International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

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1.Hip Resurfacing Arthroplasty- Will it Stand the Test of Time?
Deepak Rohella, Ananda Kumar Behera, Harekrushna Sahu, Abhimanyu Madhual, Bibhudatta Mall, Kishore Ku. Panda
The current metal-on-metal hip resurfacing as an alternative to traditional complete hip replacement in younger people constitutes the third generation of resurfacing, with enhanced metallurgy, better designs, and improving operating procedures. Short- and medium-term results are good to exceptional, but long-term results are awaited. Some obvious theoretical benefits of the method include bone stock preservation, ease of revision, when necessary, a more natural gait pattern, and larger ranges of movement. However, as evidenced by numerous research, these have not been fully achieved. Critics of this technique have identified various concerns, including a unique cause of failure involving the neck of the femur, a steep learning curve for aspiring surgeons, and the unknown significance of elevated ions levels. The lack of a specific approach for determining metal allergy. Many surgeons believe that the hazards outweigh the benefits.

2. Comparison of Fixed-Bearing Prosthesis vs. Mobile-Bearing Prosthesis in Total Knee Arthroplasty among Indian Patients
Deepak Rohella, Ananda Kumar Behera, Harekrushna Sahu, Abhimanyu Madhual, Bibhudatta Mall, Kishore Ku. Panda, Sunil Dash
Background: It has been claimed that mobile-bearing knee prostheses achieve more flexion in laboratory testing and may provide a better functional outcome in patients than traditional fixed-bearing knee prostheses. Aim: To assess the mid-term clinical results of total knee arthroplasty (TKA) in Indian patients using a fixed- or mobile-bearing prosthesis. Methods: 120 patients (50 men and 70 women) with arthritis of the knee with similar deformities and range of motion were randomly assigned to have TKA with a fixed- or mobile-bearing prosthesis. Patients with mediolateral instability and infective arthritis were not allowed to participate. Knee and functional ratings, range of motion, and the presence of flexion contracture were all evaluated by the Knee Society. Results: The average duration of follow-up was 3.5 years (range, 1 – 4.6 years). The mid-term results of the two groups were comparable. At postoperative week 2, one patient with a mobile-bearing prosthesis experienced recurrent dislocation due to iatrogenic medial collateral ligament injury. Conclusion: Long-term studies of functional and radiological outcomes are required to identify the indications for fixed-vs. mobile-bearing prosthesis.

3. Hormone Replacement Therapy in the Diagnosis and Intervention of Postmenopausal Osteoporosis
Rahul Anshuman, Amrita
Reducing the frequency of vertebral and non-vertebral fractures (particularly at the hip), which are to blame for the morbidity associated with the illness, is the goal of treatment for postmenopausal osteoporosis. In early postmenopausal women, hormone replacement therapy is still an important tool for osteoporosis prevention. At various doses, hormone replacement treatment (HRT) quickly restores bone turnover and preserves bone mineral density (BMD) at all skeletal locations, resulting in a marked decline in both vertebral and nonvertebral fractures. A one-year follow-up was done by 84 postmenopausal women who were randomly assigned to one of four groups. The first group (n = 20) received conjugated estrogens (CE; 25 days/month) at a rate of 0.625 mg/day. The third (n = 17) received 50 p g/day of transdermal 179-estradiol cyclically (24 days/month) while the second (n = 23) received 0.625 mg/day of CE continuously. The fourth group (n = 24) served as a treatment-free control group, whereas all of these groups additionally received 2.5 mg of medroxyprogesterone acetate consecutively throughout the final 12 days of hormone replacement therapy. Dual photon absorptiometry was performed prior to treatment and again after a year. Prior to treatment and six and twelve months later, measurements of serum calcium, phosphate, and osteocalcin levels as well as urinary calcium/creatinine and hydroxyproline/creatinine ratios were made. The amount of bone mineral increased across the board in all treatment groups. This rise was greater in the transdermal group (7.1 percent, P <0.01) and the continuous CE therapy group (4.4 percent, P <0.05). Concomitant biochemical effects at 6 and 12 months, including decreases in blood calcium, phosphate, and osteocalcin, as well as decreases in urine calcium and hydroxyproline, were consistent with the effects on bone mineral reported.

4. Electrocardiographic and Angiographic Profile of Isolated Left Circumflex Coronary Artery Disease in Tertiary Care Centre of Bihar.
Dhananjay Kumar, Girish Narayan Mishra, Sankar Paul Chowdhury
Introduction: Isolated left circumflex coronary artery disease is uncommon and occurs in a small percentage of patients undergoing coronary angiogram. Because of the rarity of isolated coronary artery disease not many studies involving isolated coronary artery disease are available in literature. Clinical, electrocardiographic, Echocardiographic and angiographic features of these patients with isolated left circumflex coronary artery disease is therefore, poorly characterised. Aim and Objective: To determine the specific electrocardiographic changes as well as angiographic findings in isolated left circumflex coronary artery diseases. Methodology: This study was conducted in the department of cardiology, Narayan medical college, Jamuhar, Rohtas, Bihar. This study is a Descriptive observational study involving 55 patients. Institutional ethics committee clearance was obtained to conduct this study in our hospital. All study subjects fulfilling the inclusion and exclusion criteria were included in the present study. Observation: 30 patients (54.5%) showed Q waves in the resting ECG. Q waves were seen in inferior leads in 20 patients, lateral leads in 6 patients and both in inferior and lateral leads in 4 patients.   Ischemic ST-T changes were noted in 40 patients (72%). Ischemic ST-T changes were seen in inferior leads in 28 patients, lateral leads in 7 patients and both in inferior and lateral leads in 5 patients. RV pattern of ECG changes was noted in 15 patients (27.3%) among the study population. RV pattern was noted in inferior leads in 14 patients and both in inferior and lateral leads in 1 patient. Conclusion: On the basis of our study we can conclude that Single stenosis is the most common finding in the coronary angiogram of the patients with isolated LCX disease. Central stenosis involving proximal left circumflex coronary artery is more common than peripheral stenosis involving distal LCX. Central stenosis involving proximal LCX is more common in patients with documented evidence of MI. Most of the patients with isolated LCX disease have normal left ventricular function.

5. Angiographic Severity of CAD in Patients with Acute Coronary Syndrome in Correlation to their Glycaemic Status in Tertiary Care Centre of Bihar
Dhananjay Kumar, Girish Narayan Mishra, Sankar Paul Chowdhury
Background: Interventional studies have established that cardiovascular complications are mainly or partly dependent on sustained chronic hyperglycemia. This glycemic disorder can be estimated as a whole from the determination of hemoglobin A1c (HbA1c) level, which integrates both basal and postprandial hyperglycemia. The incidence of cardiovascular complications has been identified as depending on HbA1c and on fasting and/or postprandial hyperglycemia. Aim and Objectives: To assess the Angiographic severity of study subjects with acute coronary syndrome and its associations with glycemic status of study subjects. Methodology: The present study is a cross-sectional study. This study was conducted on 100 patients with ACS among which 50 patients who are diabetics and other 50 patients who are non-diabetics admitted in Department of Cardiology, Narayan medical college Jamuhar, Rohtas, South Bihar. Patients who matched the inclusion and exclusion criteria were selected randomly during period of approximately one and a half years formed the study group. Results: In non-diabetic group out of 50 study subjects 23 had single vessel disease, 13 subjects had double vessel disease, and 14 subjects had triple vessel involved whereas in diabetic group out of 50 study subjects 23 subjects had single vessel involvement, 5 subjects had double vessel involvement and 22 subjects had triple vessel involvement. On applying chi-square it was non-significant with p value-0.069. In non-diabetic group gensini score was 42.38±28.34, whereas in diabetic group it was 51.28±32.49, on applying t test it was non-significant with p value 0.15. Conclusions: The severity and extent of CAD in diabetics was more compared to non-diabetics. Involvement and occlusion of vessels were more commonly seen in diabetic patients. The incidence of triple vessel or multivessel disease was significantly higher in diabetics. Patients with poor glycemic control with elevated levels of HbA1c had diffuse pattern of atherosclerotic disease and high levels of HbA1c mildly correlated with gensini score.

6. Coronary Angiographic Profile, Clinical Presentation and Risk Factors of Young Adults (≤40 Years) Presenting with Acute Myocardial Infarction at a Tertiary Care Center in Bihar, India
Dhananjay Kumar, Girish Narayan Mishra, Sankar Paul Chowdhury
Introduction: ACS in very young adults with age ≤30 years is rare. In India, the prevalence of acute myocardial infarction (AMI) in this population is <2%. A similar study reported that 0.4% of patients presented with ACS in ≤30 years age group. ACS leads to significant effects on patient’s psychology, morbidity, and increased financial burden when it occurs at this young age. Aim and Objectives: To identify the clinical, risk factor and coronary angiographic characteristics in very young adults less than 40 years of age presenting with myocardial infarction. Material and Methods: The present study was a prospective study conducted among 100 patients of age less than 40 yrs at Department of cardiology Narayan medical college, Jamuhar, South Bihar. Patients subsequently underwent coronary angiography and revascularization by either primary PCI or pharmaco-invasive PCI or CABG surgery after obtaining informed consent with study protocol approved by Institutional Ethics Committee. All patients were clinically evaluated after detail history taking. Result: 43% study subjects had involvement in AW area, 18% subjects had involvement in EAW area, 11% subjects had inferior wall area, 9% subjects had APL involvement, 7% subjects had involvement in ILW area. 72% study subjects were had single vessel disease, in that 41 had LAD, 21 had RCA and 10 had LCX involvement. 19% subjects had double vessel involvement in which 12 % subjects had LAD and RCA, 3subjects had RCA and LCX. Whereas 9% subjects had triple vessel disease. Conclusion: The major modifiable risk factors in very young Indian population are smoking and dyslipidemia. Primary prevention by educating the public about the effects of smoking, unhealthy dietary habits, and sedentary lifestyle in early years of life may help to prevent the development of cardiac problems later in life.

7. A Study to Evaluate out Patient Prescriptions and Patterns of Drug Used
Ranjeet Kumar, Sarju Zilate, Rahul Kewal Kumar
Introduction: Prescription pattern monitoring studies are tools for assessing the prescribing, dispensing, and distribution of medicines prevailing in a particular locale. The main aim of such studies is to facilitate rational use of medicines. Hence we decided to do this study as this would throw light on deficiencies which require appropriate and sustained interventions to avoid being carried onto the next generation. Methods: The present Retrospective analytical study is carried out on 500 prescriptions / Subjects / Patients. Prescriptions were analyzed using the WHO core prescribing indicators: Average number of drugs per encounter. Percentage of drugs prescribed by generic name, Percentage of encounters with an antibiotic prescribed, Percentage of encounters with an injection prescribed, Percentage of drugs prescribed from essential drugs list or formulary. In addition, quality of prescription writing was also assessed in terms of legibility and completeness of information e.g. whether diagnosis, strength, frequency and duration of drug prescribed was written or not. Results: A large number of fixed dose combinations (46.67) had been prescribed. In this study we found 69.51% prescriptions incomplete in one or more aspect that is, in term of either absence of diagnosis /complains in the prescription or absence of duration, frequency and strength of the drug prescribed. A diagnosis was not mentioned in 418 (25.55%) prescriptions. Strength of the medicine was not mentioned for 573 (35.0%) drugs, while frequency of intake was omitted for 198(12.09%) and duration of therapy was missing in 483 (29.5%) of the drugs. All these prescriptions were considered as incomplete, amounting to 1138 (69.51%) incomplete prescriptions. Conclusions: Our audit did bring out the areas where there is a scope for improvement that is generic prescribing, use of essential medicines, restraint in use of irrational fixed dose combinations and better quality of prescription writing in terms of completeness of information provided and legibility of prescriber details.

8. A Prospective Study to Find Predisposing Factors and Different Predictors among the Non Traumatic Peritonitis
Srinivas Sitaram Pindi, Naveen Chellaboyena, T Jaya Chandra
Introduction: Peritonitis is one of the most common surgical emergencies. The prognosis and outcome of peritonitis depend upon the interaction of several factors. With these a study was taken to find the clinical status of the individuals with peritonitis. Materials and Methods: It was a prospective study, conducted in the department of General Surgery, Rangaraya Medical College. Individuals aged > 18 years, with intestinal perforations were included, traumatic intestinal perforation, malignancy were excluded. Recruitment of the participant was carried based on clinical diagnosis. Complete haemogram, renal function test, arterial blood gas analysis was carried. Levels of amylase and lipase were also measured. Perforation was confirmed by finding gas under the diaphragm in the radiograph of chest and abdomen. Ultrasound of abdomen was carried to find other pathologies. Laparotomy was carried under general anaesthesia. Perforations were closed using modified Graham’s technique. Results: Total 74 members were included, 74.3% were male participants, maximum were in < 40 years group. Alcoholism and smoking were the major (22) risk factors. Only 33% (25) were presented within 24hrs of onset of symptoms. Totally, 26 participants presented to the hospital after 24hrs of onset of gross abdominal distension. Diabetes was the leading (10) cause of morbidity followed by hypertension (6). Majority of perforation were found in the stomach (20). Fourteen were presented with shock at the time of presentation, out of which 12 died. Conclusion: This study helps us in assessing the mortality and morbidity among the patients presenting with peritonitis using the predictors described. This is very useful in stratification of severity of the disease.

