International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1.Vertical Integration in a Competency Based Medical Education (CBME) Curriculum – A Feedback Analysis Study from IMBBS Students of One Medical College
Bandar Subhashini, Dubbasi Praveen Kumar
Background: The teaching program for MBBS students is carried out with a purpose to enable the medicals student to give primary care to the patients. Competency Based Medical Education (CBME) is introduced in MBBS curriculum to focus on learning, which is competency based, integrated and student centered. This is done to achieve skills, ethical and humanistic values among MBBS students. Integration is a part of this new curriculum. Integration is a learning experience that allows the learner to perceive relationships from hindering blocks of knowledge and develop a broad view of the subject. Aim & Objective: To know the impact of vertical integration class for 1 MBBS students in a Competency Based Medical Education (CBME) curriculum. Materials and Methods: A feedback questionarre form was given to I MBBS students at the end of vertical integration class. The students were explained in detail and informed consent was taken. One hundred and two (102) students from I MBBS (batch 2020-2021) of Government Medical College, Nalgonda, Telangana submitted the feedback forms. The results of students perception are recorded using 4 point Likerts scale and Yes/No questions. The results are analysed in descriptive tables and expressed as percentage. Results: In our present study based on the CBME format, vertical integration helped the students in understanding the subject, guided them in attaining early clinical knowledge regarding the topic of MI (Myocardial Infarction) discussed in the class. In our present study 97.06% students found the vertical integration class to be very effective. It helped 98.04% students in attaining clinical knowledge. A total of 98.04% of students recommended vertical integration class for certain topics. Conclusion: Vertical integration should be encouraged for certain topics by clinical speciality as it enables the students to learn better and also get early acquaintance with the clinical experience which will enable them to give better patient care.

2. GCRBS Scoring System for Predicting Outcome in Severe Falciparum Malaria
Bandar Subhashini, Dubbasi Praveen Kumar, Vajja Sagar, Ega Lakshman Kumar
Background: Malaria is a protozoan disease caused by plasmodium species, transmitted by bite of infected female Anopheles mosquito, characterised by febrile paroxysms presenting with intermittent periodicity. It is diagnosed by Rapid antigen tests and blood smear tests. Severe malaria is almost exclusively caused by Plasmodium falciparum infection and can cause death within hours or days. Present study was done to give scoring system to predict the outcome in severe cases of falciparum malaria. Aim and Objective: To assess the utility of GCRBS scoring system in predicting the outcome in severe falciparum malaria. Materials and Methods: This is a prospective study done on 100 patients diagnosed as severe falciparum malaria, admitted in the Department of General Medicine wards and Intensive Care Unit (ICU) of Kakatiya Medical College, Warangal, Telangana, India, between the period September 2015 to November 2017. GCRBS Scoring system was done on all patients using 5 parameters which includes G-GCS (Glasgow Coma Scale), C-Creatinine levels, R-Respiratory rate, B-Bilirubin levels and S-Systolic blood pressure. Results: The GCRBS score of 0-10 was given for all patients. The maximum score is 10 and least score is 0. Cutoff score was taken as 5. A score of >/= 5 was considered as having bad prognosis and score of < 5 was considered as having good prognosis. In the present study out of 100 patients with severe falciparum malaria, 77 patients had GCRBS cutoff score <5, of which 04 patients developed multi organ failure. 23 patients had GCRBS cutoff score >/=5, of which 20 patients presented with multi organ failure. Total of 24 patients who developed multiorgan failure had a long stay in the Hospital Intensive Care Unit for more than 10 days and were later discharged. Conclusion: The GCRBS scoring system is very simple and easy to calculate using 5 parameters namely G-Glassgow Coma Scale (GCS), C-Creatinine levels, R-Respiratory rate, B-Bilirubin levels and S-Systolic blood pressure of the patient. It can be used to predict the outcome in severe falciparum malaria cases as our present study has a sensitivity of 86.95% and specificity of 94.8%. Thus, GCRBS scoring system can be used at bed side to predict the severity of falciparum malaria cases which can help the clinicians to give intensive care to the needy patients at the earliest for better outcome.

3. A Clinical Study on Maternal and Fetal Outcome in Cases of Preterm Premature Rupture of Membranes
Chandni Singh, Chanchala Kumari, Arshi Praveen, Ujjwal Sourav
Introduction: Preterm premature rupture of membrane complicates about 2-4% of singleton pregnancies and 7- 20% of twin pregnancies, it is associated with 60% preterm deliveries and 10% of perinatal death. Preterm PROM is an important cause of perinatal morbidity and mortality mainly due to prematurity and its sequelae. Perinatal infection, increased incidence of hyaline membrane disease, intraventricular hemorrhage, sepsis, cord prolapse, umbilical cord compression resulting from oligohydramnios, fetal distress further compromises the outcome and there is increased fetal wastage. Aim and objective: To study maternal and perinatal outcome in patients with preterm premature rupture of membranes. Methodology: The present study on “Maternal and Perinatal outcome in cases of preterm premature rupture of membranes (PPROM)” was conducted in the Department of Obstetrics and Gynaecology, Narayan medical college, sasaram, Bihar. The study group includes patients admitted with PPROM under the Department of Obstetrics and Gynaecology, Narayan medical college, sasaram. Result: The 72% were healthy. Birth asphyxia was seen in 12% patients, Jaundice in 12 % and septicaemia was seen in 12% subjects. 43.33% subjects were within 2-2.5 kg, (22%) subjects had birth weight less than 1.5 kg, whereas rest 22% had birth weight equal or more than 2.5 kg. Conclusion: PPROM significantly resulted in an increased risk of preterm deliveries and its associated complication, making it one of the most important causes for perinatal morbidities and mortality.

4. Stroboscopy, Voice Handicap Index and Maximum Phonation Time as Objective and Subjective Methods to Assess the Voice Quality Following Micro Laryngeal Surgery in Benign Lesions of the Vocal Cords
Sree Devi, P. Asha Rani
Background: Altered voice quality is commonly reported by patients with benign lesions of the vocal cords; 84% of them could be corrected surgically. Patient’s response as subjective improvement in voice quality and objective improvement on Stroboscopy has revolutionized the role of voice clinics. Aim: To evaluate the final outcome of micro-laryngeal surgery for benign lesions of vocal cords with Stroboscopy and subjective improvement of quality of voice with voice handicap index and Maximum phonation time. Materials: 71 patients with benign lesions of vocal cords like cysts, polyps, nodules, plaques, angiomas, fibromas and Reinke’s edema were included in a prospective study for a period of 25 months. Preoperative and postoperative Stroboscopy variables of amplitude, mucosal wave, and glottic closure were used. Subjective assessment of voice quality was done by voice Handicap index questionnaire. Maximum phonation time was calculated before and after surgery. The study data was analyzed statistically to assess the significance using paired‘t’ test and Chi square test. Results: Patients were aged between 16 and 65 years. Out of 71 patients, 49 (69.12%) were males and 22 (30.98%) females, with a male to female ratio of 2.22:1. 49/71 (69.01%) patients belonged to the age group of 26 to 45 years. The mean age was 44.56±3.15 years. Hawkers were 21 (29.57%), Agriculturists were 18 (25.35%), Office goers were 14 (19.71%). Significant improvement on Stroboscopy variables and Voice handicap indices postoperatively at the end of 10 weeks was noted with p value 0.001. Conclusions: Voice quality assessment on Stroboscopy and VHI (Voice handicap index) was ensuring satisfaction to both the patients and the surgeon alike. The assessment methods were not time consuming and except to the initial cost of establishing Stroboscopy the overall results of the study were effective.

5. Assessment of Osteoporotic Fractures of Distal End of the Radius in Post-Menopausal Women by Using Dexa Scan
Simranjit Singh, R K Amandeep, MM Ray
Background: Fractures of the distal radius are extremely common. The present study was conducted to evaluate osteoporotic fractures distal end of the radius in post-menopausal women by using dexa scan. Materials & Methods: All the patients between 45 to75 year age group postmenopausal women of attending Orthopaedics department with fracture distal end of radius were included. All the patients would undergo height and weight measurement, noted about status of last menstrual period, amount of physical activity, activities causing joint pain. Then bone mineral density measured by using DEXA scan and compared according to WHO definition of osteoporosis. Results: Among 100 osteoporotic women, 23% having joint pain while walking on the surface, 46% while walking upstairs, 21% while walking up hills and 10% having no pains. 34% of women do physical activity for less than 20 min, 37% women do for 20- 40 min, 13% do for 40-60 min and 16% do it for more than 60 min/day. In 45-50 yrs age group, minimum bone mineral density is 0.415 and maximum bone mineral density is 0.615 with mean BMD of 0.526 with standard deviation of 0.0746. In 51-56 yrs age group, minimum BMD is 0.343 and maximum BMD is 0.515 with mean BMD of 0.435 with standard deviation of 0.0425. In 57-62 yrs age group, minimum BMD of 0.263 and maximum BMD of 0.467 with mean BMD of 0.348 with standard deviation of 0.0583. In 63-68 yrs age group, minimum BMD is 0.263 and maximum BMD is 0.452 with mean BMD is 0.332 with standard deviation of 0.0491. In age group 69-75 yrs, minimum BMD is 0.013 and maximum BMD is 0.315 with mean BMD 0.173 with standard deviation of 0.103. Conclusion: DEXA scan is safe and non-invasive method of detecting patient at risk of osteoporotic fracture distal radius.

6. Comparison of I-Gel LMA and LMA Proseal in Paediatric Patients Undergoing Elective Surgery under General Anaesthesia
Saurabh Varshney, Kumar Parag, Shiveta Gautam, Hariom Khandelwal
Objective:  LMAs are now commonly used in pediatric anaesthesia, the primary objective of this study was to compare Proseal LMA and I-Gel for ease and time of insertionand secondary objectives were to see hemodynamic stability and perioperative complications with these 2 devices. Methodology: The proposed study was conducted in department of anaesthesia and intensive care, SGRRIHM & HS after obtaining informed consent from parents. In this prospective randomised study, 60 patients weighing 10-25 kg with ASA grade I & II, mallampatti I & II posted for elective surgeries under GA, with duration up to 120 mins, were enrolled & divided into 2 groups (I-Gel & Proseal) with 30 patients in each group. The data were scored & analysed by using SPSS ver. 16.01. Results: Demographic and surgical data were similar between groups, the 1st attempt success rate for LMA Proseal & I-Gel were comparable with no statistical significance. Hemodynamic parameters were comparable between 2 groups; the incidences of hoarseness & postop cough were more in Proseal group as compared to I-Gel with statistical significance. Conclusions: I-Gel can be better alternatives to Proseal due to its less time of insertion with hemodynamic stability & minimal postop complications.

7. Overall Standard of Living in Glaucoma Patients with Dry Eye Syndrome
Samia Rahman
Background: The multifactorial condition of the tear and ocular surface known as dry eye syndrome (DES) can manifest as symptoms of pain, blurred vision, and unstable tear films. Methods: 61 patients were enrolled in this observational cross-sectional study at a clinical practise. Depending on how many glaucoma drops the patients received each day, they were split into three groups (G1=1 drop/day, G2=2 drops/day, G3=3 drops/day). A control group of 20 subjects was also selected (G0). Along with a thorough ocular examination that included tear function and ocular surface state (OSDI). Punctate keratitis and a reduced break-up time were used to define DES. The Kruskal-Wallis analysis of variance, Mann-Whitney U tests, the χ2 and Fisher test, as well as the comparison of median values between groups, were all used in the statistical study (to verify significant differences). Results: In comparison to 11 percent of G1 patients and 5 percent of G0 patients, DES was present in a total of 40% of G3 patients and 39% of G2 patients (p=0.01). (NEI-VFQ 25 total mean, GSS total mean, and symptoms average: p=0.0085, p=0.006, and p=0.03, respectively) QOL was considerably impacted and changed. OSDI identified variations by group: A moderate OSDI was evident in 26% of G2 and 15% of G3, while a severe OSDI was detected in 15% of G3 and 8.7% of G2 (p>0.05). Conclusions: DES is more frequently found in patients with topically treated glaucoma than in a comparable control group (p=0.01). The patient’s QOL suffers because of the presence of DES. Regular evaluations of glaucoma patients’ ocular surface health are necessary to ensure the prompt identification and treatment of any pathologic symptoms on the ocular surface.

8. Impact of Door-to-Balloon Time on Clinical Outcomes in Patients with ST-Elevation Myocardial Infarction
Panchanan Sahoo, Binayananda Padhee
Background: Studies on the connection between the Door-to-Balloon time and ST-Elevation myocardial infarction have produced inconsistent findings. Although its effectiveness may be constrained by delivery delays, prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) can considerably reduce mortality and morbidity. For patients with ST-segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention, we wanted to ascertain the impact of door-to-balloon time on death (PCI). Methods: For three years, we conducted a cohort analysis of 292 STEMI patients treated with PCI within six hours of presentation at our hospital. We assessed the impact of door-to-balloon time on in-hospital mortality using hierarchical models in the full cohort as well as in other patient subgroups based on symptom onset-to-door time and baseline risk status. Results: Increased in-hospital mortality was linked to longer door-to-balloon timings (mortality rates of 3.0%, 4.2%, 5.7%, and 7.4% for door-to-balloon times of ≤ 90 min, 91 to 120 min, 121 to 150 min, and > 150 min, respectively; p-value= 0.01) Patients with a door-to-balloon time more than 120 minutes had a higher risk of dying than those with a door-to-balloon time of 90 minutes (odds ratio 1.42; 95 percent confidence interval [CI] 1.24 to 1.62). In subgroup analyses, mortality increased with longer door-to-balloon times independent of the length of time between the beginning of symptoms and the door (≤ 1 h, >1 to 2 h, >2 h), as well as the presence or absence of high-risk factors. Conclusions: Regardless of how long it takes for symptoms to manifest and regardless of the pre-existing risk of mortality, the time from primary PCI to mortality risk is crucial. All patients should be included in efforts to reduce door-to-balloon times.

9. Influence of Lipophilic Statins Treatment in Heart Failure
Panchanan Sahoo
Background: Studies on statins have not shown any appreciable improvements in heart failure outcomes (HF). Studies might not, however, necessarily be generalizable. Comparing the incidence of heart failure (HF) among initiators of hydrophilic and lipophilic statins was the goal. Methods: We discovered new initiators of hydrophilic or lipophilic statins data gathered from our hospital situated at Bhubaneshwar. Following a one-year waiting period following the start of statin therapy, follow-up for the primary endpoint of incident HF started. 1 inpatient or 2 outpatient diagnosis codes for HF and the usage of loop diuretics were considered the outcome. Confounding was taken into consideration using propensity scores (PS). To produce dose-adjusted effect estimates, hazard ratios (HR) for incident HF were first estimated separately for low- and high-intensity statin users. Results: All 204 individuals who were eligible to start taking statins did so (hydrophilic and lipophilic statins). The average age was 58 years, and 23% had diabetes mellitus and 40% had hypertension. There were 120 patients in the high-intensity statin group and 84 patients in the low-intensity statin group following PS matching. There were 89 cases of incident HF (95 percent confidence interval [CI] 4.4-4.6) after a median follow-up of 25 days. For hydrophilic versus lipophilic statins, the unadjusted HR for the risk of HF was 0.77 (95% CI 0.76-0.79), and the pooled adjusted HR for incident HF after PS matching was 0.94 (95% CI 0.90-0.98). For hydrophilic versus lipophilic statins, the HR for incident HF was 1.06 (95 percent CI 1.00–1.12) for the low-intensity statin group and 0.82 (95 percent CI 0.78–0.87) for the high-intensity statin group. When comparing rosuvastatin and atorvastatin, as well as those who were younger and older than 65 years old, a similar tendency persisted in subgroup analyses. Conclusion: When compared to lipophilic statins in this observational cohort analysis, hydrophilic statins were associated with a moderate risk reduction in incident HF. It is advised that future studies replicate similar findings in various populations.

10. Prevalence and Antimicrobial Sensitivity Pattern of Central Line Associated Blood Stream Infections in a Tertiary Care Hospital: Need for Continuous Quality Improvement
Areena Hoda Siddiqui, Preetha Rajan
Background: It is a well-known fact that regular training of the healthcare workers keeps their morale high and motivates them to indulge themselves in infection control practices. Purpose: This study was undertaken to find out the impact of training on central lines associated bloodstream infection rates. This study was conducted in a tertiary care hospital; it included all the patients on central line. Method: Lab confirmed bloodstream infection cases were obtained from Microbiology lab. Central lines associated bloodstream infections were deduce after follow up. Rates were calculated as per CDC guidelines. Organisms included were further evaluated for identification and their sensitivity. Results: The rate before training was 4.2/1000 catheter days which reduced to 2.91/1000 catheter days. Klebsiella pneumoniae was the most common isolate which was sensitive to polymixin B (100%) and colistin (97%) only. 3% of isolates were harbouring K. pneumonia carbapenemases enzymes. Conclusion: This study shows that regular educational programme is important to bring out behavioral change among staff and sensitivity of these nosocomial isolates if shared with nursing staff might act as an eye opener for these staffs.

11. A Retrospective Study to Determine Incidence of Adenocarcinoma Bladder in Patients with Cystitis Cystica ET Glandularis
Manu Gupta, Ashutosh Kumar Singh
Background: The present study was undertaken for assessing the incidence of adenocarcinoma bladder in patients with cystitis cystica et glandularis (CCG). Materials & methods: Retrospective reviewing of all the patients diagnosed with CCG was done. Record of all the patients was done in which cystoscopy and biopsy findings were available. Complete demographic and clinical details of all the patients were assessed. Total sample size was 250. On the basis of histopathological findings, patients with confirmed diagnosis of adenocarcinoma were separately analyzed. All the results were recorded in Microsoft excel sheet and were analyzed by SPSS software. Results: The overall incidence of adenocarcinoma patients was 3.2 percent. Mean age of the patients with adenocarcinoma was 39.8 years. Out of these 8 patients, 6 were males while 2 were females. Conclusion: There is associated risk of malignancy among patients with CCG.

12. A Retrospective Comparative Outcome Assessment between Laparoscopic and Open Total Gastrectomy for Advanced Gastric Cancer after Neoadjuvant Chemotherapy
Rakesh Kumar Singh, Amarjit Kumar Raj
Aim: To compare the short and long-term outcomes between LTG and OTG for AGC after neoadjuvant chemotherapy (NACT). Material & Methods: This is a retrospective study of prospectively collected data conducted at the Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. Clinical and pathological data of patients with AGC who accepted NACT before LTG or OTG plus D2 lymphadenectomy, over a period of 3 years (from Nov, 2016 to Oct, 2020) were collected. Results: We collected the clinical data of patients who underwent total gastrectomy over a period of 3 years at the Department of Surgical Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.  After screening, 50 patients were included into this case-control study with 25 patients in NACT-LTG group and 25 patients in NACT-OTG group. The LTG group had significantly longer chemotherapy–surgical procedure interval compared with the OTG group (5.38 ± 1.89 week vs. 4.69 ± 1.81 week; P = 0.05). There was no significant difference in adjuvant therapy between the two groups (P = 0.662). In the univariate analysis, BMI, pTNM stage, tumor diameter, estimated blood loss, and vascular and nerve invasion were significantly correlated with OS (P < 0.10), and pTNM stage, tumor diameter, estimated blood loss, and vascular invasion were significantly correlated with DFS (P < 0.10). Conclusion: After NACT, LTG shows comparable 30-d postoperative morbidity as well as 2-year OS and DFS rate to OTG. We recommend that experienced surgeons select LTG other than OTG for proper AGC patients after NACT.

13. Frequency and Distribution of ABO and Rh Blood Groups Among the in-Patients at a Tertiary Hospital in Northern Telangana
Swathi Samala, M. Lavanya, Farida Begum, Smitha Vadana, R. Nagarjuna Chary
Background: International Society of Blood Transfusion has recently recognized 33 blood group system however the ABO system and rhesus (Rh) blood group remain clinically most important. After ABO blood group and Rh blood grouping discovered by Landsteiner and Weiner in 1901 and1941 respectively, these two systems have proved to be the most important systems.  Based on presence of the antigens and agglutinins human blood is divided into four major blood groups A, B, AB and O, based on which tranfusions are made. The present study aims to investigate the ABO and rhesus (Rh) blood group frequency in the in-patients of Government general hospital, Nizamabad, Telangana state, over a period of 3 years from 2019 January to 2021 December. Method: The retrospective study was conducted on more than thirty thousand in-patients including both male and female patients admitted to the government general Hospital, Nizamabad. Blood samples were taken from each subject and subsequently ABO and Rh blood groups were evaluated separately by using commercially available standard poly clonal antisera applying on the slide by using Tile Agglutinination techniques. And all relevant data of patients were collected from blood bank department of the hospital. Results: Out of 45352 individuals, 29932 (66%) were males and 15420(34%) were female individuals. The most common blood group found was O positive (33%) and least common being AB negative (1%).  The prevalence of Rhesus positive and negative distribution in the present studied population was found as 93.9% and 6.1%, respectively. Conclusion: The present study is useful in providing information on the status of ABO and Rh-D blood group distribution in the district of the Nizamabad and knowledge of it will help in effective management of regional blood transfusion services of the area.

14. A Cross Sectional Study of Prevalence of Various Dengue Serotypes Along with Hematological and Biochemical Profiles of Dengue Patients in Western Part of India
Jitendra Kumar S Parmar, Diptiben Patel, Niyati H. Zaveri, Manjula J Babariya, Kishor N. Chinchodkar
Introduction: As per WHO, the 30 most highly endemic countries for Dengue in the world includes five countries as India, Indonesia, Myanmar, Sri Lanka and Thailand (December 2020). In India total 10172 cases were reported and 3 deaths were reported till 22 June 2022. In Dadara Nagar haveli, total 547 and 46 cases were reported during 2021 and till 22 June 2022 respectively. Objective: The objectives of this study are1) to find out prevalence of various Dengue serotypes of the given population, 2) to compare hematological and biochemical parameters of the various dengue serotypes. Methods: A hospital based cross sectional study was conducted in a tertiary care hospital at western part of India during January 2021 to December 2021.Those study participants who fulfilled the inclusion criteria were enrolled in the study. Hematological and biochemical parameters tests were done. The statistical ANOVA test is applied to check significance of various parameters among serotypes. Results: During the study period, a total of 100 dengue cases were included in the study. Mean age±SD of dengue patients was 27.15±10.82 years along with this 89% were in the age group of 11 to 40 years. Males were found to be 67 % and females were 33%. Maximum proportion of the patients belonged to DEN 2 serotyping, which is 53%, followed by DEN1 serotyping, i.e., 23 %. Conclusion: The study revealed that, dengue positivity was higher in male population than in females, DEN2 serotype was higher as compared to other serotype of dengue virus viz. DEN1, DEN3 and DEN4 as well as some of the patients were co-infection with serotypes-1 and 3 and serotypes-2 and 3. In dengue patient’s hematological parameters like, total leucocyte counts, and PCV/Hematocrit was increased while platelet counts decreased. Biochemical parameters like, ALT, AST, Serum Bilirubin Total, have found to be higher than normal range. Dengue Type 2 serotype is more severely causing reduction in platelet, leucocytes, RBC counts, and HB level as compared to other serotypes. This can be correlated with its antigenic structure that have more virulence power as compared to other serotype.

15. Study of Late Anthracycline Cardiotoxicity in Childhood Cancer Survivors
Mandli Lavanya Reddy, Yamasani Nageswara Reddy
Background: Anthracyclines are the most commonly used drugs in paediatric cancers. Early and late cardiac side effects are reported with anthracyclines. Children should be followed up into adulthood anticipating the delayed side effects of anthracyclines. Aims: To evaluate cardiac electrophysiological and functional parameters in long term survivors of childhood malignancy who received anthracycline therapy, using electrocardiogram and echocardiography. Materials and Methods: This cross-sectional study was conducted by the Department of Medicine and Department of Pediatrics at a tertiary care teaching hospital in Kurnool between Sep 2019 and February 2022. The study group consisted of 25 cases of long-term survivors of childhood malignancy who received anthracycline therapy. Results: Total 25 patients were divided into 3 groups based on cumulative dose of anthracyclines: <300 mg/m2, 300 – 400 mg/m2, >400 mg/m2. Among 25 patients 19 were treated for ALL, 5 were treated for lymphoma and 1 was treated for Hepatoblastoma. Two relapsed cases of ALL received more than 400mg/m2 of anthracycline dose. Comparison of electrocardiographic variables (HR; PR interval; QTc interval; QRS axis, amplitude and duration; R/S in V1 and V6) between the groups were not significant. In the three cumulative dose groups there is no statistically significant difference between echocardiographic variables.

16. Chronic Lymphocytic Thyroiditis- Cytological Grades, Radiological and Biochemical Evaluation- An Integrated Approach
Aarti K Buge, Varsha M Dhume, Vikas Kavishvar
Introduction: Chronic lymphocytic thyroiditis (CLT) is one of the common autoimmune disorders of thyroid. There is rise in the incidence and diagnosis of CLT due to iodine supplementation of diet and improved diagnostic techniques repectively. Various diagnostic modalities including TFT’s, USG, anti-TPO antibody levels & FNAC help in its early diagnosis and thereby facilitate in planning of treatment. Aims & Objectives: To correlate Cytological findings in Chronic lymphocytic thyroiditis with TFT, USG & with anti-thyroid antibody levels. Material and methods: Total 313 cases of chronic lymphocytic thyroiditis diagnosed on cytology were included in the study group, of which 165 were prospective & 148 were retrospective. In all cases, FNAC findings were statistically correlated with TFT, USG & anti-TPO using Chi-square test. Conclusion: CLT can have unusual presentations like euthyroid status, Solitary thyroid nodule & negative ant-TPO antibody levels, for early diagnosis of such cases FNAC plays a key role.

17. Stressful Experiences of Mothers of Neonates or Premature Infants in a Neonatal Intensive Care Unit
Arati Shivhare, Raginee Singh, Pranav Prakash Choudhary, Rohit Alok
Introduction: When an infant is admitted to a neonatal intensive care unit (NICU), the parents experience psychological stress, primarily because of the NICU’s culture and procedures. On the other hand, when the infant’s condition is discussed openly and they are given permission to care for their child, they become calmed. Objective: The study’s goal is to evaluate mothers whose infants are admitted to the Neonatal Intensive Care Unit for psychological morbidity (NICU). Methods: In the Neonatal Intensive Care Unit of the Katihar Medical College Hospital in Katihar, Bihar, India, a case control study with a sample size of 100 patients was done. The Edinburgh Postpartum Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), and PSS NICU [Parental Stressor Scale for Neonatal Intensive Care Unit] questionnaires were provided to study participants at the beginning of the 12-month period. Results: According to the STAI-S, potential anxiety affected 23.0 percent of NICU mothers in our study, depression affected 46.0 percent of NICU mothers and stress affected 85.0 percent of NICU women, according to the PPSS-NICU. Conclusion: A higher degree of maternal stress was substantially linked with the neonatal gestational age, birth weight, and length of NICU stay in NICU mothers (P<0.05). It was determined that there was no statistically significant difference in the State Trait Anxiety Inventory Score between mothers who did not have an anxiety condition and those who did (p>0.05).

