conclusion: Vitamin A deficiency prevalence was much higher indicating missed opportunities for vitamin A supplementation at a younger age. Refractive error was more prevalent in the urban population as well in the older age group (11–15 years), indicating a need for frequent eye screening.

55. Comparative Assessment of the Hemodynamic Variation between Low Dose Oral Clonidine (100mcg) and Placebo Group in Laparoscopic Surgeries
Manzar Nadeem Kazmi
Aim: This study aims at comparing the hemodynamic variation between low dose oral clonidine (100mcg) and placebo group in laparoscopic surgeries. Material & Methods: 60 consecutive patients undergoing laparoscopic procedures of 90 to 180 minutes were enrolled into the study. Inclusion criteria was ASA (American Society of Anesthesia) I and II in the age group of 18 and 70 years. Exclusion criteria were patients of ASA III and IV, patients on antihypertensive medications and patients with known cardiac disease. Results: A statistically significant difference and reduction in heart rate was seen in clonidine group compared to placebo group at various interval. At 90 and 120 minutes, systolic and mean arterial blood pressure was similar between the clonidine and placebo group. Conclusion: Low dose oral clonidine is a very efficient, easy to administer and cost-effective premedication drug during laparoscopic procedures.

56. Morphometric Data Assessment of Proximal Femur in Indian Population
Pradeep Kumar Verma
Background: The prosthesis for proximal femur used in India is manufactured by the western countries whose morphometry does not fit our people leading to complications. Hence, this study is to provide the morphometric data of proximal femur for Indian population and to clear the drawbacks in the information about proximal femur in our people and customize the implant design to suit the Indian people and thereby reduce the complications. Material & Methods: The material used for the study contained 5° human femora of unknown sex obtained from different the Department of Anatomy, Anugrah Narayan Magadh Medical College, Gaya, Bihar, India. The instruments used are metal sliding caliper and osteometric board. The maximum length of femur and anterioposterior diameter of upper, middle and lower shaft of femur was measured. Results: The study was undertaken in 50 human femurs for measuring epicondylar breadth, Neck shaft angle, transverse and vertical diameter of head.The average mean transverse diameter of head was 35.7 ± 3.07 mm, mean right transverse diameter of head was 38.0 ± 3.10 mm and left it was 37.8 ± 3.15 mm. The average mean vertical diameter of head was 41.5 ± 3.56 mm, mean right vertical diameter of head was 40.4 ± 3.07 mm and left it was 41.45 ± 3.90 mm, Neck shaft angle ranges from a minimum of 105° to maximum 134° with a mean value of 125.5°. Conclusion: This study showed that our values were comparatively smaller than the western people and varied with regional ethnicity. This study will encourage our biomechanical engineers to bring in a revolution in the designing and manufacturing of implants with correct morphometric data to befit our Indian population and lead to improved surgical outcome with minimal surgical complications.

57. Spectrum of Clinical Manifestations in Patients Diagnosed of Malaria and to Compare the Severity of P. Vivax and P. Falciparum Malaria
Kumari Preeti Ranjana, Sujit Kumar, Aravind Kumar
Aim: The aim of our study was to find out the spectrum of clinical manifestations, infecting species, age distribution and mortality in admitted patients of malaria in our hospital and to compare the clinical profile with severity of P.vivax and P. falciparum malaria. Material & Method: The study was carried out on 150 patients admitted during the period of seven months in the hospital. It was analytical cross-sectional study, which was done in the Vardhman Institute of Medical sciences, Pawapuri, Nalanda, Bihar, India. Results: In the present study, out of 150 patients more number of males (93 patients) were affected when compared to females (57 patients). Fever is the most common presentation in all 150 patients both falciparum and vivax infected patients. Pallor was the most common clinical sign, was observed in 82 patients of falciparum and 61 with vivax species. Conclusion: Malaria is a fairly common disease in our country. Early detection and treatment of severe malaria, which is mainly caused by the falciparum rather than the vivax, reduces mortality and morbidity.

58. A Prospective Observational Assessment of the Treatment Outcome of Advanced White Cataracts with Manual Small Incision Cataract Surgery
Rajesh Kumar, Arun Kumar Sinha
Aim: To assess the complications and visual outcome of manual small incision cataract surgery in the treatment of advanced white cataracts. Materials and methods: This prospective observational study was conducted in the Department of Ophthalmology, Bhagwan Mahavir, Institute of Medical sciences, Pawapuri, Nalanda, Bihar, India and private hospital. We included 60 eyes of 60 consecutive patients with white cataract who underwent MSICS by a single surgeon (ASM) over a period of 12 months. Results: At 45 days postoperatively, 57 patient’s had a best corrected visual acuity of 6/9. Conclusion: Manual small incision cataract surgery proves to be a safe and effective surgical option for patients with advanced white cataracts due to its low rates of intraoperative and postoperative complications and good postoperative visual outcomes.

59. A Hospital Based Visual Outcome Assessment of Single Piece Yellow Tinted Hydrophobic Acrylic Intraocular Lens
Rajesh Kumar, Arun Kumar Sinha
Aim: To evaluate the visual outcome of single piece yellow tinted hydrophobic acrylic intraocular lens (IOL) following phacoemulsification. Materials and methods: This prospective observational study was conducted in the Department of Ophthalmology, Bhagwan Mahavir, Institute of Medical sciences, Pawapuri, Nalanda, Bihar, India and private hospital for 1 year. Patients aged 50 years and above whose visual loss can only be attributed to cataract in an otherwise healthy eye were enrolled in the study. Results: The mean ± SD of manifest refraction spherical equivalent at day 180 was 0.9±0.86. Results indicate that single piece yellow tinted hydrophobic acrylic intraocular lenses significantly improve contrast sensitivity function (p=0.000). Conclusion: Implantation of single piece yellow tinted hydrophobic acrylic IOL provides expected visual outcome, refractive stability, enhances contrast sensitivity with minimal glistening, glare and adverse events. The square edge design of the hydrophobic lens reduces incidence of posterior capsular opacification.

60. Cross-Sectional Descriptive Online Survey to Assess the Adequacy of Knowledge to Prevent COVID-19 Pandemic
Preeti Kumari
Aim: To determine the level of knowledge towards COVID-19 among people. Material & Methods: A cross-sectional descriptive research design was used for the present study and was conducted among people attending Anugrah Narayan Magadh Medical College, Gaya, Bihar, India, to assess their knowledge regarding COVID-19. A total of 461 people were recruited for this study and sample of 400 eligible people who fulfill the inclusion criteria were enrolled. Results: The association of socio-demographic variables of participants and their knowledge score. It shows that group (p>0.001), gender (p=0.020), education (p=0.001), marital status (p=0.001), age (p=0.020), and inhabitants (p=0.001) were significantly associated with knowledge. Majority of participants 63% having good knowledge while 33% and 1.4% having average and poor knowledge respectively regarding the corona virus pandemic. Conclusion: Study concluded that many people were still had average and poor knowledge on COVID -19. Higher authorities must find the ways for making people more aware on this pandemic to control its impact.

61. A Prospective Hospital Based Study to Assess the Correlation Between Glycemic Control, Lipid Profile and C-Reactive Protein in Adults with Type 2 Diabetes Mellitus
Ravish Gupta, Nidhita, Suraj Kumar Srivastava, Bibhu Prasad
Introduction: Onset of type 2 diabetes mellitus (T2DM) at early age heralds many years of disease and an increased risk that the full range of both microvascular and macrovascular complications will occur when affected individuals are still relatively young. Thus, further generations may be burdened with morbidity and mortality at the height of their productivity, potentially affecting workface, and healthcare systems of countries across the world. Methods: Total 50 patients with T2DM reporting to Nalanda Medical College & Hospital, Patna were included in the study, in whom CRP levels were estimated by using commercially available kits and correlated with HbA1C and other risk factors of coronary artery disease. Follow-up was done on 10 patients who were not on statin therapy with repeat HbA1C and CRP. Results: This study showed that both HbA1C and CRP levels had reduced significantly in follow-up patients after putting them on treatment (p<0.05). It was also found that lowers the HbA1C, lower was the CRP. A positive correlation was found between HbA1C and CRP (p<0.05). Conclusion: A positive correlation was found between serum CRP and HbA1C in the initial group and in the follow-up patients, showing that CRP levels lowers with better glycemic control and correlates with dyslipidemia profile.

62. A Retrospective Observational Study to Assess the Prevalence of Dengue Viral Infection among Clinically Suspected Patients
Kumari Preeti Ranjana, Sujit Kumar, Aravind Kumar
Aim: To estimate prevalence of dengue viral infection among suspected patients attending a tertiary care center in Bihar State. Material & Method: Total 230 samples were tested for dengue sero-positivity. Data was recorded and analyzed. The present study is a retrospective study to observe prevalence of dengue infection, conducted at the Vardhman Institute of Medical sciences, Pawapuri, Nalanda, Bihar, India. Patients clinically suspected of having dengue infection and advised for dengue investigation for establishing the diagnosis were enrolled in the study, irrespective of their age or sex, over one-year period. Results: Total 230 samples were tested during a period of one year. Out of which 55 (23.91%) showed laboratory evidence of dengue; either for NS1 Ag or IgM Ab or for both. Conclusion: The present study confirms that dengue is mainly a disease of rainy season and also identifies certain vulnerable groups for effective planning of interventions.

63. A Cross Sectional Observational Study to Examine the Echocardiographic Features of Patients with T2DM
Vivek Kumar, Ashok Kumar
Aim: To examine the echocardiographic features of patients with T2DM. Materials and Methods: The present cross-sectional study was carried out in the General Medicine ward and Outpatients Department, and Diabetic Clinic of the Patna Medical College & Hospital. A total of 80 patients were studied. 40 male and 40 female diabetic patients were selected. 48 of the patients were on oral hypoglycemic agents and 32 were on insulin. Patients were diagnosed as having diabetes mellitus based on the criteria laid down by the American Diabetes Association, 2017. Each patient underwent a thorough Echocardiographic and Doppler study to assess the cardiac structure and function at PMCH. The system has a full sector movable dipper facility with a movable curser and inbuilt computer software. Two dimensional and M- mode echocardiography was performed with a 3.5 HZ transducer. The echo cardiographer was kept uninformed about the clinical details of the subject in order to eliminate the possibility of biased observation. Echocardiography and Doppler studies were performed in the resting state and during valsalva manoeuvre. Results: All of the 80 cases selected had altered waist hip ratio. However, 74 out of the 80 patients had high BMI. Increased Interventricular septal thickness was found in 60% of cases as compared to 10 % of controls. Increased LV posterior wall thickness was found in 63.75 % of cases whereas none of the controls had increased LVPWT. Early diastolic dysfunction was found in 62.5% of cases as against 7.5 % of controls. 52% of male cases had early diastolic dysfunction as against 48 % of females. Pseudonormalization pattern was found in 32 % of cases whereas none of the controls showed pseudonormalization pattern. Conclusion: Type 2 diabetics with obesity, particularly central type, have an increased predisposition to the development of left ventricular structural or geometrical abnormality. They have significantly higher left ventricular Mass. Obese type 2 diabetics also have higher incidence of diastolic dysfunction. All these abnormalities occur with greater frequency in females.

64. Safety and Efficacy of DDP-4 Inhibitor Teneligliptin, as add on Therapy in Type-2 Diabetes Patients Inadequately Controlled with Dual Combination Oral Hypoglycemic Agents: Placebo Controlled Study
Ravikant, Ashok Kumar
Aim: To evaluate the safety and efficacy of DDP-4 inhibitor Teneligliptin, as add on therapy
in type-2 diabetes patients inadequately controlled with dual combination oral hypoglycemic
agents. Materials and Methods: This is 24-week prospective interventional clinical study in 104 patients of T2DM who had inadequate Glycemic control with dual combination of metformi and other oral hypoglycemic agents. Patient attending the Outdoor Patient Department of medicine department of Patna Medical College and Hospital, Patna from July 2020 to March 2021 for treatment of type 2 diabetes mellitus. Results: This study showed significant reductions in HbA1C from baseline to 24-week, mean HbA1C difference before and after addition of teneligliptin was 0.84%. significant reduction in fasting blood glucose level from baseline to 24 week, mean fasting blood glucose level difference before and after addition of teneligliptin was 26.61 mg/dl. A significant reduction in serum triglyceride level, with mean triglyceride level reduction of 45.58 mg/dl after addition of teneliptin to dual combination of traditional oral hypoglycemic agents. Conclusion: The current study demonstrated that addition of teneligliptin to dual therap such as metformin with glimepiride, acarbose etc, showed significant reduction in HbA1C level, fasting blood glucose level, and post-prandial blood glucose level.