9. Coblation Tonsillectomy versus Conventional tonsillectomy a Study from Tertiary Health Care Unit
Krishna Sumanth Kotagiri, Loya Naga Srivalli, M. Ravi Kumar Raju, B Krishna Santosh, T Jaya Chandra
Introduction: The traditional methods of tonsillectomy are cold steel techniques metal instruments are used. A study was conducted to compare different parameters of conventional tonsillectomy (COVT) and total subcapsular coblation tonsillectomy (COBT). Materials and Methods: This was a prospective study, conducted in KIMS, Amalapuram. Chronic tonsillitis patients aged > 5yrs were included in this research. Acute tonsillitis, with bleeding disorders and <5 years were excluded. Routine blood investigations, viral markers, chest radio graph and ECG were carried. The patient was put on general anaesthesia, randomly divided for COVT and COBT.  Parameters such as operative time, intra operative complications, intra operative blood loss, post operative complications were compared among the groups. To find the significant difference between the bivariate samples in independent groups, unpaired sample T test was used and chi square test for the categorical data. P < 0.05 was considered to be statistically significant. Results: Total 50 (100%) members were recruited; 50% each group.  Majority (54%) were in <10 years group, male female ratio was 1.08. Statistically there was significant difference in the mean operative time, recovery time, postoperative pain, the mean intra operative blood loss and the mean recovery period. Conclusions: COBT technique has several advantages such as less operative time, intraoperative blood loss, short duration to attend work as well as job.

10. Study on Vitamin B12 and Folate Levels in Patients with Diabetes Mellitus Admitted to Niloufer Hospital
K. Rajeev, Karnabathula Karunya, Vinod Kumar Mandala, Ponnathota Mallareddy
Background: In this study, we wanted to evaluate the prevalence of vitamin B12 deficiency and folate deficiency in type 1 diabetes patients in the South Indian paediatric population. Hence this study was undertaken to evaluate serum B12 and folate levels in type 1 diabetes mellitus patients. Vitamin B12 is an essential micronutrient, required for optimal hemopoietic, neurologic and cardiovascular function. However, there is insufficient data regarding the prevalence of vitamin B12 deficiency and folate deficiency in the South Indian paediatric population. Materials and Methods: This was a hospital-based prospective observational study conducted among paediatric patients with type I diabetes mellitus presented to the Department of Paediatrics, Niloufer hospital, affiliated with Osmania Medical College which is the largest tertiary care centre in the state of Telangana, situated in the heart of Hyderabad from November 2021-2022. Results: To study the prevalence of vitamin B12 and folate deficiency in type 1 DM patients among the study population, 51% belonged to the age group of 6-10 years, 30% belonged to 11-14 years, and 19% belonged to less than 5 years. The prevalence of vitamin B12 deficiency was 25% and prevalence of folate deficiency was 15% and the prevalence of both vitamin B12 and folate deficiency was 2%. Conclusion: Type 1 Diabetes Mellitus is an autoimmune condition known to be associated with multiple co-morbidities. Vitamin B12 deficiency is a potential co-morbidity that is often overlooked in these patients. Hence the prevalence of vitamin B12 deficiency was 25% and folate 15% and also the prevalence of both vitamin B12 and folate deficiency was 2% in type 1 DM patients.

11. A Study on Clinical Profile of Unilateral Disc Edema
Vinay Reddy Jitha, P. Ramapathi Rao, S. Deepa
Background: Optic disc edema is swelling of intraocular portion of the optic nerve. Disc edema is an ophthalmoscopic finding defined by unilateral or bilateral swelling of the optic disc. Unilateral disc edema can be inflammatory, ischemic, compressive or infiltrative. It may also be an eye opener for detection of certain systemic diseases. Aim and Objectives: To know the clinical profile of Unilateral  Disc Edema. Material and Methodology: This was an observational prospective study conducted in the department of ophthalmology, Dr. Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Hyderabad, for the period of one year.  We have included 60 Patients presenting with unilateral disc edema and males and females between the age of 20 -65 years. Results: 60 patients, among them 34(56.7%) of the patients were female and 26(43.3%) of the patients were male, half of the patients were belonged to the age group of 30 – 40 years and mean age of all the patients was 38.56 with standard deviation of 6.42. The commonest cause for unilateral disc edema is non arteritic AION and the next common cause is optic neuritis. it was observed that NAION affects age group between 40 -50 years of age and that of optic neuritis affecting between 20 -30 years of age group. Most common presenting complaint was Diminution of Vision (DOV)  in 47 % cases followed by headache in 50 % cases. Conclusion: patients with unilateral disc edema, NAION and optic Neuritis should be considered as first among various diagnosis and these diagnosis are common in age group of 40-50 years of age. Differentiating NAION and optic neuritis is very essential because for each of the diagnosis treatment condition is different.

12. Study of Functional Outcome of Surgical Management of Distal Humerus Fractures
Praneeth Kumar Reddy, P. Rohit Raj
Background: Less than 2% of all adult fractures are distal humerus fractures, which are infrequent injuries. Adult distal humeral fractures must typically be surgically repaired for better functional results. The aim of this study was to assess the functional outcome & complications of open reduction and internal fixation surgical method of distal humeral fractures among the patients at tertiary care hospital. Materials and Method: A Prospective clinical study was conducted over a period of 2 years which included 25 patients in the tertiary care centre. Surgery was performed either under general anaesthesia or under brachial block. The patients were treated with primary open reduction and internal fixation. The implants used were Recon plates, DCP, DHP, 1/3 tubular plates and cancellous screws. During the follow up patients were received in outpatient department once in every 3 weeks and fracture union was assessed clinically and radiologically. All study variables were analyzed using descriptive statistical methods such as frequencies and percentages for categorical variables. Results: The average age of the patients in our study was 39.8 years with a range of 21-70 years. Male predominance was found in the study with 75% male and 25% female patients. The results were excellent in 10(40%) patients, good in 8 (32%) patients, Fair in 6 (24%) and Poor in 1(4%) patients. 2 (8 %) patients had superficial wound infections with hardware pain. 1(4%) patient had delayed union and 1 (4%) patient had presented with hardware pain. Conclusion: The idea of open reduction and internal fixation of distal humerus fractures is very useful in restoring the joint surface and getting the patient back to work quickly, which reduces morbidity and leads to good results.

13. Validation of Lung Ultrasound for Early Diagnosis of Ventilator Associated Pneumonia in ICU
Preeti Kumari, Akrity Singh, Nitin Kumar, Ritu Singh, Rajbahadur Singh, Saurav Shekhar
Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in critically ill patients which are often reported to be associated with morbidity, mortality, long duration of ICU stay, and mechanical ventilation (MV). Due to the lack of validated gold standard diagnostic test for VAP detection, delay in patient treatment results in increased patient mortality. A total of 40 patients were included in the study. Of the 40 patients, 28 patients had mini-BAL culture-confirmed VAP that was considered the gold standard for VAP diagnosis while 12 patients did not have mini-BAL culture confirmed VAP. The CXR, microbiological culture, CPIS and LUS score were recorded and compared from the Day 1 to Day 7 till the discharge of the patients. The mean lymphocyte and platelet count among the patients with mini-BAL culture-proven VAP was found to be higher in comparison to those without mini-BAL culture-proven VAP. The mean SOFA and APACHE score was also found to be significantly higher among the patients with mini-BAL culture-proven VAP. There was a significant decrease in the mean LUS score and CPIS score for the patients from Day 1 till the day of the discharge of the patients. The study concludes that the LUS score and the CPIS score are good diagnostic marker for the detection of VAP which can be utilized for clinical decision making of patients admitted in hospital with suspected VAP.

14. Correlation of Pulmonary Function Tests with BMI in Type-2 Diabetes Mellitus
Sohail Ahmed, Rishabh Dangi
Diabetes mellitus is a public health problem in developing and developed world, according to WHO, India will be world diabetic capital in 2025. Diabetes is a complex medical syndrome comprising of heterogeneous group of disease resulting from diverse aetiologies predominantly of genetic and environmental origin. DM affects almost all the organ systems in the body producing biochemical, morphological and functional abnormalities mainly of collagen and elastine . The alterations in these scleroproteins in turn affect the mechanical behaviour of the lungs manifesting in altered lung volumes measured by pulmonary function tests. The alterations in these scleroproteins in turn affect the mechanical behaviour of the lungs manifesting in altered lung volumes measured by pulmonary function tests. People with a higher BMI are more susceptible to diabetes and its complications .High body fat increases insulin resistance in muscles, liver, adipose tissue which increases body insulin production and causes impaired glucose tolerance. The effect of BMI in reducing lung function has been well documented .The present study has focused on correlation of pulmonary function test with BMI in type 2 diabetics.

15. Breast Mass Evaluation with Strain Elastography: A Prospective Cohort Study
Tushar Kumar, NarendraKumar M. Shah, Vinod Kumar Mishra
Introduction: Breast cancer is the most common cancer in the world and is one of the most common causes of morbidity and mortality. Hence, early detection by non- invasive technique is required without causing discomfort to patients which brings forth the role of real time breast elastography, a new method to assess the stiffness of any breast mass. Among different Elastographic methods we have used the strain ratio which is a semiquantitative method. Aims and Objectives: To differentiate benign breast masses from malignant ones , to correlate it with pathological investigations done and to know the sensitivity, specificity , positive predictive value, negative predictive value and accuracy of real time elastography for breast lesions. Material and Methods: Sample of 100 patients presenting with breast lump on which Elastographic sonography was done in Radiology department during the period, January 2018 to December 2018 at SDM Medical College and Hospital, Dharwad, Karnataka. Strain ratio were calculated and a cut off ratio of 3 was taken. A ratio above 3 was considered positive for malignancy and below 3 was considered to be benign. These findings were correlated with pathological investigations findings. Results: Out of 100 patients examined sonographically with breast lumps, 45 were malignant cases and 55 were benign cases. Sensitivity, specificity, PPV and NPV were 87%, 91% and 89% and 89% respectively. Significant correlation between Strain ratio and pathological outcome were found. Mean strain ratio for malignant lesions was 3.55 +\-1.46 m\s and that for benign lesions were 1.86 +\-1.32m\s. Conclusions: In our studies sensitivity, specificity, PPV, NPV and accuracy of strain elastography were good. So we can conclude that Strain elastography is very helpful in screening and diagnosing the malignant breast lesions, hence decreasing the need of biopsies to diagnose malignant lesions.

16. A Study of New Onset Arrhythmias in Acute Myocardial Infarction
K. Sinha, Dhananjay Prasad, Sushil Kumar
Aim: To study various types of arrhythmias in relation to time between the admission and the onset. Material & Method: The present study was done a Cross-sectional prospective study conducted at the Department of Medicine, Darbhanga, Medical College & Hospital, Laheriasarai, Bihar, India. The study was conducted over a period of one year. Results: Predominance of alcoholism and smokers were present in the study group. Time interval between presentation and onset arrhythmias was studied in the study population. It was found that majority of arrhythmias occurred in the first day post MI which was 76.7%. Conclusion: Myocardial infarction was most common in 40 – 49 years age group. Incidence is least in below 30 years age group. Majority of deaths was seen in 50 – 59 years age group. Males were the predominant population and sex did not affect the prognosis significantly. Alcohol consumption and smokers were predominant in the study group. Alcoholism does not affect the outcome. Majority of arrhythmias occurred on day 1 post MI. the time interval between the presentation and onset of arrhythmias does not affect the prognosis significantly.

17. An Observational Assessment of the Knowledge and Awareness of General Practitioners Concerning the Management of Hypertension
Md. Israrul Haque, Md. Farid Alam Ansari
Aim: To assess awareness and approach of general practitioners towards hypertension management. Methodology: The present study was conducted in Department of General Medicine, Netaji Subhas medical College and Hospital, Bihta, Patna, Bihar, India for 1 year, among 100 general practitioners who agreed to participate in the study. All were enrolled after obtaining their written consent. Data pertaining to subjects such as name, age, gender etc. was recorded. A detailed questionnaire was prepared which comprised of information regarding the technique of measurement of blood pressure, diagnosis of pre-hypertension and hypertension, evaluations of newly diagnosed hypertensive patients, the role of non-pharmacological measures to treat prehypertension and hypertension, level of blood pressure to start pharmacological treatment and selection of antihypertensive agents in different clinical conditions. Each participant was personally visited and questionnaire was filled accordingly. The questionnaire was thoroughly checked after being filled for any leftovers. Results thus obtained were subjected to statistical analysis. Results: Out of 100 subjects, males were 53 and females were 47. Cuff placement covering 2/3 of the arm at heart level was recommended by 80%, preferred position of patient was sitting replied by 48%, supine by 35% and standing and supine by 17%. The number of readings of blood pressure was 1 by 5%, 2 by 43% and 3 by 52%. The difference was significant (P< 0.05). Investigation preferred by general practitioners were ECG by 89%, urine examination by 63%, serum creatinine by 78%, lipid profile by 84%, ultrasound of abdomen by 39%, serum potassium level by 66% and RBS by 94%. Common symptoms reported were morning headache by 67%, dizziness by 49%, palpitation by 48%, easy fatigability by 55% and impotence by 50%. Conclusion: It can be concluded after this study that most of the general practitioners are well aware and updated about the initial lab investigations, symptoms and techniques.

18. Evaluation of Natural Enamel Wears Against Polished Yitrium Tetragonal Zirconia and Polished Lithium Disilicate: Comparative Study
Aim: To compare wear of the natural teeth against polished yttrium tetragonal zirconia and polished lithium disilicate crowns. Material & Methods: This study was carried out in the Department of Maxillofacial Surgery, Narayan Medical College & Hospital, Sasaram, Bihar, India, over a period of one year. A total of 20 patients were included in the study. Results: Wear was measured using baseline and 12‑month interval cast of opposing dentition and 3D scanning and superimposition technique. A statistically significant difference was found in the comparison of the amount of natural enamel wear against polished zirconia crowns (Group 1) with the amount of natural enamel wear against natural antagonist (control Group 1, i.e., 35.72 μm) (P = 0.01). Conclusion: Within the limitations of the study, it can be concluded that polished lithium disilicate showed better clinical outcome than polished yttrium tetragonal zirconia, though the evaluated data was statistically non-significant.