18. A Retrospective Study on Recurrent Laryngeal Nerve Palsy during the Immediate Post-Thyroidectomy Period among Inpatients of a Tertiary Hospital
Farid Alam Ansari, Vibhu Priyadarshi
Background: After thyroid and parathyroid surgery, recurrent laryngeal nerve (RLN) injury is a potentially dangerous consequence. Significant postoperative morbidity is brought on by it. In a tertiary care facility, the prevalence of RLN palsy will be estimated by this study. Methods: A retrospective analysis of 250 thyroidectomy cases carried out over a two-year period in a tertiary care facility. Results: 23.72 percent of people had RLN palsy. Only 3 patients experienced RLN injuries during surgery, and one patient had vocal cord palsy that was documented after extubation. In the first 22.45 percent of patients’ post-operative days, hoarseness was prevalent. Conclusion: The second most frequent side effect following thyroid surgery, after hypocalcaemia, is RLN palsy. This is a potentially fatal consequence that needs to be anticipated early and patients kept under close observation. Since we included individuals who had post-operative hoarseness, a routine indirect laryngoscopy is advised following surgery to determine the prevalence in detail.

19. Evaluating Male Sexual Dysfunctions in the Rural Areas of Bihar’s Koshi Region
Rohit Alok, Ahmad Ijtaba Karim, Pranav Prakash Choudhary, Arati Shivhare
Aim: To ascertain the incidence of sexual disorders in males among the rural population of Bihar’s Koshi region. Methodology: A research with 275 patients was conducted. Patients provided a detailed case history using a self-prepared Semi-Structured Proforma, including demographic information, educational level, occupational and marital records, family history, socioeconomic situation, and various symptoms, beliefs, and behaviour relevant to treatment. Each patient was given the 13 Arizona sexual experience scale, and their responses were documented. Results: 80 men (29.09 percent) were diagnosed with sexual disorders. Erectile dysfunction was reported by 36 (45.0 percent), premature / early ejaculation by 22 (27.5 percent), male hypoactive sexual drive disorder by 12 (15.0 percent), and delayed ejaculation by 10 (10.0%). (12.5 percent) Of the 36 erectile dysfunction patients, 38.9 percent had mild to moderate erectile dysfunction, 30.6 percent had moderate erectile dysfunction, 11.1 percent had severe erectile dysfunction, and 19.4 percent had mild erectile dysfunction. There was no significant link with age, socioeconomic status, religion, education, or marital status. Conclusion: To fight the rising prevalence of sexual issues, the media and health care practitioners must give sex education. In order to address treatment demands and increase case discovery in the general community, sexology must also be included in undergraduate and postgraduate medical education. Providers of health care must educate and treat such persons as soon as possible.

20. Efficacy of External Fixation, K-Wire Fixation and Volar Locking Plate in the Management of Intra Articular Distal Radius Fractures in Adults
Rajesh Kurapati, Yugandhar Polepaka, Ramesh Ramineni
Background: Intra articular fractures of distal radius are unstable and complex fractures leads to severe pain, swelling, restricted range of motion. These fractures faced instability because fail to achieve anatomical reduction of fragments and surrounding ligaments. The present prospective study was designed to evaluate functional and radiological outcome of closed intrarticular distal radius fractures. A total of 42 cases with acute closed intra articular fracture of distal radius > 25 years of age were recruited. Among the study participants, 15 cases were treated with K-wire fixation, 15 with volar plating and 12 with external fixation method. Gartland and Werley score was used to assess functional recovery and Lindstrom and Frykman grading was used for anatomic evaluation. The functional outcome was assessed by Gartlannd and Werley score and anatomical outcome by Lindstrom and Frykman grading showed statistically significant between study groups (p<0.05). The grip strength and functional status was statistically significant between study groups. Wrist stiffness and infection are commonly associated with all fixation methods. Volar locking plating showed superiority in terms of radiological outcome and patient satisfaction than k-wire fixation and external fixation.

21. Relationship between Alcoholism and Severity of COVID-19 Infection: An Institution Based Study
Rakesh Raj E, Sri Vengadesh Gopal, Saravanan Pandian, Vignesh Thiruvalluvan, Sujethram Palanivelu
Background: Pandemic caused by Covid 19 infection witnessed several patients suffering from severe acute respiratory syndrome (SARS) due to severe inflammatory response. Risk factors that contributed to severe covid 19 infection include age, diabetes, previous lung disease, liver and kidney disease. Several other risk factors like smoking, alcoholism, hypertension and obesity are also being studied to understand their contribution in causing severe covid 19 infection and death. Alcohol is well known to cause immunosuppression and multiple organ injury including liver, pancreas and lung. It is a necessity to understand the effect of alcoholism on covid severity and risk of infection to create better awareness and understand the prognosis of covid 19 infection among alcoholics. The relationship of Alcoholism and COVID-19 infection is still controversial. In the literature, fewer studies are done to assess alcoholism and covid severity. Objective: The present study is done to find out the relationship of alcohol consumption on Covid severity among individuals admitted at Covid designated tertiary care hospital. Materials and Methods: This retrospective, cross sectional study was carried out in a covid designated tertiary care hospital. After approval from Institute Ethics Committee (Human studies), the patients admitted for covid illness from January 2021 to June 2021 were taken up for the study and their case records from medical records department were studied. Telephonic conversation was also done for patients with inadequate data. The collected data was entered in google forms and MS excel sheet and analysis done using descriptive statistics involving SPSS (version 24). Result: A total of 1109 patients were included in the study. Most of the patients in our study were males- 851(76.73). The male:female ratio was 3.2:1. The maximum patient belonged to the age range 30 to 60 years. CT severity was mild in most of the patients (32.82%). Diabetes was the most common (33.18%) comorbidity among the study population. Majority of the admitted patients were Non-alcoholics 884 (79.7%). Among alcoholics and non-alcoholics, majority showed normal, mild to moderate CT severity. There is no statistically significant association between alcoholism and CT severity score compared to non-alcoholics (p value=0.947). Also, there is no significant association between alcoholism and Covid severity among Diabetic and Hypertensive patients compared to patients without these medical morbidities. Conclusion: In conclusion, majority of the patients who required admission in hospital for covid illness treatment were non-alcoholics. There is no significant association between alcoholism and covid-19 severity compared to general population. Also, there is no significant association between alcoholism and Covid severity among Diabetic and Hypertensive patients. Further human and experimental studies with more sample size is needed for further clarification of our findings.

22. Association of Hypocalcemia with Disease Severity in Patients of Dengue – An Observational Study
Champa Kumari Saini, Chetanya Kumar Sharma, Madhurya M., Mahima Makhija, Deepak Raj Sakhnani
Background: Dengue is a vector-borne disease known to mankind since 1780. The main culprit being the dengue virus which is transmitted by Aedes mosquito. Dengue infection and Dengue hemorrhagic fever (DHF) are the major causes of morbidity and mortality in the tropical regions all over the world. An estimate reveals that 390 million people become infected with dengue every year, of which 96 million manifests apparently. Dengue virus is an arbovirus which belongs to the genus Flaviviridae. Aim and Objectives: To analyze the association of hypocalcemia with disease severity in patients of dengue as well as the prevalence of hypocalcemia and its potential value as a biochemical marker in patients with severe dengue infection. Material and Methods: This was an Observational cross-sectional descriptive study started from June 2019 onwards for One year, conducted at Department of General Medicine, SMS Medical College and attached group of hospitals, Jaipur, Rajasthan. After application of inclusion and exclusion criteria sample size was calculated 90 cases of Dengue as per previous studies, showing prevalence of hypocalcemia 29.9 % with 80% power, 0.05 α error and 10% absolute error. Result: In this study with the Sample size of 90 patients we found that 67.8% patients were less than or equal to 30 years of age, followed by 23.3% patients were between 31-45 years. Out of 90 patients 64.4% were having more than or equal to 4.7 mg/dL Ionic calcium and 35.5% patients were having less than 4.7 mg/dL Ionic calcium. 60 patients suffered from uncomplicated dengue fever out of which 53 patients were having ionic calcium more than 4.7mg/dl and 7 patients were having less than 4.7mg/dl ionic calcium whereas 30 patients suffered from Severe complicated dengue including DSS and DHF out of which 5 patients had ionic calcium more than 4.7mg/dl and 25 patients had less than 4.7mg/dl ionic calcium. Conclusion: From this study we demonstrate that the serum free calcium levels significantly correlated with the severity of Dengue fever. The serum free calcium levels were significantly lower and hypocalcemia was more prevalent in patients with DHF/DSS than in those with DF. Further studies and randomized control trials are required to evaluate the effectiveness of calcium therapy in the prevention of complications in dengue infection.

23. Telogen Effluvium as Sequela of COVID-19 in Patients from Central India: A Retrospective Observational Study
Arpita Mishra, Anand Kumar Dubey, Ashutosh Pandya
Introduction: Corona virus disease has several dermatological symptoms. Telogen effluvium is one of them. The present study presents a case series of post COVID Telogen effluvium from Central India region. Material and Method: This retrospective observational study included 72 patients (61 females & 11males), aged 29 to 62 years (median 49 yrs). The patient’s demography, history of hair fall, signs and symptoms, co morbidities and the treatment received for COVID-19 infection, Psychological perceived stress score, triggering factors for Telogen effluvium, Vitamin B12, Vitamin D and Ferritin levels were recorded & analysed. Result: The included patients were suffering from at least one co morbidity. Thirty patients had severe COVID-19 infection and were hospitalized. Psychological perceived stress score was low (12) in two, moderate (16-24) in twenty and high (29-38) in fifty patients. Vitamin B12 was low in twelve and Ferritin in ten patients. Seventy patients (97.2%) had positive hair pull test and 69 (95.8 %) had diffuse loss of hair. Discussion: Post covid Telogen effluvium was seen generally in females, and in middle aged. Most, 70/72 had moderate to severe psychological stress, Psychological perceived stress score was more than 16. Patients reported 2.2 to 6 months (median 3.5 months) after COVID-19 infection. Most 69 (95.8%) had diffuse hair loss. Post Covid patients may have several triggering factors for Telogen effluvium like psychological stress, nutritional deficiency or the drugs (heparin). Conclusion: Post Covid Telogen effluvium could be triggered by psychological stress, nutritional deficiencies (Vitamin B12, Iron) or drugs (heparin). Such cases could be managed by identification of triggering factors, proper counselling, high protein diet with vitamin supplementation.

24. Assessment of the Variations in Gross Morphology and Any Change in Histological Architecture in Cadaveric Liver
Nitisha, Kumari Ayushree, Pramita Kumari
Background: The aim of the present study was to investigate the type and frequency of anatomical variations and to find out any histological changes and correlate these with intrauterine development, in a collection of cadaveric livers. Methodology: Fifty livers from adult human cadavers irrespective of age and gender, fixed in 10% buffered formalin solution available in the department of Anatomy, ESIC Medical College and Hospital, Bihta, Patna, Bihar, India was studied. The specimens looked apparently normal. Histological sections from lingular process (if present) and different areas from the lobes in other specimens were taken and processed by H and E staining. These were observed for any variations in architecture and cellular structure. Livers were examined on different occasions by three observers. The results obtained were compared and ratified. The distinct morphological characteristics observed were recorded on data sheets. Results: The present study showed an incidence of 39 specimens of type 1 i.e. normal (78%). Types 4 and 5 are defined as livers with very deep renal and costal impression and diaphragmatic grooves respectively with incidence of 1 specimen each (2%). Type 6 is defined as liver with enlarged left lobe which was seen in 2 specimens (4%). Type 7 is defined as liver with lingular process of left lobe (8%). Lingular process is defined as tongue-like projection from the margin of liver. They have been categorized into three types: apical (2 specimen, 4%), conical (1 specimen; 2%) and rounded (1 specimen; 2%). Conclusion: Though many anatomical variations in the shape of the liver were encountered, histologically all specimens were normal hence the present study suggests that functionally these livers were normal. The possible explanation for gross anomalies could lie in its embryological development.

25. Retrospective Audit of Surgically Treated Patients of Carcinoma Penis at a Tertiary Cancer Centre of Eastern India
Shashi Singh Pawar, Kunal Kishor, Nadeem Ahmad, Manish Kumar, Sanjeet Kumar Singh, Kumari Anshu Lata
Introduction: Carcinoma of the penis is a disease of developing world with incidence rate of around 10% of all malignancies. There has been lack of data pertaining to carcinoma penis from this part of country. We therefore present our experience of management of penile cancer. Methods: A retrospective audit of all cases of penile cancer surgically treated between May 2017 and April 2021 in Department of Surgical Oncology, State Cancer Institute, Patna, Bihar was done. Comprehensive cinico-epidemiological data was recorded. Results: 56 patients were found to be eligible for our study. The mean age of presentation was 52.43 years. Majority of the patients were of rural background and low economic class. 66% of tumors primarily involved glans and 91% presented with ulcer. 59 % of patients had partial penectomy and 35.7% had total penectomy. 62.2 % patients underwent bilateral inguinal lymph node dissection, and 37.8 % patients underwent bilateral ilioinguinal lymph node dissection. Most common complication was reported to be lymphorrhoea. Majority of tumor (44.6 %) were of grade I differentiation. 34 out of 56 (60.7%) patients had lymph node involvement. Majority of tumors with T2 and beyond stage had lymph nodal involvement. Similarly, most high-grade tumors were associated with lymph nodal metastasis. Conclusion: Incidence of carcinoma penis rises with age. Surgery remains the mainstay of treatment. The type of surgery depends on various factors like size, grade, lymph nodal status etc. Patients may require adjuvant radiation therapy. In locally advanced cases neoadjuvant chemotherapy may help in down staging of tumor. Nodal metastasis is significantly associated with higher T stage and high-grade lesions (grade II & III). In view of poor outcomes of patients with regional or distant disease and the lack of a reliable tool in predicting risk of regional metastases, we strongly recommend aggressive surgical management of the inguinal lymph nodes.

26. Analysis of Auditory and Verbal Outcome of Cochlear Implant in Pediatric Age Group and Various Factors affecting it: Our Experience
Richi Sinha, Rakesh K Singh, Amit K Sharma
Background: Cochlear Implantation is not just a surgical procedure but a well formulated program to transform hearing, speech, and language. Intensive auditory rehabilitation is particularly essential in cases with delayed intervention, and those with relatively poor intelligence and cognition. To assess the outcome of this surgery, the commonly used scoring systems include Categories of Auditory Performance (CAP) level, Speech Intelligibility Rating (SIR) score and Parents’ Evaluation of Aural/Oral Performance of Children (P.E.A.C.H.) score. Aim: To analyse the results of cochlear implant surgery in pediatric patients in terms of SIR test scores, CAP scale and PEACH score and also to analyze various factors affecting these outcome measures. Method: A retrospective analysis of the records of 120 pediatric patients diagnosed with bilateral severe to profound sensorineural hearing loss who underwent cochlear implant surgery at the otorhinolaryngology department of Indira Gandhi Institute of Medical Sciences between 2017 and 2022 was performed. The parameters used to assess outcome included SIR score, CAP scale and PEACH score. These parameters were evaluated at various stages of follow up, 3, 6, 9 months initially and annually thereafter. Various factors affecting these outcome variables were also evaluated and their correlation was studied. These include age at the time of implant, duration of deafness, gender, duration of AVT, PEACH score and mode of AVT. Results: At 3 months the mean SIR score, CAP score and PEACH score were 1, 1.27 and 1.64 respectively; at 6 months these scores were 1.14, 1.57 and 1.71 respectively; at 9 months 1.5, 2.9 and 2.4 respectively; at 1 year 1.29, 2.96 and 2.46 respectively; at 2 years 1.25, 3.4 and 3.25 respectively; and beyond 3 years 1.79, 4.35 and 3.23 respectively. There is positive effect of Duration of AVT on SIR score and CAP score (p=0.06 and p<0.001 respectively) Effect of Age at implant on SIR and CAP score showed higher scores in 5-15 years of age group. (p= 0.325 p= 0.165 respectively). PEACH, SIR and CAP score show positive correlation (p<0.001). Out of total 120 patients 34 received offline AVT, 4 received online AVT and the remaining 82 patients attended AVT sessions both online and at the centre. When SIR and CAP scores were compared across the three groups there was positive correlation (p=0.01 and p=0.007 respectively). Conclusion: We conclude from this study that the longer the duration of auditory and speech training the better is the outcome. To encourage this, facility of online AVT can be a valuable option. Also, parental satisfaction is another factor which favors patient compliance and enhances the outcome of cochlear implant surgery.

27. Cochlear Implant Procedure: Our Experience
Richi Sinha, Rakesh K Singh, Amit K Sharma
Background: Cochlear Implant is the first bionic organ that allows a person to regain a sense and transform hearing, speech, and language in an otherwise handicapped individual. Cochlear implant is a relatively new technology where an electronic device is surgically implanted, and the electrodes are placed in the cochlea of the inner ear which stimulates the cochlear nerve. This requires a multidisciplinary approach of which surgical technique is an integral part. Several other factors influence the outcome of cochlear implant like the length of profound deafness, age at implant, etiology, use of hearing aids before implantation, family support and commitment, optimized programming and amount and quality of re/habilitation before and after implant. If carried out under optimum circumstances, the results are promising and highly beneficial. Aim: To describe and evaluate the epidemiology, sociodemographic factors, and surgical outcome in patients with hearing impairment who have undergone cochlear implant surgery at our center and to add to the current knowledge of approach to the cochlear implant procedure. Method: A retrospective analysis of the records of 131 pediatric patients diagnosed with bilateral severe to profound sensorineural hearing loss who underwent cochlear implant surgery at the otorhinolaryngology department of Indira Gandhi Institute of Medical Sciences between 2017 and 2022 was performed and demographic factors and surgical outcome were evaluated. Results: A total of 131 candidates were evaluated. Mean age of 3.26 years ± 0.91 in the age group 0-5 years and 6.96 ± 1.77 years in the age group 5-15 years was found. 79 (56%) were male and 62(44%) were female. All the patients belonged to low socioeconomic status except 1 with a wide geographic distribution. The mean duration of deafness was 4.33 ± 2.08 years. Radiology of temporal bone showed abnormal findings in 13(9.9%) cases. Mostly the right ear was operated (93.1%). The postoperative complications were observed in only 5(3.8%) cases and the mean duration of postoperative hospital stay was 8.09 days ± 2.25. Conclusion: Cochlear implant is not just a surgical management of deafness but a program that requires meticulous preoperative, intraoperative and postoperative care and evaluation. Its outcome depends on several factors. Considering the lower complication rates in our study we can say that this surgery is safe and reliable in pediatric patients when performed with utmost care.

28. Sexual Dimorphism in Lumbrical Muscles in Cadaveric Hands: A Morphometric Study
Nitisha, Kumari Ayushree, Pramita Kumari
Background: To know about morphometry and comparison between parameters of lumbrical muscles in both sexes of human hands. Methodology: This study was conducted in the Department of Anatomy in ESIC Medical College and Hospital, Bihta, Patna, Bihar, India with 40 forearms & hands (20 right & 20 left) of human embalmed cadavers of both sexes with the age range of approximately between 30-60 years. 12 cadavers were male (24 hands) and 8 cadavers were female (16 hands). The study was carried out during the routine dissection for undergraduate medical students in the department of Anatomy. With the help of scale, thread and digital vernier caliper, the following parameters were measured for Morphometric study: Length of muscle belly, Length of tendon, Breadth of muscle, and Width (Thickness) of muscle. Results: The present study was carried out in 40 hands irrespective of side of hands out of which 24 hands were of male and 16 hands were of female. The length of lumbrical muscles was found significantly different in all the lumbrical muscles. In male hands, range of tendon length was from 0.7cm to 2.0cm, with mean value of 1.2cm. In female hands, range was from 0.8cm to 1.3cm, with mean value of 1.0cm. On applying Unpaired T test, it was found significant statistically. In male hands, range of breadth was from 0.3cm to 1.8cm, with mean value of 0.96cm. In female hands, range was from 0.5cm to 1.2cm, with mean value of 0.82cm. On applying Unpaired T test, it was found significant statistically. Thickness of all lumbrical muscles was non-significant statistically. Conclusion: In this study, it was found that length of lumbrical muscles was found significantly different in all the lumbrical muscles. Tendon length and breadth of 1st lumbrical muscle was found significantly different in both the genders, while it was non-significantly different in all other lumbrical muscles. Thickness of all the lumbrical muscles was non-significantly different on comparing both the genders. The observations of the present study will be useful to anatomists, orthopedic and plastic surgeons.

29. Neovascular Glaucoma: An Update
Sunil Kumar, Ajay Kumar Sinha, Sujata Kumari
Background: Neovascular glaucoma (NVG) is a severe secondary and refractory condition accounts for a varying prevalence of 0.01 to5.1% of all glaucoma in different regions of world. This pathological condition which is caused by the new vessels over Iris and followed by growth of a fibrovascular membrane secondary to a local angiogenic stimulus over the trabecular meshwork obstructing aqueous outflow at angle of anterior chamber resulting increased Intraocular pressure (IOP), that results from a number of ocular and systemic conditions with retinal ischemia leading to anoxia as a mediator in over 95% of cases. Most of them are affected with proliferative diabetic retinopathy (PDR) followed by central retinal venous occlusion (CRVO), and ocular ischemic syndrome (OIS) along with other uncommon causes or all those causes that causes retinal anoxia which led to angiogenic activity in eye. Although NVG overall prevalence is low, but it is a dreadful condition led to blindness. The objective of this review is to provide detailed information on its basic and clinical aspects, to enable us to manage it logically. Here its Etiopathogenesis, methods of early diagnosis and management are discussed. It was concluded that if NVG is detected earlier and managed systematically (both medical and surgical) along with an eye on alleviation of different aggravating factors of the retinal hypoxia, it could be sight saving to the affected person.

30. Awareness about Monetary Compensation for Wage Loss in Cases of VL and PKDL in a Village of Highly Endemic District of Bihar
Varsha Singh, Sanjay Kumar, Shivani Agrawal, Shivani Sinha, Shefali Kuntal
Background: Prevalence of PKDL in endemic district of Bihar is not known. However, Post Kala-azar Dermal Leishmaniasis (PKDL) develops in 5-8% of patients apparently cured of Visceral Leishmaniasis (VL), and 5-10% of patients not earlier treated for VL. Skin lesions of PKDL are infectious to sand flies and may contribute to disease transmission. Govt of India and Bihar have incentive schemes for VL and PKDL cases. Monetary compensation for wage loss is given after VL and PKDL diagnosis and complete treatment. Mostly PKDL cases present with hypopigmented macular lesions and no other systemic symptoms. Patients do not have urgent need to get treatment. Objective: 1. To know the proportion of rural people who have knowledge about Monetary compensation for wage loss in case of VL and PKDL in the village2.To know the level of literacy of the people. 3. To know the type of housing of the people/community. Method-Community based cross sectional study. Total of 602 people were interviewed by trained staff and faculty of department of community medicine. Result: Less than 20% people knew about the Monetary compensation schemes for VL and PKDL cases. Source of information was ASHA in most of the cases. Literacy among males was 67% and among females it was 37%. There was significant difference between literate and illiterate people about the awareness of monetary compensation scheme.

31. Randomized, Prospective Double Blinded Control Trial Comparing the Efficacy of Fentanyl and Dexmedetomidine with Low Dose 0.42% Hyperbaric Levo-Bupivacaine for Elective Anorectal Surgeries under Saddle Block
Sachin Kumar, Shruthi H.R., Yashoda V., Shasihikala T.K.
Background: About 90% of the anorectal surgeries is performed in day care surgery basis. Most of the time benign anorectal surgeries will be done under saddle anaesthesia. Saddle anaesthesia is a type of spinal anaesthesia, that localizes to the lowermost sacral spinal segments allowing for preservation of lower extremity motor function and faster recovery. Methods: 240 ASA I&II Who were posted for elective benign anorectal surgeries were selected randomly by sealed envelope method. The study groups randomly divided into three groups (n=80). Group LD Received 4.2mg of 0.42% hyperbaric Levobupivacaine +10µg Dexmedetomidine. Group LF Recieved4.2mg of 0.42% hyperbaric Levobupivacaine + Received 4.2mg of 0.42% hyperbaric Levobupivacaine 25µg fentanyl, Group C 4.2mg of 0.42% hyperbaric Levobupivacaine +0.5 ml NS (Total of 1.5 ml). Results: Sensory onset and motor onset assessed, sensory onset in Group LD (2.41+0.724) min Group LF (2.01+0.464) min and Group C (3.8+1.141) min. Group LD has significantly faster sensory onset compared to Group LF and Group C (P<0.001). The total duration of analgesia in Group LD (314.54+54.719) min, Group LF (200.98+17.916) min, Group C (185.71+9.096) min(P<0.001), which was statically highly significant without motor block. Time for 1stvoid of urine in Group LD (242.56+36.82), in Group LF (135.90+10.93) min, in Group C (100.25+13.48) min (P<0.001), which was statistically highly significant, without any haemodynamic changes throughout the procedure. Conclusion: Low dose hyperbaric levobupivacaine with adjuvants like dexmedetomidine and fentanyl can aid no or least motor block with stable hemodynamic status and prolonged post operative analgesia with early ambulation.

32. Role of Biochemical Markers in the Monitoring of COVID-19 Patients
Jyoti Kumari, Dev Kant, Anita Suneel
Objectives: This present study was to evaluate the role of biomarkers for diagnosis and management of COVID-19 patients. Methods: Throat-swab upper respiratory specimens were obtained from 100 patients and real-time PCR (polymerase chain reaction) was used to confirm SARS-CoV-2 infection. Clinical characteristics and blood biochemical tests of COVID-19 patients were examined and recorded. Venous blood (4.5 mL) was obtained. Blood samples were dispensed into a gel tube. All tubes were allowed to stand for 30 minutes at room temperature, followed by centrifugation for 10 minutes at 3500 rpm to get the serum. Liver and kidney function test were performed to all patients. Results: In this present study, out of 100 COVID-19 patients, they had 20(20%) diabetic, 29(29%) smokers, 04(04%) cancerous and 15(15%) hypertensives. Mean age of COVID-19 patients was 42.4±13.18 years. Conclusions: Abnormalities in biochemical markers play a pivotal role in the SARS-CoV-2 pandemic, it is not only from a diagnostic point of view but also in terms of the management and prognosis of COVID-19 patients. It helps for clinical decision making in order to adjust the therapy to the biological changes experienced by the subjects. Changes in the biochemical markers indicate abnormalities in various tissues and organs, indicating the development of COVID-19. Urea, CK, and LDH show the most predictive parameters of severe COVID-19 patients. LDH as an important biomarker is associated with poor outcomes in COVID-19 patients.

33. Efficacy of Dexmedetomidine as an Adjuvant to Levobupivacaine in Caudal Anaesthesia in Paediatric Patients
Ankita Atri, Meenakshi Devi, Neelam Gupta
Background: Postoperative pain management is becoming an integral part of anaesthesia care. Single shot caudal block is a common technique for paediatric analgesia but with the disadvantage of short duration of action. Several adjuvants have been used to prolong the duration of caudal analgesia. So we designed this study using dexmedetomidine as an adjuvant with levobupicaine for caudal block to assess analgesic efficacy, duration of postoperative analgesia, hemodynamic stability and any adverse effects in children. Methods: After getting approval by Institutional Ethical Committee and written informed consent from parents, this prospective, double blind trial was carried on 80 children aged between 1 to 12 years scheduled for elective subumbilical surgeries that were allocated randomly into one of two groups. Children in Group A received 0.25% levobupivacaine 1 mL kg-1 body weight with 0.5 mL normal saline and in Group B received 0.25% levobupivacaine 1 mL kg-1 body weight with dexmedetomidine 1µg  kg-1 in 0.5 mL normal saline as caudal drug mixture. Results: The mean duration of analgesia in Group A was 324.±55.6 min and in Group B was 678±170.9 min which was statistically significant (p<0.001). The total analgesic requirement over 24 hours and the mean pain score was also lesser in group B. Conclusion: Dexmedetomidine in doses of 1 μg kg-1 as an adjuvant to 0.25% levobupivacaine for caudal block in pediatric infraumbilical surgeries provides significant prolonged postoperative analgesia and better quality of sleep without any increase in adverse effects.