65. Vitamin D Insufficiency Prevalence and Severity in Type 2 Diabetes Mellitus Patients at IGIMS, Patna: A Case Control Study
Govind Prasad, Manoj Kumar Choudhary, Jyoti Kumar Dinkar, Arshad Ahmad, Bhim Ram, Naresh Kumar
Aim: The aim of the study to assess the prevalence and severity of vitamin D insufficiency in type 2 DM patients and to know whether any correlation between level of glycemic control and vitamin D insufficiency. Methods: A case-control study was conducted in the Department of General Medicine, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India. Total 200 participants were included in the study, out of which 100 type 2 diabetic patients were included as case (Group A) and 100 healthy people as controls (Group B). Routine laboratory Investigations like CBC, FBS, RBS, PP2BS, HbA1C, blood urea, serum creatinine, lipid profile, urine albumin and Vitamin D3 levels were done by standard methods in central laboratory of Institute. Results: In the study population, the mean age of group A (case) was 50.58±10.55 years while that of group B (control) was 48.82±10.36 years. Total 110 males and 90 females were enrolled in study. 66% of group A were male and 34% female. Group B (control) had 46% males and 54 females. Prevalence of low vitamin D level in healthy population was only 24 % in my study, while prevalence was 85 % in Diabetic group. Among diabetic patients having abnormal Vitamin D level, majority 67%) were having insufficiency, only 18% were having overt vitamin D deficiency in Diabetic patients. In patients with controlled diabetes as per HbA1C criteria, the prevalence of sufficient, Insufficient and Deficient Vitamin D was 20.45%, 65.91% and 13.64% respectively, where in patients with uncontrolled diabetes it was 7.14%, 75% and 17.86% respectively. More number of diabetic patients with uncontrolled status (17.86%) were having overt vitamin D deficiency in comparison to controlled status (13.64%). Hypertension was most common co-morbidity found in diabetic group (12%) followed by ischemic heart disease (7%). Serum vitamin D level was measured in all participants. 85 of diabetic population was having less than normal vitamin D level, while only 24% had less than normal vitamin D level in group B (control). Mean value of vitamin D in type 2 Diabetic patients was 28.83±6.97 ng/dl and mean value of vitamin D in healthy individuals was 37.21±4.89 ng/dl. Conclusion: We concluded that the control of diabetic status is mandatory in order to prevent vitamin D deficiency.

66. Socio-Demographic Confounder of Oral Cancer
Shilpi Singh, Shreya Nigoskar, Pankaj Kumar Srivastava, Anand Narayan Singh, Prashant Tripathi
Background: Even though examining the oral cavity is easy, most cases of mouth cancer are detected in late stages. This situation affects the type of treatment used, as therapeutic procedures vary depending on the stage and histological factors. The present study was carried out to evaluate that socio-demographic characteristics are related to the advanced clinical stage of oral cancer. Material & Methods: This study included histopathological confirmed 98 cases of oral cancer and age-, sex- and ethnicity-matched 98 cancer free controls. Data collection was carried out over a period of 6 months and the following information was used: clinical stage of cancer, grading, gender, age group, schooling, marital status, family history of cancer, and origin of referral. The clinical stage of cancer was categorized according to the TNM classification. Data were tabulated and statistically analyzed using the software Statistical Package for Social Sciences (SPSS, 22 version). Results: The result showed that systematic no. of Maximum females (33.3%) and males (36.4%) belong to TNM stage I. Chi square value was 0.479 and p value was 0.923, which was non-significant. 79.1% female cases were well differentiated and 85.1% male’s cases were well differentiated.  Chi square value was 0.472 and p value was 0.491, which was non-significant. 67 cases were doing hard job and 31 cases were doing sedentary jobs. 35.8% cases who were doing hard jobs had TNM stage I and 83.5% cases were well differentiated. Chi square value for TNM staging was 0.038 and p value was 0.997, which was non-significant. Chi square value for grading was 0.001 and p value was 0.971, which was non-significant. 35.4% cases who were doing sedentary jobs had TNM stage I and 83.8% cases were well differentiated. 27 cases were vegetarian, 43 cases were non-vegartarian (Weekly/Occasionally) and 28 cases were Non- Vegetarian (Daily). 29.6% vegetarian cases belong to stage I and 77.7% vegetarian cases were well differentiated. 41.8% non-vegetarian (Weekly/Occasionally) cases belong to stage I and 83.7% non- vegetarian cases were well differentiated. 32.1% non-vegetarian (Daily) cases belong to stage I and 67.8% non- vegetarian cases were well differentiated. Chi square value for TNM staging was 3.471 and p value was 0.747, which was non-significant. Chi square value for grading was 2.452 and p value was 0.293, which was non-significant. 62 cases were non-smokers and 36 cases were smokers. 40.3% non-smokers cases belong to stage I and 90.3% non-smokers cases were well differentiated. 27.7%smokers cases belong to stage I and 72.2% smokers cases were well differentiated. Chi square value for TNM staging was 6.209 and p value was 0.101, which was non-significant. Chi square value for grading was 5.462 and p value was 0.019, which was non-significant. 27 cases were non-tobacco chewer and 71 cases were non-tobacco. 29.6% non-tobacco chewer cases belong to stage I and 85.1% cases were well differentiated. 32.0% tobacco chewer cases belong to stage I and 83.0% smoker’s cases were well differentiated. Chi square value for TNM staging was 2.13 and p value was 0.544, which was non-significant. Chi square value for grading was 0.062 and p value was 0.802, which was non-significant. 64 cases were non-alcoholic and 34 cases were alcoholics. 34.3% non-alcoholic cases belong to stage I and 82.8% non-alcoholic cases were well differentiated. 38.2% non-alcoholic cases belong to stage I and 85.2% non-alcoholic cases were well differentiated. Chi square value for TNM staging was 0.686and p value was 0.876, which was non-significant. Chi square value for grading was 0.100 and p value was 0.751, which was non-significant. Conclusion: The present study concluded that socioeconomic factors may be related to the advancement of the clinical stage of oral cancer.

67. Comparison of Outcome of Interference Versus Suspensory Fixation of Hamstring Tendon Autografts on Tibia During Arthroscopic Anterior Cruciate Ligament Reconstruction in a Tertiary Care Hospital
Suryakant Purohit, Saurabh Agrawal, Prashant Gupta
Background: Arthroscopic anterior cruciate ligament ACL reconstruction is a surgical procedure to restore the stability and function of the knee joint after an ACL rupture. Some previous studies have shown that the type of femoral fixation device can influence the risk of revision ACL reconstruction, but it is unclear whether the type of tibial fixation has an effect. Aims and Objectives: The aim of this study was to compare suspensory and interference methods of tibial side fixation and compare their clinical outcomes after one year of follow-up. Materials and Methods: This was a prospective study of the cohort with ACL insufficiency treated with arthroscopic assisted ACL reconstruction using autogenous quadrupled hamstring tendon graft using suspensory technique in one group and screw fixation in another group. The subjects were evaluated based on two factors: joint stability measure and functional outcome measure preoperatively as well as postoperatively after 1 year of surgery. Results: There was no incidence of graft failure at 1 year follow-up. Post operative Lachman and Pivot Shift test showed no statistically significant difference at 1 year follow up. Functional outcome was assessed using IKDC score. Preoperative average score was 32.8 which improved to 78.1 at 1 year follow-up. However, the difference between two groups was found to be statistically non-significant. Conclusion: In our study both the techniques of ACL fixation on tibial side i.e., interference screw and suspensory fixation showed comparable results in manual knee laxity tests, instrumental knee laxity tests using KT-1000, and functional outcome as assessed by IKDC scores.

68. A Tertiary Hospital Based Clinical Study on Thalassemia Patients in Relation to Onset of Blood Transfusions
Shravya R, Alikhangari Shafikhan, Angadi Wasim Akram
Background: Among the hemoglobin disorders Thalassemia is considered as the frequently encountered disorder all over the world. Studies on clinical spectrum are varying. Aim of the study: To record the population prevalence and spectrum of thalassemia diseases. The objectives were to observe the epidemiological and social factors of this disease. Materials: Prospective and descriptive study for two years in a tertiary care Hospital included 71 Thalassemia children between 02 to 15 years. Interview with formulated questionnaire proforma consisting of social and demographic variables was used. Children given blood transfusion 08 years after and 08 years before diagnosis were grouped as A &B. Variables used: BMI, Hb, MCV, MCH and RDW-CV levels, Hb chromatogram: (HbA2 and Hb F levels) and spleen size. Results: Among 71 children 44 (61.97%) males and 27 (38.02%) were female. 77.46% of the total children belonged to below 5 years to 11 years. The mean age was 07.32±2.85 years. The mean age of diagnosis of Thalassemia was 2.36±2.05 years. 60.56% children were from rural background and 39.43% from urban. 22.53% children belonged to upper class of social status, 49.29% belonged to middle class and 20 (28.16%) of children belonged to lower social class. Conclusion: The incidence of Thalassemia was in concurrence with the national figures. >75% children were diagnosed before 11 years.  Commencement of blood transfusions was not significant as the BMI and hematology profiles were same in all the children.

69. An Observational Clinical Study of Deep Venous Thrombosis Patients at Tertiary Care Center of Central India
Shiv Sagar Mandiye, Praveen Sharma, Anuradha Choudhary, Mohd. Tabish Ansari
Introduction: Considering day to day life style modifications and increased hospital stays deep venous thrombosis (DVT) has become an undercover mortal disease complicating too many diseases and syndromes and finally death. To avoid such complications early diagnosis and treatment of DVT is the need of time. Materials and Methods: In present hospital based prospective observational study a total of 97 patients were primarily considered amongst which 7 were either drop outs or not full filing inclusion criteria hence a final of 90 patients were considered after their written and informed consent. The study comments about patients coming to tertiary care center of central India from a period from May 2021 to May 2022. Diagnosis of the patients were primarily made on their clinical presentations followed by Radiological investigation. Routine pathological, biochemistry and microbiology lab investigations were performed wherever and whenever required. Results: Considering the demographic data mean age of patient was 52.8 with majority of cases belonging to 6th decade of their life. Present study showed male dominance and including smoking to be the most common risk factor amongst 45.5% with 82% having homan’s test of the population under study. Nearly 54% of the patients were having oedema and commonest vessel to be affected was superficial femoral vein. While majority of the patients were having acute features of the disease and got relived after appropriate treatment showing better results of complete recanalization after six weeks. Conclusion: The well-known direct risk factors for deep vein thrombosis were immobilization, and smoking. Patient need to have regular follow up to evaluate the recanalization. Patient needs to be highly motivated and educated regarding need to regular oral medication. Regular checkup of high-risk patients, early detection and prompt treatment of the disease can reduce chances of complication and enhance complete recovery of the patients.

70. Role of Complete Blood Count, Coagulation, ABO Blood Group Parameters in Nephrolithiasis
Shaik Basha, Inampudi Sailaja, Neha D Sheth, Vandana Vasava, Ivvala Anand Shaker, Ketan Shyamsundar Patil, Tushar Pradhan
Background: Complete blood count (CBC), Coagulation & ABO blood group parameters may associate with multiple diseases. Urinary stone disease is common public problem. Predictive value of CBC, Coagulation & ABO blood group parameters may be associated with effects of Nephrolithiasis disease. Objectives: To analyze the association between complete blood count (CBC), coagulation, ABO blood group parameters and Nephrolithiasis disease. Methodology: This study was done on the patients who were admitted to the urology (Surgical OPD) outpatient clinic or diagnosed with Nephrolithiasis disease in the emergency services department. There were 36 patients & 30 controls included in the study, the patients were confirmed by Multi detector CT (MDCT) urinography. Both patients and control subjects were studied for CBC, coagulation, ABO blood group parameters. Data of patients were retrieved from the hospital database and statistical analysis was performed. Results: An increase in Hb, MCH, MCHC, RDW, Neutrophiles, PT, WBC, Haematocrit, lymphocyte and decrease in RBC, MCV, Monocytes, Platelets, MPV, and PDW is statistically associated with urinary stone disease. In nephrolithiasis patients with B+ group is more affected. Conclusions:  It is important to remember that CBC, Coagulation & ABO blood group parameters may support urinary stone disease and considering CBC & Coagulation results may be useful in the diagnosis of nephrolithiasis.