19. A Retrospective Assessment of the Predictors of Difficulty in Laparoscopic Cholecystectomy
Santosh Kumar Sharma
Aim: To develop and validate a scoring method to predict difficult and very difficult LC preoperatively. Material & Methods: This is a retrospective study conducted in the Department of General Surgery, NMCH, Patna, Bihar, India.  Patients who underwent Laparoscopic Cholecystectomy in the Tertiary Care Centre by the same surgeon involved in the study. The study involved patients who were operated over a period of 12 months (July 2019 to June 2020) Results: Among different demographic and history related factors, the only history of hospitalization and ERCP±Stenting were significantly associated with the difficulty of the procedure (p<0.001).The lone biochemical factor i.e. raised ALP, also showed a significant association with the level of difficulty (p=0.001). The diagnostic accuracy of the score for the prediction of very difficult procedures was 97.1%. Conclusion: The proposed scoring system was effective and can help diagnose preoperatively into easy, difficult and very difficult cases.

20. Post-Operative Pain Management in Elective Laparotomies in a Tertiary Care Facility: A Prospective Observational Assessment
Alok Kumar Niranjan, Sanjeet Kumar
Aim: Prospective analysis of post-operative pain management in elective laparotomies in a tertiary care centre in Bihar region. Methods: This prospective observational study conducted in the Department of General Surgery, Jannayak Karpoori Thakur Medical College and Hospital  Madhepura, Bihar, India, India from  August 2020 to July  2021. 100 patients who underwent elective laparotomy were provided details about the study and method. Informed written consent was obtained. Detailed history of the patient, condition, surgery performed, analgesics used were documented. NRS score was calculated. Results: A total of 100 patients were included among which 41(41%) were female and 59 (59%) were the male patients. Most common mode of analgesia used was combined analgesia. Injection tramadol 50 mg in 100 ml normal saline with continuous epidural bupivacaine in 48 (48%) patients followed by injection diclofenac AQ 75 mg in 100 ml N.S with continuous epidural in 32(32%) patients. Pearson’s Chi square test for intravenous and epidural analgesics: value-2.31, df (degrees of freedom)-8, p=0.88. By the second day 53(53%) patients were shifted to oral analgesics most common drug used was the combination of aceclofenac, paracetamol and serratiopeptidase. 7(7%) patients were on transdermal patch on post-operative day 2 and 2 (2) patients were on diclofenac patch and 5 (5%) patients were on fentanyl patch. The use of analgesics was shifted from parenteral to oral route from post-operative day 2. All the patients received analgesics within 6 hours of surgery. NRS score was recorded for all the 100 patients on postoperative days 1, 2 and 3. Severity of pain gradually reduced from postoperative days 1-3 with the use of various analgesics. Conclusion: Multimodal analgesia was used in most of the patients for management of postoperative pain combined analgesia was better mode of pain management method than a single analgesic. For 48(48%) of patient’s opioid with epidural was used for post-operative pain and for 32 (32%) of patients NSAID with epidural was used for post-operative pain.

21. A Comparative Clinic-Radiographical Assessment of the Stability and Crestal Bone Loss of Implants Placed using Osseodensification and Traditional Drilling Protocol
Aim: To evaluate and compare the stability of the implant and the loss of crestal bone in the implants placed using OD drilling and traditional drilling technique. Material & Methods: The study was approved by institutional review board. The study was conducted in the department of prosthodontics, to evaluate and compare the stability and crestal bone loss (CBL) of implants placed using traditional and OD drilling technique. It was conducted over a period of 1 year in the Department of Maxillofacial Surgery, Narayan Medical College & Hospital, Sasaram, Bihar, India. In the present study for Group II, the mean values of implant stability RFA1 (baseline) and RFA2 (6 months) was 67.4 Ncm and 65.8 Ncm, respectively, however, in the Group I, the mean values RFA1 and RFA2 are 54.3 Ncm and 69.2 Ncm. In the intragroup comparison the data was found to be statistically significant at 4 months for Group II and at 8 months for Group I (P < 0.05). Conclusion: Within the limitations of this study following conclusions were drawn: there was no statistically significant difference in implant stability between the traditional drilling and OD drilling (P < 0.05). On comparison of crestal bone levels between OD and traditional drilling, no statistically significant difference was found between the two groups (P < 0.05).

22. A Histomorphological Study of Preterm Human Placenta and Term Human Placenta in North Indian Population
Mohd Arshad, Neha Gupta, Mohd Tabrej Alam, Durgesh Singh, Shashi Prabha Singh, M. Tariq Zaidi
The status of the fetus in-vivo is based on the function of placenta which is responsible for the hoemostasis and nutrition of the fetus. The current study is intended to evaluate the morphometric and histological changes in the placenta collected during preterm and term birth. The study arranged 80 placentas from JNMCH, AMU, Aligarh, Department of Gynecology and Obstetrics. 2 groups were made based on the age of the placenta. Those placentas which are of upto 36 weeks were made into assigned to one group while placentas collected during full term birth (37 weeks to 40 weeks) were classified as another group. The samples of placenta were fixed in a 10% solution of saline and formol. The general characteristics specially the morphological properties were evaluated. The weight, decidual region, the diameter of the cord of the term placenta were all determined and were observed that these were significantly higher than those of preterm placenta. Whole thickness tissue blocks were managed from each placenta and each sample was processed with paraffin. Haematoxylin-eosin and Van Gieson stains were utlized for preparation of 1 mm thick slices for observation in light microscopy. It was observed that each sample had 200 villi in total, under high power field microscope. The villi of term placentas almost completely lacked microvilli and syncytial buds. The evaluation of the placenta also revealed that the number of capillaries increased with increasing gestational age. The number of syncytial knots, vasculosyncytial membrane, fibrinoid necrosis, significantly increased in the group formed of term placentas. On the contrary, it was also observed the villi revealing cytotrophoblastic cells and Hofbauer cells significantly reduced.

23. Maternal and Fetal Complications during Cesarean Section Done in Second Stage of Labour
Chaudhary P, Madan A, Sharma S, Kaur J, Singh D
Introduction: Second Stage of labor  begins with complete dilatation of cervix and ends with fetal delivery. Prolonged second stage of labour is diagnosed if the duration exceeds 2 hrs in nullipara and 1 hr in multipara, when no regional anaesthesia is used. Cesarean section at full dilatation, with or without attempt at operative vaginal delivery, is a more challenging surgical procedure than a first stage cesarean section and carries a higher rate of maternal morbidity. Material & Method: This Prospective Study was conducted in the Department of Obstetrics and Gynaecology, BNMCC, GNDH, Government Medical College, Amritsar from March, 2020 to March, 2021. Inclusion Criteria: All women at term and preterm with singleton pregnancies willing to participate. Exclusion Criteria: Patients refusing / not willing to participate in the study, Multi fetal gestation, History of Previous caesarean section, Abnormal Placentation e.g. Vasa previa and complete placenta previa, Active genital herpes infection, Cervical Cancer, Prior Myomectomy. Duration of labor & Indication for LSCS was noted. Maternal and fetal complications were observed. Results:  In our study 150 women, who underwent cesarean section during second stage of labour, were selected according to exclusion and inclusion criteria. Most of women (66%) were referred patients and rest were booked patients who ended up in cesarean section. It was observed that labour dystocia was most common indication seen in our patients followed by fetal distress. Majority of them were referred patients, and from rural background who did not have proper antenatal checkup. Conclusion: This implies good antenatal checkup and recognition of complications can reduce the risk of prolonged second stage of labour. Difficult access to the healthcare facility, delay in referring the patient to the tertiary care centre increases the rate of cesarean section in second stage of labour. Timely  decision for cesarean section and neonatal facilities can reduce the number of fetal complications.

24. To Study the Efficacy of Quiz as Teaching Learning Method in First Phase MBBS Students in Biochemistry
Shivkar Rajni Rajendra, Gulajkar Supriya Rameshrao, Panchbudhe Sanjyoti Ankur, Naphade Manoj
Background: Focus of medical education is to prepare students for lifetime patient care. It has been progressively recognized that didactic lectures are considered by students as an inefficient mode of learning due to one way flow of content. Learning could be shifted from teacher centric to student centric where learner would take active part in the learning process. Quiz could be one of such tool, which not only assesses what one knows, but also enhances later retention, a phenomenon known as the testing effect. So, objectives of our study were to study the utility of quiz in Biochemistry as a teaching learning method and to get perception of quiz by students through feedback. Methods: Present comparative cross sectional study was carried out on First phase MBBS students of batch 2020-2021. Quiz participants and students who attended the quiz were considered as Group A (n=120). While Students who were absent for the quiz were considered as Group B (n=30). Statistical analysis was done using unpaired ‘t’ test using GraphPad Prism 5 software. Results: We have seen improved performance of Group A as compared to Group B. Average scores of Group A and Group B students were 12.00 ± 1.60 (mean ± SD) and 7.03± 2.30 respectively. The p value for comparison was <0.001 which is highly significant. Interpretation and conclusions: Quiz can be used as a learning tool for students in Biochemistry to enhance their active participation and increase their interest in the subject which would motivate them to acquire knowledge about core and applied aspects of subject.

25.The Relationship between Umbilical Cord Arterial PH and Short Term Outcome in Neonates
Malvia S, Jain P, Bhardwaj BK
Background: Perinatal asphyxia has been one of the causes of neonatal morbidity and mortality. Morbidity and mortality in asphyxia depends on factors like duration and severity of asphyxia. The present study was carried out to find out the relationship between umbilical cord arterial blood pH with severity of birth asphyxia and short-term outcome in the neonates. Materials and Methods: hospital based prospective study carried out at NICU of tertiary care hospital attached to medical college in southern Rajasthan from January 2020 to December 2021. All term neonates born by Caesarean Section (C/S) to a high risk mother were included into the study. An umbilical cord arterial blood gas analysis was done for these neonates. All the neonates with congenital anomalies and those who were not willing to give consent were excluded. All the admitted newborns were followed till discharge/death for final outcome. The correlation umbilical arterial cord blood pH and outcome was analysed statistically. Result: During the course of the study, 78 babies who included for the study. Out of the 78 babies, 77 babies were discharged live and one baby died. On the basis cord blood ph level, the babies were divided into two groups. Among whom 34 had pH less than 7.25 (group 1) and 44 had pH more than 7.25 (group 2). Comparison of short term outcomes between two groups were as the following: need for resuscitation 9 vs. 1 (P = 0.004), NICU admission 8 vs. 2 (P = 0.012), convulsion 2 vs. 1 (P = 0.41), encephalopathy 3 vs. 1 (P = 0.19), delay to start oral feeding 5 vs. 1 (P = 0.04). Conclusion: An umbilical cord arterial ph of less than 7.25 could be associated with unfavourable short term outcome in neonates with perinatal asphyxia.

26. Impact of Human Milk Bank on Morbidity, Mortality, Duration of Stay, and Feeding Characteristics of Neonates in a Tertiary Care Centre NICU
Bhuvnesh Kumar Bhardwaj, Keshav Bansal, Dhaval Bhatt, Harshida Vagadoda
Objective: To study the impact of Human Milk Bank on morbidity, mortality, duration of stay, and feeding characteristics of neonates in a tertiary care Centre NICU. Material and Methods: An observational prospective case control single Centre study. All details of the newborns under study were recorded on a structured proforma designed for this study. PDHM was issued from mother milk bank on the request of doctor working in the NICU. All collected data was analyzed with standard software. Statistical analysis of the data was done with Chi-square test, Student t-test with assistance of qualified statistician. P value <0.05 was considered statistically significant. Results: A total of 140 neonates were included in the study was divided into study group (71) and control group (69). There was no statistical significant difference between study and control groups in terms of gender and weight. Most common indication of PDHM supplementation was insufficient milk production (73.2%). Majority of neonates on PDHM feeding (67.8%) tolerated the feed well, 20% had abdominal distention and 11.2% had vomiting. In study group 12% babies develop NEC, whereas 5.7% babies in control group developed NEC. In the study group 19.7% babies developed clinical features of septicemia whereas in control group only 10.1%. The difference was statistically significant (P-0.047). 67 babies (94.3%) in study group were discharged. Conclusion: Babies fed on PDHM had no significant risk for developing apnea, hypoglycemia and overall complications in comparison to those fed on mothers own milk. Also there was no significant difference in terms of weight recovery time, duration of stay in the hospital and final outcome amongst babies who were fed on PDHM and who were fed on mothers own milk. Hence it is concluded that PDHM can be a safer alternative when mothers own milk is insufficient or unavailable. Also it provides the benefits of mother’s milk along with eliminating the demerits of formula feed in a resource limited setting like ours. “Breastfeeding is nature’s health plan.”

27. Our Experience with Management of Foreign Bodies of Ear Nose and Throat During COVID Pandemic at Andaman Nicobar Islands
Meena Maruthi Ohal, Sattien Arun Maran
Background: COVID pandemic during 2020-21 had affected the management of foreign bodies in the ear, nose and throat, as aerosol spread of the virus created a risk to the treating ENT surgeon. Due to tremendous increase number of COVID positive patients affected the healthcare system and the specialists alike. Following the COVID guidelines to use personal protective equipment, face shield, goggles and N-95 masks during the simple procedures performed in OPD or the operation theatre made the procedure cumbersome to the surgeon. The number of patients with foreign bodies attending the Hospital had increased during the pandemic as other private hospitals were not taking up these patients. Aim: To analyze the foreign bodies in the Ear, Nose and Throat encountered during the COVID pandemic of 2020-21 and to formulate a clinical guideline to prioritize the cases to avoid COVID spread. Materials: A Prospective study with 330 patients who attended the Department of ENT, ANIIMS Hospital, Port Blair with foreign bodies in the Ear, Nose and Throat were included. It was an observational study following the STROBE Epidemiology checklist was used for strengthening the Reporting of Observational Studies. All the patients who attended the ENT Department with history of foreign body in the ear, nose, throat and trachea-bronchial tree with or without COVID-19 positivity were included. COVID protocol was adhered to in selection and treatment of the patients. Results: 330 patients were included in the study, among them 177 (56.63%) male patients and 153 (46.36%) female patients. The male to female ratio was 1.15:1. The age distribution showed that children aged between 01 to 10 years constituted to 128 (38.78%). Patients with foreign bodies in the Ear were 131 (39.69%), foreign bodies in the nose were 87 (26.36%) and foreign bodies in the throat were 110 (33.33%). Total foreign bodies removed under General anesthesia were 64/330 (19.39%) patients in this study. Among these 31/110 (28.18%) patients had foreign bodies in the throat, 24/87 (25.28%) had in the nose and 09/131 (06.87%) had in the ears. Conclusions: The present study which analyzed all the foreign bodies in the Ear, Nose and Throat that were encountered during the COVID pandemic of 2020-21 and successful removal of foreign bodies was undertaken without any surgeon turning COVID positive as strict protocol was formulated and followed with international clinical guidelines to prioritize the cases to avoid COVID spread and at the same time give satisfactory treatment to the patients.