34. A Study of Efficacy of Endoscopic Middle Meatal Antrostomy in the Management of Chronic Maxillary Sinusitis
Lakshmi Sowjanya, S. Shashi Kiran, B.V. Surendra
Background: Sinusitis refers to a group of disorders characterized by inflammation of the mucosa of the paranasal sinuses. The present study was conducted to assess the efficacy of middle meatal antrostomy in the management of chronic maxillary sinusitis. Materials & Methods: A hospital based prospective study was done in the department of otorhinolaryngology, Viswabharathi Medical College, Kurnool. The study involved the evaluation of 50 patients with chronic maxillary sinusitis of both gender after evaluating inclusion and exclusion criteria with consent. A clinical otorhinolaryngological examination and nasal endoscopy was conducted on all the patients. CT findings were evaluated. Pre and post-operative endoscopic findings and symptoms were compared. Complications encountered postoperatively were evaluated. All data were entered into excel sheets and statistical analysis was done by SPSS version 20. Results: Most of the patients presented with nasal obstruction, facial pain and headache. Most common endoscopic finding was middle meatalmucopus. Maxillary sinus opacity was the most common CT finding. There was an improvement in post operative period in symptoms and endoscopic parameters. postoperative middle meatus synechiae was developed in 4 % patients. Conclusion: In patients with persistent maxillary sinusitis, middle meatal antrostomy is a safe, minimally invasive, and effective surgery with a lower rate of complications and quick postoperative recovery.

35. A Comparative Study and Evaluation of Serum Adenosine Deaminase Activity in the Diagnosis of Pulmonary Tuberculosis
Rahul Jain, Rajendra Saugat, Gunjan Soni, Manak Gujrani, Jk Khatri, Ravi Chandak, Dheeraj Sharma, Tamanna Garg, Mohd Shakeel
Background: A Comparative study and evaluation of serum adenosine deaminase activity in the diagnosis of pulmonary tuberculosis. Methodology: This Hospital based cross-sectional study was conducted in the Department of Respiratory medicine, S.P. Medical College and P.B.M Hospital, Bikaner from Jan-2020 to Dec-2021 at Rajasthan after getting approval from ethical committee 100 cases and controls were randomly selected for the study. Written informed consent was obtained from each participant prior to participation in the study and the sample collection process. Data was collected and analysed with the help of Microsoft excel and statistical software SPSS and appropriate statistical tests were applied. Results: In our study mean ADA level in cases (23.66±4.72 U/L) was significantly higher as compared to control (12.62±2.11 U/L). ADA level was significantly lower after 2-month treatment (15.22±3.18 U/L) as compare to ADA level at the time of diagnosis ((23.66±4.72 U/L). our study found diagnostic accuracy of ADA was 82.00%. Conclusion: our study concludes in that serum ADA levels may be used as a supplementary aid for diagnosis of pulmonary tuberculosis and to evaluate the response to treatment at follow up.

36. Association of Metformin use with Vitamin B12 Deficiency and Peripheral Neuropathy in Indian Type 2 Diabetes Mellitus Patients: Can Supplementation Help
Jitendra Kodilkar, Vinod B Avhad, Sahil Sankalecha, Siddhant S. Jagdale, Vaishnavi Dikkar, Digvi Pandit
Background: Type 2 diabetes mellitus is one of the most common endocrine disorders in the world. Metformin is being used as monotherapy or in combination with other medications. In addition, lifestyle counselling, weight loss and exercise are usually recommended to every diabetic person particularly overweight and having normal renal functions. Literature is full of reports suggesting association between long-term metformin use and vitamin B12 deficiency. Objectives: To study the effect of vitamin B12 supplementation along with the metformin therapy on peripheral neuropathy in type 2 diabetes mellitus patients. Materials and Methods: This was a Cross sectional study conducted at a Tertiary care hospital of the city in 180 patients of Type 2 diabetes mellitus aged between 40-70 years who were on metformin therapy for more than 4 years to see the association. Results: The mean age of the patients were 54.6 +- 10.2 years, with 62% being men and 38% being women. Patients of type 2 diabetes mellitus on metformin for more than 4 years having VPT score more than 10 when given with vitamin B12 supplementation for 6 months, showed an improvement in their VPT scores though was found to be not statistically significant. Conclusions: Patients of DM on metformin may be suffering from silent cobalamin deficiency which might add to their existing symptoms of neuropathy and may impair their quality of life. Considering cost of laboratory investigation to rule out B12 deficiency and increasing prevalence of diabetes, it is not feasible that such monitoring will be possible in all diabetic patients of our country. The study proposes that supplementation of Vitamin B12 can be given in patients of diabetes on Metformin therapy. This might reduce the occurrence of peripheral neuropathy, reduce pain and suffering of diabetic patients and can improve their quality of life. It is a cost-effective approach to take care of peripheral neuropathy as chances of hypervitaminosis is less since Vitamin B12 is a water-soluble vitamin. However, such therapeutic approach should be done under expert medical supervision. Also, Larger studies needs to be planned to understand the exact mechanism of B12 malabsorption while on metformin, also to ascertain the association and the probable interventions to attenuate the peripheral neuropathy caused by metformin in the lager interest of our patients.

37. Role of Biochemical Markers in the Monitoring of COVID-19 Patients
Jyoti Kumari, Dev Kant, Anita Suneel
Objectives: This present study was to evaluate the role of biomarkers for diagnosis and management of COVID-19 patients. Methods: Throat-swab upper respiratory specimens were obtained from 100 patients and real-time PCR (polymerase chain reaction) was used to confirm SARS-CoV-2 infection. Clinical characteristics and blood biochemical tests of COVID-19 patients were examined and recorded. Venous blood (4.5 mL) was obtained. Blood samples were dispensed into a gel tube. All tubes were allowed to stand for 30 minutes at room temperature, followed by centrifugation for 10 minutes at 3500 rpm to get the serum. Liver and kidney function test were performed to all patients. Results: In this present study, out of 100 COVID-19 patients, they had 20(20%) diabetic, 29(29%) smokers, 04(04%) cancerous and 15(15%) hypertensives. Mean age of COVID-19 patients was 42.4±13.18 years. Conclusions: Abnormalities in biochemical markers play a pivotal role in the SARS-CoV-2 pandemic, it is not only from a diagnostic point of view but also in terms of the management and prognosis of COVID-19 patients. It helps for clinical decision making in order to adjust the therapy to the biological changes experienced by the subjects. Changes in the biochemical markers indicate abnormalities in various tissues and organs, indicating the development of COVID-19. Urea, CK, and LDH show the most predictive parameters of severe COVID-19 patients. LDH as an important biomarker is associated with poor outcomes in COVID-19 patients.

38. A Study of Three Different Scoring Systems for Prediction of Postoperative Nausea Vomiting
Namrata Sadafule, Madhavi Godbole, Aprajeeta Pandye, Manthan Indurwade
Introduction: Post-operative nausea and vomiting (PONV) is one of common side effect that occurs after the surgery. Although it is not fatal, there are several physiological changes which lead to uncomforted for the patients. For the avoidance, prophylactic anti-emetic management is provided empirically to all patients who are receiving aneasthesia but there is a need to assess patients before the surgery as all patients are not prone to PONV. For this purpose, there are various scoring systems of PONV and this study has considered Apfel, Koivuranta and Ulleval scoring system for its effective evaluation. Aims and Objectives: To statistically compare the efficacy of PONV scoring systems to predict risk of PONV in patients undergoing surgery. Materials and Methods: Total 200 number of patients enrolled in study which were posted for different type of surgeries. All patients were assessed for risk factors of all three mentioned scoring systems in pre-anaesthetic checkup. The scores obtained by the scoring systems were statistically analyzed. Result: Although all the scoring systems are effective in prediction of PONV, the study found that percentage of prediction of Ullveal scoring system is higher (80%) compare to other scoring systems but not only this sensitivity and specificity score of Ullveal scoring system is higher compare to other systems. Conclusion: The study has concluded that all the three scoring systems are effective to predict PONV but Ulleval scoring system is the most effective compared to other two scoring system for prediction of PONV.

39. Comparison of the Effect of Vitamin D on Osteoporosis and Osteoporotic Patients with Healthy Individuals
Sangram Kishore Sabat, Sucheta Panda, Gopabandhu Patra, Sambit Kumar Panda, Sidhartha Nayak
Background: Osteoporosis is metabolic disease of the bone and creating heavy burden on the community. The cost of treatment for the patient facing the problem of the osteoporosis is high as well as imposes irreparable costs on the health system. The prior screening can be helpful for reducing the cost of the treatment. According to clinical studies, as the living age increased the prevalence of Osteoporosis is increasing among the elder people. The older bones periodically absorbed by Osteoporosis in resoption site and replaced by new bone made by the Osteoporosis. This kind of process in body called as remodeling. Aim: The study aims to make comparison of the effect of vitamin D on osteoporosis and osteoporotic patients with healthy individuals. Method: The study was conducted in clinical trial on individual who were referred to bone destiny clinic of M.K.C.G Medical College and Hospital, Berhampur from January 2019 to April 2022. For the study, the participants were selected considering the age of 30-60 years and willing to take part in the study. For the current study, 400 individual who were taking the treatment related to bone. The primary data of the participants were collected using the checklist about the demographic information considering the age, gender, clinical examination and para clinical. For collecting and analyzing the data SPSS software version 23 was used. Results: The higher level of vitamin D was identified among the subjects aged between 31 to 40 years 64.2% and lowest was among the 51 to 60 years 6.2%. Apart from this, the bone density was higher among the 31 to 40 years 53.2% and lowest among the 20 to 30 years 13.2%.  Moreover, the percentage of vitamin D was higher in female in normal category 51.4%. Additionally, the level of bone density was also higher in female 54.5%. However, the percentage of bone density considering the inadequate level and shortage was higher for male 53.5% and 52.7% respectively. Additionally, the prevalence of Osteoporosis was found to be lower in the intervention group compared to the control. Here, P<0.01 and showing a statistically positive relationship between Osteoporosis and vitamin D deficiency. Conclusion: Prevalence of Osteoporosis is higher among the individual who has the deficiency of vitamin D and shows the significant relationship with gender and age. Therefore, the treatment of these patients with intake of vitamin D is helping to improve bone density.

40. A Prospective Trial to Compare the Efficacy of Bisphosphonate Therapy on Postmenopausal Osteoporotic Women with and Without Diabetes
Sangram Kishore Sabat, Sucheta Panda, Sidhartha Nayak, Sambit Kumar Panda, Gopabandhu Patra
Background: Type 2 diabetes and osteoporosis are postmenopausal issues among women. According to analysis, the diabetes is one of the major reasons of bone deterioration due to accumulation of advanced glycosylation. Therefore, more attention is required for treating the osteoporosis and prevents fractures in diabetic patients. For such patients, ibandronate 150 mg tablet is prescribed for once in month for increasing the bone mineral density. This is helpful for preventing the osteoporotic fractures. Moreover, osteoporotic is associated with the insulin secretion and sensitivity. Aim: The study aims to conduct a prospective trial to compare the efficacy of bisphosphonate therapy on postmenopausal osteoporotic women with and without diabetes. Method: The study was a multicenter prospective and open label design. The study was conducted from March 2020 to March 2022 at M.K.C.G. Medical College. The study protocol was reviewed by the ethical committee and managed according to standards and guidelines. The researcher has collected the consent form with all demographic information about the patients. For the analysis of the data collected for the study Shapiro-Wilk test was applied and normal distribution of variable was observed. The mean and standard deviation values were obtained through t-test. Results: The diabetic groups are older and having higher body mass. Moreover, the BMD, TBS and T-scores were not significantly different in these groups. Here BMD was investigated for all patients and it was carried out that lumbar spine for both groups was 3.41% and 3.71%, femur neck was 1.30% and 1.18% as well as the total hip was 1.51% and 1.58% in non-diabetic group. Unlike the BMD, no significant difference was identified for TBS as before and after the treatment which was 0.20 and 0.80. Conclusion: From the analysis, it has been carried out that bisphosphonate therapy is helpful for decreasing the bone turnover markers and increasing the BMD in postmenopausal women both with and without diabetes. Oral ibandronate can be useful for offering the treatment to the patient and improving the health.

41. Device-related Infections in Orthopaedic and Trauma Surgery
Soumya Nayak, Saroj Kumar Parida, Sangram Kishore Sabat, Sambit Kumar Panda, Gopabandhu Patra
Background: There are different types of infections that could have a significant impact on the health of the people. The surgical site infection (SSI) is one of the major issues that include deep, implant-associated infection that increase the serious complications in orthopaedic surgery. This is having a significant impact on morbidity and mortality. The outcomes of this are also involving the multiple revisions, poor financial and health related outcomes. There are some guidelines were also made for managing the operational activities and planning of the actions to minimize the infection and improve the health of the patients and staff members. Aim: The study aims to analyse device-related infections in orthopaedic and trauma surgery. Method: This was a multi-institutional case control study that conducted in SCB Medical College and Hospital,Cuttack between  September 2019 to March 2022.The study was approved by the ethical committee and followed the standards. For the study the case were defined considering the health of the patients who have any reinfection demanding any surgical revision in less than 1 year after the index procedure. Apart from this the control were defined as the patients who are not having infection demanding surgical revision. Results: The case patients were more likely involved in smoking especially male with the fracture fixation device. Moreover, the systematic antibodies treated was used for 14 and used for the 22 case and 109 control patients. The Univariate regression analysis has suggested an improvement in risk of recurrent infection with longer antibiotic treatment (OR 1.82, 95% CI 1.00 to 3.28, p = 0.049). The patient’s sub-sample with extramedullary fracture device-associated infections. Moreover, the baseline criteria were found well in both case and control and none of them is related to recurrent infection in univariate analysis. Conclusion: From the analysis, it has been considered that exposure of the infection in surgical process is having a significant impact on the health of the patients and affecting the recovery. Moreover, the large-scale confirmatory trails are needed for confirm the issues and developing the systematic process of reducing the reinfection among the surgical patients.

42. A Study on the Management of Non-Union of Fracture Distal Femur with Locking Plates
Biswakesh Panigrahy, Sanjay Kumar Behera, Goutam Satpathy, Sambit Kumar Panda, Sidhartha Nayak, Gopabandhu Patra
Background: The incidents related to the fracture occurring in 37 per 100000 persons per year. Distal fractures are common but difficult to treat using the traditional method of implants due to high failure rate and secondary varus collapse. The consideration of distal femoral fractures in young age groups is most common as the high energy trauma while older age is associated with low energy trauma along with osteoporosis. The non-union as fracture bone that has not completely healed in 9 months since injury which not showed any signs of healing over 3 consecutive months on serial x-rays. Aim: The study aims to analyze the management of non-union of fracture distal femur with locking plates. Method: This was a multi-institutional case control study that conducted in tertiary referral hospitals of MKCG MCH, Berhampur, Odisha and BBMCH, Balangir, Odisha between March 2019 upto September 2021. This study was a prospective study that has included the patients with non-union of distal femur. The patients were admitted and examined according to protocol after obtaining the details of the patients and collecting the consent from the patients. Moreover, the permission from the institution was obtaining the ethical approval to complete the study. To analyze the condition of the patients the fracture was classified as per the AO trauma and non-union score were also assessed for individual. Now, for the current study, 72 patients were selected, and 40 patients were followed up and 32 patients have lost follow up. Results: The right limb was observed among 60% of patients and 40% were found with the left limb. The observation study has found that 65% of fractures caused by the road accidents and rest 35% were fall from the height. Moreover, the 72% patients sustained trauma post road traffic addition and where 20% of patients were under the age of 50 years. 28% patients who fall from the height 2 were under the age of 50 years and 9 over the age of 50 years. Moreover, the study has observed the patient with non-union time in which 30% patients were less than 18 weeks, 50% were 18-24 weeks and 20% were more than 24 weeks. Conclusion: From the analysis, it has carried out that the operative treatment depends on the type of non-union and one and two steps procedure is used according to the principle of the diamond concept. The involvement of mechanical situation and local application of osteoconductive carriers is playing a significant role in managing the operations.

43. Efficacy of Intravenous Fentanyl and Magnesium Sulfate in Attenuating Haemodynamic Response to Laryngoscopy and Endotracheal Intubation
Bindu, Mallikarjuna, Davan K R
Introduction: Magnesium sulfate is cheap, readily available and widely used in obstetric practice with an established anaesthetic adjunct effect on hemodynamic parameters during anaesthesia and surgery. Narcotics have been extensively used for blunting the pressor response to endotracheal intubation. One of the most popular opioids used to attenuate this response is fentanyl. Aim: To compare the efficacy of fentanyl and magnesium sulfate in attenuating hemodynamic response during laryngoscopy and intubation. Methodology: A Comparative prospective randomized double blind study between two groups with 30 patients in Group F (Fentanyl) and 30 patients in Group M (MgSo4) was conducted. The study was conducted in the Department of Anaesthesiology at Bangalore Baptist Hospital, Bangalore. Results: There was insignificant rise in diastolic blood pressure in both groups after giving the study drug. Rise was strongly significant immediately after intubation and at 10th minute following intubation. Mean arterial pressure increased in both groups after intubation. Comparison of changes in mean arterial pressure across the groups indicated strong significance (P < 0.05) consistently following intubation till the end of study. Conclusion: It is possible that a combination of magnesium sulfate and fentanyl in lower doses may produce the benefits of both and is worthy of further studies and analysis.

44. A Cross Sectional Study of Correlation between Thyroid Dysfunction with Blood Sugar levels and Serum Lipid levels in Post Menopausal Women
Shobha Kumar Prasad, Kumari Nisha, Anil Kumar Mehta
Background: According to American Association of Clinical Endocrinologists, it has been found that millions of women with menopausal like symptom may in fact be suffering from thyroid disease. They predominantly have subclinical thyroid dysfunctions, Hypothyroidism being more than Hyperthyroidism. Objective: To study the correlation between thyroid dysfunction with blood sugar levels and Serum lipid levels in postmenopausal women. Methods: This cross-sectional study was conducted at Darbhanga Medical College and Hospital, Laheriasarai, Bihar. Total 100 Postmenopausal women who attending the outpatient and inpatient of Medicine department from June 2021 to May 2022. Results: 100 postmenopausal women were screened for thyroid dysfunction in this cross sectional study. Prevalence of hypothyroidism was found to be 22% and of subclinical was 8% and of thyrotoxicosis was 2%. It is seen that thyroid dysfunction has a correlation with duration of menopause with maximum patients having more than 10 years of menopause. Conclusion: Thyroid dysfunction is seen in a significant percentage of postmenopausal women. The predominant dysfunction seen is overt hypothyroidism, followed by subclinical hypothyroidism. The incidence of thyrotoxicosis was very less in these women. Hypothyroidism was seen more in women with increasing age and increasing duration of menopause and was associated with an increased BMI.

45. Laparoscopic Hysterectomy for Benign Conditions a Hospital Based Cross Sectional Study
Seema Kumari, Anupama Sinha, Archana Jha
Background: Hysterectomy is one of the most common surgical procedures performed in women. It is a ‘signature’ procedure for all gynaecologist. As a frequently done surgery the best route is imperative in the interest of the patients. Aim: The aim of this study is to evaluate, analyze the indications of surgery and compare hysterectomy, i.e., laparotomy for Total Abdominal Hysterectomy (TAH) and Non-descent Vaginal Hysterectomy (NDVH) in a patient with benign disease. Materials and Methods: In this hospital-based cross-sectional study, total Hundred women requiring hysterectomy for benign non-prolapsed uterus were selected for the study, 50 cases for each group were admitted due to benign gynaecological conditions in Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar from September 2019 to February 2020. Data were analysed statistically by simple proportions and statistical tests, i.e., Chi-square test and F-test. Results: Most of women underwent hysterectomy in either group were of age group 41-50 years. Age range was 30-55 years and women who underwent hysterectomy in study were of lower and middle socio-economic groups. Parity was 3 or more than 3 in most of the women who underwent hysterectomy in both groups. Nulliparity was 2% in NDVH and 4% in TAH. Majority of cases who underwent NDVH and TAH were of thin, and average built. In either group bleeding disorder was the most common chief complaints. All-women who underwent hysterectomy had Hb% more than 9gm%. Pap smear showed inflammatory or normal smear in most of the cases. On cervical biopsy pre-malignant lesion was present in 12% NDVH cases and 8% in TAH cases. On endometrial sampling, majority of cases who underwent NDVH had endometrial hyperplasia and those underwent TAH had normal endometrium. Majority of cases had history of previous surgery i.e. BLTL. Most common indications were DUB and fibroid comprising of 66% and 64% in NDVH and TAH group respectively. Majority of cases who underwent NDVH had normal to just bulky uterus (90%) in TAH utrine size was 6-12 weeks (in 64%). BSO was the most common associated procedure in TAH. ACR and PNR were the most common associated procedure in NDVH group. There was 1 case of failed surgery and 1 case of bleeding pedicle in NDVH. There was1 case of bladder injury in TAH group. Mean blood loss in NDVH was 254 gm where as in TAH was 136.6gm. Mean haemoglobin change in NDVH was 0.671 gm% where as in TAH was 0.79 gm%. Post-op minor complications were 98% in TAH group and 38% in NDVH group. Majority of patients in NDVH were ambulant within 24h. and in TAH group after 24h. to 36h. Blood transfusion was given in 4% cases of NDVH and 12% cases of TAH. Majority of NDVH cases were discharged on 4-5th day and TAH cases were discharged on 7-8th day. Fibroid was most common histological finding followed by endometrial hyperplasia in both groups. In NDVH groups cost was less as compared to TAH group. Vault granuloma was the most common finding on follow up of patients in both groups. One case of incisional hernia and 2 cases of hypertrophic scar were seen in TAH group. Mean convalescence period in NDVH group was 16-24 and In TAH group 42-36 days. Conclusion: The utility and safety of vaginal hysterectomy for the moderately enlarged uterus upto 12 weeks with good mobility and proper anatomic condition. Thought vaginal hysterectomy is possible for the uterus of more than 12 weeks size, it needs good experience. With experience operative time, blood loss and complications can be reduced.

46. Radiological Evaluation of Septic Arthritis
Ankita Kashyap, Pranjit Thapa, Dibyajyoti Nath
Introduction: Inflammation of joints by pyogenic bacteria results in septic arthritis. It is an emergency condition, which needs early diagnosis & treatment. Delay results in cartilage & joint destruction resulting in significant morbidity & mortality. The prevalence of septic arthritis patients in the emergency department varies significantly between studies. Higher rates of septic arthritis are present in immune-compromised patients and those with prosthetic joints. X-ray is commonly used for joint imaging as it is widely available. CT & MRI gives more precise information on joints & adjoining soft tissue involvement. Aim: The aims and objectives of this study were to evaluate age, sex distribution & the pattern of involvement of septic arthritis. Method: It is an observational study conducted in the Department of Radiology, Silchar Medical College & Hospital (SMCH), Silchar, Assam, India from 1st June 2017 to 31st May 2018, for one year, after taking approval from the ethical committee of Silchar Medical College and Hospital, Silchar in clinic-pathologically confirmed cases of septic arthritis. A total of 23 patients of confirmed septic arthritis patients were evaluated with X-ray, CT & MRI. These findings were compared using suitable statistical methods. Result: Of 23 cases of septic arthritis, the high incidence was found in the range 20-40 years (16 cases) followed by 40-60 years (4 cases).17 cases (74%) were males and 6 cases (26%) were females. The most common radiographic finding in septic arthritis was the presence of marginal erosions followed by joint effusion, joint space narrowing and periarticular osteoporosis. On USG joint effusion and synovial thickening were seen in all cases. Synovial hyperemia in the Doppler study was noted in 20 cases. Joint effusion contained echogenic contents in a maximum number of cases. On CT, erosions and joint effusion were seen in all cases. Synovial thickening was seen in 20 cases and joint space narrowing in 12 cases. On MRI, erosions, bone marrow oedema, joint effusion, and synovial thickening with enhancement were seen in all cases. Soft tissue involvement was seen in 10 cases. Conclusion: Imaging plays a vital role in diagnosing a case of septic arthritis and thereby decreasing both mortality and morbidity. Plain radiography is the basic first-line investigation. Ultrasound had an excellent sensitivity in diagnosing joint effusions, soft tissue changes and synovial thickening. CT also has a definitive role; however, radiation risks narrow down its use. MRI is the imaging modality of choiceas it is both specific and sensitive. The only limitation is high cost and more time consumed. The sensitivity of diagnosing septic arthritis by MRI was 100%, by CT was 91.3%, by Radiography was 70% and by USG was 43.5%.

47. Interventional Study Assessing Impact of Health Education Tool on Knowledge of HIV Transmission in Serodiscordant Couples in Mumbai
Lakshay V. Beri, Pallavi S. Shelke, Shrikala M. Acharya
Introduction: Heterosexual serodiscordant couples are those in which one partner is HIV positive and other is HIV negative. HIV negative individuals in such discordant couples are at a high risk of HIV infections and preventive interventions targeted at such individuals is the priority. Objective: This study was conducted to assess the impact of interventional tool on the knowledge of HIV transmission in serodiscordant couples. Material and Methods: Total 50 serodiscordant couples were selected from ART centre and their knowledge regarding safe sexual practices, benefits of condom use, role of exclusive breast feeding for HIV positive mother and care options for both HIV positive mother and the baby were assessed. Results: Mean age of positive male and female partner was 39 (SD+4) years and 34 (SD+5) years respectively. Significant improvement was observed in the knowledge of HIV transmission prevention, condom usage and vertical transmission reduction post intervention (p value <0.05). Conclusion: This study illustrates the interventions enhances the knowledge about HIV transmission reduction, vertical transmission prevention and condom usage among serodiscordant Indian couples. Therefore, conducting individual and group interventions seems to be beneficial among such population.

48. Anatomic Evaluation of Foramen Magnum and Occipital Condyles in Dry Human Skulls of Decca Plateau Region and Its Surgical and Medico Legal Significance
Dubbaka Ravikul Manuva, Naveen Kumar Edulla
Introduction: The Basicranium consist a largest bony aperture foramen magnum (FM), bounded with occipital condyles on its anterolateral aspect. The knowledge on morphology and morphometric dimensions of FM and occipital condyles plays an important role in craniovertebral surgeries. The present study was designed to evaluate the morphology and morphometry of foramen magnum and occipital condyles in the dry human skulls of Deccan plateau region, India. Material and methods: Sixty six adult human dry skulls of unknown gender were collected and evaluated at the Department of Anatomy. The morphologic and morphometric parameters like shape, anteroposterior and transverse diameter of foramen magnum; length and minimum & maximum width of occipital condyles, anterior and posterior intercondylar distance were measured and compared. Results: The oval shaped (53.03%) FM was more frequent, followed by round (13.63%) and hexagonal shape (13.63%). The FM has higher mean anteroposterior diameter (34.86mm) than transverse diameter (30.42mm). The mean difference of length, maximum width and minimum width of right and left occipital condyles was statistically not significant (p>0.005). Discussion and conclusion: The study results illustrated that the anteroposterior and transverse diameters and area of FM were similar with studies from different regions of India. However, the mean length, minimum and maximum width of occipital condyles was higher than the other regions in India. The present study attempted to evaluate the morphometry of FM and occipital condyles in the dry human skulls is first of its kind. The knowledge about the foramen magnum and occipital condyles is important for surgeons to achieve the convenient exposures at craniovertebral region with effective surgical outcome.