71. Evaluation of Safety, Efficacy and Tolerability of Rabeprazole (Enteric Coated, EC) 20mg with Levosulpride (Sustained Release, SR) 75mg Fixed Dose Combination in Patients with Gastroesophageal Reflux Disease
Arun R Keshwala, Hemal J. Dholakia, Arun Hebbar J N
Background: Gastroesophageal reflux disease is a highly prevalent gastrointestinal disorder in 10-20% of population. Main treatment possibilities for GERD are lifestyle modifications and pharmacological therapy. New publications have raised questions upon long term safety and over prescription of current therapeutic agents. Methodology: The present study is prospective, single centre, open-label, comparative, observational study initiated to compare the safety, efficacy, and tolerability of rabeprazole (enteric coated, EC) 20mg with levosulpride (sustained release, SR) 75mg fixed dose combination in patients with gastroesophageal reflux disease. Results: Global assessment of efficacy at the end of therapy was rated as “excellent” (17% in group A and 10% in group B),”very good” (63% in group A and 50% in group B) “good” (17% in group A and 23% in group B), and “satisfactory” (3% in group A and 16% in group B). On global assessment of tolerability, the product rated to have “good” (84% in group A and 64% in group B) and “moderate” (16% in group A and 36% in group B) at the end of the study. Conclusion: The treatment with levosulpride to rabeprazole in GERD patients with high FSSG score provides better symptomatic relief compared to rabeprazole monotherapy with minimal mild side effects.

72. Retrospective Analysis of Prevalence of Orbital Mucormycosis in Post Covid Patients in Melmaruvathur
Venkatesan C, Santhanalakshmi R, Divyatharini V.
Background: Coronavirus 19 pandemic had a significant impact worldwide not only on health status but also on a socioeconomic level and created a major health awareness among every individual, in addition like adding fuel to the fire co infections caused by bacterial or fungal infections have worsened the situation. Purpose of the Study: The main purpose of this study is to analyse retrospectively the prevalence and various patterns of presentations of mucormycosis in post covid patients. Methods: In this retrospective time bound study, we have analysed the various patterns of orbital mucormycosis in patients with covid who have been taken oxygen supplementation and steroid therapy. Their immunological status is assessed by the presence of diabetic and its influence on the outcome of mucormycosis in these patients are observed by means of ocular examination, nasal swab, radiological imaging, histopathological and microbiological analysis were done in these patients for future preparedness. Results: Among the 32 patients we have assessed there is a strong association between the duration of oxygen therapy and mucormycosis (p value<0.001) According to the Phi and Cramer’s V Value there is  77.8  percent association between prevalence of mucormycosis among patients Oxygen Supplementation and a strong association between dosage of steroid therapy and mucormycosis (p value<0.001) in addition those with diabetes have  strong association among the covid patients and severe forms of mucormycosis is seen in these patients According to the Phi and Cramer’s V Value there 56.4 percent association between prevalence of mucormycosis among patients with diabetics. Intra orbital involvement is found to be 68.75 percent and intra cranial extension in 8.65 percent. Control of blood sugar in these patients has drastically improved the outcome of mucormycosis in terms of visual outcome. Conclusion: Orbital mucormycosis has been like adding fuel to the fire in this covid pandemic, as ophthalmologists it is important to take necessary preventive measures regarding this sight threatening complications due to co infection. Especially diabetics when controlled properly and cautious use of steroids and oxygen supplementation in these diabetic patients will definitely improve the visual outcome in future waves.

73. Comparison of Efficacy of Ibuprofen & Paracetamol in the Treatment of Acute Migraine in Children – A Randomized Controlled Clinical
Anil Galwa, Pankaj Gyanani, Poonam Mehta
Background: Migraine is a common clinical condition in children affecting their quality of life. Limited literature studies are available on the pharmacological treatment of acute migraine in children. Thus, the present randomized controlled clinical blind trial was designed to evaluate the clinical efficacy of oral Ibuprofen with oral paracetamol in the acute treatment of migraine in children. Material & Method: The study included 60 school going children (age 6-10yrs) fulfilling criteria of International Classification for headache disorders,3rd edition, with at least one migraine attacks per month for 2 hours; with recurrence for at least 6 months & with unsatisfactory relief from prior treatments. Written informed consent acquired from parents & permission undertaken by the ethical committee. Any other etiology of migraine attacks was ruled out. The cases were randomized into Group Ibuprofen (n=30) and Group Paracetamol (n=30). A written record was maintained at home. Pain relief (≥ 2-point reduction from the baseline values) & freedom from pain (VAS scale), associated symptoms, side effects of drugs were noted. Results: No statistical differences in baseline characteristics found in the two groups. Pain relief in 95% of children and 33.3% reached freedom from pain at 2 hr interval with relief in associated symptoms in 50% of children. Relief after drug administration noted with regards to associated symptoms of nausea, vomiting, photophobia & phonophobia were observed with no statistically significant differences in both groups. Mild adverse events of epigastic pain & nausea reported in both groups. Conclusion: Both Ibuprofen & Paracetamol are equally efficacious and can be adopted as safe, economical drugs in relieving the acute migraine in children.

74. Study of Obesity in the Children (5-15 years) in Selected English Medium Schools, Berhampur with Special Reference to Their Lifestyle & Family Pattern
Abinash Routray, Seshdev Panigrahi, Suchitra Rani Haldar, D. Shobha Malini, Niranjan Mohanty
Background: In this study, we wanted to estimate the prevalence of overweight and obesity among school-going children aged between 5 and 15 years in the English medium school of Berhampur town, identify the factors influencing overweight and obesity and evaluate the lifestyle & family patterns of these children. Materials and Methods: This study was conducted in M.K.C.G Medical College, Odisha, after obtaining ethical committee clearance from the institutional ethical committee, among students (5-15 yrs.) of English medium schools of Berhampur city from December 2013 to November 2015. Results: During the year 2015 prevalence of overweight and obesity was 7.6% in E. M. school children of Berhampur city. Prevalence of overweight and obesity was slightly more in boys (7.9%) than girls (7.4%). Conclusions: The education of parents and family income had a direct relationship to childhood obesity. Parental obesity had a definite influence on the obesity of children. An increase in the frequency of snack intakes like chocolates, sweets, ice creams, bakery products and other fast foods was more commonly seen in obese children than in non-obese children.

75. Clinico-Pathological Profile of Patients with Bullous Pemphigoid
Athira Sudhesan, Anjana Suresh, Athira Mohan, Keerthy Joy Irimpan, Amitha N. P
Bullous pemphigoid (BP) is the most common subepidermal immunobullous disorder, classically manifests with tense blisters on skin accompanied by intense pruritus. Many co-morbidities have reported to be associated with Bullous pemphigoid. A wide variety of atypical presentations can occur in this condition. Aim of the study was to find out the clinico-pathological profile of patients with Bullous pemphigoid. Materials and Methods: This record based descriptive study was done on 62 patients admitted with Bullous pemphigoid in the department of Dermatology and Venereology of a tertiary care hospital during 5 years. The diagnosis of BP was made by clinical, histopathological and immunofluorescence study. Data was collected by reviewing the hospital’s medical records. Clinical profile and investigation results were collected from case notes. Results: The study highlights the atypical presentations of Bullous pemphigoid, and associated co-morbidities. Conclusion: There are a variety of atypical presentations of Bullous pemphigoid, and much co-morbidity is associated with it. Bullous pemphigoid may be a differential diagnosis of itchy or bullous skin conditions in the elderly with eosinophilia. Awareness about the atypical presentations and co-morbidities will be helpful to avoid delay in diagnosis and to reduce the healthcare costs.

76. Assessment of the Role of Electronic Media in Affecting the Cardiopulmonary Fitness, Physical Fitness, Obesity, & Psychosocial Well Being in School Going Children-An Observational Study
Pankaj Gyanani, Anil Galwa, Poonam Mehta
Background: Available evidence suggests the role of electronic media watching time on endurance, physical & mental health of the children. Such sedentary activities can lead to pathway for cardiopulmonary & metabolic diseases. Thus, this observational study was undertaken to assess the role of electronic media in affecting the cardiopulmonary fitness, physical fitness, obesity, & psychosocial wellbeing in school going children. Material & Method: This study recruited 532 healthy school going children (age range of 9 – 15 yrs ) for a period of four months from September to December 2021. Children suffering from any respiratory conditions (asthma, tuberculosis, etc.), cardiac conditions (congenital heart diseases), neurological deficit (poliomyelitis, etc.), or musculoskeletal disorders (muscular pain, fractures, or any other related conditions) were excluded from the study. The parameters assessed were body mass index, waist to hip ratio, VO2 max, electronic media watching time per day using a questionnaire. Results: The average age was 12.03 yrs. Average BMI was 16.24 ± 4.35 kg/m2(males) and 17.56 ± 3.67 kg/m2 (females); Average WHR was 66.43 ± 0.63; Average VO2 max was 36.34 ml/kg/min; Average EMT was 120 min/day (range 60 – 200min). A positive linear relationship between EMT and BMI (r = 0.68) and between EMT & WHR (r=0.34) was observed. Thus, as EMT increases the BMI & WHR of students also increases. No statistically significant difference between EMT of boys and girls were observed (p<0.05). A negative linear relationship between EMT & cardiopulmonary fitness (VO2 max) (r= -0.79) Thus as EMT increases cardiorespiratory fitness reduces. There is a statistically significant decrease in physical activity with increase in the EMT(p<0.05). Conclusion: The study concludes that there is a significant negative impact of increased electronic media watching time on school going children which increases the chances of obesity, reduces the level of cardiorespiratory fitness by reduction in the levels of physical activity & altered psychosocial wellbeing.

77. Prevalence of Substance Abuse and Its Correlates amongst Street Children of Guwahati City, Assam
Mousumi Krishnatreya, Kabindra Deva Sarma, Rinku Borah
Background: Children in the street of urban India are a common phenomenon and they are underprivileged and Vulnerable. Such Vulnerabilities may subsequently lead to substance abuse as an attempt to cope up with difficult situations Guwahati being the largest city of Northeast India share a great number of these children. This study will attempt to throw light on their lives on the streets and the problems they face. The main objective of the study is to assess the prevalence of substance abuse among street children and to know the Co relates of substance abuse in the study population. Materials and Methods: The study is a community based Descriptive Cross- Sectional study done during the period of August 2019 to July 2020. Study was conducted among the street children of Guwahati city. Study population comprise of a sample of street children in the age group of 7 to 16 years. Sample size was calculated to be 380. Area as potential hotspots were listed before collecting data. From these hotspot children were selected through purposive sampling and snowball technique. Results: Out of total 380 street children interviewed 224 (58.95%) Reported substance abuse. Majority of the children abuse smokeless tobacco (86.60%) and glue (80.80%). It was found that 62.95% children abuse more than one substance. Gutkha (67.86%) was reported to be the most common substance first introduced by them. The main reason for using substance were to suppress hunger (76.78%). More than half reported use for recreation and relaxation. Conclusion: The prevalence of substance abuse among the children studied was 58.95%. Smokeless tobacco (86.60%) and dendrite (80.80%) were the most commonly abused substance alone or in combination. Children abuse substances mainly to suppress their hunger (76.78%) and due to influence by partners (75.89%).