28. An Evaluation and Analysis of Immune Markers in Patients with Chronic Rhinosinusitis
Hanish Haneefa, Nazeem Abdul Majeed
Background: Chronic rhino sinusitis (CRS) is a common inflammatory disease resulting in marked decrease in quality of life of patients and affected their socio-economic life. Multiple factors like inborn immunity of the airway epithelium, reduced barrier function, altered mucociliary mechanism, and fabrication of plenty of antimicrobial peptides played important roles. Followed by activated involvement of eosinophils, mast cells, and innate lymphoid cells (ILCs) contributed to the chronic inflammatory changes and directly activated adaptive immune cells like T and B cells.  Studies are required to identify such specific immune factors which drive the CRS pathogenesis process and this study is an attempt in that direction. Aim: To find the role of immune markers in the pathogenesis of the chronic inflammation in chronic rhino sinusitis (CRS) and to identify other markers of immune system pathways in patients with CRS. Materials: 83 patients diagnosed with CRS based on the Clinical features and X-ray and CT scan findings were divided into two groups; CRSsNP- 42 patients (50.60%) and CRSwNP- 41 (49.39%) patients. Results: The mean levels of secreted IL-6, 10, 13, 21 and IFN- γ of both the groups of CRSwNP-41 patients and CRSsNP-42 patients’ tissue levels correlated well (p> 0.05 for all). CRSwNP patients had mean tissue levels of IL-2, 4, 5, 7, 12, 17 and 22 greater than mean tissue levels of patients with patients CRSsNP. Conclusions: The two types of CRS: CRSsNP and CRSwNP are heterogeneous diseases at molecular level as the values of cytokines liberated due to respective inflammation are different. Hence the inflammatory state of CRS was also highly heterogeneous, with mixed profiles of type 1, 2 and 3 inflammations seen within classical CRSsNP and CRSwNP phenotypes. Estimation of cytokines levels is emerging as an important diagnostic and prognostic tool in the management of CRS disease.

29.An Observational Study of Association between Serum TSH Levels and Thyroid Malignancies
Abraham Joseph, Kunhambu V, Dinulal P P, Nabeel MV
Background: The prevalence of malignant thyroid malignancies is 5-6% and treatment strategies are almost entirely based on the FNAC results and ultrasound examination. This study is focused on the levels of preoperative serum TSH levels and its co-relation with thyroid malignancies and their clinical presentation and management. Aim: To study the association between the serum levels of Thyroid stimulating Hormone (TSH) and thyroid malignancies. To study the clinical profile of thyroid malignancies and laboratory results. Materials: A cross sectional observational study involved 60 patients who were diagnosed with suspected Thyroid Malignancy at the department of General Surgery in ACME Pariyaram. A descriptive analysis of the clinical presentation was done and correlation of preoperative serum TSH level and final histopathology were done. Inclusion criteria, patients with thyroid swelling, Thyroid profile and serum TSH measured before any medical interventions and al the patients included were euthyroid. Patients who were not euthyroid were excluded. Informed written consent was taken and history was taken. FNAC, surgical management, and histopathology follow up was done. Results were arranged and analyzed statistically. Results: Among the 60 patients 51 were females (85%) and 09 (15%) were males and the female to male ratio was 5.6:1 (Table 1). The mean age of the patients was 42.70±12.82 and ht means TSH levels was 1.97 ± 1.16mlU/L; range from 0.5 to 5.0 mIU/L range taken as the lab standard. The mean duration of the disease noted was 26.6 ± 20.59 months. 07 patients had malignancies; FNAC was positive for papillary carcinoma in 05 (08.3%), 01 (01.7%) follicular carcinoma, 01 (01.7%) medullary carcinoma. Conclusions: Thyroid malignancies though have varied clinical presentation, the commonest was MNG. The association of preoperative serum TSH levels with malignancy showed a statistically significant correlation (P=<0.01) between higher TSH levels and malignant swellings.

30.Anatomical Characteristics of Foramen Ovale and Foramen Spinosum in Dry Human Skulls
Dubbaka Ravikul Manuva, Naveen Kumar Edulla
Introduction: Cranial base holding important foramina through which various important neurovascular structures transmits from extra cranial to intracranial region. The anatomical knowledge of these foramina plays a vital role in surgeries to cranial base. This study was designed to assess the morphology and morphometry of foramen ovale and foramen spinosum in the dry human skull of Deccan plateau region. Material and Methods: A total of forty-four adult human dry skulls of unknown gender were evaluated for morphological parameters like shape, incidence of foramen of Vesalius, presence or absence of foramina and morphometric parameters such as anteroposterior (AP) and medio-lateral (ML) diameter of foramen ovale and foramen spinosum were measured. Results: Oval shaped FO (56.81% right & 52.27% left) and round shaped FS (65.9% right & 61.36% left) on both sides were recorded. The AP diameter was 8.09 mm on right and 7.57mm on left and ML diameter was 5.54mm and 5.81mm for FO. The AP diameter was 2.74mm on right and 2.61mm on left and ML diameter was 1.64mm and 2.04mm for FS. The mean difference of morphometric parameters was statistically significant (p<0.05). Discussion and Conclusion: The comprehensive knowledge on anatomy and developmental variations of foramen ovale and foramen spinosum has great importance in surgical interventions at the base of skull, and sex determination in medico legal procedures.

31.Comparative Efficacy of Topical Tacrolimus 0.03% Ointment Vs. 0.005% Fluticasone in the Treatment of Sub Acute Eczema
Anil Kumar, G. Reena Prasoona, Sowmya Alahari, K. Raj Kumar
Introduction:  Eczema is a clinical and histological pattern of inflammation of the skin seen in a variety of dermatoses with widely diverse aetiologies. The present study was undertaken to compare the efficacy of Topical Tacrolimus 0.03 % ointment vs 0.005% Fluticasone in the treatment of sub-acute eczemas. Materials and Methods: This is a prospective, randomized; open-labelled interventional study carried out at tertiary care hospital included 100 patients with sub-acute eczemas. They were allocated at a ratio of 1:1 to either Tacrolimus 0.03% Ointment group A or Fluticasone 0.005% ointment group B. Group A subjects were treated with Tacrolimus 0.03% Ointment once daily for 4 weeks follow up at 1 week, 1 month & 3 months Another Group B patients were treated with Fluticasone 0.005% ointment once daily for 4 weeks follow up at 1 week, 1 month & 3 months. Results: Percent reduction of Eczema assessment severity index score at the end of 4 weeks was 83.70±1.73 in group A and 79.10±2.17 in group B  (P<0.001) which was significant (P<0.001). Adverse effects were observed in 10 % of patients in Group A and 18% of group B after 4 weeks, with a major side effect of Folliculitis (8%) in Group B which was not significant. Conclusion: We concluded that Patients who received Tacrolimus 0.03% ointment had better clinical improvement in terms of efficacy, and was better tolerated in terms of side effects compared with Fluticasone 0.005% ointment.

32.A Comparative Study between Oral Azithromycin and Doxycycline for the Treatment of Meibomian Gland Dysfunction.
Manoj Kumar Mishra, Vaidehi Kumari, R. K. Singh
Objectives:  This present study was to compare the clinical outcome between oral azithromycin and oral doxycycline for the treatment of meibomian gland dysfunction. Methods: A total of 100 meibomian gland dysfunction patients were enrolled in this study. All enrolled patients were divided into two groups (group A & group B). Each group had 50 patients. Group A patients were treated with Oral five days azithromycin (500mg on day 1 and then 250 mg/day). Group B patients were treated with first week oral doxycycline (200 mg/day) then rest 3 weeks oral doxycycline (100mg/day). On every visit the patient had undergone a detailed eye examination and various visual parameters had been rechecked and recorded. Results: In azithromycin group mean of symptoms (8.01) and signs (8.87) at pre-treatment clinically improved to mean of symptoms (0.86) and signs (1.65) at last visit. Similarly in doxycycline group mean of symptoms (8.98) and signs (8.23) at pre-treatment clinically improved to symptoms (0.66) and signs (2.24) at last visit. when pre-treatment and last follow up symptoms and signs were compared in both groups, they showed highly significant differences (p < 0.0001), which indicates that both the treatment was equally effective. Conclusions: This present study concluded that the both oral azithromycin and oral doxycycline are the effective treatment of meibomian gland dysfunction. While oral azithromycin is comparatively better choice of treatment as compared to oral doxycycline for meibomian gland dysfunction in terms of better clinical improvement, shorter treatment duration, lesser side effects and lower cost.

33.To Compare Neuromuscular Blockers and Ventilation among Airway Pressure Release Ventilation (APRV) Mode and Synchronized Intermittent Mandatory Ventilation (Simv) Mode among Acute Respiratory Distress Syndrome (ARDS) Patients
Charu Sharma, Nilesh Kumar Patira, Nishigandha Mahajan, Manoj U Mahajan, Suresh Chandra Dulara, Vipin Narayan Sharma, Nishkamni
Introduction:ARDS was defined as: the acute onset of respiratory failure, bilateral infiltrates on chest radiograph, hypoxemia as defined by a PaO2/FiO2 ratio ≤200 mmHg, and no evidence of left atrial hypertension or a pulmonary capillary pressure <18 mmHg (if measured) to rule out cardiogenic edema. Aim: to compare use of SIMV and APRV mode of ventilation in patients suffering from ARDS in terms of ventilatory function, sedative and neuromuscular blocking agent requirement and final outcome in terms of mortality and ICU stay. Methodology: Present study was carried out for one year duration from 1 November 2015 to 31 October 2016 on patients who were pre-diagnosed as ARDS, who were on mechanical ventilation in the Intensive Care Unit of MBS hospital attached to Govt. Medical College, Kota. Results: Mortality rate in Group I was 55% whereas the same in Group II was 60%. Despite having higher mortality rate in Group II, the difference was not significant statistically (p=0.749). Conclusion: primary use of APRV with maintained unsupported spontaneous ventilation as compared to SIMV with PS lowers sedation and NMBD requirement.

34. Clinical and Epidemiological Study of Parotid Gland Tumours
Subhabrata Das, Rama Narayan Sahu, Asutosh Hotta, Manas Ranjan Behera, Abinash Pattanaik, Meenakshi Mitrabinda Parashar, Yaswanth Lakshmi Sainath Veera
Background: We wanted to study the age and sex distribution, various types of tumours occurring in different salivary glands, and their modes of clinical presentation. We also wanted to assess the efficacy of treatment offered to the patient and identify the complications ensuing therein, as a consequence of the intervention. Materials and Methods: This was a prospective study of salivary gland tumours conducted among 40 cases admitted in various surgical units in M.K.C.G Medical College and Hospital, Berhampur, from July 2019 to June 2021. Results: In this study, 11 (27.5%) patients were males and 29 (72.5%) were females. M: F ratio was 1:2.6. In benign tumours, M: F ratio was 1:2.8 and in malignant tumours it was 1:2. The incidence of benign tumours was 85% and the malignant tumour was 15%. Patients presented with a history of swelling varying from 3 months to 12 years and swelling was the most common symptom. The commonest surgery for the benign parotid tumour was superficial parotidectomy and for the malignant tumour was total parotidectomy. The commonest postoperative complication was facial nerve weakness. This was seen mainly in patients with malignant and recurrent tumours. The incidence of permanent facial nerve weakness was 5%. This is comparable to the western standard (0-17%). Conclusion: Parotid gland tumours occur more commonly in the 3rd to 5th decade and are seen most commonly in females. Parotid gland tumours are more often benign, pleomorphic adenoma constitutes the majority of all neoplasms.

35. Prevalence of Fatigue in Post Covid 19
Gayathri V., Jesin Kumar C.
Background: Following covid 19, most patients have variety of neurological symtoms (headache, dizziness, tinnitus, paraesthesia, sleep disorders, loss of taste and smell, mental fog, concentration issues, anxiety, depression) persisting even after resolution of fever, cough. Fatigue is the most frequently described and globally recognized as a disabling symptom following covid. Fatigue reflects subjective state, decreased capacity to perform, decrement in vigilance. General psychophysiological phenomenon in which motivational decrement, diminished ability to perform tasks with alertness, vigilance is reduced. Several weeks after COVID 19, some patients are still dealing with lung complications and crushing fatigue. The long-term consequences of covid 19 are being studied. The aim of the study is to understand persisting fatigue, investigate associated risk factors, disease severity. Materials and methods: COVID 19 post-acute outpatient clinic. Outpatients who met WHO criteria for discontinuation of quarantine i.e., no fever for 3 consecutive days, improvement in other symptoms, RT PCR negative. Results: 19 of 53 patients reported of chronic fatigue syndrome. No association between severity of illness, inflammatory markers and fatigue. Persistent fatigue following SARS-CoV-2 is common and independent of severity of initial infection. Conclusion: Fatigue persists after COVID 19. Identifying the type of fatigue, early interventions could reduce socio economic burden. Frequent follow up is required    to identify long term consequences of covid 19.