49. A Randomized Clinical Trial on Efficacy and Safety of Flecainide Alone and in Combination with Metoprolol in the Treatment of Atrial Fibrillation
Hitesh Reddy, Niketan. D, P. Saifulla
Introduction: To study the role of Flecainide alone, flecainide and Metoprolol and Metoprolol alone in attaining sinus rhythm, prevention of recurrence of Atrial Fibrillation (AF) in acute, persistent and paroxysmal AF patients. Objectives: To measure the resting and peak heart rates, exercise duration, maximum workload, sinus rate at the onset of arrhythmias, recurrence rate and exercise induced arrhythmias. Materials: 68 patients with AF studied over a period of 2 years with three anti-arrhythmic drug therapies (Metoprolol-22, Flecainide-23 and Combination therapy-23). Demographic details and clinical parameters were taken as variables: Resting and peak heart rates, exercise duration, maximum workload, sinus rate at the onset of arrhythmias, ECG changes (PR interval, QT interval and QRS complex), LV impairment and exercise induced arrhythmias. Results: 68 patients with AF were divided in to 3 groups (Metoprolol-22, Flecainide-23 and Combination therapy-23) of ant-arrhythmic therapies by randomization where the three groups were matching in relation to age, gender, duration of AF prior to the study, recruitment period after initiating the anti-arrhythmic drugs, duration of follow up, side effects, deaths and the clinical categories of AF. The clinical parameters of the three groups analyzed with Pearson R calculator and found to be significant (p value was 0.0001; p significant at <0.05). Exercise induced AF was observed in all three groups. Conclusions: Flecainide was found to be a safe, effective anti-arrhythmic drug which could be used as a monotherapy or in combination with Metoprolol with low side effects and no mortality. Combination therapy with Metoprolol gave an added advantage of controlling the heart rate both at rest and at exercise and preventing exercise induced arrhythmias.

50. Evaluation of Serum Lipid Profile Correction after Laparoscopic Cholecystectomy in One Year Follow-Up
Sourabh Trivedi, Samir Anand, Rahul Jaggi, Saurabh Sharma
Background: Gallstone disease is a prominent healthcare burden worldwide and is managed by laparoscopic cholecystectomy. The literature supports normalization of lipid profile after cholecystectomy after one month of follow-up. However, the change on long-term follow-up remains unascertained. The study examines the sustainability of lipid profile correction over one year follow-up. Methods: A cohort of 108 subjects undergoing laparoscopic cholecystectomy were enrolled. Demographic details documented and values of fasting lipid profile at pre-operatively, one-week, 6 months and 12 months post-operatively were noted. The mean values of all lipid profile parameters were compared with the pre-operative levels. Results: The first week post-operative follow-up only had significant increase in triglyceride (p-value: 0.02). Although, at six-month follow-up values of total cholesterol and low-density lipoprotein normalized (p-value: 0.01; 0.001 respectively), however, this correction was found ephemeral at twelve-month follow-up with comparable levels of all parameters to the pre-operative values. Conclusion: Lipid profile values seem to normalize after laparoscopic cholecystectomy; however, this correction seems fugacious on long follow-up. To sustain this rectification after cholecystectomy, it is advisable to enfold lifestyle modifications which could prevent a subsequent risk of future cardiovascular event.

51. Evaluation of Iron Status in Children Presenting with Febrile Seizure in a Tertiary Health Care Facility
Ayushi, Satwik Andrews, MohdAdil Khan, Prashant Tomar
Background: Febrile seizures are one of the most common forms of seizure in children and affect 2% to 5% children below the age of 5 years. According to clinical analysis, febrile seizures occur between the age of 6 months to 5 years with the temperature of 38 degree or higher. These are not caused due to central nervous system infection or any metabolic cause or without any history of prior afebrile seizure but influence the growth of brain. In addition to this, the fall in serum ferritin level provides the information related to deficiency of iron and can be seen prior to anaemia. The serum ferritin provides the information related to the iron store in the human body and helps to analyze the health condition of the individual. Aim: The study aims to evaluate iron status in children presenting with febrile seizure in a tertiary health care facility. Method: The current study is conducted using a cross-sectional approach. The study was conducted at GS Medical College and Hospital, Pilakhuwa, Hapur, Uttar Pradesh over the period of 4 months from March 2022 to June 2022 and approved by the Ethical committee. The researcher has followed the guidelines proposed by the committee to maintain the standards of the study. The written informed consent from was submitted to the committee to enrol in the subject study. For the current study, total of 100 children were selected from pediatric outpatient department and admitted to pediatric ward. For the selection of sample, consecutive method was used. The children enrolled for the study were aged between 6 months to 5 years having the history of seizures with fever. Moreover, children with iron deficiency were also selected for the study those have the problem related to the hematological other than iron deficiency. Results: Children from different age groups were considered, 80% were 6-24 months 12% 25-42 months and 8% 43-60 months for group 1. Group 2 has 24% 6-24 months, 20% 25-42 months and 40% 43-60 months. The current study involved 84% male and 16% female for group 1 and 48% male and 52% female for group 2. In Group 1 (febrile seizure) 44% subject had anemia while 56% had no anemia. In group 2 only 30% of subject had anemia. Moreover, there was significant difference found in both groups. In Group 1, 61.7% of subjects had iron deficiency and 38.3% has normal iron level. Apart from this, 23.3% in group 1 had low serum ferritin level and 43.3% had normal level and 33.4% had high serum ferritin level. Conclusion: Iron deficiency is common in febrile seizure and had the positive association with serum iron. Therefore, early detection and replenishment of iron store in children using the iron therapy can be helpful for increasing the iron level and decreasing the frequency of febrile seizure.

52. A Study of Thyroid Function Tests as a Prognostic Marker in Patients with Cirrhosis
Damodaran, J. T. Sathish Kumar, J. Balasubramaniyam, Bijin Oliver John
Background: In this study, we wanted to evaluate thyroid function tests in patients with cirrhosis and assess the severity of liver dysfunction in relation to the interpretation of thyroid function and its use as a prognostic marker. Materials and Methods: This was a cross-sectional study conducted among two hundred patients with cirrhosis admitted to the medical ward and attending the outpatient department at Government Vellore Medical College, Adukkamparai, Vellore, for one year (May 2021 to April 2022). Results: Age distribution was mainly between 40-49 years of age among males and between 20-39 years of age among females. The most common aetiology for cirrhosis among male patients was alcoholism. Among the females, autoimmune hepatitis, Hepatitis B, Wilson disease and cryptogenic cirrhosis were some of the common causes. The most common risk factor for Non-Alcoholic Fatty Liver Disease was found to be obesity. As the Child-Pugh score increases from A through B and C, the derangements in bilirubin, INR, degree of ascites, hepatic encephalopathy and serum albumin levels also worsen. Thyroid dysfunction was more pronounced in patients belonging to Child-Pugh C, less pronounced in Child-Pugh B patients and was absent in patients belonging to Child-Pugh A. Conclusion: As the severity of cirrhosis increases, from Child-Pugh A, B, and C, the thyroid dysfunction becomes more pronounced with the majority of patients having a low FT4 and high TSH. Hence, the usefulness of Thyroid Function Tests as a prognostic marker in patients with cirrhosis has been explored and positive results have been obtained. So, it is essential to perform a thyroid function test in all patients with cirrhosis especially those with higher Child-Pugh Score.

53. Study of Different Modalities of Scalp Defect Reconstructions & Devising a Treatment Protocol in a Tertiary Care Center in Eastern Part of India
Rasmi Ranjan Mohanty, Rojalin Mishra, Bibhuti Bhusan Nayak
Background: Various modalities for managing scalp defects have previously been described in the literature. Aims & Objective: This study estimates and describes the various causes of scalp injury and suitable method for closure of scalp defects in eastern part of India and to devise a treatment protocol for the management of scalp defects resulting from different conditions. Methods: A prospective study of patients who sustained trauma, electrical burns, marjolin᾿s ulcer of the scalp & bear mauling to the head from September 2018 to November 2020 was carried out in department of plastic & reconstructive surgery, SCB medical college & hospital, Odisha, India. Etiology, Size of scalp defect, age, sex and modalities of reconstruction were analysed. Results: Thirty-four patients were enrolled in this study. Twenty-seven electric burn injuries accounted for most of the scalp injuries. The scalp defects in 28 patients were covered using local scalp flap rest with free flap, regional flap or skin graft. X ray skull and NCCT brain were used to assess the underlying calvarium. Conclusions: Majority of the soft tissue defects of the scalp resulting from trauma, high- voltage electrical burns, resection of marjolins ulcer & bear mauling can be managed with local scalp flaps alone. In cases of larger defects, free flaps can be used. Other methods of coverage include SSG and tissue expansion using expanders. In cases of progressive diseases like electric burns delayed reconstruction is better. Secondary procedures for cosmetic reconstruction and alopecia management are required later.

54. A Prospective Study to Evaluate the Effect of Deep Breathing Exercises and Incentive Spirometry on Pulmonary Functions in Patients before and After Laparoscopic Cholecystectomy
Sharad Kumar, Shailly Gupta, Lily Upreti, Ram Manoj Parik
Introduction: Postoperative pulmonary complications have been found to be lower in patients with laproscopic cholecystectomy who receive physiotherapy and respirator compared to those who do not take it. Aim: to compare the effect of deep breathing exercise, flow incentive spirometry, on pulmonary function and diaphragm excursion, following laparoscopic surgery. Methodology: The study was carried out in S.N Medical College, Agra, starting from December 2016 to September 2018. Eligible patients were selected based on the inclusion and exclusion criteria. Randomization carried out by using sealed envelops method. Results: There was a statistically significant decrease in Forced Vital Capacity (FVC) in the 1st day when compared with the preoperative period in all groups. The mean difference in values between the preoperative and the 1st postoperative day in the Deep Breathing Exercise group was 0.57 (21.11%), the Flow Incentive Spirometry group was 0.67 (25.19%), and in the control group was 0.85 (37.78%). Conclusion: There is a significant decrease in pulmonary function {Forced Vital Capacity (FVC), Force Expiratory Volume in the first one second (FEV1), and Peak Expiratory Flow Rate (PEFR)} and on the 1st postoperative day when compared to the pre-operative day in laparoscopic cholecystectomy surgery patients.

55. A Comparative Study of the Effectiveness of Topical Betamethasone Dipropionate and Tacrolimus in the Treatment of Alopecia Areata
Sowmya Alahari, G. Reena Prasoona, K. Raj Kumar, P. Anil Kumar
Objective: Alopecia areata (AA) is a typical disorder that results in patchy, non-scarring hair loss at the scalp. To allay the patient’s concern over appearance, a variety of treatment approaches have been tried. The current study compares the efficacy of Tacrolimus and topical Betamethasone dipropionate in the management of patchy alopecia areata. Methodology: It was a prospective, randomized trial conducted over 12 weeks. In this study, 60 patients between the ages of 10 and 50 with alopecia areata of either sex were included. Patients were separated into A and B therapy groups. Group A was administered a lotion containing 0.05 percent betamethasone dipropionate (BMD) twice daily. Group B was administered a topical lotion containing 0.05 percent Tacrolimus twice daily. At the conclusion of 12 weeks, the groups’ responses were compared using the alopecia grading scale (AGS) and regrowth score (RGS), and adverse effects were assessed. Results: We found that 80% of patients in Group A showed statistically significant clinical improvement (RGS 3 and 4) when compared to 10% of patients in Group B. Mean AGS was improved in group A (AGS 4.23) compared to Group b (AGS 10.96) at the end of 12 weeks of treatment. Side-effects encountered with Topical Betamethasone were comparably less than with Topical Tacrolimus. Conclusion: Betamethasone is more effective than Tacrolimus in promoting hair regrowth in patients with patchy alopecia areata.

56. A Study to Correlate Liver Function Tests in Patients of Congestive Heart Failure
Shyam Savaliya, Amit D Mehta, Gaurav Sharma
Background: The liver being a multifunctional organ with major function of various metabolisms, it is strongly dependent on hepato-cardiac vascular connection. Objectives: To study the relationship between liver function test (LFT) and severity of congestive heart failure (CHF) and to correlate the functioning of liver with etiology of CHF patients. Materials and Methods: This prospective observational study was conducted in General Medicine department of tertiary care teaching hospital of Udaipur, Rajasthan. All patient aged 18-65 years with CHF of any aetiology were included. Serum bilirubin, serum SGOT and SGPT, serum ALP, serum proteins and prothrombin time was measured in all the patients and these were correlated with the severity of cardiac disease. Results: There was significant rise in mean serum ALT level, AST level, prothrombin time and bilirubin level with advancement of heart failure severity and were found highest in NYHA class IV. (p<0.001) The mean albumin level had decreased significantly as the severity of heart failure increased and was found lowest in NYHA class IV. (p <0.05) The mean serum ALP values didn’t show any significant correlation with NYHA classification of heart failure. (p>0.05). Conclusion: This study concluded that LFTs were significantly elevated in NYHA class IV of heart failure as compared to NYHA class I and LFTs showed significant correlation with severity of heart failure (NYHA class). Early and timely management of congestive heart failure will improve LFTs and will prevent significant liver failure.

57. Comparison of Diagnostic Effectiveness of Ultrasound Elastography and Color Doppler in Breast Mass Lesion Presuming Histopathology as Gold Standard
Shashi Meena, Narendra Kumar Meena, Devraj Yadav
Background: Breast cancer originates from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Breast ultrasonography (US) is widely used as a diagnostic tool in evaluating mammographically detected masses, palpable lumps, nipple discharge and in guiding biopsy. The purpose of our study is to confirm the utility of elastography and color Doppler with B-mode ultrasound to differentiate benign from malignant breast masses. Aims: To assess & compare the diagnostic effectiveness of B-mode ultrasound, color Doppler and US elastography in evaluation of breast masses assuming histopathological examination as gold standard. Materials and Methods: The observational study group consisted of 150 patients suspicious breast masses referred from Surgery Department for mammography, ultrasound and elastography. Results: In the study patients were between 18-60 years of age. Benign lesions were common in the 21-30 years and malignant lesions in the 41-50 age group. The commonest benign lesion encountered in the study was fibroadenoma (38) followed by fibrocystic disease (27). Majority of malignant lesions was invasive ductal carcinomas. Benign masses were predominantly well defined hypoechoic, round or oval in shape, regular margins, having pseudo capsule or smooth margins, homogenous solid mass or anechoic cystic mass with regular margins showing posterior acoustic enhancement. Breast carcinoma were predominantly hypoechoic, ill-defined mass with irregular margins, heterogeneous echotexture and showed posterior acoustic shadowing. On color Doppler USG high proportion of malignant lesions showed increased vascularity as compared to benign lesions, with malignant lesions showing predominantly grade 2, however Doppler alone gave high false positive values. On US elastography malignant lesions showed more toward blue pattern indicating hardness of lesions while benign lesions showed more of red pattern indicating soft lesions thus predicting chances of malignancy.US elastography proved to be more accurate than Doppler and B– mode USG in categorizing the majority of disease entities. Sensitivity, specificity, PPV, NPV and accuracy of US elastography is 85.4%, 91%, 83.6%, 92%, and 89% respectively, which were definitely higher than B mode ultrasound and Doppler. Conclusion: US elastography is a safe and effective method for evaluation of breast lesion. In maximum number of cases the synchronized evaluation and characterization of breast lesion by US elastography will help in overall assessment of breast lesions. By use of US elastography, highest level of sensitivity, specificity and accuracy was achieved.

58. Role of Prognostic Factors in Non-Muscle Invasive Transitional Cell Carcinoma of Bladder
H. L. Prasad, H. S. Prakash, K. N. Nithyashree, Das Debabrata
Background: Bladder cancer is the 9th most common cancer worldwide & accounts for 7% of all cancers in male and 2% of all cancers in female. Bladder cancer is a heterogeneous disease, with 70% of patients presenting with superficial tumours and 30% presenting as muscle-invasive disease associated with a high risk of death from distant metastases. Bladder cancer is less common in developing areas, with 0.6% of men and 0.2% of women diagnosed before the age of 75 years. Materials and Methods: A Cross sectional study conducted from January 2019 to June 2021 at K.R Hospital, Mysore. Study included 40 patients of all age group with NMIBC, who were diagnosed by ultrasonography/CT-KUB and underwent TURBT, the progress of the study and data collection reviewed every two months and at the end of study period, data was analysed with SPSS software in reference to prognostic factors in NMIBC. Results: These patients were within the age of 45 and 86 years with a mean age of 63.22 years. 82.5% were male and 17.5% were female. 77.5% patients had Hematuria as the main symptom. 17.5% and 5% patients had dysuria and increased frequency of micturition along with Hematuria respectively. Out of the 40 patients 13 had T1 disease and 26 had Ta disease. One patient had Tis component. Out of 10 patients, who had received BCG, 3 patients had recurrence and underwent check cystoscopy and Re-TURBT. Among those 3 patients, 2 (5%) patients progressed to T2 (MIBC). And the patients who progressed to MIBC were found to be of T1G3 and Tis group of tumours. Conclusion: Our results suggest that intravesical BCG therapy with lower dose than recommended after transurethral bladder resection for stage T1 grade 3 bladder cancer may delay the time to recurrence and cystectomy. Further large-scale randomized study is required to assess the outcome after short course BCG with lower dose in high grade NMIBC.

59. Evaluation of Effectiveness of Simulation-Based Basic Life Support Training Among the First Year Medical Students
A. Anbu Muruga Raj Annamalai, Prasath Chandran
Background: Cardiovascular disease is the first and foremost cause of morbidity and mortality worldwide. Cardiorespiratory arrest is fatal without resuscitation. BLS is the foundation for saving lives after cardiac arrest. An integral part of BLS is effective Cardiopulmonary resuscitation. In this regard, it is important for the medical students to learn and perform cardiopulmonary resuscitation effectively. For this student will undergo simulation-based CPR training. We conducted this study to know about the existing knowledge BLS among medical students and then evaluated the impact of simulation based BLS with the help of mobile application training by conducting written and practical tests. Aim: The aim of the study was to evaluate the knowledge and technical skills of first year medical students in providing BLS, after undergoing the simulation based BLS training with the help of mobile application. Methodology: A total of 150 first year undergraduate students of First year MBBS, of both sexes, were included in this experimental study. Patients were randomized into two groups with computer generated random allocation number, namely Group A-75 students (mobile application with traditional video-based learning) and Group B 75 students (traditional video-based learning). A self-administered, pre-tested questionnaire was given, a pre-test and post-test along with a practical skill assessment. The data were analyzed using the statistical package for the social sciences version 22.0 – paired t-test and multiple regression analysis. Feedback was collected from the participants whether BLS training was helpful with the help of 5-point Likert scale with rating. Results: A total of 150 students were participated with 69 males and 81 females. There was a statistically significant difference between pre-test and post score in terms of compressions per cycle, average depth of compressions, compressions in 2minutes between two groups. Conclusion: Introducing a mobile application in the traditional video-based learning with simulation training is an effective innovative and interesting teaching learning method.

60. A Study of Clinicoaudiological Profile of Ossicular Status in Chronic Suppurative Otitis Media Patients: A Prospective Study
Amit Kumar Sharma, Mahesh Kumar, Paresh Chavan
Background: COM is a common disorder which causes hearing deficit. It can be due to perforation of tympanic membrane or ossicular erosion. Aim: To find out ossicular profile in COM and to correlate it clinically with hearing status. Material and Methods: A total of 137 patients with COM who underwent surgery were included in the study. Results: Hearing loss was significantly higher in males & in patients with ossicular erosion. Conclusion: Ossicular erosion can rise to hearing loss of more than 60dB.

61. A Study to Assess the Role of NT-PROBNP as a Prognostic Marker in Pregnant Women with Heart Disease
Hemant Narayan Ray, Prattay Guha Sarkar, Nishu Kumar, Dhananjay Kumar
Background: The signs and symptoms of pregnancy can be very similar to the signs and symptoms of cardiac decompensation, the clinical diagnosis of cardiac disease in pregnant patients is complicated even more; as a result, additional tests, such as serum NT prob-BNP levels, may be useful diagnostic markers to detect adverse events during pregnancy. When ventricular volume and pressure rise, the neurohormone NT pro-BNP is released. It has a high sensitivity and specificity for detecting heart disease that is unaffected by subjective variables. Aim and Objectives: To assess the performance of NT-proBNP as diagnostic tools for cardiac complications, including heart failure and pre-eclampsia, in pregnant women and recently delivered women. Material and Methods: This study prospectively enrolled 50 pregnant women with heart disease and 50 pregnant women without heart disease receiving care at RIMS. All pregnant women with congenital or acquired cardiac lesions admitted from Jan 2020 to June 2021 were eligible for enrolment. All women were followed throughout pregnancy and until 3 days after delivery. Results: Median age of both cases and control was 26 years. 44 % of cases (n=22) and 42% of control (n=21) were of gravida 2, with median gravida of 2 in both cases and control. There was significant association between level of NT-proBNP in all the three trimester and requirement for increased dose of diuretics, hospitalization for heart failure, pulmonary arterysystolic pressure, severity of tricuspid regurgitation, NYHA class, DCMP and requirement for LSCS. Conclusions: There was significant association between level of NT-proBNP in all the three trimester and requirement for increased dose of diuretics, hospitalization for heart failure, pulmonary arterysystolic pressure, severity of tricuspid regurgitation, and all NYHA class.

62. A Randomized Comparative Assessment of the Maternal and Fetal Outcomes and Adverse Effects of both Intravenous Labetalol and Oral Nifedipine
Priyanka Shahi, Geeta Sinha
Aim: To compare the two most commonly used drugs, oral nifedipine and IV labetalol in terms of their adverse effects, maternal and perinatal outcomes. Material & Methods: The present study was a prospective randomized double blind comparative clinical trial conducted in the Department of Obstetrics & Gynecology, Patna Medical College & Hospital, Patna, Bihar, India. The study was done over a period of four months in which a total of 100 women with sustained hypertension of 20 weeks pregnancy or more were enrolled in the study. Results: In our study we observed there is a higher incidence of preeclampsia in the first pregnancy. No notable adverse effects were reported in the majority of the recruited patients. The commonest adverse effect was nausea in both groups. Conclusion: Both intravenous Labetalol and oral Nifedipine are efficacious having minimal side effects; however oral Nifedipine controls hypertension more rapidly compared to intravenous Labetalol.

63. An Observational Assessment of the Prevalence of Hypothyroidism in First Trimester Pregnancy in Primigravida
Priyanka Shahi, Neena Agrawal, Geeta Sinha
Aim: To find out the prevalence of hypothyroidism in first trimester pregnancy in primigravida in a tertiary care hospital of Bihar. Material & Methods: This was conducted in the Department of Obstetrics & Gynecology, Patna Medical College & Hospital, Patna, Bihar, India over a period of 5 months. Total 300 pregnant women with singleton pregnancy presenting in first trimester were included in the study. Results: In this study 22 out of total 300 study subjects showed hypothyroidism. 6.6% patients had subclinical hypothyroidism 1% patients had overt hypothyroidism. Conclusion: Duration/trimester of pregnancy, gravida status, socioeconomic status, all have possible role in deciding the prevalence of hypothyroidism in pregnant population.

64. A Single Centre Hospital Based Assessment of the Functional Outcome of Scaphoid Nonunion Treated with Herbert Screw and Bone Grafting
Manoj Kumar, Swati Sinha
Aim and objective: The aim of this study to evaluate the functional outcome of scaphoid nonunion treated with bone grafting and Herbert screw fixation. Material and Methods: This study was done in the Department of Orthopedics, ESIC Medical College, Bihta, Patna, Bihar, India, for the period of 1 year. 50 cases were referrals from peripheral centers with a possible diagnosis of scaphoid nonunion after failed conservative treatment. 50 patients were initially assessed with fresh radiographs and MRI wrist was taken in all cases. The injuries were classified according to Herbert’s Classification. Clinical examination included the assessment of tenderness, active and passive range of movement in wrist, and grip strengths were also measured. A firm padded removable splint were used to support the wrist for the first two weeks and after the suture removal, patients are advised to start mobilizing exercises of the wrist. Results: There were 50 cases of scaphoid nonunion treated with Herbert screw fixation and cancellous bone grafting. All the patients were males and dominant hand was involved in 45 cases. Out of 50 patients 22 patients had road traffic accidents, 25 had fall on outstretched hand and 3 fracture caused by assault. The right wrist was affected in 42 cases and left in 8 patients.The mean time from injury to surgical fixation was 15 months. The mean age of the patients was 28.5 years. Our study resulted in 60% excellent, 30% good and 10% fair functional outcomes. 98% of patients were satisfied with the outcome of the procedure mostly because they could return to job with a painless joint. Most of our patients had moderate to severe pain preoperatively, but 86% cases had no pain at the latest review. Conclusions: We concluded that the healing of the nonunion is better than that in other surgeries like k wire fixation or bone graft surgeries alone.

65. A Nested Case-Control Assessment Determining Emerging Risk Factors in Patients of Acute Myocardial Infarction
Sandeep Kumar, Sunny Kumar, Meetu Kumari
Aim: To determine the risk factors associated with patients of acute myocardial infarction. Materials and methods: This study was a nested case-control was carried out to determine risk factors associated with AMI in the Department of Medical Cardiology, Indira Gandhi Institute of Cardiology, Patna, Bihar, India. Cases from the cohort of patients with in-hospital AMI identified and compared with controls. The study duration was one year. Results: Case patients had a mean (SD) age of 65.5 (11.0) years and control individuals had a mean (SD) age of 65.5 (11.0) years. Variables associated with an increased risk of in-hospital AMI included being married, a history of coronary artery disease, prior myocardial infarction, peripheral vascular disease, elevated heart rate. Conclusion: Factors associated with an increased risk of in-hospital AMI included history of atherosclerosis, traditional atherosclerotic risk factors, and markers of physiological stress. Additional research to define risk reduction and optimal treatment strategies of in-hospital AMI are needed to address this common and high-risk condition.

66. To Analyze Different Histopathological Patterns of Endometrium in AUB
Manish Kumar Jha, Santosh Kumar, Prashant Kumar
Aim: To analyze different histopathological patterns of endometrium in AUB and observe the incidence of various pathologies in different age groups. Material & Methods: This one-year prospective study was done in the Department of Pathology, Darbhanga Medical College, Laheriasarai, Darbhanga, Bihar, India. which included 100 cases of clinically diagnosed AUB. Results: The present study has been conducted on 100 specimens of the endometrium (endometrial curetting’s/biopsy and hysterectomy specimens) received in the Pathology Department. Maximum 41% were of proloferative endometrium followed by hyperplastic and Secretory endometrium 17cases. Conclusions: Our study revealed the highest incidence of AUB in the perimenopausal age group (41-50 years). Hence a thorough histopathological workup and clinical correlation are mandatory in cases of abnormal uterine bleeding.