78. Ultrasound Guided Transversus Abdominis Plane Block versus Ilioinguinal Iliohypogastric Nerve Block for Post Operative Analgesia in Caesarean Section – A Randomised Controlled Study
Mamatha H. K., Anasuya Hegde, Sagar Majigoudar, Bojja Paul Shravan Kumar
Introduction: Effective post-operative analgesia for caesarean section has become a major medical challenge due to increasing rates of caesarean deliveries in the last two decades, and may help promote recovery, ambulation and breastfeeding. We studied the efficacy of Transverse abdominis plane block vrs Ilioinguinal-iliohypogastric nerve block for post-operative analgesia. Material and Methods: 62 parturients posted for elective caesarean delivery under spinal anaesthesia were selected for the study. Transverse abdominis plane block [group TAP] or Ilioinguinal -iliohypograstic block [group IIH] was performed with 0.125% bupivacaine +4mg dexamethasone on each side postoperatively. Ease of performance assessed by time taken for the procedure. Assessment of pain using VAS score, time to first rescue analgesic, duration of analgesia, total analgesic consumption and patient comfort in terms of breast-feeding experiences, were assessed post-operatively for 24 hrs. Results: The two groups were comparable with respect to the baseline characteristics [P>0.05]. The duration of procedure was significantly less in the IIH group compared to TAP group [p<0.05], the time to first rescue analgesic [12.133±7.351 hrs. vrs. 17.806±9.547 hrs.] and the total analgesic consumption were statistically significant [P<0.05] in the TAP group and IIH groups respectively. A statistically significant difference was observed in the VAS scores at all points of assessment except at 2 hrs. where it was not significant. Conclusion: We conclude that USG guided IIH block is preferable to TAP block for postoperative analgesia for caesarean section patients, due to its ease of performance, higher success rates and good postoperative analgesia.

79. Transdermal Drug Delivery System-Future for Post Operative Pain Management- A Study in Post MRM Patient
Neena Raizada, Sharad Singh, Gaurav Singh, Nitu Nigam
Introduction: Modified Radical Mastectomy is usually associated with severe post operative pain and sometime phantom pain .Transdermal delivery system is non-invasive method and provides sustained release of drug for prolonged period with lesser side effects with less variation in therapeutic plasma levels and less need for parentral analgesia. Material and Methods: Sixty patients undergoing Modified Radical Mastectomy were randomly divided into two equal groups. Group “A” received Fentanyl 25 µg/hr transdermal patch and Group “B” received Buprenorphine 20 µg/ hr transdermal patch 18 hours prior to the surgery. Patients in both the groups were followed for 3 post operative days for percentage of pain relief, break through pain and any adverse effects. All the patients received injondensetron 0.15 mg/kg every morning and Injparacemol infusion 1 gm immediately after surgery. The break through dose of 75 mg inj diclofenac in IV infusion was planned and if VAS score was more than 4 after diclofenac injection then inj tramadol 100 mg IV slow was planned as extra rescue dose. Result: The VAS score was comparable in both the groups with P value= 0.3135. The requirement of rescue dose was comparable in both the groups P=0.3317. No patient had any other side effects. Conclusion: Fentanyl 25 ug/hr and buprenarphine 20 ug/hr transdermal patch are effective non invasive method of pain relief in post operative cases of MRM.

80. A Prospective Study of Thyroid Dysfunctions in Patients with Diabetes Mellitus
Sangita Parikh, Zalak Gadani, Kaushika Chaudhari, Brinda Mevada
Background: Diabetes Mellitus and thyroid dysfunctions are two most common endocrine disorders in clinical practice. The unrecognized thyroid dysfunctions may adversely affect the metabolic control. Objective: The objective of study is to find out presence of thyroid dysfunctions in patients with type1 and type 2 DM. Method: This is a cross sectional observational type of study in which 204 patients with type 1 and type 2 DM were enrolled. All patients underwent a clinical and a laboratory evaluation. Patients were evaluated for thyroid profile and classified in subgroups as Euthyroid, Sub clinical hypothyroid, Overt hypothyroid, and hyperthyroidism. Results: The thyroid dysfunction was found in 33.3% of diabetic patients. Most frequent thyroid dysfunction was sub clinical hypothyroidism which was 26.4 %, followed by overt hypothyroidism in 4.9 %. Hyperthyroidism was found in 1.96%. Conclusion: Present study showed presence of thyroid dysfunction in diabetic patients suggesting that routine screening of all diabetics for thyroid profile to prevent metabolic complications and improve quality of life.

81. Gastrointestinal Manifestations of Dengue Fever and Their Association with Dengue Mortality in a Tertiary Care Hospital Setting in North Kerala
Shameer V K, Rajasi, R. S, Abdul Kadar S, Anoop K K
Background: Worldwide incidence of Dengue Fever is on an increasing trend with varying manifestations from mild febrile illness to dengue hemorrhagic fever and shock. Rarely encephalitis, pancreatitis and acute hepatic failure are reported. “Expanded dengue syndrome” is a term used to denote such atypical organ involvement in Dengue among which gastrointestinal system involvement is relatively common. Aim: To estimate the incidence of gastrointestinal manifestations in dengue infected individuals and their association with lab investigations and mortality. Materials: A prospective, observational study was conducted in 500 patients with Dengue fever, confirmed by NS1 antigen and /or IgM antibody tests. A semi-structured questionnaire-based data collection was used. Results: Among the 500 patients with confirmed dengue fever 50% had liver involvement (46% had SGOT > 100U/l and 34% had SGPT >100U/l). 13% an associated pancreatitis was observed. Significant factors contributing to the mortality were Age, presence of Ascites, SGOT>500 U/l, SGPT> 500 U/l and systolic BP < 100 in critically ill patients. Conclusions: Despite the small sample size, the study inferred those gastrointestinal manifestations were relatively common in dengue. Presence of high liver enzymes and pancreatic enzymes could be used to triage patients requiring intensive care to reduce mortality.

82. Association between Glycosylated Hemoglobin, Complete Blood Count and Coagulation Parameters in Metabolic Syndrome
Ketan Shyamsundar Patil, Inampudi Sailaja, Santosh Bidwe, Neha D Sheth, Ivvala Anand Shaker, Shaik Basha, Tushar Pradhan
Complete blood count (CBC) &Coagulation parameters associate with multiple diseases. We investigated the relationship of metabolic syndrome in adolescences which imposes prolong risk causing micro-macro complication, which is leading global problems in 21st century. Therefore, the study aimed to determine the possible changes in CBC, Coagulation and glycosylated haemoglobin (HbA1c) in metabolic syndrome patients. The Adolescent subjects (students) who were visiting to the Medicine diabetic OPD and the subjects who were diagnosed with Metabolic syndrome in the emergency services department were grouped as group-A (patients) & group B(controls) in the study; both male /female patients whowere also admitted. It was noticed to have a possible correlation between the CBC, Coagulation and HbA1c parameters in metabolic syndrome. In Both groups, Group A patients, HbA1c value is (5.21 ± 1 .76%) Group B control HbA1c is (3.21 ± 0.82 %). We analysed the CBC parameters, coagulation parameters. There was a statistical difference found in CBC parameters with increased (Hb, RBC, MCH, MCHC, RDW, PDW, MCV, Neutrophils, WBC, Hematocrit. Lymphocyte,) and statistically correlated with HbA1c. The results conclude that CBC &coagulation parameters associated with comparable change in HbA1c &blood cell indices. As they are the first to be exposed during hyperglycaemic conditions, with variable stastical changes implicated in the study. This study will be helpful tool for clinical correlation for the clinicians in the diagnosis, follow-up, prognosis of the of metabolic syndrome diseases.

83. Revisiting Challenges in Recognizing and Treating Childhood Acquired Pneumonias in a Tertiary Referral Hospital
Shravya Reddy R, Angadi Wasim Akram, Alikhangari Shafi Khan
Background: Childhood acquired Pneumonias are reported to referral Hospitals in India thought the incidence has come down remarkably. Children of all age groups are affected due to rise in antimicrobial resistance to the organism. Differentiating Pneumonias of bacterial from viral etiology using rapid surrogate markers is pivotal in achieving clinical success. Aim of the study: To study the clinical criteria and analyze the causes, laboratory investigations in the accurate diagnosis and treatment of Childhood Acquired Pneumonias. Materials: 153 children between 3 months and 12 years diagnosed as Childhood Acquired Pneumonia (CAP) were analyzed. Children presenting with history of foreign body inhalation, fever, productive cough, purulent sputum, breathlessness, and pleurisy were included. Signs of Tachypnea, Ronchi, Rales heard over the chest, increased bronchial breath sounds, tactile fremitus, egophony and decreased tactile fremitus were included. X-Ray chest, CT scan chest were undertaken. Antigenic tests for influenza A and B and respiratory syncytial virus were undertaken. Radiological evidence of pleural effusion and Alveolar infiltrates was considered as bacterial Pneumonias. Presence of Interstitial infiltrates was taken as viral or bacterial infections. Total WBSC count, C-reactive protein and erythrocyte sedimentation rate were done Results: There were 90 (58.82%) male children and 63 (41.17%) female children. A male to female ratio was 1:1.42 was observed. Among the 90 male children, there were 49 (32.02%) children aged between 3 months and 5 years and 41 (26.79%) were above 5 years. Among the 63 female children, there were 34 (22.22%) children aged between 3 months and 5 years and 29 (18.95%) were aged above 5 years. Conclusions: Community Acquired Pneumonia remains a common and major disease in children causing morbidity. Hospitalization of the children with CAP was individualized resting upon their age, underlying medical risk factors, and clinical features like severity of illness. Symptoms such as tachypnea and vomiting were significant statistically in the diagnosis of CAP in this study, when correlated with the laboratory findings. Laboratory investigations like Highest WBC count, Highest CRP were statistically significant in children aged below 5 years when compared to above 5 years old children.

84. Prevalence of Anaemia in View of Socio-Demographic Profile of Adolescent Girls in Urban Area of Patna District, Bihar, India
Shikha, Manish Kumar Singh
Objectives: Anaemia is a major health problem of adolescent girls in developing country. In this present study, we evaluate the prevalence of anaemia in view of Socio-demographic profile of adolescent girls in urban area. Methods: A detailed history was performed which included socio demographic details, history of any chronic illness, socio-demographic characters, menstrual history and presenting complaints. By venipuncture of anti cubital vein, 2 mL of venous blood was drawn and collected in ethylenediaminetetraacetic acid (EDTA) vacutainers under aseptic precautions. The collected blood samples were analysed in the Department of Pathology by five‑part automated cell counter (Beckman Coulter AC T diff 2). For interpretation of anaemia, the cut‑off point for haemoglobin (Hb)gm% was taken as< 12 g/dL), moderate (7 to < 10 g/dL), and severe (<7 g/dL) [6].  Sociodemographic status was estimated by modified B. G. Prasad’s classification. Socio-economic status classified as: class II-upper middle class, class III- lower middle class, class IV- upper lower class, class V- lower. Results:  Out of 200 adolescent girls, anaemia was found in 148(74%) girls. most of the anaemic girls 55(78.57%) were in age of 10-12 years. Most of the anaemic girls 64(32%) belonged to lower middle socio-economic status. 64(32%) anaemic girls belonged to lower middle socioeconomic classes. Majority of anaemic girls 111(75.51%) lived in nuclear family. Parents [fathers: 79(77.45%) and mothers: 78(68.42%)] of most of the anaemic girls had primary education. BMI of most of the anaemic girls 83(73.45%) was <18.5. Menarche was seen in 136(68%) girls. Most of the anaemic girls 119(87.5%) had attained menarche. Conclusions: Prevalence of anaemia is high in adolescent girls who belongs to a lower middle and lower socioeconomic status. Anaemia is more common in age 10-15 years followed by girls with menarche, lower BMI and family illiteracy. Thus, anaemia is a major health issue in adolescent girls. Hence, regular health check-up camp must be organised in school and Mohalla, in urban as well as rural area for awareness and prevention of anaemia in adolescent girls. So that, proper diagnosis and prompt treatment can be made.