36. A Comparative Study of Granisetron, Palanosetron and Ondansetron in Post-Operative Nausea and Vomiting After Gynaecological Surgery under General Anaesthesia
Debasis Bandyopadhyay, Babrak Manuar, Tapobrata Mitra, Habibur Rahaman
Background: Postoperative nausea and Vomiting (PONV), one of the most common and distressing adverse events experienced by patients after an anaesthesia and surgery. It may prolong recovery, delay patient discharge and increase hospital costs. The overall incidence of PONV has been reported to be between 20%-30% but can increase up to 80% in high risk cases. Adult women are two to four times more likely to suffer from PONV than men. Patients undergoing gynecological surgery have been associated with highest risk of PONV, of around 58% after general anaesthesia. Aims and Objectives: This study was carried out to compare the efficacy of Granisetron, Palanosetron and Ondansetron in preventing PONV after Gynaecological surgery under general anaesthesia. Setting and Design: It was a prospective randomized cotrolled study. Methods and Materials: The healthy adult female patients posted for elective gynaecological surgery were randomly allocated in to three equal groups. Group G (n=30) received inj. Granisetron 2.5 mg iv, Group P received inj Palanosetron. 75 mg iv and Group O received inj Ondansetron 8 mg iv immediately before the induction of anaesthesia. All the groups had similar fasting guidelines and received similar premedication. Episodoses of PONV were noted at 0.5,1,2, 4, 6, 12 hours postoperatively. Results: In this study, the number of patients with nausea over the 24 hrs study period was 10% in granisetron group, 3.3% in the palanosetron group and 33.3% in the ondansetron group. The percentage of patients with vomiting was 6.7% in the granisetron group, 3.3% in the palanosetron group and 30% in the ondansetron group. Conclusion: On the basis of the present study it can be concluded that: Prophylactic granisetron, palonosetron and ondansetron individually are effective and safe antiemetic in prevention of PONV. Palanosetron and Granisetron are superior to Ondansetron in the prevention of postoperative nausea and vomiting. There was no significant difference in the incidence of side effects among the three study groups.

37.Correlation between Robinsons Cytological Grading with Elston-Ellis Nottingham Modification of Bloom Richardson Histopathology Grading for Breast Carcinoma
Asutosh Hotta, Rama Narayan Sahu, Krishmita Sahu, Reshma Rani Satapathy, Bandana Mishra, Yaswanth Lakshmi Sainath Veera
Background: In this study, we wanted to evaluate the correlation between Robinson’s cytological grading with Elston-Ellis Nottingham modification of Bloom Richardson histopathology grading for breast carcinoma. Materials and Methods: The present study is a prospective study carried out in the Department of Pathology at Maharaja Krushna Chandra Gajapati Medical College, Berhampur, Odisha from September 2018 to August 2020, with the approval of the ethical committee of this institute. Results: 14 tumours (66.67%) were graded I on cytology and histopathology, 5 tumours (23.81%) were graded I on cytology and grade II on histopathology and 2 tumours (9.52%) were graded I on cytology and grade III on histopathology. Out of 46 cases with cytological grade II, 38 tumours (82.61%) were grade II also on histopathology, while 5 (10.87%) were downgraded to grade I and 3 (6.52%) were upgraded to grade III. Out of the 28 cases with cytological grade III, 26 (92.86%) were grade III on histopathology while 2 (7.14%) were downgraded to grade II on histopathology. The p-value was <0.05. Conclusion: Every FNAC report should be incorporated with a cytological nuclear grade for robust clinical management.

38.Role of MRA as a Diagnostic Tool in Posterior Circulation Stroke- Study Done in a Tertiary Care Hospital in South India
Tariq Harris, V. Senthilvel Murugan, R. Kishore
Background: MRI Brain is an important imaging modality in posterior circulation stroke; there are very few studies on the role of MRA in posterior circulation stroke. Aims and Objectives: 1. To study the various MRA patterns in posterior circulation stroke. 2. To study other radiological patterns in posterior circulation stroke. Materials and Methods: This is a hospital-based observational descriptive study conducted among 100 patients who presented to the medical wards and outpatient departments of Neurology and General Medicine in MGMGH hospital attached to KAPV GMC, Trichy with symptoms and signs of posterior circulation stroke from December 2021 to May 2022. Results: The most common radiological patterns found in the study were occipital infarcts and cerebellar infarcts found in 31% and 16% of cases respectively. The most common MRA findings were hypoplastic vertebral artery at 14%, fetal PCA at 11% and non-visualisation and attenuation of PCA at 8%. Conclusion: The majority of the patients with posterior circulation stroke were male. Dizziness and headache were the most common symptoms. The most common radiological patterns found in the study in patients with posterior circulation stroke were occipital infarct and cerebellar infarcts. The most common MRA findings were hypoplastic vertebral artery, fetal PCA, and non-visualisation and attenuation of PCA.

39.Glycemic Index of Different Rajasthani Diets in Diabetic Patients and Healthy Controls and Effect of Psyllium Supplementation on Glycemic Response
Mumtaz Jahan, Ajay Kumar Bhargava
Disease like diabetes is continuously spreading in the population. There has been substantial evidence regarding the health promoting impacts of different Rajasthani diets. The beneficial effect of these diets in the management of type II diabetes has not been totally demonstrated. The purpose of this study was to determine glycemic index (GI) of various Rajasthani diets and to evaluate effect of psyllium husk on their glycemic response. Ninety six, non-diabetic volunteers and ninety seven, diabetic patients consumed reference (glucose) and test foods missi roti (diet -1), missi roti with psyllium husk (diet- 2), bajra roti (diet -3) and bajra roti with psyllium husk (diet -4)  providing 50 g of available carbohydrate. Finger pricked capillary blood samples from the fasting subjects were collected at 0, 30, 60, 90 and 120 min from the start of each food. For test foods, the incremental area under the curve was calculated and GI values were determined. It was found that in diabetic patients missi roti  with GI 43.1 + 7.1, and missi roti with psyllium husk with GI 35.7 +8.0fell under the category of foods with low GI with p< 0.0001 (HS). In diabetic patients bajra roti has GI 56.0 +5.0 and bajra roti with psyllium husk with GI 47.5 +5.5 low or medium GI with p< 0.0001 (HS). Similarly in healthy subjects missi roti has GI 35.2 + 3.5 and missi roti with psyllium husk has GI 30.1 + 4.2 fell under the category of foods with low GI with p< 0.0001 (HS). In healthy controls bajra roti has GI 56.7 + 5.2 and bajra roti  with psyllium husk with GI 49.0 + 5.6, low or medium GI with  p< 0.0001 (HS). Our results demonstrate values of glycemic indices for Rajasthani diets and evaluate effect of psyllium husk on glycemic response, addition of 5 gm of psyllium husk to test diets significantly decrease the value of glycemic index in both the groups.

40.Hematological Indices and Their Correlation with CD4 Cell Count among HIV Patients Attending ICTC Centre at a Tertiary Care Centre of Northern India
Naresh Jain, Nitya Vyas, Manish Bansal, Babita Sharma
Introduction: In the resource-limited settings, especially rural and underserved areas that do not have the facilities to determine CD4 T lymphocytes count, there is a need to identify alternate markers of disease progression in HIV that are easily available, reliable, and affordable. This study aimed to determine the association of various hematological indices with CD4 T lymphocytes count. Material and Methods: This cross sectional observational study included 150 newly diagnosed HIV seropositive patients, aged >18 years attending Integrated Counseling and Testing Centre (ICTC) at our Institute. The HIV status of these patients was confirmed at ICTC as per National AIDS Control Organization (NACO) strategy III with three rapid HIV antibody test with different antigen or principle. Complete confidentiality was maintained regarding the identity of the subjects. CD4 T lymphocytes count was estimation by CyFlow Counter (Sysmex Partec GmbH, Germany). Results: Most of the HIV positive patients were in age group, between 26-40 years (49.33%). Male: female ratio was 2.19: 1. Mean hemoglobin level was significantly lower among patients with CD4 <200 cells/mm3 (10.58 ± 1.34 gm/dl). The mean total leucocyte count and lymphocyte count was significantly low among patients with CD4 <200 cells/mm3 (p<0.001). Mean Total Red Blood Cells (TRBC) level, hematocrit and platelet count were significantly low among patients with CD4 <200 cells/mm3.  The mean of MCV was significantly lower among patients with CD4 <200 cells/mm3 (88.33 ± 6.2 fl) as compared to those with CD4≥500 cells/mm3 (93.47 ± 8.11fl). The mean red cell distribution width was significantly higher among patients with CD4 <200 cells/mm3. Conclusion: Most abnormalities in Hematological indices could be coordinated to CD4 T lymphocyte cell counts, and these indices, specially anemia, leucopenia and lymphopenia can be used as indicators of disease progression. These indices can be useful as rough predictors of CD4 T lymphocyte cell counts in resource constraint settings where CD4 T lymphocytes and viral load estimations are not available.

41. Intraperitoneal Instillation of Levobupivacaine with Adjuvants (Magnesium Sulphate & Dexmedetomidine) for Post Operative Analgesia in Laparoscopic Cholecystectomy: A Randomized Double Blinded Controlled Study
Karia Swati, Partani Seema, Sharma Charu, Sharma Karuna, Desai Himanshu Shivani, Digra Yashasvi, Chhabra Alka, Bhatnagar Neelesh
Background and Aims: Intraperitoneal instillation of local anaesthetics with adjuvants is emerging treatment modality for postoperative pain relief following laparoscopic surgeries. This study was conducted to compare the postoperative analgesia and other recovery variables on intrapaeritoneal instillation of MgSO4 and dexemedetomidine added to levobupivacaine for laproscopic chlolecystectomy. Methods: Total 90 patients were enrolled for the study and randomized into three groups (Group L, Group LM, and Group LD) of 30 patients each. Primary outcomes were comparison of post-operative analgesia in terms of; pain assessment using Visual Analogue Scale [VAS] and time to request for first rescue analgesia [TFA] along with total number and dose of rescue analgesics in 24 hours. Secondary objectives were to measure; Haemodynamic variables, Ramsay Sedation Score, recovery variables, adverse effects of study drugs and satisfaction score of patient and surgeon. Results: Group LD showed lower VAS at all time intervals than other two groups. The time (minutes) to first rescue analgesic requirement was prolonged in group LD (269.09±54.76 min) as compared to group LM (170±57.28 min) and group L (63.10±28.08 min) which was found to be highly significant (p<0.001).Total number and dose of rescue analgesic required in 24 hours was lowest in group LD as compared to group LM and group L which was statistically highly significant (p<0.001). Patients and surgeons satisfaction scores were high in group LD; however haemodynamic variables, Ramsay Sedation Score, recovery variables and adverse effects were comparable among all groups. Conclusion: Dexmedetomidine and magnesium sulphate both are safe as an adjuvant with 0.25% levobupivacaine for postoperative pain relief however dexmedetomidine provides longer duration of post-operative analgesia with minimal side effects as compared to magnesium sulphate.

42.Inclination of Medical Students for Paraclinical and Preclinical Subjects during Integrated Teaching Modules: A Questionnaire Based Cross-Sectional Study
Rajendra Sharma, Sanjay Kumar Verma, Rajit Sahai, Sanjeev Kumar, Saurabh Kohli
Introduction: Imparting knowledge about a clinical condition with consideration of related pre and para-clinical subjects leads to better perception and understanding, but liking towards individual subject(s) that are taught during these sessions may differ from student to student. This study aims to assess the opinion of medical students towards their likings for various subjects taught and teaching methods used in the integrated teaching sessions. Aims & Objectives: To assess the opinion of medical students towards their likings for various subjects taught  and teaching methods used in the integrated teaching sessions. Material and methods:  A total of two hundred students from this institution participated in this study. A multi-graded questionnaire was prepared and a pilot study of 20 students was done and the results were discussed among the authors to modify the questionnaire. This modified questionnaire was used in the main study. The same questionnaire was used for eliciting feedback from clinical students. Results: Out of 200 medical students, male students (61.7%) were higher than female students (38.3%). The mean age was found to be 18.3 ± 4 years SD. Most of the medical students (50%) wanted to become doctor, to either become rich and famous or to satisfy parents aspiration, 29% wanted to go to abroad (considerable brain drain). 25% of the students perceived that Pharmacology is the most interesting and most relevant basic science subject for clinical studies and in Pharmacology theory hours of teaching is to be increased (19%). Biochemistry was the most uninteresting subject (33%) of Basic sciences and if they are assured of attendance which subject they would not like to attend, maximum students opted for community medicine (33%) and Biochemistry (33%) classes. The best teaching method is Chalk and Board Method (53%) followed by LCD slides (40.5%). Conclusion: The observations were alarming and may be taken up seriously by the policy makers. They can fetch modifications in course curriculum of universities in future.

43. Correlation of Hematological Parameters to Cycle Threshold Value of Real Time Reverse Transcriptase-Polymerase Chain Reaction Positive COVID-19 Patients Admitted in Intensive Care Unit: Study from a Tertiary Care Center in Eastern India
Sakshi Kawatra, Manish Ranjan, Saumya Singh, Shveta
Introduction: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the novel coronavirus SARS-CoV2, causing an enormous strain on the already burdened healthcare systems. The clinical course of COVID-19 is variable; those with a poor prognosis tend to develop severe viral pneumonia requiring ventilator support and intensive care unit (ICU) admission. Aim & Objectives: The aim of this study is to correlate the Cycle Threshold (Ct) score of RT-PCR reaction with different biomarkers like White cell count (WCC), Neutrophils%, Lymphocytes%, Monocytes%, Neutrophil-Lymphocyte ratio (NLR), Lymphocyte – Monocyte ratio (LMR), Platelet count, Prothrombin time(PT), Interleukin 6(IL-6), C- Reactive protein (CRP), Blood sugar level (BSL) .Thus enabling if a low Ct score can help early identification of patients at a high risk to progress to a severe disease. Method: A prospective analytical study conducted at a tertiary care hospital, included 114 severe COVID-19 positive patients, admitted in ICU. The medical history, comorbidities, clinical findings, and laboratory data of each patient were obtained with data analyzed to identify and correlate significant laboratory parameters leading to the severe outcome. Results: Total 114 patients were studied. The mean age of the study population was 59 years with a male predominance.  Significant positive correlation of Ct values was seen with Total WBC counts (p=0.004), Neutrophil % (p=0.001), NLR (p<0.001), IL-6 (p=0.010), Procalcitonin (p=0.015) and D-dimer (p=0.041). Significant negative correlation of Ct value with Lymphocyte % (p=0.001) and monocyte % (p<0.001). And no significant correlation was seen with Age, Gender, LMR, CRP, Platelet counts, Prothrombin time and Blood Sugar levels. Conclusion: It is known that biomarkers help in identifying the disease severity and mortality and help in proper diagnosis and patient treatment. Ct scores can be used as a surrogate marker of disease severity, although further studies are required to validate the same.