67. A Hospital Based Study to Correlate the Degree of Thrombocytopenia and Platelet Indices with Neonatal Sepsis
Santosh Kumar, Prashant Kumar, Manish Kumar Jha
Aim: To correlate degree of thrombocytopenia and platelet indices with neonatal sepsis in our NICU set up. Material & Methods: This study was conducted in the Department of Pathology, Government Medical College, Bettiah, Bihar, India, we studied total 100 cases over a span of 8 months. Results: 40 out of 150 neonates (26%) were classified as sepsis proven, as they have positive blood culture, 63 (42%) had probable infection and 47 (31%) were non-infected  Gram negative organisms were more commonly isolated in neonatal sepsis cases. Pseudomonas aeruginosa was isolated in 16 cases out of 40 proven sepsis which was most common organism found in our NICU set up. Conclusion: Variation in the degree of thrombocytopenia and platelet indices was seen in neonatal sepsis. Severe degree of thrombocytopenia associated with proven sepsis. PDW was significantly increased in newborns with sepsis. Gram negative organisms were common cause of neonatal sepsis.

68. Observational Cross Sectional Study to Assess the Adherence Status to the Medication in Patients Suffering from Hypertension, in a Tertiary Care Teaching Hospital of North Bihar
Anita Kumari
Aim: Adherence to medication in patients suffering from hypertension. Material and methods: This observational cross-sectional study was carried out in the Department of Pharmacology, Shree Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. The participants suffering from hypertension and on treatment for the past 12 month were recruited in the study after they gave a written informed consent. A detailed history was taken and the participants underwent a thorough clinical examination, they were also given counselling for life style modifications. The patients were given questionnaire of Morisky Medication Adherence Scale-8 (MMAS-8) and WHO- QOL Bref; they were given time to fill up the questionnaire in a separate room without any interference from the treating physician. Results: The mean age of patients was 54.16±11.01 years, the mean number of medication used was 1.78±0.89 per person and 75% of patients were taking combination of drugs for hypertension. The mean MMAS-8 Score was 4.40±1.17. As compared to participants in Group 1 who were taking a single medication, the participants in Group 2 were on 2.51±0.60 medication per person for treatment of hypertension. The number of participants in Group 1 who were on single compound in one medication was 35 which was statistically (p<0.05) higher than participants in Group 2 (n=15). The mean duration of illness was significantly (p<0.05) less in Group 1 as compare to Group 2 (4.34±2.44 years vs. 5.42±2.72 years), the MMAS-8 scores were significantly (p<0.05) higher in Group 1 (4.75±1.30 vs. 3.83±0.87) – patients in Group 1 were more adherent to treatment as compared to Group 2. WHO-QOL bref scores are shown in Fig. 1. Group 1 had higher scores in 3 domains that is, physical health (11.86±1.36 vs. 11.82±1.35), and social relationship (12.96±3.98 vs. 12.34±3.96)     and environment (11.76±1.32 vs. 11.75±1.36) whereas Group 2 had higher scores in psychological (12.67±2.36 vs. 12.84±2.25) domain, but it was not statistically significant. As the questionnaires were to be filled up by patients only, hence there was a possibility of interpretation bias based on understanding of the patients. Conclusion: To conclude it was observed that patients had a low adherence score and it was significantly lower in patients who were taking two or more medications in combination or single compound.

69. Single Centric Hospital Based Observational Prospective Assessment of Clinico-Laboratory Profile of Seropositive Celiac Diseases in Severe Acute Malnutrition
Ashutosh Kumar Verma
Aim: To study clinico-laboratory profile of seropositive Celiac Diseases in Severe Acute Malnutrition. Material & Methods: The present study was single centric hospital based observational prospective study, conducted at Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Lady Hardinge Medical College, Delhi, India. The study was conducted over a period of one year. All the children of 1-5 years age group suffering from Severe Acute Malnutrition (SAM) admitted in Department of Pediatrics. Total 100 children with Severe Acute Malnutrition in age group 1-5 years, admitted in MTC were enrolled and screened for celiac serology. Out of these 100 cases celiac serology was positive in 25 cases with sero-positivity of 25%. Results: While mean MUAC was 11.88±1.47 v/s 11.38±1.14. The difference in MUAC in seronegative and seropositive cases was statistically insignificant (p-value>0.5). Total no. of cases in form of Z-score (<-2SD, <-3SD) in seronegative group and seropositive group were 2,73 and 0,25 respectively. This difference in sero-negative and sero-positive cases was statistically insignificant (P-value= >0.05). Conclusions: Recurrent diarrhoea and blood in stool were common presenting feature on admission in celiac seropositive patients suffering from severe acute malnutrition. Vit. B12 and Folic acid deficiency were also observed as a common finding in seropositive patients.

70.  Prospective Interventional Assessment of the Anatomic and Functional Results of Endoscopic Composite Cartilage Tympanoplasty in Chronic Otitis Media Cases with Safe Central Perforation
Deepak Kumar Raman, Raj Kumar Choudhary, Rana Pratap Thakur
Aim: To determine the anatomic and functional results of endoscopic composite cartilage tympanoplasty in chronic otitis media cases with safe central perforation. Material & Methods: This prospective interventional study included 60 patients of chronic otitis media with dry and safe central perforation (small/medium), who underwent endoscopic composite cartilage tympanoplasty (type I) in the Department of ENT, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India over a period of 4 months. Results: The pre-operative ACT was 43.74 ± 8.62 dB whereas postoperatively it was 33.47 ± 7.38 dB and the difference between the pre-operative and post-operative values was found to be statistically significant (p=0.001). Conclusions: This study concluded that endoscopic composite cartilage tympanoplasty in chronic otitis media cases with dry central perforations is an effective surgical modality with good audiological and morphological outcomes and negligible post-operative complications.

71. Hospital in-Patient Based Prospective Study to Assess the Hyponatremia in Children of 2 Months to 5 Years of Age with Pneumonia and its Correlation with Outcome
Kishore Kumar Sinha, Krishna Murari, Rajeev Ranjan
Aim: To find the frequency of hyponatremia in 2 months to 5 years old children hospitalized with pneumonia and to correlate the hyponatremia with the severity of pneumonia. Material & Methods: This hospital in-patient based prospective study was conducted in the department of Paediatrics in Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India over a period of 12 months. Patients were diagnosed to have pneumonia based on clinical signs and symptoms and confirmed with chest radiograph showing lobar/segmental or patchy consolidation. Results: 80 children admitted with pneumonia were included in the study. 12 patients in pneumonia group and 6 patients in severe pneumonia group had mild hyponatremia. It was seen that mild hyponatremia was the commonest in both the pneumonia and severe pneumonia group. The difference was statistically significant (P value =0.01). Conclusion: Hyponatremia is a common electrolyte imbalance found in pneumonia and more commonly seen in severe pneumonia. Hyponatremia is associated with increased mortality.

72. A Prospective Assessment of Predictors of Outcome in Pediatric Septic Shock
Manoj Kumar Ram, Anup Kumar, Binod Kumar Singh
Aim: To determines the predictors of outcome in pediatric septic shock in patients admitted to the PICU of a tertiary care hospital in Bihar Region. Material & Methods: The study was carried out in the Pediatric Intensive Care Unit of the Department of Pediatrics in Nalanda medical College and Hospital, Patna, Bihar. It was a prospective, observational study done in a time period of seven months. Results: During the study period of 6 months, total 120 cases were admitted in PICU. There were 86 cases of shock of different etiologies and of these 50 cases of septic shock were enrolled in the study. On analysis of the vital parameters, a delayed capillary refill time (>3 seconds) was a statistically significant (p=0.005) predictor of poor outcome with all the 8 patients having failed to survive, having a prolonged CRT on admission. Statistical association of the other vital parameters with outcome. Conclusion: A delayed capillary refill time on admission and a low mean pH were statistically significant predictors of mortality in this study.

73. Hospital Based Descriptive Assessment of the Prevalence of Dry Eye in Post-Menopausal Women
Nutan Narayan
Aim: To assess the prevalence of dry eye in postmenopausal females. Material & Methods: This was a hospital based descriptive study where post-menopausal women were evaluated prospectively. The study was carried over the period of one year. Results: A total of 380 cases were selected from the OPD of the hospital. 145 Women presented with dry eyes, hence prevalence was 38.2%. 27.5% cases were >70 years of age followed by 65-69 years (19%) and 60-64 years (15.5%). Conclusion: Dry eye & its symptoms may be left unnoticed for years in post-menopausal women. Dry eye is a highly undiagnosed disorder in these women and therefore regular eye check-up of all such women should be done. Higher age group post-menopausal women are more susceptible to it.

74. A Prospective Analytical Assessment of Cardiac Failure and its Prognostication with 3C: Reactive Protein as a Marker of Severity
Rajkumar Deepak, Sumit Kumar, Naresh Prasad Yadav
Aim: To evaluate the cardiac failure and its prognostication with 3C: Reactive protein as a marker of severity. Material & Methods: The cross-sectional analytical study was conducted in the Department of Medicine, Government Medical College, Bettiah, Bihar, India. Chagas disease was confirmed by 3 serological tests: direct agglutination, immunofluorescence, and enzyme- linked immunoassay (ELISA) and patients with 2 or more positive assays were accepted as positive. Results: The multiple regression analysis found no correlation between age and status of Chagas disease progression. Multiple regression analysis relating Chagas phase to serum IL-6 concentrations (analyzing the variables of age, sex, diabetes mellitus, hypertension, heart failure, and dyslipidemia), confirmed the hypothesis that IL-6 values show a significant correlation to disease phase. Although the simple correlation analyses showed a positive correlation between IL-6 or CRP and LVMI, a negative correlation between IL-6 or CRP and the ejection fraction, as well as between IL-6 and BMI, the multiple regression analysis did not confirm these results. Conclusion: Elevated IL-6 concentrations were related to the phase of Chagas disease, indicating that once these patients have progressed beyond the acute phase, they experience a chronic inflammatory process, which becomes more severe with progression to Phase III status.

75. A Retrospective Study of Endometrial Pattern and it’s Clinico-Pathological Correlation in Abnormal Uterine Bleeding (AUB)
Seema Singh
Aim: To evaluate clinically gynecological causes of abnormal uterine bleeding and to study endometrial pattern in AUB. Material & Methods: This is a retrospective study conducted at the Department of Obstetrics & Gynecology, Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India. Records from history sheets and files of patients admitted in gynaec ward for hysterectomy for AUB over a period of one year were collected. Results: A total of 100 cases were selected for this study. The majority of the women 51% presented with menorrhagia. Histopathological reports revealed that endometrium was proliferative in 52% and secretory in 20%. Conclusion: Abnormal uterine bleeding predominantly affects women of perimenopauses age group which is alarming and needs thorough evaluation as it could be the only clinical manifestation of endometrial cancer.

76. Single Centered Prospective Observational Assessment of the Intravenous Fluids in Acute Pancreatitis
Sekhar Chakraborty, Bimal Kumar Chatterjee, Shahid Ahmed
Aim: To compare the occurrence, persistence or worsening of systemic inflammatory response syndrome (SIRS) and occurrence organ failure in patients with acute pancreatitis receiving normal and high-volume fluid therapy in the first 24 hours. Material & Methods: This was a single centered prospective observational study conducted in the Department of General Surgery, Jagannath Gupta Institute of Medical Sciences and Hospital, Budge Budge, Kolkata, West Bengal, India. 50 patients admitted with AP as per the definition of modified Atlanta criteria were included in the study. Results: The study population consisted of 34 males (65%) and 16 females (45%). The etiology of acute pancreatitis was most commonly alcohol (n=34%) and gallstone (n=18%) related. Other 15 cases were due to drugs and post endoscopic retrograde cholangiopancreatography (ERCP). The organ system involved was renal system. Conclusions: Our study did not show any statistically significant difference in outcomes in patients with acute pancreatitis receiving normal or high-volume fluids in the initial 24 hours. Further multi-centric randomized control trials are required to analyze the outcomes of high and normal volume fluid resuscitation in acute pancreatitis.

77. To Understand the Demographic Characteristics, Details of Clinical and Laboratory Risk Factors Predicting High Disease Severity in Patients with Snake Envenomation to a Tertiary Care Center-An Institutional Study
Sumit Kumar, Rajkumar Deepak, Naresh Prasad Yadav
Aim: The primary aim of the study was to understand the demographic characteristics, details of clinical and laboratory risk factors predicting high disease severity in patients with snake envenomation to a tertiary care center. Material & Methods: This was a Prospective observational Cohort study with nested case control design. The study was conducted among the patients presenting to the Department of Medicine, Government Medical College, Bettiah, Bihar, India, over a period of one year. Sequentially encountered patients with snake envenomation were recruited after taking written informed consent and were followed up till discharge with a clinical research form. Results: A total of 100 patients with newly diagnosed case of snake envenomation, above the age of 15 presented to the emergency department were included in the study. The mean bite to needle time for first medical contact was 2.46 hours with a standard deviation of +/- 2 hours. The most clinical feature was pain at the bite sit which was present in 89% of the patients followed by local swelling which was seen in 82% of the population. Conclusion: Socio-demographic variables, clinical findings, treatment variables, ASV related data and mortality in our study was found to be consistent with the studies done earlier.

78. Retrospective Assessment of the Antimicrobial Drugs Utilization in Medical ICU in Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, India
Veena Kumari, Ashwani Kumar Mishra
Aim: The objective of this study was to study the antimicrobial drugs utilization pattern in medical ICU in Darbhanga Medical College & Hospital, Laheriasarai, Darbhanga, Bihar, India. Methodology: It was a retrospective and observational study, conducted during the period of 1 year (May, 2021 to April, 2022). Data of 120 patients was collected from the Central Record Section (CRS) of the hospital. The data was analyzed for demographic distribution, disease pattern and antimicrobial drugs use. The data was entered in MS Excel sheet and results were presented as tables and figures. Drug utilization data was presented as percentage. Results: Total 120 patients were enrolled in the study. Out of 120 patients, males were 76 (63.3%) and females were 44 (36.7%). The mean age of males was 59.54 ± 21.73 years and females were 63.82 ± 19.24 years. 50 (41.7%) patients were more than 60 years of age. Most of the patients were >40 years of age. CVS system was affected in 94 (78.3%), followed by respiratory system in 8 (6.7%), excretory system in 5 (4.2%), GIT in 4 (3.3%), CNS in 3 (2.5%) and others in 6 (5%) patients. Duration of Hospital Stay was 1-3 days in 93 patients, 4-7 days in 22 patients and more than 7 days in 5 patients. At the end 69 (57.5%) patients were referred, 41 (34.2%) patients were discharged, and 10 (8.3%) patients left against medical advice (LAMA). A total of 84 antibiotics in 120 patients were used. Most commonly 3rd generation cephalosporin was prescribed in 44 patients, macrolides in 25 patients, quinolones in 7 patients, anti-anaerobics in 5 patients, tetracycline in 3 patients, oxazolidinones in 3 patients, aminoglycosides and antifungals in 2 patients each and others in 1 patient. Conclusion: Antimicrobial prescription pattern was found to be appropriate in terms of hospital and supplemental indicators. But there is a need for improvement in the area of prescribing and patient care indicators and the use of guidelines, educational initiatives, surveillance, and antibiotic restriction policies at all levels of health care. Results of this study may help the primary healthcare providers to rationalize the antibiotic utilization for better patient care.

79. Prospective, Comparative Assessment of Efficacy of Amitriptyline and Fluoxetine in Patients Presenting with Mixed Anxiety and Depression
Naresh Prasad Yadav, Raj Kumar Deepak, Sumit Kumar
Aim: To analyze the comparative study of efficacy and tolerability of amitriptyline and fluoxetine in patients presenting with Mixed Anxiety and Depression. Material & Methods: The prospective, comparative study was conducted for a period of 12 months in the Department of Psychiatry, Government Medical College, Bettiah, Bihar, India. Patients with anxiety and depression having the target symptoms were selected. The patients were subjected to the questionnaire (i.e. HAM-A and HAM-D as per the diagnosis). Follow-up was done after every second week, fourth week (i.e. 30 days) and eighth week (i.e. 56 days). A total of 100 patients from hospital OPD were selected for the study. Results: Mean Difference in Reduction of HAM-D Score at baseline was 4.523 [CI-95%, 7.8201-2.5281] and at the end of 8 weeks was 1.201 [CI-95%, 1.2810 -0.9261]. It was found to be statistically significant [p=<0.001].92.51% improvement with reference to baseline in HAM-D score was seen with Fluoxetine and 91.03% in Amitriptyline at the end of 8 weeks. Conclusion: Our study shows Fluoxetine apparently working faster than Amitriptyline. Fluoxetine being an SSRI claimed to be equally effective as TCA in treating Mixed Anxiety and Depression with least adverse effects and better tolerability.

80. Prospective Assessment of HS-CRP, MDA Levels in Type 2 Diabetic Patients and Also to Explore Their Association with Hba1c and Insulin Resistance
Amarendra Kumar Amar, Shabana, Deokant Deepak
Aim: To evaluate hs-CRP, MDA levels in type 2 diabetic patients and also to explore their association with HbA1c and insulin resistance. Methodology: A prospective evaluation study was carried out in the Department of Biochemistry, Jan Nayak Karpuri Thakur Medical College and Hospital, Madhepura, Bihar, India for 1 year period. The study population consisted of 100 subjects divided in to two groups viz., diabetic patients (type 2 diabetic subjects; n=50) and non- diabetic participants (n=50). 48 male and 52 female were including in this study. The age of the patients of both sex were 30-50 years. Biochemical analysis Fasting venous blood samples were collected from the study subjects and routine laboratory investigations were carried out by standardized protocols like serum insulin, HbA1c, hs-CRP, and malondialdehyde (MDA) and analyzed. Results: Out of 100 patients, 48% were males and 52% were females. 37% patients belonged 30-40 years of age group, while most of the patients (63%) belonged to 40-50 years of age group. Mean age of control group was 37.9±4.5 years, while 40.2±7.1 years in type 2 diabetes mellitus patient group. Mean systolic and diastolic blood pressure in DM patients was higher as compared to control group. The mean serum hs-CRP and MDA levels were significantly high in type 2 diabetic patients compared with healthy patients. Hs-CRP and MDA levels are shown significant positive correlation with glycocylated hemoglobin (HbA1C), insulin resistance, triglycerides and negative correlation with HDL cholesterol. Conclusion: The use of stringent blood glucose management, frequent monitoring of hs-CRP, and monitoring of MDA levels may be beneficial in the prevention of vascular problems in type 2 diabetics.

81. Hyponatraemic Dehydration in Neonates and Children: A Prospective Study
Ashutosh Kumar Verma
Aim: To estimate the incidence of hyponatraemic dehydration in neonates and children. Material & Methods: The study was done in Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Lady Hardinge Medical College, Delhi, India which provides tertiary level clinical care. A total of 100 Children including neonates are enrolled in the study. Results: It was found that 65% of the males were having acute gastroenteritis while it was 35% in female subjects. The data also reveals that higher incidence of acute gastroenteritis was noted between 6 to 24 months of age while the lower incidence was found in the subjects above 36 months of age. The number of episodes of loose stools were correlating with the extent of dehydration. Higher the episodes the severe were the dehydration. Conclusion: The clinical impression of the type of dehydration and electrolyte disturbances was fairly consistent with serum electrolytes values. This suggest that routine estimation of serum electrolytes is not necessary however it is necessary whenever electrolyte imbalance is suspected on clinical grounds and in cases which do not respond satisfactorily with routine fluid electrolyte therapy.

82. A Retrospective Hospital Based Assessment of D Dimer – Prognostic Indicator for Disease Severity in Patients Hospitalized with COVID 19
Gyanendra Kumar, Prashant Kumar, Pradeep Kumar Singh
Aim: To evaluate the usefulness of D-Dimer levels in blood to correlate with disease severity in COVID 19 patients. Material & Methods: The present retrospective study includes 50 patients hospitalized for COVID-19 during a period of 6 months in Government Medical College, Bettiah, Bihar, India. D-dimer evaluation was performed using an immunoturbidimetric assay on Erba Mannheim ECL 105 machine. Results: The study was conducted on 50 COVID 19 positive patients admitted to the hospital. Of the total patients, 34 were male and 16 were female. In mild cases D Dimer varies from 52 ng/ml to 192 ng/ml with mean 98.3 and median 99. In moderate cases D Dimer varies from 262 ng/ml to 998 ng/ml with mean 664.8 and median 812. Conclusion: D dimer helps in identifying severe disease and can be used as an essential biomarker in developing the management protocol for COVID 19 patients.

83. Assessment of the Clinico-Epidemiological Profile of Thalassemia Patients in a Tertiary Care Hospital in Bihar Region
Kishore Kumar Sinha, Rajeev Ranjan, Krishna Murari
Aim: To assess the pattern, clinical presentations, complications, and management practices among thalassemia cases. Material & Methods: This is a retrospective record-based cross-sectional study was conducted in the Department of Pediatrics, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Bihar, India. The secondary data of all confirmed cases of thalassemia were examined by the investigators. Results: The mean age of cases was 6.2 years. The age at diagnosis ranged from 0.1 to 11 years. The majority of cases were under-fives 31 (38.75%) and were male. Bone deformities were reported in 17 (21.25%) cases, all of which were beta thalassemia major cases. Conclusion: Hemoglobinopathies are the commonest hereditary disorders in India and pose a major health problem. The data on the prevalence of β-thalassemia’s and other hemoglobinopathies in different caste/ethnic groups of India is scarce.

84. Prospective Assessment of the Pattern of Community Acquired Pneumonia among Pregnant Women
Nutan Narayan
Aim: The aim of this study was to assess the pattern of community acquired pneumonia among pregnant women in tertiary care hospital. Material & Methods: Total 50 pregnant ladies presented with signs, symptoms & radiological findings consistent with community acquired pneumonia were selected from outpatient’s clinics at the Department of Obstetrics & Gynecology, Nalanda Medical College & Hospital, Patna, Bihar, India for 15 months. Results: Cough (94%) was the most common symptom followed by fever (76%) among the patients. The most common organisms isolated were streptococcus pneumonia, hemophilus influenza, staphylococcus aureus mycobacterium tuberculosis. Conclusion: Morbidity and mortality in pregnant patients with pneumonia continue to pose a significant challenge. Early recognition of the diseases process and appropriate antibiotic treatment are required to ascertain an optimal outcome. The treatments in the gravid patients generally follow standard guidelines for the treatment of pneumonia in adults. Concern for fetal outcome should not delay any treatment strategies as improvement in maternal oxygenation and status is the best way to ensure fetal protection.

85. An Observational Assessment of the Metastatic Malignancy in Fine Needle Aspiration Cytology of Lymph Nodes
Prashant Kumar, Manish Kumar Jha, Santosh Kumar
Aim: To detect and diagnose metastasis in lymph nodes. Material & Methods: The prospective study of Fine needle aspiration cytology in Lymphadenopathies was conducted between over 5 months at Department of Pathology, Government Medical College, Bettiah, Bihar, India. Results: Out of 31 cases of metastatic tumors, maximum no. of cases were metastatic squamous cell carcinoma (77.1%). In 20 cases out of 100 cases, histopathological confirmation was available. Conclusions: Fine needle aspiration cytology of lymphadenopathy is a useful tool in diagnosing metastatic lesions with good certainty.

86. A Prospective Clinico-Hematological Assessment of Profile in Dengue Fever in Bihar Region
Rajkumar Deepak, Naresh Prasad Yadav, Sumit Kumar
Aim: To elucidate the positive laboratory profile of serologically diagnosed dengue patients so as to facilitate early diagnosis, treatment, management and vector control measures, to reduce the morbidity and mortality because of this disease. Material & Methods: This was a descriptive study with analysis of patients who were admitted for dengue fever in the Department of Medicine, Government Medical College, Bettiah, Bihar, India for duration of 15 months. This study was conducted on 100 indoor patients. Results: Raised hematocrit (>47%) was noted in 20 patients at presentation and the hematocrit ranged from 20-51%. In the present study out of 100 cases of dengue fever, 88% cases had thrombocytopenia and 12%. Conclusions: Hemoconcentration, leucopenia, thrombocytopenia, and raised liver enzymes SGOT and SGPT along with reactive/ plasmacytoid lymphocytes on peripheral smear gives enough clues to test for dengue serology so that dengue cases can be diagnosed in their initial stages.

87. An Observational Study on Influence of Pre-Existing Diseases on Vestibular Rehabilitation of Vertigo in Patients with Head Injuries
P. Asha Rani, P. Sree Devi
Background: A symptom complex of Vertigo, dizziness, and imbalance occur in patients following concussion. Multiple factors play role in their recovery following rehabilitation. The causes may be peripheral or central. Aim and Objectives: To study the influence of pre-existing diseases on the vestibular dysfunction recovery in patients with head injuries. Objectives were to observe the factors which predispose, promote and perpetuate the rehabilitation of vertigo. The objectives were to record the predisposing and promoting factors of vertigo, undertake bedside equilibrium tests and caloric test for peripheral and central causes of vertigo. Materials: 83 patients with head injuries were included who presented with vertigo. Patients with pre-existing diseases like hypertension, diabetes and thyroid hormone dysfunction were included. All the patients were assessed using a Dizziness handicap index with subscales to assess the physical, functional and emotional aspects. Vestibular rehabilitation was done and DHI scores were evaluated at the end of 12 weeks. Results: Out of 83 patients 61 (73.49%) were males and 22 (26.50%) were females. Male to female ratio was 2.3:1. Patients aged 18 to 27 years were 12 (14.45%), Patients aged 28 to 37 years were 36 (43.37%), Patients aged 38 to 47 years were 21 (25.30%), and Patients aged 48 to 57 years were 14 (16.86%). The mean age was 38.75±3.15 years. The head injury severity as per Head Injury Severity Scale (HISS) was minimal in 24 (28.91%), 26 mild in (31.32%) and 33 moderate in 33 (39.75%) of patients. There were 44 (53.01%) patients with Pre-existing diseases and 39 (46.98%) patients without pre-existing diseases. There was no statistical significant predilection of any age group to gender or degree of head trauma (p>0.05). Conclusions: Vertigo after concussion brain injury was common. All the patients responded to vestibular rehabilitation from 3rd week onwards. By 12th week the patients without pre-existing diseases with central vestibular dysfunction and fixed peripheral vestibular dysfunction were either resolved or greatly improved. The patients with pre-existing diseases responded rather slowly and the DHI indices/scores were more compared to the patients without pre-existing diseases.

88. Assessment of Hospitalized Patient with 2019 Novel Coronavirus- Infected Pneumonia Associated with Hypertension in Tertiary Care Hospital – A Cross Sectional Study
Ashfaq Modiwala, Abhay John, Monika Mandrai, Munesh Kumar Sharma, Sanjay Kumar Chaurasiya, R. R Wavare
Background: The pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which poses unprecedented challenges to health-care systems around the world, another one is hypertension which is growing rapidly to epidemic levels in the developing countries, that’s why described by some clinicians as a ‘silent killer’. Objective: To study the prevalence of hypertension on disease progression and prognosis in patients with SARS-COV-2 positive adults and also assess the co relation between SARS-COV-2 positive adults with hypertension in tertiary care hospital. Methodology: A Hospital based, cross sectional, observational study was conducted among the 208 SARS-COV-2 positive adults in tertiary care hospital. A comparison between patients, admitted in Non-ICU and in ICU for treatment and management. Their demographic data, clinical manifestations, were collected and analyzed. Result: In our study 65 SARS-COV-2 positive subjects were found to be hypertensive with the prevalence of 31.3%. Where; new cases of hypertension were found to be with prevalence of 16 (24.6.%). Whereas, 69.4% of hypertensive subjects were on medication still having raised blood pressure (P < 0.05). However, failed to show that hypertension was an independent risk factor for COVID-19 mortality or severity (P > 0.05). Recommendation: It is necessary to create additional attention, awareness, change attitude so that they quit and avoid modifiable risk factors associated with hypertension and SARS-COV-2 infection and prevent worsening of their condition which leads to severe pneumonia, excessive inflammatory reactions, organ and tissue damage, and deterioration of the disease.