85. Spirometry in Patients of Diabetes Mellitus
Vasant Shrivastava, Subrat Jain, Bhuvaneshwar Minj, Monica Shringirishi
Objective: To study the prevalence of spirometric abnormalities and effects of age of onset, duration of disease, compliance and sex on spirometric parameters in diabetic patients. Methods: The present study was a hospital based cross sectional study. Patients selected were those attending medical OPD or admitted in medical wards. 100 patients who were known case of DM with duration more than 5 years were selected. Results: The mean FVC %, FEV1 % and FEV1 / FVC % was abnormal for age & sex insignificant percentage of cases. Study of spirometric values of patients with different age of onset and duration of disease did not revealed any decline in pulmonary function and their mean value of FVC%, FEV1% and FEV1 / FVC % were normal for age and sex. Also, there was no decline in pulmonary function in patients with relation of their sex. It was found that there was no decline in PFT in patients who were non-compliant & was not having good glycemic control. No decline in PFT was observed in patients who were obese and had BMI > 25 kg/m2 Conclusion: Routine screening for detection of PFT, which was found in few patients, could be because of ethnic factor or presence of early emphysematous change or due to diabetes incluced reduction in lung compliance and/ or reduced respiratory effort due to diabetes.

86. A Comparative Study of Etiopathological Profile and Outcome in Acute Kidney Injury in Inborn and Outborn Neonates: A Cross Sectional Observational Study in Central India
Priyanka Shrivastava, Ankur Singhai, Ruma Agarwal, Priyasha Tripathi
Background: Acute kidney injury (AKI) is a common occurrence in the neonatal intensive care unit (NICU) as has been shown to be associated with adverse outcomes including increased length of mechanical ventilation, prolonged length of stay, and rise in mortality. Neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria is applied as the standard definition for neonatal AKI for clinical and research purpose. Aim: To study and compare etiopathological profile and outcome of acute kidney injury in outborn and inborn neonates, estimate incidence of AKI and compare outcome of acute kidney injury in outborn and inborn neonate. Methods: A cross-sectional study was done at tertiary centre from December 2021 to May 2022 for duration of 6 months in which neonates with AKI were admitted in inborn and outborn unit respectively and were analysed in detail and outcome was studied. Results: There was preponderance of AKI in term neonates in outborn newborns (55%) as compared to more preterm neonates in inborn unit (60%). More number of neonates with AKI was admitted during summer months (i.e. April, May). Among outborn neonates the most common risk factor associated with developing AKI was sepsis, followed by perinatal asphyxia and shock. Out of 20 outborn neonates who had AKI, nine (45%) expired and eleven (55%) were successfully discharged with complete recovery of renal functions, while out of ten inborn neonates who had AKI, two (20%) expired and six (60%) were successfully discharged with complete recovery while two were discharged with residual kidney disease and called for further follow up. Conclusion: The results show better outcome in inborn unit patients as were discharged with complete recovery and are maintained on follow up. The study emphasises on proper antenatal and perinatal management with postnatal monitoring of newborn to prevent AKI and also for the early diagnosis and management in patients with risk factors to avoid morbidity and mortality due to acute kidney injury.

87. The Comparative Analysis between MRI and Mammography in Screening of Breast Cancer
Shrivardhan Patil
Introduction: The screening of breast cancer is aimed at reducing the incidence and mortality rate due to breast cancer, by early diagnosis. Breast cancer is one of the most serious health issues. Traditional approaches for screening breast cancer have been called into question in recent studies.  Breast cancer is still diagnosed primarily through mammography. Novel imaging modalities, such as positron emission mammography, are currently being tested but they are far from being applicable in screening. Recently, Magnetic Resonance Imaging or MRI has been in debate as it is found that its sensitivity and efficiency is significant in screening breast cancer. Aims and Objectives: To find out the efficiency of MRI and Mammography to be used as screening method in breast cancer. Materials and Methods: This prospective study was conducted in our hospital with 50 patients susceptible of breast cancer. All the patients received mammography, MRI and biopsy. The biopsy was done for confirmation of their breast cancer.  The findings of MRI and mammography were assessed according to the Breast Imaging Reporting and Data System (BI-RADS) classification. The statistical analysis was conducted to compare the efficiency of MRI and Mammography as screening method. Results: The study has shown that for early scores (0 to 2), the efficiency of MRI is more than Mammography (P<0.05) and there is no significant difference between their screening ability at advanced stage (scores of 3 to 5). Conclusion: The study has concluded that both the modalities (mammography and MRI) are effective in advanced stage while MRI is more efficient in earlier stages of breast cancer.

88. A Study On MRI in Subchondral Fractures with Fore foot Pain
Shrivardhan Patil
Introduction: The subchondral or shaft area of the metatarsal head may be broken in metatarsal bone fractures. Trauma is the main cause of such fracture. There are different modalities to effectively assess the fracture but there is a need to introduce a modality which can show more efficient findings of the fracture with specific features of the condition. There are studies describing plain radiography features in details. But there are less availability of studies mentioning about the MRI features in this case. The current study intended to fill the gap by providing the detailed features of MRI findings in subchondral fractures in lower limb with forefoot pain. Aims and Objectives: To evaluate and present the MRI findings in cases with subchondral fractures in the head of metatarsals in individuals with symptoms like forefoot pain. Materials and Methods: The current prospective study was conducted between July   2021 to February  2022 with 60 patients. All the patients received MRI scanning and the features were studied thoroughly by two experienced radiologists. Results: It was found that about 70% of the patients had fracture in the head of 2nd metatarsal followed by 5th metatarsal and 3rd metatarsal. It was also found that the right limb (65%) was affected more than the left limb (35%). The study has stated that the mean length of subchondral fractures was found to be 9.2±1.1 mm while the mean subchondral sclerosis was found to be 8.5±0.3 mm. Conclusion: This present study has successfully shown that MRI scan can be used for effective determination of subchondral fracture involving the head of metatarsal.

89. Comparison of Minimum Volume and Dose of Epidural Levobupivacaine 0.125%W/V and 0.25%W/V with Fentanyl for Labor Analgesia
Anu W., Nanna R, Chandran, Letha J
Background: The pain of childbirth is arguably the most severe pain women will endure in their lifetime. Since pain relief in labor has always been surrounded with myths and controversies, providing effective and safe analgesia during labor have remained an ongoing challenge. In our study we did the comparison of minimum volume and dose of epidural levobupivacaine 0.125%w/v and 0.25%w/v with fentanyl for labor analgesia. Objectives: To assess the minimum volume and dose of epidural levobupivacaine 0.125% & 0.25% with fentanyl for labor analgesia, to compare maternal analgesia, progress of labor, mode of delivery, neonatal outcome and maternal side effects in both groups. Methods: After obtaining institutional ethics committee approval a prospective observational study was performed on 48 parturients consenting for labor analgesia and receiving continous doses of formulated drug. Parturients were divided into two groups. Group 1 received 0.125% levobupivacaine with 2 microgram/ml fentanyl and group 2 received 0.25% levobupivacaine with 2 microgram/ml fentanyl. For analysis purpose, data collected from 24 parturients who received 0.125% levobupivacaine with fentanyl were listed in group 1 and 0.25% levobupivacaine with fentanyl in group 2 respectively. Statistical analysis was done using computer software SPSS version-18. Student’s t-test and Chi-square test were used and p <0.05 was considered as significant. Results: The total volume of drug required in group 1 was more compared to group 2. The total dose of drug used in group 1 was less compared to group 2. Motor blockade was more in group 2 parturients and were associated with assisted delivery. Number of top-up boluses given were more in group 1 compared to group 2. Maternal satisfaction, heart rate, foetal heart rate, progress of labor, neonatal outcome, maternal side effects were comparable in both groups and was not statistically significant. Conclusion: In our study 0.125% levobupivacaine can produce same analgesia with a 24% increase in volume and 45 % reduction in dose when compared with 0.25 % levobupivacaine.

90. Study of Central Corneal Thickness by Pachymeter in Myopic Eyes
Abhilasha Yadav, Chhaya Shinde, Rajarathna Hegde, Shruti Shirwadkar
Background: The approximate thickness of cornea is around 500-600 micrometer at its centre and increases gradually towards periphery upto 670 micrometer. Myopia is public health concern, having rapid increasing prevalence in world in recent decades, so myopia is considered multifactorial. With increasing rates of refractive errors, refractive surgeries are becoming very popular. Central Corneal thickness (CCT) is an important consideration to rule out abnormally thin corneas. The purpose of our study was to determine the correlation between CCT and degrees of myopia. Despite of widespread clinical use of refractive surgeries of cornea, there are only few studies from the general population on the distributions and correlations of pachymetry measured corneal thickness in myopic patients. A major concern in refractive surgery is accurate measurement of corneal thickness. It is critical in patients with high myopia because more tissue needs to be ablated to achieve emmetropia; while overestimation can be associated with the risk of postoperative keratectasia, underestimation may lead to inadvertent exclusion of patients because of concerns about insufficient corneal thickness. Material & Methods: In this prospective, observational study of patients aged 15 to 50 years who attended Ophthalmology OPD of Tertiary care Hospital, Central Corneal Thickness was measured in 304 eyes of 152 myopic patients using Ultrasound Pachymetry. Ophthalmic evaluation included: 1. Visual acuity (Unaided and aided Best corrected visual acuity); 2. Torchlight examination; 3. Slit Lamp Examination; 4. Intraocular Tension; 5. Axial length; 6. Direct ophthalmoscopy; 7. Indirect ophthalmoscopy; 8. Fundus photo if required. Results: There was no correlation found between degree of myopia and central corneal thickness in the subjects studied. Conclusion: There was no correlation found between degree of myopia and central corneal thickness in the subjects studied.

91. Prospective Study on Anti-Helicobacter Pylori Therapy and Endoscopic Biopsy Following Surgery in Cases of Peptic Perforation
Sulata Choudhury, V Rajesh, Siba Prasad Dash, Jitendra Dalai
Background: The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs), and the PUD leads to perforation. Perforation of gastric or duodenal ulcer is one of the most serious and overwhelming catastrophes that can befall on human being. The incidence of peptic ulcer disease has decline in worldwide in recent years following judicious use of wide spectrum and highly effective ulcer healing drugs. Despite the widespread use of gastric antisecretory agents and H. pylori eradication therapy the incidence of perforated peptic ulcer has changed little. Aim: The current study aims to check the involvement of the H. pylori in peptic perforations and whether by eradicating the bacterium H. pylori can we prevent the ulcer recurrence in post operative peptic perforation patients. Materials and Methods: After the confirmation of peptic perforation and detecting the H. pylori infection patients were subjected to graham’s repair by both open and laparoscopic method. Then after recovery they were included in the trial category. This study also involves the comparison between effectiveness of triple therapy regimen over esomeprazole alone therapy in post-operative periods. The patients were advised to follow up upto 1 year and ulcer recurrence was observed. Results: Study was conducted on 128 patients, out of which 68 were excluded and remaining 60 patients were included in the study. 30 patients were included in triple therapy group and 30 to only esomeprazole therapy group. After 1 yr. follow up it was found that 25(83.3%) out of 30 patients and 5(16.6%) out of 30 patients has H. pylori eradication. Ulcer recurrence occurred 3.3% in case triple therapy and 36.6% in case of only esomeprazole therapy. Conclusions: In this study it was found that in cases of peptic perforations triple therapy (anti- helicobacter pylori therapy) is superior to esomeprazole alone in the eradication of H. pylori. Triple therapy also prevents long term recurrence of ulcer in post operative peptic perforation in 1 year follow up study.