44.Prevalence of Anaemia among Patients with Type 2 Diabetes Mellitus and its Prognostic Significance
Mohd Akbar Ali, Taha Mahboob Ali Khalid
Background: Diabetes mellitus, commonly known as diabetes, is a metabolic disease that causes high blood sugar. The increasing prevalence of type 2 diabetes mellitus has become a major public health concern. Anemia in diabetic person has a significant adverse effect on quality of life and is associated with disease progression and the development of comorbidities. Aim and Objective: To know the prevalence of anemia among type 2 diabetes mellitus and its prognostic significance. Material and Method: A prospective observational study was undertaken in which 70 cases of type 2 diabetes mellitus were studied for period of one year, in Department of General Medicine,  Bhaskar Medical College and General Hospital, Yenkapally, after approval of ethical committee and followed exclusion and inclusion criteria. Results: Among all the patients, 30 (42.90%) of the patients were female and 40(57.10%) of the patients were male. 41(58.60%) of the patients were lying in the age group of 41 -60 years of age. Study observed prevalance of anemia was 80% among Type 2 diabetic patients. Cut off value to predict anaemia for HbA1C was 8.7 with sensitivity of 64.30% and specificity of 50%. Conclusion: Study conclude that the prevalence of anemia among adult diabetic mellitus patients is high. Therefore, anemia is a public health problem according to the finding of this research.

45.A Prospective Comparative Study of Two Methods of Dressing (Open versus Bolster Dressing) in Split Thickness Skin Grafting
Vivek Kothari, Harshwardhan Sahijwani, D D Duttaroy, Samir Kacheriwala
Background and Aim: The management of wounds with loss of the dermo – epidermic layer where primary closure is impossible has been a challenge to surgeons since historical times. Success in skin grafting is dependent on adequate contact of graft with a vascular supply and control of infection. A prospective randomized study of 60 patients with wounds related to pre – existing clinical condition like ulcer, wounds and burns which required STSG was conducted in the Department of Surgery, Medical College and hospital. Material and Methods: A total of 60 patients admitted in surgical units in General Hospital and Medical College, having wounds with skin loss which hindered primary closure were incorporated to this study. Wounds with soakage mild to moderate in amount were included in study. Wounds with positive bacterial culture were included in the study. After preparing the recipient site patient was randomized into two groups to receive one of the two techniques of dressing in STSG: cotton bolster group and open group. We recorded patient – related factors like gender, age, haemoglobin, nutritional status, obesity, diabetes mellitus, steroid therapy, jaundice, smoking status, chronic alcoholism, Operation related factor that was recorded was type of anaesthesia. Results: The mean age of the patients in the study population was 43.33 years. 6 patients from open group and 7 patients from bolster group were found to be having associated co – morbidities. Out of 60 patient evaluated majority had ulcer following cellulites (n = 43 ) , other had trauma (n=11) and burns (n=6) as the cause of ulcer. Mean duration of ulcer in open dressing group was 28.83 days as compared to 25.73 days in bolster dressing group. In both the groups the characteristics of the wound including cause, site, duration of ulcer number of wounds having moderate discharge and positive bacterial culture was not significantly mismatched. pre-operative positive bacterial culture didn’t influence graft uptake in open group but it had significant influence on graft uptake in bolster group. Conclusion: open dressing of STSG can be effectively utilized in management of wound, even for that having persistently more amount of exudates and is inoculated with bacteria. It increases the graft uptake in such wounds and also decreases the operative time. Thus it gives better results of skin grafting in such situations and is eminently acceptable by the patient.

46.Study of High Sensitivity C Reactive Protein in Acute Ischemic Stroke
Sangeetha J Nair, P S Pipliwal, Gajender Kumar Kumawat, Rohit Ishran
Background: Stroke is one of the most devastating neurological diseases, often resulting in death or disability. It is the second most common cause of death and the leading cause of adult disability. The present study was undertaken to assess high sensitivity C Reactive Protein (hs CRP) levels in acute ischemic stroke and hence correlate the inflammatory marker as a predictor and prognostic factor in atherothrombotic disease. Material & Methods: 30 cases of ischemic stroke within initial 72 hours of presentation diagnosed based on history, neurological examination and neuroimaging- CT Brain and MRI Brain, and 30 controls without evidence of active infection or inflammation were enrolled in this study, their hsCRP levels were estimated and compared. Results were recorded in Microsoft Excel sheet and data was analysed by SPSS software. Results: We found that mean hsCRP of case group was 8.69 and that of control group was 2.02 and there was a statistically significant difference between these groups. Increasing age, male sex and hypertension were found to be risk factors contributing to ischemic stroke. Conclusion: This study demonstrated that high levels of hsCRP are prevalent in all ischemic stroke subtypes and high hsCRP levels may be a marker for starting therapy with statins for both primary and secondary prevention.

47.Comparison of Labor Progress and Delivery Outcome among Spontaneously Induced Patients
Seeba Hussain
Background: The signs for inducing labour have virtually remained the same. Primary indications for induction include active medical conditions, being past the due date, and extended ruptured membranes when there is a need to protect the mother’s health. Additionally, when the foetus is in danger, indication is justified. Methods: At the district hospital in Katihar, Bihar, India, 300 pregnant women were randomly chosen from the outpatient department over the course of a year for a prospective research. There were two groups in the study group. Results: A total of 300 patients were enrolled in the trial throughout the study period. 150 patients underwent induced labour, and 150 patients experienced spontaneous labour. Conclusion: We come to the conclusion that spontaneous pregnancies are more economical than artificial pregnancies.

48. A Study to Analyze Potential Long-Term Post-COVID Clinical Conditions and Their Management in a Tertiary Care Hospital
T. Kalyani, B. Vijay Kumar
Background: Long term Covid is frequently described as clinical features persisting Covid-19 symptoms after three months beyond the initial illness. More research is being carried out into how best to define long Covid, what its symptoms are and how to treat it. Aim: To study the long term persistence of symptoms of COVID-19 and their health-related quality of life (HRQoL) 3 months after the initial COVID-19 disease. Objectives: To classify the systems affected based on the symptoms and treatment in the Hospital. Materials: 86 patients attending the Department of General medicine and ENT with long COVID symptoms were included. Demographic details, clinical symptoms, return to work after active disease discharge, “mMRC’ dyspnoea scale scores HRQoL and HRQoL- EQ-5D-5 and EQ-VAS were observed and recorded. Statistical analysis was done using standard methods to know the levels of significance. Results: Out of 2654 COVID-19 patients treated at MGM Hospital 86/2654 (03.24%) patients were included with persistent symptoms as long COVID-19 status. Out of 86 patients 19 (22.09%) were ICU patients and 67 (77.90%) were ward patients. Males were 61 (70.93%) and females were 25 (29.06%) and the male to female ratio was 2.44:1. Patients aged 38 to 57 years constituted to 48/86 (55.8%) of total patients. The mean age was 56.68± 6.20 years in males and 51.45± 4.10 years in females. Conclusions: Patients required hospitalization for persistent COVID-19 disease symptoms like cough, dyspnoea, fatigue, confusion and Mucormycosis. Though overall HRQoL was appreciable, there was notable difference between ward and ICU patients. The overall work performance and return to the job after discharge from COVID-19 was significant. Constant supervision of mental status of COVID-19 patients was necessary during post long COVID-19 period by the health professionals.

49. Role of Voice Quality Assessment Tools in Patients after Botulinum Injection for Spasmodic Dysphonia
Hanish Haneefa, Nazeem Abdul Majeed
Introduction: Spasmodic dysphonia (SD) is a neurological status of larynx with periodic dystonia of its muscles affecting the voice and speech. Botulinum toxin (BT) injected in the muscles of Larynx, helps in overcoming the dystonia. The final results of BT injection on the voice quality were measurable with various indices. This study was conducted to analyze the voice quality at fixed time intervals. Aim: To evaluate quality of voice and speech in spasmodic dysphonia patients following BT injections at fixed time intervals. The objectives were to use VAS, VHI and GRBAS score as diagnostic tools for assessing the severity of SD before and after BT injections. Materials: 38 subjects with SD were treated in the ENT Department of Kannur Medical College and Hospital, Anjarakandy, Kannur, Kerala were included. The patients were assessed for their degree of voice symptoms with visual analogue scale (VAS), GRBAS score and VHI (Voice Handicap Index) before and after BT injection. Results:  The VHI, VAS and GRBAS scores among the patients of both the BT group (Group A) and non-BT group (Group B) were almost similar before the commencement of treatment. One-Way ANOVA calculator including Turkey HSD analysis of the voice quality test scores showed significant improvement. The results of BT injection were statistically significant with p value 0.0001; p taken as significant at <0.05. Conclusions: Perceptual evaluation of voice quality in patients with SD done at admission and at follow up after Botulinum Injections was good and voice quality assessment tools like VAS, VHI and GBRAS showed high sensitivity and specificity. The final outcome of quality of voice was statistically significant when compared to placebo treatment.

50. Role and Effectiveness of Normal and Abnormal Admission Cardiotocography (CTG) and its Association with Perinatal Outcomes
Seema Kumari, Archana Jha, Anupama Sinha
Background: Cardiotocography (CTG) is worldwide the method for fetal surveillance during labour. Although it is applied on a large scale, this technique is still subject to debate. Cardiotocography provides direct information of fetal condition in contrast to other technique. The aim of the study is to identify the intrapartum fetal heart rate patterns associated with increased risk of neonatal depression using cardiotocography (CTG). Methods: This prospective observational study conducted in the Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar for the period of 1 year (June 2021 to May 2022). Total 250 pregnant women were studied in this period. Statistical analysis of significant cases p <0.05. Result: According to inclusion criteria Total 250 cases divided into two groups i.e. normal and abnormal CTG. In Abnormal CTG group takes both suspicious and pathological cases. The difference in Apgar score, NICU admission and perinatal asphyxia was statistically significant (p<0.05). Conclusion: Cardiotocography can be continued as good screening test of fetal surveillance. Abnormal &TG in fluence the fetal outcomes, i.e., poor Apgar score at 1 minute and 5 minutes, increased rate of caesarean section and neonatal resuscitation.

51.Comparative Study of Clinical Significance of Serum Amylase and Glucose Level in Organophosphorus Poisoning: A Hospital Based Cross-Sectional Study
Shobha Kumar Prasad, Anil Kumar Mehta
Background: Organophosphorus compounds have assumed considerable importance in most parts of the world particularly developing countries but also in western countries. Hospital based statistics suggest that nearly half of the admissions in emergency with acute poisoning are due to Organophosphorous compound poisoning. The toxicity of those compounds and paucity of appropriate medical facilities lead on to a high fatality rate. Organophosphorous compound poisonings are found to be a leading cause of death in agricultural countries globally. Aim of the study to estimate serum amylase and glucose level in organophosphorus poisoning. Materials and Method: Present hospital based cross-sectional comparative study were conducted at DMCH, Laheriasarai, Bihar. Total 38 Organophosphorous poisoned patients included in this study were compared at the time of admission and before discharge. Results: The majority of cases have mild OP poisoning 27(71.1%), 9(23.7%) have moderate and 2(5.2%) have severe in total 38 cases as per Peradeniya Organophosphorus Poisoning (POP) score. Serum amylase mean initial level in patients with mild poisoning was 152±73.92 (IU/L) (p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22 (IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis. Conclusion: Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.

52.Study of Histopathological Changes in Fibroadenoma of Breast
Ankita, Shiksha, Pankaj Kumar Patel
Background: Fibroadenoma represents a long-term risk for breast carcinomas especially in women with complex fibroadenomas, ductal hyperplasia, older women, or a family history of breast carcinoma. Material and Methods: This prospective study was done in Department of Pathology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from September 2021 to July 2022. Total 123 cases of fibroadenoma and further histopathological examination were done. Formalin fixed excisional breast biopsies of patients, with histopathological diagnosis of fibroadenoma was included in the study. Results: Fibroadenomas were commonly encountered in the age group of 21–30 years (63.2%). 42.5% of Fibroadenomas had associated pathological entities. Complex Fibroadenomas were 1.5%, 0.9% of infarcts and 0.3% of Fibroadenoma with extensive squamous metaplasia. 24.3% of Fibroadenoma with fibrocystic disease, 12.3% of Fibroadenoma with varied degrees of hyperplasia and 0.3% of invasive carcinoma was noted. Incidental detection of even single case of carcinoma within Fibroadenoma emphasizes the need for comprehensive histopathological examination of all Fibroadenomas. Conclusion: Fibroadenoma is a benign biphasic tumour and the commonest benign solid tumour in young women. They develop from a terminal duct lobular unit due to uncoordinated proliferation of the epithelial and stromal components.