89. A Study of Three Different Scoring Systems for Prediction of Postoperative Nausea Vomiting
Namrata Sadafule, Madhavi Godbole, Aprajeeta Pandye, Manthan Indurwade
Introduction: Post-operative nausea and vomiting (PONV) is one of common side effect that occurs after the surgery. Although it is not fatal, there are several physiological changes which lead to uncomfort for the patients. For the avoidance, prophylactic anti-emetic management is provided empirically to all patientswho are receiving aneasthesia but there is a need to assess patients before the surgery as all patients are not prone to PONV. For this purpose, there are various scoring systems of PONV and this study has considered Apfel, Koivuranta and Ulleval scoring system for its effective evaluation. Aims and Objectives: To statistically compare the efficacy of PONV scoring systems to predict risk of PONV in patients undergoing surgery. Materials and Methods: Total 200 number of patients enrolled in study which were posted for different type of surgeries. All patients were assessed for risk factors of all three mentioned scoring systems in pre-anaesthetic checkup. The scores obtained by the scoring systems were statistically analyzed. Result: Although all the scoring systems are effective in prediction of PONV, the study found that percentage of prediction of Ullveal scoring system is higher (80%) compare to other scoring systems but not only this sensitivity and specificity score of Ullveal scoring system is higher compare to other systems. Conclusion: The study has concluded that all the three scoring systems are effective to predict PONV but Ulleval scoring system is the most effective compared to other two scoring system for prediction of PONV.

90. Positive Effect of Raj Yoga and Om Meditation on Hypertension and Type II Diabetes Mellitus in Mithilanchal Area
Mritunjay Kumar, Sheela Kumari
Background: Yoga is well known for improving oxygenation to the biological system and combating oxidative stress which is responsible for numerous lifestyle diseases which includes type 2 diabetes and hypertension. Therefore, the present study was conducted to evaluate the positive effects of Raj yoga and Om meditation in modifying and improving the quality of life in type II diabetic with hypertension patients. Aims and Objectives: This study is contemplated to focus on the results of Raja yoga and Om meditation in patients with DM and Hypertension in Mithilanchal area. Materials and Methods: An interventional, prospective and open labeled study was done involving 30 patients of type 2 diabetes along with hypertension from April 2022 to June 2022. Patients received yoga therapy for 45 days along with the standard treatment. Oxidative stress markers such as changes fasting blood glucose levels, systolic & diastolic blood pressure, body mass index and symptoms associated with type 2 diabetes were evaluated before and at the end of the yoga therapy. Results: Significant reduction in the levels of malondialdehyde (P<0.01), blood glucose (P<0.05), Systolic blood pressure (P<0.01) body mass index (P<0.001) and improvement in the unpleasant symptoms were observed after yoga therapy when compared to same patients before starting yoga therapy. Conclusions: Regular practice of Raja yoga and Om meditation results that yoga intervention has therapeutic values in patients having type 2 diabetes with hypertension. This may have direct impact on the dose minimization of hypoglycemic drugs of the patient which requires further study in this area.

91. Comparison between Intermittent Epidural Boluses of Levobupivacaine with Fentanyl and Ropivacaine with Fentanyl for Combined Spinal Epidural Technique in Labour Analgesia: A Double- Blinded Prospective Study
Sushant Satya Priya, Srinivas H.T, Rashmi H. S
Background: Combined spinal epidural (CSE) analgesia is an established technique for labour analgesia. It offers “effective, rapid-onset analgesia with minimal risk of toxicity or motor block”. Levobupivacaine & Ropivacaine are less cardiotoxic, long acting amide LAs. Aims and Objective is to compare 0.125% Levobupivacaine and 0.2% Ropivacaine with fentanyl as epidural drugs for labour analgesia using CSE technique regarding time for onset & duration of analgesia of the first epidural bolus dose and to compare quality of labour analgesia, and assess the maternal and foetal outcome, incidence of instrumental delivery, study of motor blockade, haemodynamic changes, maternal satisfaction. Methods: Following approval from Institutional Ethical committee, 50 ASA PS II pregnant women requesting for labour analgesia, satisfying the inclusion criteria were randomly divided equally into groups L & R. CSE performed, 0.5ml hyperbaric bupivacaine 0.5% with fentanyl 25mcg administered intrathecally. Intermittent boluses 10 ml of study drugs given through epidural catheter as demand dose. Result: The mean onset of analgesia with Group R= 16.280+ 1.59 min and with Group L = 21.480+1.32 min (p=0.000). Total duration of analgesia in Group R= 72.08 +1.97 min, whereas Group L= 82.160 +2.07 min (p=0.000). There was no difference between the groups for maternal demographic traits, mode of delivery, maternal and fetal outcome and maternal satisfaction. Both 0.125% Levobupivacaine and 0.2% Ropivacaine produces excellent quality of analgesia. Conclusion: Ropivacaine produces an early onset of analgesia than Levobupivacaine but Levobupivacaine had significant prolonged analgesia compared to Ropivacaine. Both drugs were found to be safe for labour analgesia. Maternal satisfaction and foetal outcome were similar with both the drugs.

92. Study of Incidence of Shivering in Patients undergoing Lower Segment Caesarian Section (LSCS) under Spinal Anaesthesia with Bupivacaine vs Bupivacaine with Fentanyl
Veena Horo, Ashutosh Ranjan
Background: Shivering is a normal thermoregulatory mechanism in patients undergoing central neuraxial anaesthesia. Shivering is common in women undergoing caesarian section under spinal anaesthesia and can interfere with patients monitoring. It can cause discomfort to patient and also increases tissue oxygen demand. The aim of the study was to evaluate the incidence of shivering with addition of 10-25mcg of fentanyl to bupivacaine in patients undergoing LSCS under spinal anaesthesia. Material and Method: A total of 60 healthy women belonging to ASA grade I and II were enrolled in our study that were scheduled for both elective as well as emergency caesarian section under spinal anaesthesia. They were randomly divided into 2 groups. Group C with 30 patients were given 0.5% hyperbaric bupivacaine (2.5-3ml) and group F with 30 patients were given 0.5% hyperbaric bupivacaine (2.5-3ml) with 10-25mcg fentanyl. Results: The overall incidence of shivering in group F was lower (5 out of 30 patients) as compared to group C (13 out of 30 patients).There was significant difference in the incidence of shivering between group F and group C (16.66% in group F ; 43.33% in group C , P<0.012). The severity of shivering was also reported less in group F as compared to group C. Conclusion: Patients which received 10-25mcg fentanyl with bupivacaine had less incidence and severity of shivering than those who did not receive fentanyl with bupivacaine.

93. An observational Study of Ocular Changes in Patients with Type-2 Diabetes Mellitus
Kumari Preeti, Nitu Kumari, Alka Jha
Background: Diabetes mellitus increasing fast in worldwide. In India is set to emerge as the diabetic capital of the world. According to the WHO, 31.7 million people were affected by diabetes mellitus (DM) in India in the year 2000. This figure is estimated to rise to 79.4 million by 2030, the largest number in any nation in the world. Aim: To find out ocular changes in patients with type 2 diabetes mellitus relations. Materials and Methods: Total 50 patients attended in Eye OPD for ocular complication with Type 2 diabetes mellitus at DMCH, Laheriasarai, Bihar from June 2019 to May 2020. In 50 patients, 30 patients selected for this study whose aged 40-70 years and suffering from diabetes mellitus 5 or >5 years. Results: We found the majority of cases 12(40%) in age group between 51-60 years and sex distribution males 18(60%) were more than females (40%). The other most common ocular manifestations were Diabetic retinopathy 14(46.66%), cataract 13(43.33%), cranial nerve palsy 4(13.33%) and glaucoma 4(13.33%). Conclusion: In this finding patient advice to time-to-time screening and eye examination, who is suffering from diabetes.

94. Comparative Study of Incidence, Recurrence Rate and Conjunctival Autografing with intraoperative Mitomycin-C in Management of Pterygium
Nitu Kumari, Kumari Preeti, Alka Jha
Background: Pterygium excision with CONJUNCTIVAL AUTOGRAFTING is very popular technique to prevent recurrence with very few side effects. This is being tried out with success in different country. Aims of the present series an attempt was made to do a comparative study between intraoperative application of Mitomycin-C (0.02 %) and conjuctival autografting and their effectiveness, effects and rate of recurrence in patients. Material and Methods: The study was carried out on 30 patients who presented to the Eye department at Darbhanga Medical College and Hospital, Laheriasarai during the period from July 2019 to September 2020 and was analysed retrospectively. Efforts were made to select patients with pterygium. Selected patients were divided into two groups Group I and Group II. The statistical calculations show standard error of difference is 10.6, whereas observed difference (13.33 – 6.66) was 6.67. The observed difference between the two groups is less than twice the S.E. of difference i.e. 2 × 10.6. Therefore, observed difference between recurrence rates was not significant. Results: It was found that pterygium was more prevalent in between 3rd and 5th decade and beyond this range of age the incidence declines. The disease was more common in males than females. In symptomatology growth of red mass or fleshy mass was the predominant presenting symptom. This was followed by redness and irritation of the eye. In most of the patients improvement of visual acuity occurred after pterygium surgery. In group one patients, (conjunctival autografting) recurrence rate was 6.66 % (one out of fifteen). In group two patients, (intra-operative application of Mitomycin-c) there was 13.33% (two out of fifteen) recurrence rate. When recurrence rates of two groups were compared statistically, the difference was not significant. Conclusion: So it was concluded that either excision of pterygium with bare sclera technique along with conjunctival autograft or intra-operative application of Mitomycin-c (0.02 %) for 3 minutes are both equally effective adjuncts to prevent recurrence in pterygium surgery.

95. Assessment of Final Outcome of Ambulation and Exercise in the Management of Patients with Deep Vein Thrombosis in a Tertiary Care Hospital of Andhra Pradesh
Hitesh Reddy M, Niketan. D, Shamsheer Khan. P
Background: Deep vein thrombosis (DVT) was reported as the third commonest cardiovascular disease and a major cause of hospital morbidity and mortality due to its propensity to cause pulmonary embolism and post thrombotic syndrome. Bed rest has been advised historically as the main anchor of its treatment. However early ambulation has its beneficial effects. Aim of the Study: To study the effects of ambulation and exercise in patients with Deep Vein Thrombosis in its progression and improving limb pain and preventing the risk of thromboembolism. Materials: 56 patients with different types of DVT were included after confirmation with laboratory and radiological investigations. Patients were divided into two groups; Group A patients were subjected to a fixed protocol of ambulation and exercise. Group B patients were restricted to bed rest. Both the groups received same line of medical treatment containing anticoagulants, DOAC drugs and LMWH. VAS score, Villalta score and limb measurements of patients were used to assess the final outcome. All the data was analyzed using standard statistical methods. Results: Among the 56 subjects selected for the study, there were 19 (67.85%) males and 09 females (32.14%). The mean age was 49.34±4.10 years in group A and 51.27±4.25 in group B. The mean values of VAS score, Villalta score and limb measurements of patients were similar in both the groups. The p value was 0.461 and there was no difference in the final outcome in both groups; p taken as significant at 0.05. There was no incidence of pulmonary embolism in both the groups. The number of recurrences was 02 in the group A and 08 in the group B. There were no deaths in both groups. Conclusions: Ambulation and exercises in patients with Deep Vein Thrombosis reduced pain, swelling of the limbs better and earlier than in patients on bed rest. It does not increase the incidence of pulmonary embolism or mortality. It prevents recurrences of DVT.

96. A Comparative Study of Colposcopy and Histopathological Findings of Unhealthy Cervix in Tertiary Care Hospital
Nilofer Poonawala
Background: Cervical cancer is common worldwide and ranks third among all the malignancies for women. Performing colposcopy with more accuracy using standardized scoring system, taking a colposcopy directed punch biopsy, and sending it for histopathological diagnosis would result in a better diagnosis of premalignant and malignant diseases. The study was conducted to compare colposcopy and histopathological findings of unhealthy cervix in tertiary care hospital. Methods: The present comparative cross-sectional study was carried among women who presented with various gynaecological complaints at Department of Obstetrics and Gynaecology of tertiary care centre during November 2019 to October 2020. Sample sizes of 112 participants were enrolled in study. The collected data were analyzed with proper statistical methods using MS excel 2016. Results: Themajority of participants were in age group 31-40 years (58.04%) with mean age of 37.48 ± 8.03 years and white discharge (74.10%) as the commonest complaint. Colposcopy shows sensitivity of 84%, specificity of 70.27% with accuracy of 79.46% when compared to histological findings. Conclusions: The high specificity and sensitivity of colposcopy indicated that colposcopy has an important role in the diagnosis of cervical intraepithelial neoplasia.

97. Detection of Hemoglobinopathies by HPLC in Patients with Microcytic Hypochromic Anemia
J Nayak, JK Behera, S Das, SR Senapati, SR Mohanty, SP Samanta
Introduction: Most commonly encountered disorders manifesting as microcytic hypochromic anemia are iron deficiency and thalassemia. These need to be accurately categorized epidemiologically and also to provide necessary counselling and avoid unnecessary iron overload. HPLC has emerged as one of the best methods for detection of hemoglobinopathies with rapid, precise and reproducible results. Aim and Objective: To evaluate the role of HPLC in the diagnosis of hemoglobinopathies in cases of microcytic hypochromic anemia & to detect various rare variants of hemoglobinopathies. Materials & Methods: This study was conducted in the Department of Pathology, M.K.C.G. Medical College, Berhampur from October 2019 to September 2021. Blood samples of 1260 patients with microcytic hypochromic anemia were collected and analyzed on the Bio-Rad Variant II HPLC system with use of the Variant II β -Thalassemia Short Program Reorder Pack (Bio-Rad Laboratories). An Hb A2/F calibrator and two levels of controls (BIORAD) were analyzed at the beginning of each run. The integrated peaks are assigned to manufacturer-defined “windows” derived from specific retention time (RT). Observations & Result: Out of 1260, 737 (58.5%) cases displayed abnormal hemoglobin fractions on HPLC. Beta thalassemia trait (362 cases, 28.7%) was the most prevalent followed by Sickle cell trait (247 cases, 19.6%). Other hemoglobinopathies found were Sickle cell disease (5.26%), Beta Thalassemia homozygous and sickle-beta thalassemia double heterozygous (1.9% each) and HbE heterozygous (0.47%). There were also 3 cases of HbE-beta thalassemia, 2 cases each of HbS-HbE double heterozygous and 1 case of HbE homozygous. Discussion: Thalassemia was the most common hemoglobinopathy detected in this study indicating the importance of early detection followed by genetic counselling for prevention of birth of thalassemia homozygous baby. Sickle cell cases were the next most prevalent indicating possible associated iron deficiency and/ or alpha thalassemia.

98. Evaluation of First Trimester Vaginal Bleeding
Luzoo Prachishree, Sanghamitra Mohapatra, Hemanta Panigrahi
Introduction: First trimester Vaginal bleeding associated with or without pain abdomen is a common presentation in ANC clinics and emergency. Aims and Objectives: To identify the magnitude of the complication of vaginal bleeding in the first trimester of pregnancy in this part of our state, to find out the causes of bleeding and its outcome at the end of first trimester. Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, MKCG Medical College Hospital, Berhampur from January 2019 to December 2019.476 women were clinically evaluated for diagnosis and their outcome at the end of first trimester. Results: Majority belonged to the age group of 21-25yrs and mostly primigravida (34%). Abortion accounted for 80.5% of cases followed by ectopic in 13.8% and molar pregnancy in 5.7% of cases. Out of the cases of abortions, the clinical diagnosis was threatened abortion in 35.9%, incomplete abortion in 22.5%, missed abortion in 12.4%, inevitable abortion in 6.5%, and complete abortion in 3.2% The overall rate of continuation of pregnancy in the study is 85/476 i.e.17.6%. Conclusion: According to the result of the present study first trimester vaginal bleeding predicts the future of pregnancy at the end of first trimester. Diagnosis of a normal intrauterine pregnancy at this stage assists the physician in expectant management and gives a psychological boost to the patient.

99. A Study on the Effect of Deep Breathing Exercise on Heart Rate Variability (HRV) in Healthy Subjects
Bhupendra Buda, Silvi Banerjee, Susajit Kumar Pradhan
Background: Cardiac Autonomic Dysfunction is reported in several cardiac pathologies. Heart Rate Variability (HRV) is a standard tool reflecting the Cardiac Autonomic status. Respiration is an important modulator of Heart Rate Variability. So as Physiologists, we designed a research plan to study the effect of a Physiological Intervention (ie Deep Breathing Exercise) on Heart Rate Variability. Hypothesis: Our hypothesis was Deep Breathing Exercise Training for a considerable duration leads to improvement in HRV. Aim: We conducted our research plan to study the effect of Deep Breathing Exercise on Heart Rate Variability (HRV) in healthy subjects. Methodology: This is a prospective case-control study conducted for 1 year (November 2014 to October 2015) including 70 non-smoking healthy men. Control Group (n=35) – No intervention. Study Group (n=35) – Intervention (Deep Breathing Exercise Training). Initial and Final Assessments (Including HRV Analysis) of all subjects were done. Results: The baseline parameters of the two groups were similar. Time Domain Components of HRV Analysis showed a significant increase (p< 0.05) in the Study Group as compared to the Control Group. Frequency Domain Component of HRV Analysis (LF: HF Ratio) showed a significant decrease (p<0.05) in the Study Group. Conclusion: Our study shows that Deep Breathing Exercise Training at a rate of 06 (six) breaths per minute for 30 minutes per day for one month either in supine or sitting position is an Effective Physiological Intervention for improvement of HRV and maintenance of Normal Sympatho-Vagal Balance.

100. Carcinoma of Stomach as a Common Cause of Gastric Outlet Obstruction in Southern Odisha
Laxmidhara Padhy, Premakanta Mohanty, Debabrata Patra
Introduction: Carcinoma of Stomach a highly progressive tumour and common site at Antrum causing Gastric Outlet Obstruction (GOO). There are many other causes like PUD, pancreatic cancer, periampullary cancer, Bezoars etc. Due to delayed diagnosis and different clinical presentation patients are unaware of the disease. On advanced stage patients present with Gastric Outlet Obstruction. Diagnosis is conformed with upper GI endoscopy and biopsy, USG abdomen and Histopathology study of operated specimens. Methods: A total number of 60 cases of Gastric outlet obstruction due to different causes were presented at M.K.C.G. Medical & Hospital, Surgery Department for the time period from August 2017 to July 2021. A prospective study is conducted in the department of surgery. Observation: Most cases of GOO present in the 5th decade of life followed by 6th decade. Both malignant and benign etiologes were high in the age group. Carcinoma stomach, Adenocarcinoma variant is the commonest cause of gastric outlet obstruction in this region. Distal gastrectomy with billorth – II reconstruction is done in 14 cases of carcinoma stomach. Rest cases of carcinoma stomach is managed by palliative operation. Vomiting and epigastric pain are the most common symptoms in the study. Anemia is found in 52% cases. A palpable mass is palpated in 25% cases. Truncal vagotomy and gastrojejunostomy is done in 21 cases of all duodenal ulcer cases causing Gastric Outlet Obstruction. Conclusion: The present study is an insight into the presentation of GOO and its etiologies. Commonest cause of GOO in adults in this region is Carcinoma Stomach because of late presentation by the patients in this hospital.

101. Clinico-Imaging and Pathological Spectrum & Management of Benign Breast Diseases
Puran, Vijay Kulshrestha, Atul Agarwal, Bhaskar Kumar, S. Kumar
Background: The mammary glands or breasts are unique identification mark of mammals. The breasts are the most distinguishing feature of female anatomy and plays an integral role in reproduction system [1]. The well-developed breasts are sign of womanhood and represent status of hormonal balance. Benign breast diseases are frequently demonstrated in females and require consultation with clinicians [2,3]. Most of the breast lesions are benign in nature and need conservative management [4]. The spectrum of Benign Breast Diseases/ ranges from mild abnormality to Moderate disorder /disease [5,6,7]. BI-RADS system using mammography and ultrasound lexicon are useful scoring system to further differentiating between normal, Benign, suspicious Benign , low , intermediate and moderate suspicion of malignancy to high level of suspicion of malignancy of breast lesions. Aims: (1) To know the clinical spectrum of Benign Diseases of Breast. (2)To establish the role of triple assessment in early diagnosis by (a) clinical examination, (b) imaging techniques and (c) pathology by FNAC of Benign breast disorder / diseases. Objectives: (1) To early diagnosis of Benign lesions of breast. (2) To differentiate benign from malignant breast lesion by imaging techniques. (3) Confirmation of benign nature by fine needle aspiration cytology (FNAC). (4) To put forward protocol for management of Benign breast lesions using BIRADS scoring system. Material and Methods: This is retrospective study after IEC approval of 130 female patients, attended OPD and admitted in indoor wards for breast related abnormality /disease at tertiary care Centre (G. S. Medical college and Hospitals, Pilkhuwa, district Hapur), U.P., India. Duration of study – 1st January to 31st December 2021. Results: Out of 130 female patients; 46(35%) were having nodularity of Breast ;32(25%) were having true non- cyclical mastalgia;28(22%) were having fibroadenoma;3(2%) were having phyllodes tumour;10(8%) were having macrocysts;5(4%) were having ductal ectasia and 3(2%) were having physiological nipple discharge and 3(2%) were having atypical duct hyperplasia. Out of 130 patient, 111(85%) patients were managed conservatively by reassurance/drug therapy/aspiration. Only 19(15%) patients were required enucleation/ excision/simple mastectomy. Conclusion: Mostly benign breast diseases were treated on conservative (85%) line of treatment while remaining (15%) benign lesions required surgical treatment. The most common benign breast disorders/diseases were ranging from nodularity /lump associated with or without mastalgia and tumor as fibroadenoma. The benign breast disorders/diseases were diagnosed by triple assessment method which provide high degree of accuracy with 98% of predictive value.

102. Fetomaternal Outcome in Instrumental Vaginal Delivery
Ranjit Kumar Sahoo, Sanghamitra Mohapatra
Objective: Instrumental vaginal delivery is anagelong obstetric practice used to expedete vaginal delivery and avoid caesarean delivery. This study is to compare maternal and neonatal outcomes of vacuum versus forceps application in assisted vaginal delivery. Material and Method: Women in labor with vertex presentation were delivered by vacuum and forceps. A total of 110 cases were included in this prospective study. Maternal and neonatal morbidity were compared in terms of perineal lacerations, episiotomy extension, post-partum hemorrhage, Apgar score, instrumental injuries of the baby, NICU admissions PNM etc. Prospective observational study was used to analyze the data. Observations: Maternal morbidity viz. episiotomy extension as well as first and second-degree perineal tear were significant in the forceps group compared to ventouse. (P = 0.0001 and P = 0.02, respectively). With regards to neonatal morbidity, no statistically significant difference was noted. Conclusion: Vacuum and forceps should remain appropriate tools in the armamentarium of the modern obstetrician. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother.

103. Histopathological Evaluation of Inflammatory Dermatoses
G Mishra, JK Behera, S Mohanty, M Nayak, J Nayak, R Behera
Background: Skin diseases have low mortality, and thus get less attention than more serious diseases, but their contribution to overall morbidity causes or significant burden to the community, placing a strain on health care services, finances and personnel. Inflammatory skin diseases are the commonest reason for patients to visit a dermatology clinic. Since many of these diseases have varied clinical presentations with clinical overlaps, they remain challenging for the dermatologist. Very few studies had been carried out in Southern Odisha regarding the various histopathological patterns seen in skin biopsies. Hence, the present study was carried out in Department of Pathology, M.K.C.G. Medical College, Berhampur, from 2018 to 2020 to assess the frequency of different inflammatory dermatoses and correlate with respective clinical diagnosis. Methods: We undertook a histopathological examination of skin biopsies in patients presenting to the dermatology department with inflammatory skin lesions as a prospective observational study. The period of study was for 2 years between 2018 to 2020. Results: Analysis of the skin biopsies from the study population (51 cases) shows a wide histopathological spectrum, with Psoriasis being the most common lesion accounting for about 15.6% followed by Hansens disease & Morphea. The other histologic diagnosis given were bullous disorders, Lichen planus, Psoriasiform dermatitis, Lichenoid dermatitis, Neutrophilic dermatoses Lupus erythematosus, Tattoo granuloma, Allergic contact dermatitis, Irritant contact dermatitis, and Panniculitis. Maximum number of patients with inflammatory skin lesions was in their third decade. Male preponderance was noted, with 52.9% of the individuals with inflammatory skin lesions being males and 47.1% females. Conclusion: High percentage (66.6%) of clinico-histopathological correlation was noted in this study, with incompatibility observed in only 33.3% of the cases studied.

104. The Study of Megakaryocytes in Bone Marrow Aspiration Smears in Patients with Thrombocytopenia
A Choudhury, G Mishra, JK Behera, H Soren, P Mishra, J Nayak
Background: Thrombocytopenia is a common hematology condition for which bone marrow aspiration is indicated. Thrombocytopenia is encountered in various hematological disorders including MDS as well as non-MDS. Dysmegakaryopoiesis is characterized by various megakaryocytic alterations in bone marrow aspirates and include both dysplastic and non-dysplastic features. Methods: A prospective study was conducted in cases of non-MDS related thrombocytopenia and the bone marrow aspirates were studied morphologically. The cases of thrombocytopenia (platelet count <150,000 per microliter or <150 x 109/L or <1.5 K/cumm) was done by automated platelet count and were further confirmed manually in peripheral smear.  Bone marrow aspiration was done in confirmed thrombocytopenia cares and the morphology of megakaryocytes was studied. Results: A total of 98 cases of thrombocytopenia were included in the present study predominated by megaloblastic anemia. 43 cases, followed by acute leukemia, 30 cases (AML-16, ALC-14), Aplastic anemia (12 cases), ITP (11 cases) and multiple myeloma (2 cases). Dysmegakaryopoesis in the form of nuclear separation, bare nuclei, micromegakaryocytes, emperipolesis, and vacuolization were observed in the present study. The evaluation of megakaryocyte alternation in morphology in cases of thrombocytopenia can provide more knowledge to the pathogenesis of various hematopoietic disorders.