92. A Study of Morphology and Histomorphometry of Adult Human Papillary Muscles- A Prospective Study
Preetam Pratyush Dash, Jami Sagar Prusti, Manoj Kumar Naik, Sulata Choudhury
Background: Historical documentation of the existence of papillary muscles as a component of cardiac anatomy exists at least as early as 16th century. They are pillar-like muscles seen within the ventricles attached to their walls. They have an integral role in proper cardiac valvular function. They are attached to mitral and tricuspid valve via chordae tendineae. The present study was done to analyse the papillary muscles of heart with respect to the variations in their number, length, shape, position and pattern in both ventricles. Aims and Objectives: (1) The objective of this study is to analyse morphological and histomorphometric features of papillary muscles in both ventricles of human heart. (2) Number of chordal attachments in each Papillary muscle and also the attachments of chordae to mitral and tricuspid annulus. Materials & Methods: The study was carried out on 60 human cadaveric hearts from Anatomy and Forensic Medicine Department of M.K.C.G. Medical College, Berhampur, after obtaining necessary clearance from institutional ethical committee. The morphometric and histomorphometric variations of the papillary muscles of both right and left ventricles were categorized and documented. Results: In the present study, the variations in number of papillary muscles were up to five(5) bellies. Increased number of bellies were found more in anterior papillary muscles of left ventricle. The shape of anterior papillary muscles in both ventricles was predominantly conical and posterior papillary muscles was predominantly cylindrical. The mean length of posterior papillary muscle of left ventricle was 18.73±3.8 mm, which was longer than that of papillary muscle of right ventricle. The breadth of anterior papillary muscle of left ventricle was 4.32±1.35 mm, which was more than all papillary muscles. In the present study, number of chordae tendineae attached to anterior papillary muscles were more than posterior papillary muscles in both ventricles. Histomorphometric findings of left posterior papillary myocyte mean length marginally higher than that of the remaining papillary myocyte. Conclusion: These results may be of great value in endoscopic and conventional mitral valve replacement or reconstruction of the chordae tendineae and the valvular homograft implantation. Thus, different architectural patterns of papillary muscles will be helpful for cardiac surgeons, which is necessary for successful cadaveric heart valve replacement surgeries.

93. Prolongation of Postoperative Analgesia by the Addition of Buprenorphine in Brachial Plexus Block
Neena Thomas, Mohamed Hussain Sait
Background: Prime goal for post operative pain management is to reduce or eliminate pain and discomfort with minimum side effects and as economically as possible. Several modalities are available with merits and demerits. Aim: We wanted to study the effect of addition of Buprenorphine to local anaesthetic solution on the duration of analgesia in supraclavicular brachial plexus block. Materials and Methods: This was a prospective, randomized, double blind study conducted after obtaining approval from Institutional ethical committee in the Department of Anaesthesiology of T.D. Medical College, Alappuzha, Kerala, over a period of one year from May 2008 to April 2009. The study population contained 50 patients of either sex in the age group of 20 to 60 years belonging to ASA I and ASA II undergoing elective Orthopaedic surgeries on upper limb and were randomly allocated into two groups A and B of 25 each. Group A: The patients received supraclavicular brachial plexus block with 30 ml of 0.375% Bupivacaine. Group B: The patients received Supraclavicular brachial plexus block with 30ml of 0.375% Bupivacaine mixed with Buprenorphine 5 microgram/Kg body weight. Results: Both groups were comparable with regard to sex, age, weight, onset of sensory block, onset of motor block, ASA grade and duration of motor blockade. Addition of Buprenorphine to local anaesthetic solution significantly prolonged the duration of postoperative analgesia. Conclusion: Buprenorphine can be safely added to local anaesthetic solution in giving brachial plexus block for upper limb surgical procedures for prolongation of postoperative analgesia.

94. Assessment of Awareness about Keys of Safer Food among Local Food Venders and Cafeteria Staff in Tertiary Care Center in Pandemic: A Cross Sectional Study
Ashfaq Modiwala, Abhay John, Monika Mandrai, Munesh Kumar Sharma, Sanjay Kumar Chaurasiya, R. R Wavare
Background: Food borne diseases, usually either infectious or toxic in nature. Agents that enter the body through ingestion of food pose global health threats, endangering everyone with an underlying illness which is particularly vulnerable. Objective: To assess the awareness of safe food among campus cafeterias staff and local food venders in the campus of tertiary care center in pandemic situation. Methodology: A cross-sectional study conducted among 237 study subjects those who were presently working; interviewed by using predesigned and pre-tested modified WHO pro-forma. Result: Overall awareness was higher in cafeteria staff as compared to local food venders in tertiary care Centre. According to the positive awareness about death occur due to food borne diseases; 19 (24.4%) cafeteria staff had lower awareness compared to local food venders i.e. 110 (69.2%) with extremely significant [chi sq; 13.9] with p-value (p < 0.001). Whereas, keeping raw and cooked food separately prevents cross-contamination; 48 (61.5%) cafeteria staff had higher awareness [chi sq; 8.12] with p-value (p=0.029). While awareness about whether it is good to wipe fruits and salads before eating than rinse into running water; 62 (79.5%) cafeteria staff had higher awareness [chi sq; 7.03] with p-value (p=0.001) compared to local food venders. Conclusion: The lack of awareness regarding safe food was being served as potential risk in our tertiary care center among local food venders. There is an urgent need of training programme for cafeteria staff in tertiary care center.

95. The Impact of Coronavirus Disease 2019 on the Disease Pattern of Oral and Maxillofacial Surgery Inpatients: A Comparative Study
Vinod Birra, H. Ramesh, Suresh M
Background: Due to the inclusion of respiratory tract  and aerosol-generating procedures, oral and maxillofacial surgery (OMFS) is regarded one of the high-risk specialty. COVID19’s impact on inpatient illness patterns and operations in OMFS, on the other hand, has yet to be investigated. Aim: To look at the effect of COVID-19 on disease patterns in OMFS inpatients, as well as to identify context-relevant important services in the OMFS field for future policy and resource distribution considerations. Methods and Materials: A total of 149 patients were included in the study after obtaining written informed consent from the relatives of patients. RT-PCR tests were carried out for all the study participants included in the study. Further there was collection of data regarding the stay in hospitals, administration of antifungal drugs like injection amphotericin, pocasonazole and tablet pocasonazole. Then there was tabulation of data regarding various surgical interventions carried out. There was comparison of these data between the COVID and non COVID patients. Results: When there analysis of study participants in which administration of oxygen was carried out then it was found that 49.23% of study participants getting oxygen were NON COVID patients while 50.77% of such study participants were COVID patients. The difference was not significant statistically. When there analysis of study participants in which administration of steroids was carried out then it was found that 45.56% of study participants getting steroids  were NON COVID patients while 54.54% of  such study participants were COVID patients. The difference was significant statistically. When there analysis of study participants who got discharged from hospital then it was found that 60.42% of study participants getting normal were NON COVID patients while 39.58% of such study participants were COVID patients. The difference was significant statistically. Conclusion: In a comparative investigation, we first provided epidemiological findings on the effect of COVID19 on oral and maxillofacial surgery illness pattern. During the pandemic, the shift in illness pattern and burden will have a long-term influence on OMFS patient care, education, and training. Our research provides data for health policymakers to think about relocating medical resources and improving medical education and services.

96. Comparative Study on Prophylactic Antibiotic versus Empirical Antibiotic in Prevention of Surgical Site Infection
Yogesh, S C Hansdah
The major objective of this study was to compare the effectiveness of a single dose of preventative antibiotic versus that of empirical postoperative antibiotics in lowering infection risk at the surgical site. Prospective observational research for a period of 8 months. A total of 100 patients requiring surgical intervention were chosen at random and divided into four equal groups of 50. While the control group had three to five days of empirical antibiotic treatment, the research group only received a single dosage of antibiotic prior to surgery. GraphPad Prism (trial version) was used for data analysis and statistical testing. The significance level for the paired analysis was determined using the Student t test. An infection at the surgical site, regardless of severity, was not linked to any further problems. The length of time patients spent in the hospital, their out-of-pocket expenses, and the amount of antibiotics they were prescribed all rose dramatically. Patients may save money and time by using single-dose prophylactic antibiotics instead of the more haphazard approach of using antibiotics just after surgery. The infection rate at surgical sites can only be kept to a minimum, since total eradication is impossible.

97. Assessment of Outcome of Surgical Management of Bile Duct Injuries with Loss of Confluence
Amarjit Kumar Raj, Rakesh Kumar Singh, Abhay Kumar, Saket Kumar, Sanjay Kumar, Manish Mandal
Introduction: Iatrogenic bile duct injuries (IBDI) with loss of confluence are understood as those where right and left hepatic ducts lose continuity with the common biliary tree. Material & Methods: This is an observational study conducted in the department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. over a period of 2 years from Jan 2017 to Dec 2018. All patients diagnosed with IBDI with loss of confluence determined transoperatively and treated with any bilioenteric derivation were included. Results: In the period of time considered for the present study, a total of 55 bile duct complex injuries were repaired (Strasberg E: 1 – E5), from them, 10 (18.1%) were injuries with loss of confluence. During long term observation, 2 patients presented biliary stenosis (20%), from these, 1 case were managed with progressive dilatations through a percutaneous catheter; one case was considered successful (10%) with catheter removal without clinical or biochemical cholestasis, and 1 cases (10%) are still in dilatation process. Conclusions: Iatrogenic bile duct injuries with ductal separation can be managed with single hepatojejunostomy with good results. Preplaced ductal catheter can be helpful in ductal identification. Post HJ anastomotic stricture can be managed with percutaneous dilatation as a first therapeutic intention.

98. The Effects of Liv.52 DS Tablets on Various Liver Parameters in Non-Alcoholic Fatty Liver Disease: Preliminary Trend Identified from a Cumulative Efficacy Analysis
Sharad C. Shah, Prasanna S. Shah, Nusly P. J. Pocha, Gontar Siregar, Srikrishna H A, Rajesh Kumawat
Background: Non-alcoholic fatty liver disease (NAFLD) is a clinical condition where excess fat accumulates within the liver and progresses from hepatic steatosis to hepatic inflammatory conditions, fibrosis, and cirrhosis. It culminates in liver failure, hepatocellular carcinoma, or liver transplantation. Objectives: We conducted a cumulative efficacy analysis on four clinical studies evaluating individuals with NAFLD post-Liv.52 DS administration. Methods: Two of the 4 studies were controlled/comparative studies [placebo/ ursodeoxycholic acid (UDCA)], and the other two were single-arm studies. In total, 159 subjects only from Liv.52 DS arm were considered for cumulative analyses. A dose of 2 tablets twice daily was recommended across the 4 studies. Treatment duration in 3 studies was 3 months, and in 1 study it was 2 months. Improvements in clinical signs and symptoms, SGPT, SGOT, hepatomegaly via ultrasonography, NAFLD fibrosis scores (NFS), AST to Platelet Ratio Index (APRI), and fibrosis-4 (FIB-4) scores were considered for analyses. When compared with baseline values, changes in parameters at end of study (EOS) were statistically analysed using chi-square or paired t-tests. Statistical analyses were performed using Graph Pad Prism software (Version 6.07). Results: Significant trends in symptomatic improvements, including reduced hepatomegaly, SGPT, and SGOT levels, were observed. NFS, APRI, and FIB-4 scores confirmed a fibrosis-free liver state. No serious or non-serious adverse events were reported or observed across studies. Conclusions: Our cumulative efficacy analysis of Liv.52 DS tablet administration for NAFLD confirmed that recommended dose was well tolerated and showed beneficial improvement trends in individuals with NAFLD.

99. Prospective Study on Functional Outcome of Percutaneous Transpedicular vertebroplasty using Calcium Phosphate Bone Cement in Osteoporotic Vertebral Wedge Compression Fractures
Swapnil Priyadarshi, Pradeep Dubey, Ajay Varun, Vipin Garg, Vikas Singhal, Sameer Gupta
Objective: To analyze functional outcome, disability index, duration and efficacy of pain relief after vertebroplasty in osteoporotic vertebral wedge compression fractures. Methods: randomized interventional prospective study A total of 21 patients having a total of 26 collapsed vertebrae were taken up the age of the patients was in the range of 55-80 years. There were 16 females and 5 males in the study. Classification of fracture was done based on Genant’s classification. Patients were followed up at 2 weeks, 1 month ,3month and 6 months. Each time patient was assessed clinically with the Pain score – Visual analogue scale, Oswestry disability index to check functional status of patient before and after procedure and also assessed radiologically (using X-Rays/CT/MRI). Results: mean preoperative VAS score was 7.86 which decreases to 4.76 in immediate post operative period. VAS score at subsequent follow up at 2 weeks, 1 month, 3 months and 6 months was 3.52, 2.48, 1.57 and 1.43 respectively .Statistically significant decrease in VAS score was found (p value <0.05). Mean pre operative ODI was 72.14 which decreases to 40.29 in immediate post operative period. ODI at subsequent follow up at 2 weeks, 1 month, 3 month and 6 month was 28.86, 23.57, 19.09 and 16.81 respectively suggesting gradual improvement in disability. Statistically significant difference was also found on comparing ODI at immediate post operative, 1 month and 3 months post operative period with ODI at 6 months post operatively (p value <0.05).In our study we had no complications in 17 (81%) cases, asymptomatic cement leakage into epidural space in 3 cases and 1 patient developing new onset radicular back pain 4 months after procedure. None of the cases had any major complications. Conclusion: Percutaneous transpedicular Vertebroplasty using calcium bone cement is a minimally invasive, promising new procedure with the benefits of quick improvement in mobility, decreased pain-related doctor visits, stature improvement, and decreased use of NSAIDS post operatively in the management of osteoporotic vertebral wedge compression fracture.