53.To Study the Diagnostic Value of Flexible Thoracoscopy in Undiagnosed Cases of Exudative Pleural Effusion in a Tertiary Care Center
Ritesh Kamal, Pushpa Kumari
Background: It is the accumulation of excess fluid in the pleural cavity and is one of the most common clinical scenarios coming in the pulmonologist practice. Pleural fluid formation occurs as a result of decreased removal or increased production. The Aim of the study to diagnostic utility of flexible thoracoscopy in undiagnosed exudative pleural effusion. Material and Methods: This prospective study was done at KMCH, Katihar, Bihar. Total 40 cases, 30 male and 10 female are included in this study the diagnostic value of flexible thoracoscopy in undiagnosed cases of exudative pleural effusion. Collection of samples as per patients inclusion criteria: Antituberculous treatment history, Symptoms duration, Chest radiograph, CT chest, Sputum for AFB, Pleural fluid aspiration and analysis, Thoracoscopy in undiagnosed case, Histopathology findings. Results: The most important indication for thoracoscopy is in exudative undiagnosed pleural effusion. It is also used in the diagnosis of malignant mesothelioma, diffuse parenchymal lung disease. It is also useful in talc pleurodesis and adhesiolysis. The overall diagnostic yield in pleural fluid cytology is 62% and blind pleural biopsy is 44%. The diagnostic yield of thoracoscopy varies from 60%-97% in various studies, where as in our study is 72.5%. Conclusion: It is a semi invasive procedure and it can be done in conscious sedation. So if there is facility for thoracoscopy, it should be preferred in undiagnosed exudative pleural effusion because of its high diagnostic yield in tuberculosis and malignancy and it is a safe procedure.

54.Comparative Study of Dexmedetomidine and Esmolol on Hemodynamic Responses during Laparoscopic Cholecystectomy
Ankita Aggarwal, Rahul Singh, Deepak Mehrotra, Satyendra Kumar
Background: Laparoscopic surgeries have revolutionized surgeries and it has now become the “gold standard” of many surgical procedures, and has been promoted, as a “gentle surgery”. However, this procedure is not risk free. In fact it produces significant haemodynamic changes especially in elderly and haemodynamically compromised patients. Aim of the study to evaluate the type and extent of haemodynamic changes associated with laparoscopic surgery and also to find out the efficacy of dexmedetomidine and Esmolol in prevention of such haemodynamic changes. Materials and Methods: Total of 100 patients aged 18-60 years, American Society of Anaesthesiologists (ASA) physical status I or II, of either sex, planned for laparoscopic cholecystectomy were included. Esmolol group received bolus dose of 1 mg/kg intravenous Esmolol just before pneumoperitoneum followed by an infusion of 200 mcg/kg/min and Dexmeditomidine group received bolus dose of 1 mcg/kg iv Dexmedetomidine over 15 minutes before pneumoperitoneum followed by 0.6 mcg/kg/hr in infusion. Heart rate (HR), systolic blood pressure, diastolic blood pressure and mean arterial pressure (MAP) were recorded preoperative, after study drug, after induction, after intubation, after pneumoperitoneum at 15 min intervals, post pneumoperitoneum and postoperative period after 15 min. Propofol induction dose, intraoperative fentanyl requirement and sedation score were also recorded. Results: Dexmeditomidine group there was a statistically significant decrease in heart rate before pneumoperitoneum (84.24±9.17) and10 minutes after pneumoperitoneumc (79.40±7.41) compared to Esmolol Group before pneumoperitoneum (91.40±5.98) and 10 minutes after pneumoperitoneum (95.18±14.17). There was statistically significant decrease in Mean arterial pressure in Dexmeditomidine group at 30 minutes (86.53±6.13), 50 minutes (77.95±4.85), after release of pneumoperitoneum (92.42±3.91) and after extubation (99.50±11.81) compared to Esmolol group at 30 minutes (91.23±8.97), 50 minutes (94.34±12.64) after release of pneumoperitoneum (102.5 ±10.44) and after extubation (112.39±11.15). Conclusion: Comparison of Dexmedetomidine and esmolol in hemodynamic responses to pneumoperitoneum in elective laparoscopic cholecystectomy, Dexmedetomidine is more effective than esmolol. Dexmedetomidine and esmolol also reduced fulfill the requirements of anaesthetic agents.

55. Effect of Prophylactic Ondansetrone on Prevention of Spinal Induced Hypotension among Women underwent Elective Cesarean Section
Deepak Mehrotra, Rahul Singh, Ankita Aggarwal, Nitin
Background: Hypotension is a common side effect after spinal anesthesia which associates with both maternal and fetal morbidity. Many interventions have been suggested to prevent this clinical problem. A commonly used antiemetic, ondansetron, can be used as an alternative to prevent hypotension after spinal anesthesia. The action believed to inhibit Bezold-Jarisch reflex. Objective: To assess effect of prophylactic ondansetron on spinal anesthesia induced hypotension among women undergoing elective cesarean section at NMCH, Patna, Bihar, from November 2021 to July 2022. Method: In this prospective study 100 patients with American Society of Anesthesiologists (ASA) status class-II, age≥18 and BMI 18 -30 kg/m2 who underwent cesarean section under spinal anesthesia were included. Prophylactic group (n=50) receive 4mg ondansetron, while Non-prophylactic group (n=50) did not receive ondansetron. The outcomes of the study were the incidence of hypotension, nausea, vomiting and the need of rescue vasopressor. Comparisons of variables between study groups were done using student t test and Chi square test. Significance was determined at P value <0.05. Table and graph were used to show result of the study. Result: The incidence of hypotension is 13(26.5%) in prophylactic group compared to non- prophylactic group 36(75% with (p=007). There was a statistically significant difference in mean systolic blood pressure, mean heart rate and mean arterial pressure between the groups at all-time point with p<0.05. The incidence of nausea and vomiting was higher in non-prophylactic group when compared with prophylactic group with (p=0.003 & 0.001) respectively. There was not significant difference in total need of rescue vasopressor between groups (6.1% in prophylactic and 10.4% in non-prophylactic group with (p=0.17). Conclusion: prophylactic use of 4mg intravenous ondansetron 5 minutes before spinal anesthesia significantly reduces the incidence of hypotension; nausea and vomiting in parturient undergoing elective cesarean section. We recommend the use prophylaxis ondansetron for prevention of spinal anesthesia induced hypotension in parturient undergo elective cesarean section under spinal anesthesia.

56. Effect of Prophylactic Ondansetrone on Prevention of Spinal Induced Hypotension among Women underwent Elective Cesarean Section
Nivedita Singh, O. P. Dwivedi
Background: Study of prostate lesion has gained more importance because development of prostatic hyperplasia is an almost universal phenomenon in aging men. Benign hyperplasia of prostate (BPH) is the most common urological disorder in men beyond 40 yrs of age and is present in almost all men aged 80-90 years. It is extremely important to differentiate the benign and malignant lesions for which we need histopathological analysis. Histomorphological study of prostate specimens is necessary in the present situation as the incidence of prostate diseases keep growing and due to its increased morbidity and mortality. Aim of the study the histo morphological features of various prostate lesions. Materials and Methods: In this study included 100 prostatic specimens received in the Department of Pathology, NMCH, Patna, Bihar from April 2020 to March 2021. After collecting the history, the specimens were examined, fixed in 10% formalin and bits were given. The sections were stained with Hematoxylin and Eosin and examined under the microscope. Results: Mean age of prostatic lesions was 68.61years. The most common prostatic lesion diagnosed was BPH followed by adenocarcinoma prostate. 5 cases of prostatic intraepithelial neoplasia also reported. Among BPH, the most common associated lesion was chronic prostatitis. Both BPH and adenocarcinoma was commonly reported in 6th decade followed by 7th decade. Conclusion: Most common finding in this study was BPH followed by adenocarcinoma, more prone in age group of 61-80 years.

57. A Clinicopathological Study of Hypopigmentary Disorders of Skin
Nivedita Singh, O. P. Dwivedi
Background: Skin can be divided into two separate but interdependent layers the epidermis and the dermis. They are composed of varying type of cells with distinct functions like mechanical, photo protection, immunosurveilance, nutrient metabolism and repair. The intention of this study is to correlate the histopathological findings with clinical findings of hypopigmented disorders of skin to arrive at an accurate diagnosis. Material and Methods: Present study was conducted at Department of Pathology associated with Department of Dermatology, NMCH, Patna, Bihar from October 2018 to March 2020. During the period of 18 months of study a total of 106 biopsies of skin, were received. Of these, 53 biopsies were hypopigmented lesions. This formed almost 50% of the skin biopsies received. Results:  Of the 53 cases, included in the study 35 were male and 18 were female. The maximum percentage of patients was between the age group of 40 to 60 years. The different types of clinical diagnosis observed in this study were totally 11. They were pityriasis versicolor, Hansen’s disease, vitiligo, LSA, Lichen striatus, IGH, PLC, parapsoriasis, Woronoff ring of psoriasis, DLE and PMLE. The HPE evaluation was done for all cases and special stains and IHC were done for relevant cases. Clinicopathological correlation was observed in 86.7% of cases. Of which pityriasis versicolor showed 83.3%, Lichen striatus showed 50%, PLC showed 66.6% correlation and parapsoriasis showed 33.3%correlation. Conclusion: Systematic approach of clinical, histopathological examination and Immunohistochemistry will provide an accurate diagnosis of hypopigmented disorders and thereby reducing the patient distress.

58.An Observation on Clinical Profile of Patients of Heart Failure at VAMCRH, Banthra, Shahjahanpur, U.P.
Sunjay Pathak, Ashish Suman
Background: Heart failure may cause by abnormalities of the heart valves in which that heart muscle is damaged by long standing pressure or volume overload or by recurrent rheumatic process. In another group of patient, a similar clinical syndrome is present but without any apparent abnormality of myocardial function. In some patients, the normal heart suddenly presented with mechanical load that exceeds its capacity such as an acute hypertensive crisis, rupture of an aortic valve cusps due to infective endocarditis or trauma or massive pulmonary embolism. It was aimed at identifying common causes and outcome of heart failure. Data regarding risk factors, co-morbid states, etiology, clinical features and investigations were collected in study periods. Materials and Methods: This study was conducted in patients admitted to different medical wards and ICU of VAMCRH, Banthra, Shahjahanpur, U.P. from August 2019 to October 2021. A total of 108 admitted patients. The outcome of the study was documented and to find out the etiology, clinical presentation, treatment profile and outcome of cases of heart failure and increase awareness among patients regarding newer treatment modalities available. Results: In this study, most of the patients were managed with combination of ACEI/ARB, Beta blockers and Diuretics. The dose of ACEI/ARB, Beta blockers was gradually titrated to optimal. Those patients who remain symptomatic or there is worsening of heart failure were added Aldosterone antagonists and or Digitalis. Antiplatelets, Nitrates, LMWH, Antiarrythmic, Digitalis, Benzathene penicillin and Hypolipidemic drugs were used accordingly. 14.28% cases of ischemic cardiomyopathy required DC cardioversion for pulseless VT. 4.63% cases required hemodialysis for their volume overload states not properly controlled with diuretics. 92.68% cases of RHD were promoted for valvular surgery (repair/replacement). 54.28% cases of ischemic cardiomyopathy and 42.86% cases of Dilated cardiomyopathy were promoted for Device therapy. The overall mortality was 13.9%. It was highest (35.48%) among patients with EF<25%. Maximum number of patients who recovered or partially recovered were had EF>40%. Conclusion: Recovery or partial recovery was highest among patients with heart failure of rheumatic origin while the rate of worsening and mortality was highest among patients with heart failure due to ischemic heart disease.

59.An Echocardiographic Assessment of Cardiovascular Hemodynamics in Patients with Large Pleural Effusion at VAMCRH, Banthra, Shahjahanpur, U.P.
Ashish Suman, Sunjay Pathak
Background: Pleural effusion is a common medical problem existing all over the world, especially in developing countries. Pleural effusion of tuberculous origin is very common in India. The effect of pleural effusion depends on the cause and the amount of fluid in pleural space. This study aims to assess the tamponade physiology occurring in cases of large pleural effusion even in absence of any pericardial effusion and treatment of this condition should be thoracocentesis rather than pericardiocentesis. Material and Methods: This cross-sectional study was done at VAMCRH, Banthra, Shahjahanpur, U.P. from February 2020 to October 2021. 73 patients were randomly selected from patients presented with large pleural effusion in medical emergency and medical ward. Detail history and clinical examination were done immediately. All patient with large pleural effusion whether unilateral or bilateral were enrolled in this study, while patients with pleural effusion of cardiac etiology, pericardial effusion and terminally ill were 11 cases excluded from this study. So total 62 cases included in this study. Results: Sixty two cases of large pleural effusion were selected randomly irrespective of age, sex, etiology or sidedness of pleural effusion and were enrolled in this study group. General clinical parameters like pulse rate, respiratory rate, blood pressure etc. were measured. All sixty two patients with large pleural effusion  were evaluated with echocardiography and echocardiographic parameters  like chamber size of heart, Right ventricular diastolic collapse, right atrial diastolic cpllapse and  respiratory flow variation across Mitral, Tricuspid, Pulmonary and  Aortic valve were noted. Then 1000 to 1500 ml of  pleural fluid were removed by thoracocentesis and a check x-ray was again repeated to make sure that pleural effusion remain below half of total lung field.A repeat echocardiography was done within 24 hour of thoracocentesis of large pleural effusion. Echocardiographic parameters like chamber size of heart, right ventricular diastolic collapse , right atrial diastolic collapse  and  respiratory flow variation across Mitral, Tricuspid, Pulmonary and Aortic valve were noted again. All the data were collected and kept for final study and were statistically analysed. The result of present study was to assess the effect of large pleural effusion on cardiovascular haemodynamics by means of echocardiography. Conclusion: Patient’s with tamponade physiology who has both large pleural effusion and pericardial effusion a pleurodesis is probably the safest initial procedure and might result in complete recovery from tamponade physiology.