105. Study of Megakaryocytes in Bone Marrow Aspiration Smears in Patients withA Study of Fetomaternal Outcome in Labour under Epidural Analgesia: The No Sweat Labour
Nina Mishra, Susanta Kumar Behera, Luzoo Prachishree Nayak
Introduction: The delivery of an infant into the arms of a conscious and pain free mother is one of the most exciting and rewarding moments in medicine. Modern neuraxial labour analgesia reflects a shift in the obstetric anaesthesia, thinking away from simple focus on pain relief towards a focus on overall quality of analgesia. Epidural blockade has the advantage of being able to provide continuous analgesia for an unpredictable period of time and to convert analgesia to anaesthesia if an operative procedure becomes necessary. Aims and Objectives: (1) To evaluate the effect of epidural analgesia on the duration of first and second stage of labour; mode of delivery and the need for instrumental delivery or caesarean sections in parturient. (2) To evaluate clinical outcomes of neonates of mothers receiving epidural analgesia in terms of APGAR scores and NICU admissions. (3) To evaluate the effect of epidural analgesia on patient satisfaction and pain relief. Materials and Methods: The study entitled “A study of fetomaternal outcome in labour under epidural analgesia, the no sweat labour” was a prospective case-control clinical trial, conducted in the Department of Obstetrics & Gynaecology, MKCG Medical College & Hospital, Berhampur from October 2018 to September 2020. Cases were selected in accordance with inclusion and exclusion criteria and included in this study in the labour room. After the cases were selected from labour room, a thorough history taking, general and obstetric examination was done and explained regarding benefits of epidural analgesia. The cases were divided into two groups of 60 patients each. Those who gave their consent for epidural analgesia formed study group whereas equal no of patients was taken as control group. The visual analogue pain scores (VAS) were recorded before the block. Results: The mean age in study group was 24.27±3.09 years and in control group was a 24.17±3.07 year. The mean no of top up dose of epidural analgesia was 2.42±0.81. Second stage duration in study group was 20-105 min and in control group was 15-75 min. The mean duration was 53.82±20.87 min in study group and 45.72±15.39 min in control group (p value= 0.020). The mean birth weight of the study group was 2.69±0.27 kg and was 2.68±0.33 kg in control group. The mean VAS score at 30 minutes after administration of epidural analgesia was 5.42±1.01 in the study group and 7.93±0.63 in the control group. At the end of 1st stage of labour the mean duration in study group was 1.75±0.84 and in control group was 9.25±0.63. At the end of 2nd stage, the mean duration in study group was 1.60±0.73 and in control group was 9.53±0.50. The p value of test was 0.000 (<0.05) for vas scores at 30 min, at the end of 1st stage and at the end of 2nd stage (statistically significant). Conclusion: Epidural analgesia endeavors at making childbirth a pleasurable and painless experience. A significantly reduced VAS score makes it one of the most effective modalities of pain relief.

106. Clinicopathological Study of CA Breast with Neoadjuvant Chemotherapy
Laxmidhara Padhy, Asiso Kumar Pradhan, Nirod Kumar Sahoo, Yerrabathina Guru Ravitheja
Introduction: Breast Cancer (BC) is the most common diagnosed cancer among women in India. With the advent of population growth, changes in the lifestyle and migration from rural to urban areas, there is increase in Breast Cancer. The age adjusted incidence as high as 25.8 per 1,00,000 women and mortality 12.7 per 1,00,000 women. Locally advanced breast cancer (LABC) is a subset of breast cancer characterized by the most advanced breast tumor in the absence of distant metastasis. Neoadjuvant chemotherapy is the primary chemotherapy given to patient prior to surgery. This has been used for treatment of LABC with development and testing of increasingly effective agents particularly anthracyclines, dramatic response had been seen in significant proportion of patients. Aim and Objective: Main objective is to evaluate the clinical /pathological response of primary tumor and lymph node to Neoadjuvant chemotherapy. Methods: 58 female patients admitted to M.K.C.G. Medical College and Hospital after confirmation of LABC by core needle biopsy from 2019 to 2021 and was evaluated clinically with detailed history of the patients, physical examination of breast and axilla. Investigation like CBC, LFT, RFT and USG/MRI of Breast, axilla, abdomen, and Chest X-ray etc. are done. A prospective study was done with ethical clearance from ethical committee of M.K.C.G. Medical College & Hospital, Brahmapur, Odisha. Observation: Overall occurrence of complete clinical response is 24% with maximum response is seen in triple negative breast cancer which is 38% and least in luminal B Her-2 positive where none shows complete clinical response. Complete clinical response is 42% in stage IIIA tumours which is more compared to stage IIIB tumours which is 9%. Conclusion: Response to Neo adjuvant chemotherapy (NACT) is more in triple negative tumour compared to hormone receptor positive tumours where endocrine therapy along with chemotherapy plays a major role. Nodal status of the patients is an important prognostic factor as the clinically nodal negative patients has better response than the clinical nodal positive patients. More and more the LABC patients should be study with new drug regimen before surgery.

107. IOTA Simple Ultrasound Rules for Triage of Adnexal Mass
Nina Mishra, Susanta Kumar Behera
Introduction: Adnexal mass affects younger population more often, the prevalence of these masses in the range of 0.17%–5.9% in asymptomatic women and 7.1%– 12% in symptomatic women. As these masses presents with very non-specific symptoms the differential diagnosis can include a long list of diseases ranging from benign conditions all the way to malignancies. The IOTA group also developed ‘Simple Rules’ that may be applied to a mass based on the presence or absence of five benign and five malignant ultrasound features. So, this study was performed to establish the diagnostic utility of these rules diagnosing ovarian malignancy. Aims and objectives: (a) To assess the ability of simple ultrasound rules to discriminate adnexal masses as benign or malignant. (b) To calculate the diagnostic accuracy of simple ultrasound rules from IOTA in diagnosing benign and malignant adnexal masses when compared against histopathology results. Material and methods: It was a cross-sectional observational study conducted from October 2019 till October 2021 in Department of Obstetrics and Gynecology, MKCG Medical College and Hospital, Berhampur, Odisha; India over 100 consecutive patients basing on following inclusion and exclusion criteria. Clinical information like chief complaints, menstrual history, and obstetric history, history of past illness and personal history were noted followed by per speculum, per vaginal and per rectal examination. Tumor markers like CA-125 were ordered for all patients after ultrasonography. IOTA classification done for all cases and placed for surgery as required. Histopathological examination was sent for the resected adnexal mass following surgery. Results: Majority of cases i.e., 66 cases (66%) were in the age group of 20 to 40 years. Out of 100 cases, 81 cases (81%) were pre-menopausal, and 19 cases (19%) were post-menopausal.  The most common presenting complaint was abdominal pain in 52 cases (52%) followed by abdominal mass in 27 cases (27%) and abnormal vaginal bleeding in 3 cases (3%).  Nonspecific complaints were presented in 18 cases (18%). Based on IOTA simple rules, in 92 patients (92%), multiple features in combination were found among which B-5 was the most common presentation in benign conditions in 68% of cases, while M-4 was the most common among malignant conditions in 22% of cases. Out of all cases studied, 77 cases (77%) of the patients had benign lesions and rest 23 cases (23%) had malignant lesions. Among benign lesions, serous cystadenoma in 25 cases (25%) was the most common.  Among the malignant lesions, serous cystadenocarcinoma was the most common. The overall diagnostic accuracy of CA-125 was of 84.5 % and overall diagnostic accuracy of RMI scoring was 85 %. The overall diagnostic accuracy of IOTA simple rule for adnexal mass was 86%. Conclusion: This overall diagnostic accuracy of IOTA simple rule was higher than that of CA-125 and RMI. IOTA simple rules have good sensitivity and specificity for identifying malignant adnexal masses and differentiating benign from malignant.

108. Middle Thyroid Vein is an Important Landmark During Thyroid Surgery
Laxmidhara Padhy, Ramani Ranjan Mund, Binayak Panda
Introduction: Thyroid surgeries are common surgeries are done in this Hospital.  The most trained surgeons are required as the organ is most vital and surrounded by major vessels and nerves.  Finding out and guiding some vital structures like Middle Thyroid Vein though this vein is rarely found in patients during surgery.  But without identifying the vessel and injury or cutting may lead to fatal complication like haemorrhage and tracheal compression. A protean range of pathologies such as goiter, nodules, thyroiditis and malignancy distort or alter the location and course of these structures and planes. Surgeons attempting thyroydectomy need to have thorough knowledge of embryology and surgical anatomy of the thyroid gland. Aim is to evaluate the prevalence of middle thyroid vein and its consequences. Method: 72 cases of thyroid swelling are operated after proper diagnosis in M.K.C.G. Medical College & Hospital, Brahmapur, Odisha from 2019 to 2021.  A prospective study was done after ethical clearance from the ethical committee of M.K.C.G. Medical College & Hospital, Brahmapur. Observation: The incidence of middle thyroid vein per lobe was 14%.  In all cases MTV was originated from middle part of gland and inserted in internal jugular vein.  In 72% cases middle thyroid vein diameter >2mm and in 67% cases its length found to be >1cm.   There was a considerably higher frequency of middle thyroid vein in hyperthyroidism (50%) and goitres (30.7%). Conclusion: Unsuccessful identification or accidental dissection of middle thyroid vein can give rise to intraoperative and postoperative considerable haemorrhage.  The study needs to be expanded to verify the incidence of middle thyroid vein.  There also is a need for studies designed to inform about the venous vascularization in lobes that do not show any presence of middle thyroid vein.

109.Compare the Surgical Site Infection in Elective Laprotomy versus Emergency Laprotomy
Dhiraj Bhambhani, Suresh Bhambhani, Sameer Soni
Background: Laparotomy is a surgical term that refers to the exploration of the abdomen and subsequent steps depending on the underlying cause. In elective laprotomy, patients get pre-operative examination in addition to having any co-morbid conditions including anemia, diabetes, hypertension, or respiratory infections treated. The majority of infections at the surgical sites of the abdomen by laprotomy are simple infections that only affect the skin and subcutaneous layer, although they can occasionally develop into necrotizing infections. Aim: To compare the surgical site infection in elective laprotomy versus emergency laparotomy. Methods and Materials: A total of 450 patients underwent laparotomy, among which 400 patients underwent emergency laparotomy and 50 patients underwent elective laparotomy. Highly specialized microbiological methods were used for the processing of samples obtained from the infected wounds at abdominal surgical sites. Most recently approved standard CLSI guidelines were followed to process these samples.  The modified Kirby-Bauer disc diffusion method was utilized for the examination of antimicrobial vulnerability. Results: In the present study the overall rate of SSI was 18.9% in emergency laprotomy and 17.2% in elective laprotomy. The proportion of male study participants was greater than female participants. The ratio of males to females was 2.7:1. The patients with an age of more than 50 years had a higher proportion of infection at the surgical site of the abdomen in comparison to the patients who were less than the age of 50 years. Regarding the duration of the operation, a prolonged time was found to be a significant risk factor for SSI and it was observed that as the order and the duration of surgery increased, the rate of infection also increased. Conclusion: The overall incidence of infection at the surgical site in emergency laparotomy is greater than the elective laprotomy, however, the difference is not significant statistically.

110. Histopathological Study of Colorectal Biopsies at Tertiary Care Centre
B. Venkata Rajeswari, Y. Sudhasree, Y. Subramanyam
Background: Numerous benign and malignant tumours can affect the colon and rectum. Since many lesions take longer to diagnose due to hazy symptoms, a biopsy is often necessary. The present study was done to study the spectrum of histopathology of colorectal biopsies. Methods: This retrospective observational study was conducted in the Department of Pathology, Viswabharathi Medical College from January 2019 to December 2019. Endoscopic biopsies of colorectal lesions received in the Department of Pathology were included in the present study. The diagnosis in all the cases was made on Hematoxylin and Eosin stained slides of processed tissue. Results: A total of 40 biopsies of colorectal lesions were received for histopathological examination. The spectrum of histopathology of colorectal lesions ranged from non-neoplastic lesions to malignancies. Out of 40 cases, 28(70%) were males and 12 (30%) were females with age range from 5 years to 80 years. Nonneoplastic lesions were nonspecific colitis, sigmoid colon volvulus, gangrene, ulcerative colitis, inflammatory polyp, and granulomatous colitis. Neoplastic lesions were Juvenile rectal polyp, Adenomatous rectal polyp, adenocarcinoma, mucinous adenocarcinoma, squamous cell carcinoma, and malignant melanoma. Conclusion: The majority of cases were non-neoplastic lesions, among which common finding was nonspecific colitis. The most prevalent neoplastic lesion was colon adenocarcinoma. For colorectal lesions, histopathology aids in early diagnosis, treatment direction, follow-up, and surveillance.

111. Cytopathological Study of Cervical Smear: A Hospital Based Retrospective Study
Y. Sudhasree, K. Vasundhara, A. Lavanya
Background: Cervical cancer is the most prevalent gynaecological cancer in developing nations and the main cause of mortality and morbidity among women worldwide. The Papanicolaou test is a simple and cost-effective cervical cancer screening method. The purpose of the present study was to examine the Pap smear for cytopathological evaluation in a tertiary care center. Materials and Methods: A retrospective study was conducted at department of pathology, Viswabharathi Medical college & Hospital from June 2020 and May 2021. The Pap smears were obtained by using conventional technique and were evaluated using The Bethesda system (2014). A total of 200 cases were analyzed. The prevalence of epithelial abnormalities was calculated in percentages. Results: Out of total 200 patients, 8 (4%) cases revealed epithelial abnormalities. The most frequent epithelial cell abnormality was Low grade Squamous Intraepithelial Lesion. The most common age group in this study was (31-40years). Conclusion: In developing nations, cervical cancer is the most frequent gynaecological malignancy. The abnormal epithelial lining of the cervix can be detected by a simple screening test such as the cervical Papanicolaou smear (Pap).

112. Role of CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) in Detection of Genital Tuberculosis in Endometrial Tissue among Women with Infertility
Payal Tiwari, Rekha Wadhwani, Pallavi Singh, Zoya Kausar
Background: Female genital tuberculosis is the second most common form of extrapulmonary tuberculosis and is a well-recognized factor associated with infertility among females. It poses a diagnostic dilemma because of its varied presentation and lack of sensitive and specific methods of diagnosis, though CBNAAT gives rapid, accurate, and sensitive results. Aims and Objectives: To evaluate the role of CBNAAT (cartridge-based nucleic acid amplification test) in the detection of genital tuberculosis in endometrial tissue among women with infertility and to find out the institutional prevalence of genital TB in patients with infertility and to get the diagnostic comparison of endometrial tuberculosis by GeneXpert, HPE, ZN staining and AFB culture. Material and Methods: 215 patients who presented with infertility were enrolled for the observation study. Premenstrual phase endometrial biopsy was obtained and subjected to histopathological examination, ZN staining, and culture for AFB and CBNAAT. Results: Out of 215 women 28 were positive for mycobacterium tuberculosis by CBNAAT making the overall institutional prevalence of FGTB in infertile women to an extent of 13%. Endometrial biopsy revealed inflammatory cells in 8.4% and culture was positive in only 2.8% of cases whereas AFB was negative in 100% of cases. Conclusion: CBNAAT is a specific method for the diagnosis of FGTB. The histopathology examination of all the samples was non-specific. No cases of positive acid first bacilli on ZN staining were observed. Among the four methods used in the FGTB case, CBNAAT has the highest utility. A comparison of culture and CBNAAT revealed that CBNAAT was more sensitive in detecting positive cases.

113. Maternal and Fetal Outcome in Pregnancies Complicated by Liver Disease – A Prospective Study
Aruna Kumar, Aisha Khan, Nitu Mishra
Background: Liver disease in pregnancy is rare. Pregnancy related liver diseases can be a serious threat to maternal and fetal wellbeing. In normal pregnancy many physiological and hormonal changes occur within the human body, some of which can mimic those seen in women with liver disease. The spectrum of disease and presentation varies hugely leading to delays in diagnosis and appropriate management. Hence once women with liver disease become pregnant, it is essential that they have rapid referral to specialised physicians with experience of managing hepatic disorders in pregnancy. Aim: The aim of the study was to evaluate the maternal and fetal outcomes in pregnancy complicated by liver disease. Methods: This was a prospective observational study conducted in the department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal, a tertiary care centre in central India. The study was conducted in 320 women admitted in the hospital with diagnosis of liver disease in pregnancy over a period of 12 months, starting from February 2020 to January 2021. Results: The incidence of liver disease in pregnancy was found to be 2.7%. Majority of the patients belonged to the age group of 18 to 25 years (48.41%) and most of them belonged to rural areas (72.5%). 51.6% among them were primigravida. Hypertensive disorders of pregnancy were the most common cause of liver disease in pregnancy (59.4%) closely followed by viral hepatitis (52.5%). 31.3% required transfusion of blood products. Majority of the patients had vaginal delivery (75.6 %).15.9% of the total deliveries had postpartum hemorrhage (PPH); 2.5% of patients had traumatic PPH and 13.4% patients had atonic PPH. Ninety patients (28.1%) required intensive care support. Maternal mortality rate was 17.8%. 14.1 % patients died within six weeks of delivery. Perinatal mortality rate was 32.5%. 19.4% had low APGAR score at birth, 23.7% were stillborn and there were 8.8 % neonatal deaths. Hypertensive disorders of pregnancy were the cause of highest mortality among patients (73.7%) followed by viral hepatitis (59.6%). Conclusion: Liver disease in pregnancy can pose a serious threat to maternal and fetal outcome and requires intervention by the hepatologist and obstetrician early during the disease process which can dramatically improve the maternal and neonatal prognosis.

114. A Study on Serum Amylase Levels in Acute Organophosphorus Poisoning
Nukala Akhila Prasanna Lakshmi, Vijay Kumar Aitipamula, Suresh Kumar Reddy Yenna
Background: To estimate serum Amylase levels in acute organophosphorus compound poisoning and find out its relationship with clinical severity and outcome. Patients presenting with Organophosphorous poisoning were the study subjects from SVS Hospital, Mahabubnagar from September 2019 to August 2021. In India, Organophosphorus compounds cause more suicidal deaths among the earning and nonearning members of the society. Of the 40 patients in our study 15 patients (37.5%) had normal serum amylase level; 25patients (62.5%) had elevated serum amylase level which is very significant.

115. Prospective Study of Correlation between Mammogram and Fine Needle Aspiration Cytology with Post operative Histopathology in Palpable Breast Lumps in a Tertiary Care Centre in Kerala
Dinulal PP, Abraham Joseph, Hafsa Salim, Ajmal Rahman KM
Background: Breast cancer was found to be the second most commonly diagnosed cancer in females worldwide with 2.3 million new cases added each year; with more than half of the deaths in low and middle income countries. Every breast lesion is classically evaluated with triple assessment, i.e., clinical examination, imaging and needle biopsy. This study intends to evaluate the correlation between Fine needle aspiration cytology and mammogram with post excision standard histopathology examination. Aim: To correlate the findings between fine needle aspiration cytology, mammogram and Histopathology examination of the Biopsies from palpable Breast Lumps and to evaluate the diagnostic accuracy of these three methods. Objectives: To assess the diagnostic accuracy of the three methods in differentiating the benign and malignant lesions and to categorize the detected breast lesions according to BI-RADS. Materials: 66 patients with lumps in the breast between 18 to 80 years ago were included. Patients willing to undergo preoperative evaluation and excision of lesion if indicated were included. Informed consent was taken. Patients were evaluated clinically and on mammogram or USG. A Fine Needle Aspiration Cytology was done in all indicated cases. The FNAC results were compared for correlation with postoperative histopathology results. The sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio of both were studied. Data was collected using study proforma, clinical examination and from case records and review of investigation reports. Results: The total 66 patients had a mean age of 48.7 (Mean age: 48.70±14.30) and mean age among patients who have malignant disease was 59 and mean age among patients with benign disease was 33.7.  Among the subjects with Breast symptoms 27 (41%) had benign breast disease and 39 (59%) had malignant breast disease. On clinical examination 27 (41%) had firm consistency on palpation and 39 (59%) patients had hard lesion on palpation? Among 4/66 patients (06%) had inadequate smears (C1) result; 06 patients (9%) had benign (C2) result; 23 patients (35%) had atypia probably benign (C3) smear; 33 patients (50%) had suspicious malignancy (C4) smear; and no patients had clear malignant (C5) result. Among 66 patients 0 patients had Category 0 result, no patients had Category 1 result, 02 patients (3%) had Category 2 lesion, 22 patients (33.3%) had category 3 lesion, 40 patients (60.6%) had Category 4 result; 2 out of 66 (3%) had Category 5 result; and no one had category 6 results. Conclusions: The age of incidence of malignant disease and its prevalence was higher. Malignant disease of the Breast was higher than the benign disease in contrast with current literature. FNAC had 96.4% sensitivity, and 72% specificity, 84% Positive predictive value (PPV); 93% Negative predictive value (NPV); and 87% accuracy with a Positive likelihood ratio of 3.54 and a negative Likelihood ratio of 0.05. Mammogram was found to be having 100% sensitivity, and 89% specificity, 93% Positive predictive value (PPV); 100% Negative predictive value (NPV); and 96% accuracy with a Positive likelihood ratio of 9.1 and a negative Likelihood ratio of 0.

116. Profiles of Lower Urinary Tract Injuries in a Tertiary Care Center
L. Prasad, H. S. Prakash, Das Debabrata, C. Kumar Prajwal
Background: Lower urinary tract comprises of bladder and urethra. Its injury results in long term morbidity. Men are more commonly injured than female. Blunt trauma accounts for 90% of lower urinary tract injuries while penetrating injuries are extremely rare. Iatrogenic injury occurs due to catheterization, post-surgery etc, Lower urinary tract injuries should be diagnosed and treated efficiently to prevent long term sequeale. As poorly managed patients will be having significant problems and recurring need for further interventions. To a young person, following urethral injury the potential complications of impotence, stricture and incontinence often create life-long morbidity and be a cause of social and psychological concern. In addition to the burden caused by the disease, treatment for lower urinary tract injuries is associated with complications that further add to the burden of disease. Aims and Objectives: (1) To identify age, sex, risk factors, nature of injury and clinical presentation of lower urinary tract injuries among the patients presenting at KRH, Mysore. (2) To evaluate the different treatment modalities available for the management of lower urinary tract injuries. Materials and methods: The study is conducted on 50 patients who are diagnosed to have lower urinary tract injury. Once admitted detailed history was taken about demographics (age, gender, and religion), history, physical examination, mechanism of injury, type of injury, associated injuries were noted. Following which patients are subjected for routine blood investigations, USG Abdomen and pelvis, X-ray pelvis, retrograde urethrogram and CECT Abdomen as per the need. They were diagnosed and management (conservative or surgical management) was done. Total duration of study and follow up was 1year and 6 months. Results: After the patients were investigated diagnosis of Stricture urethra was made in 26(52%) of patients. Bladder tear was noted in 7(14%) of patients. Genital tear and Pelvic fracture urethral distraction defects (PFUDD) was seen in 6(12%) and 4(8%) patients respectively. Straddle injury was diagnosed in 3(6%) patients. Constricting ring related injury due to a rubber band around penis was diagnosed in 2(4%) of patients and penile fracture due to trauma and penis amputation also due to trauma was seen in 1(2%) patient each. Conclusion: In our study non operative management was the predominant form of management as in 34 (68%) of patients and operative management in form of tissue repair was done in 16 (32%) of patients. While managing lower urinary tract injuries care must be taken, with the goal of optimizing long term sexual, cosmetic and urodynamic outcomes.

117. Assessment of Serum Trace Elements (Zinc, Magnesium, Calcium and Phosphorus) in Pre-Eclampsia
Akshita Choudhary, Ajay Kumar Bhargava, Neeraj Singh Songara, Laxmi Naval
Background: Deficient or excessive levels of blood trace elements can be an adverse factor in pre-eclampsia. During pregnancy, trace elements are important not only for the mother but also for fetal development.  Objectives: To determine and compare the serum levels of zinc (Zn), magnesium (Mg), calcium (Ca) and phosphorus (P) in the pre-eclampsia patients and healthy controls. Material & Methods: Estimation and comparative study of serum (Zn), (Mg), (Ca) and (P) were determined between 50 Pre-eclampsia patients and 50 healthy controls by using Atomic Absorption Spectrophotometry (AAS) and (Ca) and (P) were determined by using fully automated analyzer. Statistical comparison analyzed, results were expressed as Mean ± SD, p < 0.05 was considered statistically significant. Results: All groups were statistically matched in age distribution (p >0.05). Serum (Zn) concentrations in cases and controls were (51.14 ± 4.62mg/dL) and (63.00 ± 6.37mg/dL) respectively (p<0.0001). Serum (Mg) concentrations in cases and controls were (1.90 ± 0.334mg/dL) and (1.5 ± 0.330 mg/dL) respectively (p <0.0001). Serum (Ca) concentrations in cases and controls were (7.65 ± 0.35 mg/dL) and (8.65 ± 0.34 mg/dL) respectively (p <0.0001). Serum (P) concentrations in cases and controls were (4.02 ± 0.18 mg/dL) (3.95 ± 0.22 mg/dL) respectively (p =0.097). Conclusion:Difference in serum (Zn) levels in cases and controls were statistically significant; Serum (Zn) was lower in pre-eclampsia patients as compared to controls. Serum (Mg) was significantly higher in pre-eclampsia patients as compared to controls. Pre-eclampsia patients were found increased serum (Mg) and controls were lower than normal level of serum (Mg). Serum (Ca) was significantly lower in pre-eclampsia patients as compared to controls. Pre-eclampsia patient’s shows deficiency of (Ca) and controls were higher than normal value of serum (Ca). Serum (P) was insignificantly higher in pre-eclampsia patients as compared to controls, and both values were within normal range serum (P).

118. Plain Radiograph and MR Evaluation of Painful Hip Joint
Nageswara Rao, P.V. Srujana, T. Rajesh
Background: In this study, we wanted to make a distinction between numerous painful hip joints and conditions revealed by an MRI and determine the severity and extent of underlying lesions in diverse situations. Materials and Methods: This was a cross-sectional study conducted among 50 patients from the Konaseema Institute of Medical Sciences and Research Foundation in Amalapuram, over 18 months from June 2019 to December 2021. Results: The most common illness identified because an explanation for painful hip in our study was avascular necrosis (AVN) of the femoral head. Only 2 (6.66%, n=30) of 9 (30%, n=30) AVN cases discovered on MRI were diagnosed on plain radiography. Osteoarthritis was found in 6 (20%, n=30) instances. Both simple X-rays and MRIs revealed all six cases. Conclusion: In the diagnosis and therapy of paediatric hip problems, magnetic resonance imaging (MRI) is becoming increasingly effective. MR imaging provides various benefits, which are especially relevant within the paediatric population.

119. A Comparative Study of Serum Ferritin and Glycated Haemoglobin in Patients with Type 2 Diabetes Mellitus and Healthy Controls
Divya Khandelwal, Alka Meena, Arpit Khandelwal, Bhawna Bagaria, S K Vardey
Background: Diabetes is a metabolic disorder characterized by hyperglycemia which is associated with rise in hba1c. Serum ferritin is a ubiquitous intracellular protein complex that reflect the iron stores of the body .this study was carried out to find out the relationship between serum ferritin and hba1c in type2 diabetic patients and controls and to see the influence of body iron stores on hba1c and blood glucose. Materials & Methods: After taking necessary permissions, a cross sectional study was conducted at Department of Biochemistry and Department of Endocrinology, SMS Hospital, Jaipur. This study includes 31 patients suffering from type 2 diabetes aged 30-80 years compared with 31 controls. Hba1c was measured by latex turbidimetric method and serum ferritin was assessed by CLIA (chemiluminescence). Results: Results were analyzed statistically by Student’s t-test, Pearson correlation coefficient test. Mean serum ferritin was significantly higher in diabetics than in the control group (177.3±49.14 μgm/L vs. 94.9±55.59 μgm/L, p<0.001). There was statistically highly significant (p <0.001) positive correlation between serum ferritin and HbA1c in diabetic patients (p<0.001). Conclusion: The findings of this study concludes that serum ferritin is elevated in patients with type 2 diabetes mellitus when compared to healthy controls and it indicates that ferritin can be used as a marker for glycemic control in diabetic patients because Hba1c may be affected by a variety of genetic, hematological diseases (haemoglobinopathies), certain type of anemia, and disorders associated with accelerated red cell turnover such as tumors.