100. Evaluation of Risk Factors for Ten-Year Coronary Heart Disease using Logistic Regression Modeling
Kshitij Darshan Shah, Aruna Pancharia, Hemendra Bamaniya, Anshul Sharma, Sheshav Somani, Amit Tak
Background: Machine learning techniques were used to predict Coronary heart disease (CHD) risk. The machine learning models might be good prediction models, but they have pitfalls and provide less casual insights. The present study evaluated risk factors for the ten-year risk of coronary heart disease using logistic regression analysis. Material and Method: The present study was conducted at the Department of Physiology, RVRS Medical College, Bhilwara (Rajasthan, India), to evaluate risk factors of the ten-year CHD risk using logistic regression. The dataset (N = 4000) was publicly available from the ongoing cardiovascular study on residents of the town of Framingham, Massachusetts. The data were divided into two groups based on risk: ‘CHD Risk’ and ‘No CHD risk.’ Among 14 risk factors, those that significantly differed were selected for logistic regression analysis. The model with the lowest AIC was chosen. The Wald test was used to test the significance of logistic coefficients at 5%. Results: Except for the heart rate variables, including age, cigarettes per day, total cholesterol, systolic and diastolic BP, BMI, and plasma glucose significantly differed between two groups. Similarly, males, smokers, patients with a history of stroke, hypertension, and diabetes were associated with higher cardiovascular risk. The stepwise logistic regression model used six regressors. The model’s accuracy, the area under the ROC curve, sensitivity, and specificity was 85.58%, 73.7%, 8.6%, and 99.4%, respectively. Conclusion: The present study focused on identifying and weightage of risk factors and assessing their predictive ability and implications for disease prevention.

101. Evaluation of Major Complications of Airway Management during Anaesthesia
Seema Shukla, Sandeep Sharma
Introduction: Respiratory complications are quite common occurrence during surgery. It can lead to sudden death during surgery and as it occurs due to anaesthesia, respiratory complication can occur in any surgery. Due to application of general anaesthesia, physiological or mechanical ventilation is disrupted which is the main cause of respiratory complications. The four major principles to be followed while managing the airway are to ensure that if the airway tract is patent, if any advanced management of the airway is indicated, confirm the device placement in the airway tube, if the tube is secure and the confirmation of the device placement is checked frequently. Aims and Objectives: To evaluate the occurrence of airway complication during surgery and to find out the effective scoring system for assessment of airway complication. Materials and Methods: This retrospective study was conducted with 90 patients who were evaluated demographic characteristics, characteristics of patients’ general health, data regarding surgery, data regarding anaesthesia applied during surgery and data regarding management of patients with airway difficulty. The conditions that are considered to be the complication of airway are sudden need for airway device, hypoxemia, esophageal intubation, difficult airway management, ventilator associated complication, insufficient mouth opening, misposition of supraglottic airway devices, tachycardia and hypertension. Results: The study found that most of the surgeries were general surgery constituting about 28.8% followed by ENT surgeries (27.77%). The main findings of this study were that the scoring systems Ventilation score and Cormack-Lehane, were found to be significant in assessing the probability of complication during surgery due to general anaesthesia. Conclusion: The study concluded that there is significant airway associated complications during surgery and Cormack-Lehane and Ventilation score are the most effective scoring system.

102. Comparative Analysis between Radical and Minimally Invasive Hysterectomy in Cervical Cancer
Varuni Sharma, Navin Shukla
Introduction: Cervical malignancy is the 4th most frequently identified type of cancer.  A radical abdominal hysterectomy (ARH) was once the standard treatment for initial phase cervical cancer patients while another type of surgery known as minimally invasive surgery (MIS) has evolved into the therapy of choice. In comparison to open surgery, cervical cancer incidence has gradually increased since the introduction of minimally invasive surgery (MIS). Oncology results for MIS and open surgery have been found to be similar in many trials. Aims and Objectives: To find out the survival percentage and outcome efficiency of cervical cancer by using Radical Open surgery and Minimally Invasive Surgery (MIS). Materials and Methods: The study was conducted retrospectively and included patients from our hospital. The patients had cervical carcinoma and they were staged and classified into 2 groups according to the type of surgery they received. The outcome of the study was determined by overall survival (OS) and disease-free survival (DFS) for each type of surgery. Statistical analysis was conducted for the oncologic parameters with the patients’ survival for effective comparison between the two types of surgery. Results: The follow-up time (mean value) had no significance between the two groups (P = 0.181). There were 5 recurrent cases in “Radical Hysterectomy” group while 6 recurrent cases in “MIS” group. The study found that when radical open type surgery had significantly higher survival percentage when done on patients with more than 2cm of tumor size and with deep stromal invasion (P<0.005). Conclusion: the study concluded that “MIS” should be done in patients with less than 2 cm of tumor size.  It has also been observed that with “MIS”, oncologic outcomes are not reduced significantly. Hence, “MIS” should be done judiciously with skilled surgical technique.

103. Role of Ultrasound in the Detection of Rotator-Cuff Syndrome: An Observational Study
Goutam Satpathy, Sambit Kumar Panda, Gopabandhu Patra, Sidhartha Nayak, Amlan Dash, Aravind Subramanian
The purpose of this study was to determine the accuracy of sonography in rotator cuff tears, clinical tests are used to determine rotator-cuff syndrome but are insufficient to predict the morphology and size of the rotator-cuff tear. A total of 50 patients with shoulder pain with rotator- cuff tear, as diagnosed by orthopods, were subjected to ultrasonography. Real-time ultrasonography was done for the acromioclavicular joint, biceps, infraspinatus, posterior labrum, subscapularis, supraspinatus, teres minor tendon, and the sub-acromial-subdeltoid bursa. The USG criteria indicative of rotator cuff tear were, 1) discontinuity in the normal homoechogenicity of rotator cuff 2) focal hypoechoeic defect reaching up to either bursal or articular surface of tendon.3) Focal neovascularization of rotator cuff or a focal defect. Ultrasonography is a vital diagnostic procedure used by orthopaedic surgeons for diagnosis of the rotator-cuff tears in patients with shoulder pain.

104. A Cross-Sectional Study to Determine the Retinal Findings in Severe COVID-19 Patients
Jitendra Kumar Panda, Laxmidhar Jena, Manisha Mund, Sambit Kumar Panda
Background: The ocular manifestation is having a significant impact on the health of the people and issues related to this are not completely understood. The ocular surface disorder is reported as hyper-reflective lesion on optical coherence tomography at the level of ganglion cell and inner plexiform layers. The analysis of retina and its vasculature is helping to identify the issues related to the infection and damage to the lungs. In addition to this, the acquisition of retinal colour photography is useful for identifying the issues related to the disease including the hypertension and diabetes. The consideration of pathologic phenomena can be occurred due to direct cytopathic effects and influence the retinal neurons. It might also damage the microvasculature as the covid-19 virus impact on the vessel’s endothelium like in HIV. Aim: The study aims to determine the retinal findings in sever COVID-19 patients considering the cross-sectional approach. Method: This is a cross sectional study conducted from March 2020 to September 2021 at S.C.B. Medical College and Hospital. The study was approved by the institutional ethics committee and carried out with the relevant guidelines and standards proposed by the institute. The inclusion criteria of the study involve the concurrent endocarditis, other viral infections such as HIV and terminal cancer. There were three retinal experts have analysed the conditions and provided the information related to the treatment. The general characteristics, and baseline co-morbidities, presence of ocular systems and date of confirmatory examination was considered using the reports of RT-PCR. Results: According to findings of the study 18 patients were admitted to ICU and 12 of them have invasive medicinal ventilation. Moreover, 8 patients were on Vasoactive pharmacological support, 14 patients had Anticoagulation therapy in which 8 had the Prophylactic Anticoagulation therapy and 6 had Full-intensity Anticoagulation therapy.   Most of the patients were staying in ICU and had the Invasive mechanical ventilation. Moreover, the Vascoactive Pharmacological Support was offered to 5 patients. Conclusion: From the study, it has been concluded that retina of the covid-19 patients is affected due to severity of the infection. The lack of clinical support and other disease like diabetes and HIV are playing a critical role in improvement of infection in eyes that could affect the vision of the patients.

105. An Observational Assessment of the Lipid Profile Abnormalities in Newly Diagnosed Type 2 Diabetics
Sunil Kumar, Surendra Kumar
Aim: To study the lipid profile abnormalities in newly diagnosed type 2 diabetics. Material & Methods: A cross-sectional study was carried out to determine the lipid profile in newly diagnosed type 2 diabetics in Patna medical College and hospital, Patna, Bihar, India.. A total of 120 newly diagnosed type 2 diabetics were enrolled in our study. Results: According to ATP III classification 51% participants had normal serum triglycerides levels which is <150 mg/dl whereas 49% participants had an abnormal level of serum triglycerides. In our study, among the 120 participants, 65% participants had desirable total Cholesterol levels of <200mg/dl, 25 (51%) had borderline high levels of 200-239mg/dl and 3% had high total cholesterol levels of ≥240mg/dl. Conclusion: Deranged lipid profiles are quite prevalent in type 2 diabetics with females having higher triglyceride levels. Recognition of such elevated triglyceride levels in even newly diagnosed type 2 diabetics will help in better prevention of associated cardiovascular disease.

106. Determining the Variations of Nutrient Foramen of Humerus with its Clinical Implication: A Morphometric Analysis
Neha Singh
Aim: To determine variations of nutrient foramen of humerus with its clinical implication. Material & Methods: The present study consisted of 92 (40 right and 52 left side) dried and cleaned humerus from the Department of Anatomy, Nalanda Medical College, Patna, Bihar, India. Results: It has been observed that total of 122 number of nutrient foramina was found to be present on all humerii in relation to the surfaces. Conclusion: Our study provides details about the nutrient foramina that will benefit clinicians in surgical procedures, orthopedic procedures like bone grafting and in plastic and reconstructive surgery.

107. An Observational Assessment of the Drug Utilization Pattern in the Treatment of Diabetes Mellitus
Veena Kumari, Ashwani Kumar Mishra
Aim: To analyze the utilization pattern of antidiabetic agents in patients visiting medicine OPD in DMCH Darbhanga, Bihar. Methodology: The study was conducted in the Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar for 12 months. 150 patients with diabetes were analyzed for their prescription pattern and the data was recorded on a case record form (CRF). Data for drug utilization as per the core prescribing indicators of WHO for drug utilization studies and data for evaluating drug consumption was calculated in terms of defined daily dose (DDD). Drug utilization was expressed as average dose prescribed per day and DDD/1000 patients/day. DDD/1000 patients/day was calculated by applying a formula. Results: Amongst the 150 patients’ studies for diabetes 64% of the patients were male and most commonly affected age group was 51-60 years of age followed by 41-50 years of age.  The average number of drugs encountered per prescription were 5. Whereas prescriptions with generic name were 38% and drugs from essential drug list were found to be 78%. During the study, indicators of patient care such as mean consulting time was found to be 7.4 min. Out of 150 patients with diabetes mellitus type 2, 45 prescriptions (30%) were found with just one drug (monotherapy) whereas 105 (70%) of the patients were prescribed either dual therapy or more than 2 drugs. Most commonly prescribed antidiabetic group was biguanides (48.9%) in monotherapy followed by thiazolidinediones (37.7%) and dipeptidyl transferase and alpha glucosidase inhibitors with similar prescriptions (0.07%). In combination therapy, most common prescribed combination was found to be thiazolidinediones + biguanides (65.7%) followed by dipeptidyl peptidase-4 (DPP-4) inhibitors + biguanides, (34.3%). Conclusion: Among the antidiabetic drugs prescribed, metformin 500mg was the most commonly prescribed drug in monotherapy while in combination therapy glimepiride 2mg + metformin 500mg was most commonly prescribed. The prescription showed adherence to most of the parameters of rational drug utilization. But lesser prescription drugs from the essential medicine list points towards the need to revise and update the national essential drug list.

108. Assessment of the Usefulness of Restages Transurethral Resection of Bladder Tumours: A Prospective Study
Md. Shadab
Aim: The aim of the present study to evaluate the utility of restages transurethral resection of bladder tumor. 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 12 months. All patients with proven histological diagnosis of nonmuscle invasive urothelial cancer with either high grade or T1 cancers on histopathology were enrolled. During initial cystoscopy, the operative details such as the number of lesions, solid or papillary configuration of lesions and the site of lesions were mapped and recorded. TURBT at our center was performed using a 26 Fr resectoscope and monopolar cautery. After complete TURBT, a deep biopsy from the base of the tumor was taken. The TURBT chips and the deep biopsy were sent separately. Restage TURBT was advised at 4–6 weeks from initial TURBT as per the EAU guidelines. The cystoscopic findings were recorded during the restage TURBT similar to that at the initial TURBT. The histopathology reports of all patients were recorded. Post restages, the patients were then managed by a standard treatment protocol and follow-up. Results: Tumor was detected in 11 patients (29.7%) during restage TURBT, of which 8 patients had non-invasive disease. Of these 8 patients, tumor was present at the same site in 6 patients (75.0%) and at different site in 2 patients (25.0%). All the tumors were <3 cm in size, 9 (81.8%) had single lesion and 2 patients (18.2%) had multiple growths. In 6 patients (54.5%) the recurrence was of same stage (T1), in 2 (18.2%) it was of lower stage (Ta) and stage up-migration to muscle invasive disease (T2) was found in 3 cases (27.3%). In these five who had muscle invasive disease, deep muscle was not seen at the initial TURBT specimen in only 1 case. Of these 37 patients, 12 patients had tumor at restage and 25 did not. The recurrence and progression rates of those who had tumor at restage TURBT were 6/30 (20.0%) and 3/30 (10.0%) respectively, whereas they were 3/7 (42.9%) and 1/7 (14.2%) respectively for those who did not have tumor. There was statistically significant difference in recurrence and progression between two groups [P = 0.039 and 0.78 respectively. Conclusion: the restage TURBT is necessary in patients with solid bladder tumors. The presence of tumor at restage confers a higher risk of recurrence and progression. Poor patient compliance for a restage TURBT remains a matter of concern.

109. Determining the Size, Shape and Sexual Dimorphism of the Nasal Bones and Piriform Aperture: Morphometric Analysis
Neha Singh
Aim: To evaluate the dimensions (maximal width and length), the size and the shape of the piriform aperture (PA) and their sexual dimorphism in North Indian adult. Material & Methods: 60 adult dry skulls of unknown age and sex were collected from the collections in the Departments of Anatomy, Nalanda Medical College, Patna, Bihar, India. Results: Nasal bone classified as most common types being type A (40%) and type C (20%). Triangular to oval shape of piriform aperture is the most common (81.67%) than long and narrow type. Conclusion: Shape and size analysis of the piriform aperture and nasal bone showed the existence of a significant sexual dimorphism. These results encourage us to go further with functional and imaging correlations. This study will also be helpful in forensic research and anthropology.

110. A Prospective Observational Identification of the Most Common Etiologies and the Frequent Stage of Presentation in Patients with Neovascular Glaucoma
Sunil Kumar, Sujata Kumari
Aim: To identify the most common cause and the frequent stage of presentation in patients with neovascular glaucoma. Material & Methods: The present study is a prospective observational study, 460 patients with Glaucoma of multiple type and of etiology underwent detail ophthalmological examination and 16 case those have been diagnosed as neovascular glaucoma (NVG) in one eye or both the eyes at Department of ophthalmology, Patna Medical College and Hospital, Patna, Bihar, India over a period of 13 months were included in the study, with prevalence of 3.5% of all glaucoma cases. Results: Most of the patients i.e., 11 (68.8%) presented in rubeosis iridis stage, 3 (18.75%) in open angle stage and 02 (12.5%) in angle closure stage. The Mean IOP in Angle closure stage was found significantly higher than the mean IOP in other two stages (P = 0.001). Conclusion: In the present study, it was found although prevalence of NVG is significantly low among cases of all glaucoma but the rising trend of Diabetic in population is of concern and this study also confirms that more than half of the cases of NVG were found with Proliferative diabetic retinopathy is the most common cause and rubeosis iridis stage was the commonest finding.

111. Retrospective Estimation of Prevalence of Dengue Viral Infection among Clinically Suspected Patients Attending a Tertiary Care Hospital
Sumit Kumar, Naresh Prasad Yadav, Rajkumar Deepak
Aim: To estimate prevalence of dengue viral Infection among suspected patients attending a tertiary care center. Materials and Methods: Retrospective study to observe prevalence of dengue infection, conducted at the Department of Medicine, Government Medical College, Bettiah, Bihar, India. Patients clinically suspected of having dengue infection and advised for dengue investigation for establishing the diagnosis were enrolled in the study, irrespective of their age or sex, over one-year period. Results: Total 220 samples were tested during one year of study period out of which 45 (20.45%) showed laboratory evidence of dengue; either for NS1 Ag or IgM Ab or for both. Maximum samples were received during monsoon and post-monsoon period i.e., August to November. Dengue sero-positivity was found to be highest in post monsoon period i.e., October to November. Total 152 males and 68 females were tested for dengue sero-positivity; out of these 41 males and 8 females showed evidence of dengue infection being positive for NS-1Ag /IgM Ab or for both (Figure 1). Conclusions: For estimation of true burden of dengue in India and its geographical mapping to control further disease transmission; laboratory-based active surveillance systems are required along with passive surveillance and control programs.

112. Assessment of the Association of Fasting & PP C- Peptide with Hba1c in Type-2 Diabetes Mellitus in Population
Sunil Kumar, Surendra Kumar
Aim: To provide correlation of Fasting & PP C-peptide with HbA1C in patients of T2 Diabetes Mellitus. Material & Methods: 60 patients admitted in Department of General Medicine, Patna Medical College, Patna, Bihar, India. The study was conducted over a period of 15 months. Results: Mean & SD for fasting C-Peptide for males was1.490 ± 1.182& for females 2.371 ± 2.389. Raised Mean & SD for fasting for males was 3.482 ± 1.789 & for females were 0.820 ± 0.552. Raised Mean & SD for HbA1c for males was 10.722 ± 2.30 & for females 5.792 ± 0.281. Both were statistically significant with a p value of ≤0.05. Conclusion: Insulin secretion estimated by measurement of Fasting C-Peptide was either normal or raised in newly diagnosed T2DM subjects in my study indicating predominant role of insulin resistance in the etiology. Further research can explore the exact contribution of insulin resistance and insulin secretory defects in this area.

113. A Questionnaire Based Assessment of Awareness Concerning Hypertension and its Management among the General Practitioners
Sandeep Kumar, Meetu Kumari, Sunny Kumar
Aim: To assess the knowledge and awareness of the general practitioners concerning hypertension and its management. Material & Methods: The present cross-sectional questionnaire-based study was carried out by the Department of Medical Cardiology, Indira Gandhi Institute of Cardiology, Patna, Bihar, India. The present study included a total of 100 general practitioners from the Indian population. Results: On assessing the presenting symptoms of hypertension in the study subjects it was seen that the most common presenting symptom was fatigue which was reported by 77% subjects followed by palpitations seen in 41% study subjects. Concerning the assessment of parameters concerning the monitoring of the blood pressure, the readings one time were taken by 4%, two times by 42% subjects. Conclusion: The present study concludes that general physicians were well-informed about the diagnosis and management of the subjects with hypertension.

114. Variations in Calcaneus Articular Facets and Dimensions of Calcaneus: A Morphometric Analysis
Neha Singh
Aim: To see the variations in articular facets and dimensions of calcaneus. Material & Methods: A total of 120 dry calcaneus were procured from Department of Anatomy, Nalanda Medical College, Patna, Bihar, India. Results: The most common type of articular facet on calcanei was type B. The width and length sulcus calcanei were: 5.28 ± 1.04 mm, 33.93 ± 3.33 mm respectively. Conclusion: Analysis of morphometric parameters plays key role in reconstruction surgeries and foot rehabilitation procedures.

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.

116. Evaluation of Thyroid Nodule Calcification based on Ultrasonographic Features.
GD Maheshwari, Anil Shrivastav, Chandan Kumar Agarwal
Background: Ultrasonographic evaluations of lesions of the thyroid gland are of research importance because they directly affect the functioning of other organs of body and along with that histopathological result forms the basis of highly effective medical and surgical treatment. The prevalence and magnitude of all the thyroid disorders are associated and dependent on numerous risk factors and confounding factors. Material & Methods: The present cross-sectional, retrospective study was conducted at department of radiology of our tertiary care hospital. A sample size of 50 was calculated at 95% confidence interval at 10% acceptable margin of error by epi info software version 7.3. Institutional Human Ethics Committee clearance was obtained before start of study. Results: In the present study, on USG evaluation most common finding was multinodular goiter among 24 patients which was followed by colloid nodule among 11 patients. Solitary thyroid nodule was found among 10 patients which were followed by malignancy among 5 patients. In the present study, on USG evaluation the size of the nodule found to be ranges from 1.2×1.2 to 7×7 cm. Macro calcifications were the commonest finding and present in 32 cases. Out of these 18 cases had multinodular goiter, 5 case had solitary thyroid nodule, 08 case had colloid nodule and 1 case had malignancy. This difference was statistically significant (P value < 0.05). Apart from this, 08 cases had micro calcification, 10 cases had macro and micro calcification together. However, we did not found any statistically significant difference in these (P value> 0.05). Conclusion: We concluded from the present study that macro calcification is the commonest finding on USG in cases of thyroid nodule however, it is solely not a good indicator for malignancy. We found that nodules with macro calcification also had chances of micro calcification which could be a reason for positive rates for malignancy.

117. Comparative Study for Efficacy and Outcome of Adenoidectomy According to the Surgical Method: A Prospective Study
Pradeep Kumar Balia, Pawan Kumar Khatri, Mamta Mehra
Background: The operative procedure of choice for adenoidectomy should attain a safe removal criterion, which includes less operative time, minimum blood loss, less postoperative morbidity, no or minimum recurrence. Hence, there was need to development of newer technologies and operative procedures to improve the post-operative outcome. Material & Methods: The present cross sectional, prospective study was carried out at department of ENT, at our tertiary care hospital. The study duration was of one year from January 2020 to December 2020. A sample size of 40 was calculated at 90% confidence interval at 10% acceptable margin of error by epi info software version 7.3. Results: In the present study the operative time in Conventional adenoidectomy and Endoscopic –assisted adenoidectomy was 22.01 minutes and 39.12 minutes respectively. This difference was statistically significant (P value < 0.05). The post-operative fiber-optic nasal endoscopy done for look at the residual adenoid tissues displayed that resection was very nearly complete in Group B whereas 4 patients (20%) of Group A had residual adenoid tissues. This difference was statistically significant (P value < 0.05).  The fiber-optic nasal endoscope also assessed the associated trauma during procedure, in Group A 3 patients (15%) had trauma, all are minor and associated with the uvula and posterior pharyngeal wall whereas in Group B trauma shown in 4 patients (20%), out of then 3 patients had minor septal mucosal injuries while 1 patient had major injury and required anterior nasal packing. Velopharyngeal dysfunction resulting in hyper nasal speech without nasal regurgitation reported in 2 patients (10%) of Group A and 3 patients (15%) of Group B, all were temporary resolved spontaneously within a period of one week. However, we did not find any statistically significant difference in these (P value> 0.05). Conclusion:  We concluded from the present study that Endoscopic assisted adenoidectomy method is safe, effective and accurate than curette adenoidectomy. We found complete removal of remnants in Endoscopic assisted adenoidectomy but also had several demerits including need of specialized equipment and experience and more operating time.

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