120. Role of Multidetector Computed Tomography in Evaluation of Blunt Abdominal Trauma
Rajesh, V. Latha Mounika, D. Nageswara Rao
Background: In this study, we wanted to assess the use of multidetector computed tomography (MDCT) in recognizing intra-abdominal injuries in patients with blunt abdominal trauma and providing information that might be used to accurately identify treatment options (non-operative versus operative) and link CT findings with clinical observations, follow-up CT scans (if needed), or surgical findings (wherever applicable). Materials and Methods: This was a prospective study conducted among 30 patients with blunt abdominal trauma over 18 months (2019 to 2021). Data for the study was gathered from patients with blunt abdominal injuries who visited / were referred to the Department of Radiodiagnosis at Konaseema Institute of Medical Sciences and Research Foundation in Amalapuram. Results: All CT results were associated among these 4 cases that underwent laparotomy. Thus, the specificity of CT was 100%. Among 4 patients with isolated hemoperitoneum, 2 patients deteriorated clinically and were operated on for laparotomy. Both patients had bowel injuries which were not found in CT findings. Thus, sensitivity was 50% for bowel injuries. Conclusion: The gold standard technique is MDCT in evaluating abdominal blunt trauma.

121. A Comparative Evaluation of Intrathecal Isobaric Levobupivacaine 0.5% with Adjuvants Fentanyl and Clonidine in Patients Undergoing Lower Abdominal and Lower Limb Surgeries
Manju Kamboj, Virendra Kumar Verma, Satyaprakash, Sandeep Kothari
Aim: To study Comparative Evaluation of Intrathecal Isobaric Levobupivacaine 0.5% with Adjuvants Fentanyl and Clonidine and the anaesthetic potency and hemodynamics, onset, duration, level and time of sensory and motor block and post-operative complications. Method: After institutional ethical committee approval the study was conducted on 75 patients, whom spinal anaesthesia was given and divided in 3 groups according to drug patients received. Group 1- 0.5% levobupivacaine (3ml) + 0.5ml normal saline, Group 2- 0.5% levobupivacaine (3ml) + inj fentanyl 25 microgram in 0.5 ml, Group3- 0.5% levobupivacaine (3ml.) + inj clonidine 30 microgram in 0.5ml Normal saline. Result and Conclusion: Onset of sensory and motor block, Level of sensory block, Duration of motor block, Duration of analgesia was significantly faster with clonidine when compared to other groups.

122. An Experimental Study Comparing Preoperative Intraincisional Antibiotic Infiltration and Prophylactic Intravenous Antibiotic Administration for Reducing Surgical Site Infection in Laparotomy Surgeries
Sivachandran Kabilan, Sri Prathiba Mahalakshmi Nagarajan
Background: The goal of surgical prophylaxis is to prevent wound infection and hence complications. Failure to maintain adequate serum and tissue levels throughout the surgical procedure increases the likelihood of the infection. Polk and Lopez-Mayor have emphasized that wound levels, not blood or serum levels, appear to determine the efficacy of agents for prophylaxis of operative wound infection. Intraincisional infiltration of the antibiotic of choice enables the maintenance of adequate minimum inhibitory concentration of the antibiotics at the wound site. Materials and Methods: Patients undergoing laparotomy surgeries either in elective or emergency settings was classified into two groups, one receiving preoperative intraincisional ceftriaxone infiltration along with intravenous ceftriaxone administration and the other receiving intravenous ceftriaxone alone as prophylaxis. The wound is classified into clean-contaminated, contaminated and dirty and the outcomes of both groups were analysed in terms of superficial, deep and organ/space infection and complication. The drug concentration at the wound site and serum were measured simultaneously and documented. Results: Among the 100 patients, 35 of them were cases for whom infiltration was done and 65 of them were controls. Postoperative infection was present in 22% of cases (8 patients) and 49.23% of controls (32 patients). 12% of infection was seen in elective surgery and 87.5% of infection following emergency surgery. Organ space SSI contributes to 72.42 % of complications and deep SSI to 54.54% and superficial SSI to 29.41% respectively. The presence of contaminants influenced the occurrence of infection and complications significantly. The most important contaminants were pus, faecal matter, gangrenous bowel and toxic fluid. Among the microorganisms that colonised the postoperative infection, staphylococcus accounted for the majority of cases (50%), followed by E. coli (31.57%) and Klebsiella (15.78%). The amount of drug present in incisional drain fluid at the end of 24 hours was observed to be well above the MIC of most bacteria causing SSI in those who received infiltration while in controls, no drug was present at the incisional site by the end of 24 hours. Conclusion: In our study, there was a significant reduction in the incidence of SSI in the group, which received both intraincisional and intravenous ceftriaxone preoperatively than the other group which received only intravenous ceftriaxone. Preoperative intraincisional antibiotics significantly reduced the rate of SSI because of the higher concentration achieved at the incision site.

123. A Cross Sectional Assessment to Determine the Levels of Vitamin D and Genetic Variations in Vitamin D Receptors with the Dengue Virus Infection
Md. Farid Alam Ansari, Md. Israrul Haque
Aim: Determining the levels of vitamin D and genetic variations in vitamin D receptors with the dengue virus infection. Methodology: The present cross-sectional study was conducted at the Department of General Medicine, Netaji Subhas Medical College and Hospital, Bihta, Patna, Bihar, for the period of 1 year. Children  with  Dengue  who  were  admitted  to  ICU,  Department  of  Paediatrics,  Niloufer Hospital  during  the  study  period  were  included  in  this  study. Study sample Size was 100. Children fulfilling the diagnostic criteria for Dengue Fever were enrolled in the study after getting informed consent from the parents/guardians. We included Age 1 month-12 years. Children fitting into the diagnostic criteria of Dengue Fever-Dengue NS1 Antigen positive or Dengue IgM Antibodies Positive. Parents/guardians of children with the criteria mentioned above who are willing to give informed consent. The following investigations were  done  at  admission  (phase  1), 48  hrs  after  admission  (phase2), at  discharge (phase3) Complete  Blood  count,  Hematocrit,  Serum  Vitamin  D  levels  at  hospital  admission.  We followed up with all the children until they were discharged. We included all 100 children during that period and sample size was justified at alpha error 0.05, power 80. The treatment process and investigations were documented. The data were entered in Microsoft Excel 2010 version and analyzed. Results: Among the population studied, 51% were between the age group of 6-10 years, 27% be-longed to the age group of 11-14 years,13% belonged to the age group of 2-5 years, and 6% belonged to the age group 1 month to 12 months. Among the population studied, 54% were males and 46% were females. Among the population studied, 49% had positive, Dengue IgM antibodies 27% were positive for Dengue NS1 Antigen and 24% were positive for both. Among the population studied the mean Hemoglobin values were 12.97± 2.54 gm/dl. They decreased  to  11.22±1.23 gm/dl  before  discharge.  The mean Hematocrit values were 39.2±5.83 after admission, and they decreased to 35.9±3.64 before discharge. The mean  platelet  values  on  admission  were  77,402 926 cell/cumm Among the population studied Dengue Fever was present in 64%, Dengue Fever with warning signs was present in 25%,Severe Dengue was present in 11%. Among  the  population  studied  the  overall  mean  of  Serum  Vitamin  D  levels  was 17.95ng/ml. The mean of Serum Vitamin D levels was 21.23 ng/ml in cases with Dengue Fever. The mean of Serum Vitamin D level was 17.34 ng/ml in cases with Dengue Fever with warning signs. The mean of Serum Vitamin D levels was 10.8 ng/ml in cases of severe Dengue.  Conclusion: The Serum Vitamin  D levels were  decreasing with the  severity  of  Dengue  illness increasing  and  association  of  this  is  statistically  significant. Decreasing  levels  of  mean  Hemoglobin  were associated  with  increasing  severity  of  Dengue  illness  and  decrease  was  statistically significant. Decreasing levels of mean Hematocrit levels were associated with increasing severity of Dengue illness and decrease was statistically significant. Mean platelet levels were decreasing as the severity of Dengue was increasing. The decrease in the levels of means was also statistically significant. So from this study, it can conclude that with severity of dengue fever, serum vitamin D, hemoglobin, and hematocrit levels decrease.

124. Clinical Assessment of the Performance of Single Unit PEEK Crown Restoration: An Observational Study
Aim: To evaluate the clinical performance and patient satisfaction of PEEK Crowns. Material & Methods: This was a pilot study conducted on twenty patients who required crown placement (on vital/non vital tooth) in the posterior segment. This study was conducted over a period of 1 year in the Department of Maxillofacial Surgery, Narayan Medical College & Hospital, Sasaram, Bihar, India. Results: A total of 25 participants received PEEK crowns, all of which had complete occlusal contact with the opposite arch. No participants were lost to follow‑up during the observation period.Significant difference was seen between the periodontal status at baseline and at 1‑year recall. At 3 months, 4 (17%) patients had mild inflammation, and at 6 months, 2 (12%) patients had mild inflammation and 2 (10%) patients showed moderate inflammation. This was statistically significant as well with P = 0.038. Conclusion: Within the limitations of this study the following conclusions were drawn that the PEEK crowns demonstrated by the use of Modified Ryge’s Criteria, its capability to produce quality prostheses that were rated satisfactory with a relatively low rate of fracture over the  relative mean period of one year.

125. Assessment of the Usefulness of Alvarado Scoring and Ultrasound Abdomen to Diagnose Acute Appendicitis and Reduce Negative Appendectomy Rates
Santosh Kumar Sharma
Aim: To use Alvarado scoring and ultrasound abdomen to diagnose acute appendicitis and reduce negative appendectomy rates. Material & Methods: This was a prospective study conducted on 100 consecutive patients who underwent appendicectomy in the Department of General Surgery, NMCH, Patna, Bihar, India from June 2019 to July 2020 . All consecutive patients more than 14 years of age who had a provisional diagnosis of acute appendicitis and were willing for surgery and who gave consent for the study were included. Results: In our study of 100 patients, 58% were male, and 42% were female. The most number of patients, 45%, were between 20-29 years of age. Taking histopathology as the gold standard and comparing it with the Alvarado score, the Alvarado score was >=7 in predicting appendicitis 94% of patients with a sensitivity of 95.7, specificity of 82.4and an accuracy of 94.6. Conclusion: Clinical assessment is the mainstay of diagnosis with ALVARADO score and ultrasound significantly contributing to the more efficient diagnosis and reduction in negative laparotomies.

126.Diagnostic Accuracy of Cervical Pap Smear in Detecting Cervical Lesions: A Comparative Study
Nilofer Poonawala
Background: Carcinoma of cervix is a preventable condition and considerable effort goes into detecting and treating the preinvasive disease. Since 1943, Pap smear cytology has been used for the screening of cervical cancer. Therefore, the present study was conducted to compare pap smear and histopathological findings of unhealthy cervix in tertiary care hospital. Methods: The present comparative cross-sectional study was carried among women who presented with various gynaecological complaints at Department of Obstetrics and Gynaecology of tertiary care centre during November 2019 to October 2020. Sample sizes of 108 participants were enrolled in study. The collected data were analyzed with proper statistical methods using MS excel 2016. Results: The majority of participants were with mean age of 37.48± 8.03 years and white discharge (58.33%) as the commonest complaint. Pap smear shows sensitivity of 86.67%, specificity of 83.33% with accuracy of 84.26% when compared to histological findings. Conclusions: The high specificity and sensitivity of pap smear indicated that pap smear has an important role in the diagnosis of cervical pathology.

127.Assessment of Micronuclei Frequency in Individuals with a Habit of Tobacco Chewing by Means of Exfoliated Oral Buccal Cells
Keerti Bhardwaj, Nand Lal, Mohammad Amaa, Rohit Sharma, Vatchala Rani RM
Background: The majority of malignancies are discovered at an advanced stage, which results in low patient survival rates. Therefore, it appears that early diagnosis of oral malignancies is urgently needed. Micronuclei (MN) of exfoliated buccal cells can be examined to detect genetic damage. Aim: To carry out assessment of micronuclei frequency in individuals with a habit of tobacco chewing by means of exfoliated oral buccal cells. Methods and Materials: A total of 100 subjects were examined in the study, which were divided into 2 groups. Each group had 50 subjects. Group1 comprised of the control group which included tobacco non user’s individuals i.e. those who are without any habit and Group 2 comprised of smokeless tobacco users. This study was performed to observe and calculate MN index in oral epithelial cells and to compare MN index within above mentioned groups employing feulgen reaction for evaluation of micronuclei. Results: Maximum mean MN count per 500 cells were in group – 2 (91.40+29.17) followed by group – 1 (28.96 +11.20).One way ANOVA test found that mean MN count per 500 cells were not alike in both groups. Post Hoc Turkey HSD Test found in pair wise comparison that there was statistically significant difference (p<0.05), between group 1, group 2 with respect to MN count per 500 cells. Table 2 shows that among group 3 subjects, 76% were gutka chewers, 14% were having habit of chewing gutka along with paan, while 6% subjects used gutka in combination with masala, and 4% participants were khaini users. According to table no 3 mean MN count per 500 cells among khaini users was highest (115.00+24.04) followed by mean MN count per 500 cells (104.33+19.63) in case of subjects using combination of gutka and masala. Conclusion: The Micronuclei assay is a useful tool for assessing the severity of premalignant and malignant lesions in tobacco chewers. The micronucleus count is a non-invasive technique used for diagnosis, patient education, widespread population screening, and therapy effectiveness testing.

128. A Prospective Observational Assessment of the Minimally Invasive Nephrectomy for Inflammatory Renal Disease
Shashank Abhishek, Vir Abhimanyu Pandit
Aim: The aim of the present study to determine the minimally invasive nephrectomy for inflammatory renal disease. Methods: This was a prospective observational study conducted in the Department of Urology, Narayan Medical College, Jamuhar, Sasaram, Bihar, India. 100 patients who underwent a LN for IRD were included in this study. Interstitial nephritis, chronic pyelonephritis, renal tuberculosis and xanthogranulomatous pyelonephritis. The demographics, pre- operative diagnosis based on images (computed tomography [CT], magnetic resonance imaging [MRI], ultrasound and/or renal scintigraphy), and intraoperative variables such as operative time, blood loss, need for open conversion, length of hospital stay, intra and postoperative complications following the Clavien-Dindo classification were analyzed. Results: Left side nephrectomy was performed in 67% of the cases. A positive history of urolithiasis was present in 52% of the cases, followed by urinary tract infections (UTI) (42%), high blood pressure (HBP) (30%) and Type II diabetes mellitus (DM II) (9%).The mean operative time for patients who did not required conversion to open surgery was 203±88 min, for the conversion ones was 388±174min and for all the 100 patients was 218±111min, ranging between 85min and 647 min. The mean estimated blood loss for patients who did not required conversion to open surgery was 213±221mL, for the conversion ones was 1477±748mL and for all the patients was 258±423mL, with a range of 55-3275 mL. The mean length of hospital stay after surgery was 2.9± 2.2 days, being longer for the converted ones compared to the no converted ones (5.6± 2.2 days vs. 3.2 ±2.2 days), ranged between 1 and 14 days. Conclusion: Laparoscopic nephrectomy for IRD is a reproducible technique with low risks and complication rates despite the surgical challenge it represents.

129. A Retrospective Observational Assessment of the Prevalence of Refractive Errors and Spectacle Uptake in Truck Drivers
Prem Kumar, Rajeev Kumar, Jawed Iqbal
Aim: To study the prevalence and types of refractive errors among truck drivers, as well as their uptake of glasses. Material & Methods: This is a retrospective observational study. Data were collected through routine eye camps held for drivers over a period of one year in the Department of Ophthalmology, Anugrah Narayan Magadh Medical College Hospital, Gaya, Bihar, India. Results: A total of 1625 truck drivers were examined in the camps, with the help of a mobile van, during the study. Most of the from utilizing offered services. No association between myopia and uptake of glasses. The results of the logistic regression indicate that the uptake of spectacles was positively associated with age-classes, and negatively associated with number of affected eyes, presence of astigmatism, and presence of hyperopia. The results of the multiple logistic regression analysis conform to the findings of the univariate analysis. Conclusions: Our study highlights the importance of eye examination among truckers. There is a need to increase the uptake of spectacles by increasing awareness and developing better models of spectacle delivery.

130. A Cross-Sectional Mixed-Methods Population-Based Study to Assess the Barriers to Utilization of Oral Rehydration Solution and Zinc in Managing Diarrhea among Under- 5 Children in Bihar Region
Umesh Kumar, Bankey Bihari Singh
Aim: This study aims to assess the barriers to utilization and sources of ORS/zinc in Bihar Region. Material & Methods: A cross-sectional mixed-methods population-based study was conducted in the Department of Pediatrics, ANMMCH, Gaya, Bihar, India over a period of one year, using both quantitative and qualitative Methods. A total of 60 mothers/guardians selected using three-stage cluster sampling (wards/communities/households) participated in the study. Results: Out of 60 participants, majority of them (29) informed the unavailability of ORS/Zincs followed by Unaffordability (19). Of the 30 with recent U5C Diarrhea who used ORS/zinc in the quantitative study, 10 obtained the commodity from private chemists, and 3 each from government hospitals and government health centers. Conclusion: There is a need to design community-level behavior change components to enhance awareness, elimination and management of diarrhea. There are needs for hospital management to ensure that ORS/zinc stock-outs in public hospitals are eliminated.

131. A Hospital Based Retrospective Assessment of the Histopathology of the Soft Tissue Tumours
Ragini Kumari, Ajit Kumar Chaudhary
Aim: Histopathological analysis of soft tissue tumours in a tertiary care hospital in bihar region. Methods: This retrospective study was carried out in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India from November 2019 to October 2020. Total 100 patients of all the soft tissue tumors, both benign and malignant were included in this study. Results: Benign soft tissue tumours formed 85% of all soft tissue tumours while malignant soft tissue tumours constituted 15%. The commonest benign tumour was lipoma (50%) of all benign tumours of soft tissue followed by vascular tumours (20%) peripheral nerve sheath tumours (17%), fibrous tumours (3%), fibrohistiocytic tumours (4%) smooth muscle tumours (2%) and tumours of uncertain differentiation (1%) in the decreasing order to frequency. The benign adipocytic tumours accounted for the majority of benign soft tissue tumours (47%) followed by vascular tumours (16%). Benign tumours of smooth muscle (1%) and tumours of uncertain differentiation are nil encountered. 38% benign soft tissue tumours were seen in extremities followed by head and neck 30% and for the malignant soft tissue tumours mainly lower extremities followed by trunk and abdomen. Conclusion: The diagnosis and management of soft tissue tumors require a team perspective. Even though soft tissue sarcomas are rare and usually present just as painless mass, the clinician must be able to diagnose it early for better management.

132. Cemented Versus Uncemented Hemiarthroplasty of the Hip for Displaced Neck of Femur Fractures: A Prospective Comparative Study
Vikash M Harinandan, Kunal Shankar, Laljee Chaudhary
Aim: To study the advantages, complications, morbidity and mortality rates, the recovery to physical independence encountered in cemented and uncemented hemiarthroplasty for displaced neck of femur fractures. Methodology: The prospective comparative study was conducted in the department of Orthopaedics, Darbhanga medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India from Jan 2019 to December 2019. included 50 cases of intracapsular fracture neck of femur in the elderly aged more than 60 years where 25 patients were treated by hemiarthroplasty using uncemented fenestrated prosthesis whereas 25 patients were treated with hemiarthroplasty using cemented non-fenestrated prosthesis. Follow-up was performed at 6 weeks, 3 months, 6 months, and 1 year after the surgery. The intensity of the pain (based on visual analog scale), hip function (according to Harris hip score), and postoperative complications were recorded. All data including age, sex, type of treatment, intraoperative bleeding volume, the mortality rate (during surgery until discharge), and treatment costs were collected by a questionnaire and checklist and analyzed. Results: The mean age was 68.87 ± 6.24 years with the cemented cohort and 66.35 ± 7.38 years in the uncemented cohort. Of these, 21 (42%) were men and 29 (58%) were female. The most common mechanism of injury was a trivial fall (90%) as opposed to a road traffic accident (10%). The mean operation time was 98.35 minutes in the cemented group and 62.45 minutes in the uncemented group. The mean of the intraoperative bleeding volume was 286.35 cc and 184.25 cc in cement and uncemented groups, respectively. No significant difference was seen between cemented and uncemented methods in terms of functional outcome (HHS score) and VAS score. The intraoperative and postoperative total complication rate was 20% in cemented cohort and 24% in the uncemented cohort which was not statistically significant (P<0.05). Conclusion: In this study, no significant difference was seen between cemented and uncemented methods in terms of functional outcome. Cemented hemiarthroplasty results in more blood loss and takes more operative time but is associated with less postoperative pain and complication and better functional outcome.

133. The Preauricular Sinus: A Comparative Study of Simple Sinectomy and Supra-Auricular Approach
Pradeep Kumar Balia, Pawan Kumar Khatri, Mamta Mehra
Background: Preauricular sinus usually present unilaterally with a predominance on right sided lesions. However, hereditary lesions show bilaterality and inherited by incomplete autosomal pattern with variable expression and decreased penetrance. Previous studies suggested that the 8q 11.1 –q13.3 chromosomal anomaly for transmission of pre auricular sinus. 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.  In this prospective study patients of age of both the genders were enrolled for the study. Results: In the present study, out of total study participants Surgical procedures were performed during the period of Vital stability of the patients. Operative procedures were done under General anesthesia (15 patients in group A and 14 patients in group B) and local anesthesia (05 patients in group A and 06 patients in group B). However, this difference was statistically non-significant (P value > 0.05). The pre auricular sinus tract was found within subcutaneous tissue in 10 patients ( 06 patients in group A and 04 cases in group B). The pre auricular sinus tract was found attached to the auricular cartilage in 30 patients (14 cases in group A and 16 cases in group B). However, this difference was statistically non-significant (P value > 0.05). The overall recurrence among study participants was observed in 2 cases only which were in group A. There was no recurrence noted in group B. This difference was statistically significant (P value < 0.05). Conclusion: We concluded from the present study that the overall recurrence among study participants was observed in 2 cases only which were in group A. There was no recurrence noted in group B. This difference was statistically significant.

134. Sonography in the Diagnosis and Assessment of Dengue Fever: A Retrospective Study
GD Maheshwari, Anil Shrivastav, Chandan Kumar Agarwal
Background: The exact clinical picture is varying from subject to subject which depends on serotype of dengue virus, immunity status and sub type of dengue fever. Dengue viral infections were classified among dengue fever, undifferentiated fever and dengue hemorrhagic fever and dengue shock syndrome. Material & Methods: The present cross-sectional, retrospective study was conducted at department of radiology of our tertiary care hospital. The study duration was of one year. A sample size of 100 was calculated at 95% confidence interval at 5% acceptable margin of error by epi info software version 7.2. Results: In the present study, the spectrum of findings in our study included gall bladder wall thickening, hepatomegaly, splenomegaly, pleural effusion and ascites. Out of 100 patients, 46% had gall bladder wall thickening, 32% had hepatomegaly, 20% had splenomegaly, 13% patients had hepatosplenomegaly and 28% patients had normal ultrasound studies. Out of the total patients 08% patients had ascites. Out of the total patients 06% had bilateral pleural effusion, 09% had right sided pleural effusion. There were no cases of isolated left pleural effusion. Conclusion:  We concluded from the present study that gall bladder wall thickening was seen among majority of patients who had platelet count less than one lakh. The commonest finding in our study was gall bladder wall thickening which was followed by hepatomegaly and splenomegaly.

135. Phototherapy Induce Hypocalcemia in Neonatal Jaundice: In Tertiary Care Hospital, Patna
Amit Kumar, Binod Kumar Singh, Saroj Kumar
Background: During the newborn period, neonatal jaundice is a prevalent problem. In the first week of life, jaundice affects preterm and term infants at rates of roughly 80% and 60%, respectively. Approximately 5-10% of them have clinically significant jaundice which requiring phototherapy. Hypocalcemia is potential adverse effect of phototherapy. Aim &objective: To determine the frequency of hypocalcemia in term neonates with jaundice receiving light emitting diode phototherapy. Materials and Methods: 84 term newborns with hyperbilirubinemia were the subjects of a prospective observational study at the Nalanda Medical College and Hospital (NMCH), Patna, Bihar, to determine the effects of phototherapy with a light-emitting diode device on total serum calcium. Total serum bilirubin and total serum calcium levels were measured at the beginning and 48 hours after phototherapy, the levels of total serum bilirubin and calcium were measured. All of the neonates included in the study evaluated for the symptom of hypocalcemia, such as jitteriness, irritability/excitement, lethargy, and convulsions. Results: Our study showed a significant decrease in post-treatment total serum calcium levels compared to per-treatment levels (p <0.005). In 16.67% of the neonates, hypocalcemia (serum calcium 8 mg/dL in term neonates) was observed. Conclusions: Like traditional blue and white light phototherapy, light-emitting diode phototherapy causes hypocalcemia as a side effect while treating neonatal jaundice.

136. Prospective Observational Assessment of Prophylactic Single-Dose Antibiotic to Prevent Surgical Site Infection
Amit Anand
Aim: To evaluate the effectiveness of single-dose antibiotic prophylaxis in preventing surgical site infection in elective surgeries. Material & Methods: This prospective study was conducted in the department of General Surgery Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. 60 patients reporting to the department for elective surgery were selected for this study. Results: Cholecystectomy was the most common elective procedure conducted in this study. In SSIs was most common in cholecystectomy cases, while Staphylococcus aureus was the most common causative organism. Conclusions: A single preoperative dose of antibiotic cefuroxime effectively prevents surgical site infection in elective cases assuming an uncomplicated procedure.

137. Patient Satisfaction in Outpatient Department at Tertiary Care Hospital: A Cross-Sectional Study
Pradeep Bagavatham, Vundi Krishna Kumari
Introduction: Patient satisfaction is as important as other clinical health measures and is a primary means of measuring the effectiveness of health care delivery. Patient-centered outcomes have taken central stage as the primary means of measuring the effectiveness of health care delivery. Material and Methods: A total of 400 cases with various complications attending outpatient departments of medical allied specialities between 18 to 65 years were included. We used two-point Likert’s Scale in each component of experiences, accessibility of services and the patient satisfaction towards Outpatient Department services. Results: The overall experience was satisfactory in 93% of participants towards physical facilities at OPD, services by nurses, pharmacy, and registration department. The service procedures were good in 80.25%, 79.50% and 91% towards working time, service procedures and working schedule respectively. The overall level of satisfaction with the accessibility of services was good in 92% of participants and poor in 8%. There was a significant relationship between patient experience, accessibility and patient satisfaction on services at outpatient department (p<0.05). Conclusion: The outpatient department services form a vital element to draw a good image of the hospital services and the patients’ opinion are essential in quality improvement.

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