60.The Bethesda System for Reporting Thyroid Cytopathology and its Histopathological Correlation
Shiksha, Ankita, Pankaj Kumar Patel
Background: Fine needle aspiration cytology, is an initial investigation in evaluation of thyroid lesions. Due to lack of standardized system for reporting thyroid lesions in cytology in 2007, “The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)” was introduced. It is a six tier system. Aim: To classify thyroid FNACs based on “The Bethesda system” and to compare the results with histopathology. Objectives: To analyse thyroid cytology through TBSRTC and analyse distribution of lesions in various categories and to correlate the same with histopathology. Material and Methods: The study is a cross sectional study done in Department of Pathology, Sri Krishna Medical College, Muzaffarpur, Bihar from September 2021 to July 2022. Results:Total of 143 cases were studied, 108 were females and 35 males. Age of patients ranged from 9 to 80 years. Majority in 31- 40 years. Adequacy rate was 96%. 119 cases were non – neoplastic, 19 cases were neoplastic, and 5 cases -unsatisfactory. Category II had maximum number of cases (119) majority was colloid goiter (70 cases). No cases in the category III. Category IV – 13 cases, among them 7 cases benign in histopathology, 4 cases – Papillary carcinoma, 1 case each of Follicular carcinoma and Lymphoma. Category V – 3 cases, among them one each was MNG, Follicular carcinoma and Follicular variant of Papillary carcinoma in histopathology. Category VI had 3 cases of Papillary carcinoma and had 100 % correlation in histopathology. The Sensitivity and specificity of The Bethesda system was 20% and 100 % respectively. The PPV – 100% and NPV – 91.1%. Conclusion: Further studies with larger sample size recommended overcoming the low sensitivity rate in the present study.

61.A Prospective Study on Thermal Balloon Endometrial Ablation for the Treatment of Heavy Menstrual Bleeding
Deeksha D Samani, Usha Brindhini M, Rathnamala M Desai
Introduction: Abnormal uterine bleeding affects most of the peri-menopausal women and accounts for most of all gynaecologic visits by peri-menopausal women. Thermal balloon endometrial ablation (TBEA) technologies were introduced as an alternative to hysterectomy in those women having abnormal uterine bleeding who failed medical management and/or dilatation and curettage. The present study was conducted to assess the short term treatment outcomes of TBEA and patient satisfaction after the procedure and to identify the factors influencing its outcome. Material and Methods: This prospective study was conducted for a period of one year. Premenopausal women with heavy menstrual bleeding were included in the study. TBEA was done using the uterine thermal balloon system under anaesthesia. After the procedure, the patients were followed up after 3 months, 6 months and one year using a prevalidated questionnaire. Both improvement in symptoms and quality of life were taken in to consideration. The data was analyzed with statistical package for the social sciences version 21.0. Results: A total of 36 were included as study population the medial age of the study population was 42 years. Out of the 36 cases, 26 (72.3%) patients developed amenorrhea, 7 (19.4%) patients had hypomenorrhoea and 3 (8.3%) patients continued to have heavy menstrual bleeding and underwent hysterectomy. 88.9% patients reported satisfaction after TBEA. There was no significant association of amenorrhea after TBEA with either bmi or endometrial thickness or parity or prior dilatation and curettage. Conclusion: TBEA is a suitable alternative to hysterectomy as majority of the patients developed amenorrhea in the one year follow up and most of the patient had better satisfaction rates after TBEA.

62.Assessment of Knowledge, Attitude & Behavior towards COVID-19 Vaccination: A Cross-Sectional Survey among Medical Students from Central India
Mohit Kulmi, Ankesh Kumar Jain, Gaurav Chittora, Sanjib Das, Manish Kumar
Background: Vaccination for COVID-19 is the most effective measure for controlling the pandemic. Knowledge, attitude & behaviour study among medical students towards COVID-19 vaccination presented a unique opportunity to study and to address barriers to vaccination and their associations. Objective: To study knowledge, attitude and behaviour of MBBS 2nd& 3rd year students towards COVID-19 vaccination. Methods: This was a cross sectional study involving MBBS students from the 2nd and 3rd professional years. A semi-structured questionnaire was designed and disseminated among the students. The questionnaire consisted of items related to knowledge, attitude, and behaviour towards COVID-19 vaccination. Responses obtained were analysed. Results: It was found that 100% of the participants were vaccinated and majority of the participants were well informed regarding COVID-19 vaccine and its schedule, ADRs. Majority were of the opinion that taking COVID-19 vaccine was a social responsibility and they were motivated to take booster dose if offered. Most of the participants admitted to motivating their family and friends to get vaccinated and follow social distancing protocols. Conclusion: We found that the knowledge, attitude and behaviour of medical students towards COVID-19 vaccination was favourable. The positive result of this study highlighted the measures taken by the government and health care workers towards educating people about COVID-19 and its vaccination.

63. Perceptions of Medical Students and Faculty on Writing ‘Reflection’ in the Log Book
Rahul Kumar Bagla, Aprajita Panwar, Mamta Mohan
Background: “Reflection” is a meta-cognitive process that can build professional expertise in students and prepare them for the complex attributes of medical practice. A physician must adhere to professional and ethical values at his workplace and these must be taught to him right from the first year of MBBS program. Hence, we conducted the present study, to evaluate perceptions of undergraduate medical students and teaching faculty on writing “Reflection” in the log book. Methods: The study included first year MBBS students and teaching faculty using convenient sampling technique. The study questionnaire comprised two sections and was developed and distributed using SurveyMonkey®. The students were approached and recruited through social networking websites (Facebook, Twitter and WhatsApp) and the password-protected survey links were posted on the same. Results: 70.0% of teachers replied that all four components (writing about recently learned material, latest change in personal attitude, acquisition of new behaviors and learn to use new knowledge) constitute reflection. Two fifth of teachers (40.0%) replied that they are asking student to write the reflection, before a class starts (as soon as you tell them the competency/ specific learning objectives). Among 42.5% of students believed that feelings / thoughts (fear of revealing your thoughts to teachers, fear of revealing your thoughts to other students, and I dislike writing in the logbook) are stopping us from writing “Reflection” in the logbook. Only 50.6% of students believed that reflection writing in the logbook should be continued in medical colleges. Conclusion: In our study we collected relevant views, perceptions and suggestions on the use of log books which will enable us to develop strategies to engage more students in reflection and to guide future reflective programs within medical education.

64. Comparative Study to Know the Perception of Medical Student and Faculty about OSPE and Traditional Method of Assessment
Maharshi Patel, Piyushkumar C Parmar, Nilesh G. Patel, Niraj Pandit
Background: Medical Colleges in our country follow traditional methods of examination & these traditional methods have inter-examiner variation which in turn prevents uniform pattern of marking. These variations can be reduced by newer methods like objective structured practical examination (O.S.P.E).  The study’s aim was to determine the usefulness of O.S.P.E as a formative assessment tool and to learn about students’ and faculty’s attitudes toward OSPE. Methodology: A cross-sectional study was conducted on third-year MBBS students in phase one. For documenting the perception of students and faculty towards OSPE & traditional method, a Likert’s scale-based questionnaire used. A total of 45 MBBS students volunteered for the study. Traditional Viva Voce Examination was followed by OSPE for the students. The average score for the OSPE vs. traditional technique score comparison done. Results: Students’ average results in OSPE were 26.58 ± 3.15 but their average marks in Traditional Viva Voce Examination were 23.89 ± 4.50, and this difference was statistically significant. In comparison to traditional viva voce examination, 86.6 % of students and 80 % of faculty believe OSPE is fairer. Conclusion: This study showed that in comparison to Traditional Practical Examination, OSPE was more effective as inter-examiner variation was removed and every student had equal chance with same set of station to get marks.

65. A Prospective Study of the BISAP Score in Predicting Severity and Prognosis of Acute Pancreatitis in a Tertiary Care Hospital in Southern Bihar Region
Amit Parashar, Rajeev Ranjan, Deboshubhra Chakraborty, Sudhir Kumar
Aim: A prospective study of the bedside index for severity in acute pancreatitis (BISAP) score in predicting severity and prognosis of acute pancreatitis. Methods: The present Prospective study was conducted in the Department of General Surgery, Narayan Medical College and Hospital, Sasaram, Bihar, India.The total number of patients included in the study was 50.  Individual components of the BISAP scoring system were BUN >25mg/dl, impaired mental status (Glasgow Coma Scale Score <15) and SIRS (systemic inflammatory response syndrome). Results: Out of 50 patients 45 (90%) were males and 5 (10%) were females. Thus, a male preponderance was observed in this disease. Out of 50 patients, 40 had BISAP score ˂2. Among them, 37 patients (92.5%) had a hospital stay for ≤7 days and only 3 patients (7.5%) had a hospital stay for >7 days. 10patients had BISAP score ≥2. Among them, 9 patients (90%) had a hospital stay for >7 days and only 1 patient (10%) had a hospital stay for ≤7 days. Hence, BISAP Score ≥2 was associated with prolonged hospital stay. In this study, BISAP score had a sensitivity of 70%, specificity of 92.5%, positive predictive value of 70, negative predictive value of 92.5%, false positive rate of 7.5% and false negative rate of 30% in predicting severe acute pancreatitis and poor prognosis. Conclusion: It can be concluded that BISAP score is accurate in predicting severity and prognosis of acute pancreatitis. Patients diagnosed with acute pancreatitis having BISAP score ≥2 are prone to develop severe pancreatitis and carried poor prognosis while patients with BISAP score <2 develop only mild pancreatitis and have better prognosis.

66. Correlations of Thrombocytopenia with LDH Level in Patients of Pregnancy Hypertension and Comparison of These Parameters in Normotensive Pregnant Patients
Bhumija, Girija Wagh
Aim: To correlate the absolute platelet count with lactate dehydrogenase level in patients of pregnancy hypertension and comparison with normotensive pregnant patient. Methodology: A Prospective observational study was conducted from August 2012 to August 2014. All ANC patients diagnosed with raised BP were included in this study. Study was conducted in the department of Obstetrics and Gynaecology in Bharati Hospital having a tertiary care at Bharati Vidyapeeth University Medical College. 150 pregnant women were enrolled in this study who met the inclusion criteria and were divided into two groups: 100 Antenatal women admitted with raised BP were included as study group and 50 Normotensive pregnant women at 36 weeks were included as control group. Patients’ progress was observed and perinatal outcome were followed. All the data was collected in MS Excel and analyzed with the help of biostatistician. Results: 68% of the patients in normotensive group were primigravida, while 60% in mild preeclampsia group were primigravida and 76% in severe preeclampsia group were primigravida but difference was moderately significant. Most common age group was 20-25 years. The difference in mean SBP and DBP in normotensive, mild preeclampsia and severe preeclampsia group was statistically significant. The mean LDH levels were 278.85±114.83, 498.63±182.26 and 696.78±132.67 respectively in each group and it was statistically significant. Maximum number of patients in severe pre-eclamptic group underwent lower segment caesarean section in which majority had LDH levels >800IU/l. 44.44% each of the low birth weight babies were seen in LDH levels >800IU/l and in between 600-800 IU/l. With serum LDH levels <600 IU/l, only 11.11% of babies were seen. Both were statistically significant. Neonatal complications like intra uterine growth retardation, birth asphyxia, still birth and NICU admission were seen in neonates who were born to preeclamptic mothers and majority of the neonatal complications were seen in serum LDH levels >800IU/l. Neonatal pathological jaundice was seen in neonates who were born to preeclamptic women with serum LDH levels >600IU/l. Majority of the neonatal sepsis were seen in those neonates who were born to severe preeclamptic women and had serum LDH levels >800IU/l. Conclusion: Raised LDH is associated with preeclampsia and higher the LDH levels more are the chances of complications. Hence serum LDH can be measured in all pregnant women to predict preeclampsia.

67. A Population-based Assessment of the Association between Vitamin D Deficiency and Hypothyroidism
Prashant Kumar, Gyanendra Kumar, Pradeep Kumar Singh
Aim: To evaluate the relationship between hypothyroidism and vitamin D levels. Material & Methods: For this study, a total of 250 patients were selected. This study was conducted in the Department of Pathology, Government Medical College, Bettiah, Bihar, India. All participants who were ≥ 18 years of age had signed a written informed consent following an extensive and detailed description about the survey including the interview, medical examination and laboratory evaluation. Results: A total of 250 participants were included in this study, of which 25 (10%) were having hypothyroidism. The man age of this cohort was 47.2 years and 53.4% were females. About 55.8% of the participants had more than 12 years of formal education. Comparison of clinical characteristics between hypothyroid patients and normal controls also showed significant difference in majority of the factors. There was a significant association (P < 0.001) between vitamin D categories and hypothyroid state. Conclusion: Low vitamin D levels are associated with autoimmune hypothyroidism. Healthcare initiatives such as mass vitamin D deficiency screening among at-risk population could significantly decrease the risk for hypothyroidism in the long-term.

68. Prospective Observational Determination of the Most Common Cause and the Frequent Stage of Presentation in Patients with Neovascular Glaucoma
Rajeev Kumar, Prem Kumar, Jawed Iqbal
Aim: To identify the most common cause and the frequent stage of presentation in patients with neovascular glaucoma. Material & Methods: The present study is a prospective observational study, 100 eyes of 78 patients who underwent ophthalmological examination and diagnosed as having neovascular glaucoma in one eye or both the eyes at the Department of Ophthalmology, Anugrah Narayan Magadh Medical College Hospital, Gaya, Bihar, India over a period of 7 months were included in the study. Results: The present study was conducted in 100 eyes of 78 patients. The mean IOP in different stages of NVG. Mean IOP in Angle closure stage is significantly higher than the mean IOP in other two stages (P = 0.001). Conclusion: In the present study, it was found that Proliferative diabetic retinopathy is the most common cause and rubeosisiridis is the most common stage of presentation in NVG.

69.Assessment of Open versus Closed Method of Establishment of Pneumoperitoneum in Laparoscopic Surgery: Prospective Comparative Parallel Randomized Trial
Roshani Prasad, Sumit Raj, Lallan Singh, Ashok Rai
Aim: To compare open or Hasson’s method and closed or Veress method of creation of pneumoperitoneum. Material & Methods: This was a prospective comparative parallel randomized control trial with an allocation ratio of 1:1. The study was conducted at the Department of Surgery, over a period of one year and included all the patients (n=160) who were undergoing laparoscopic surgery in this time period at our department. Results: The mean time required to create pneumoperitoneum by closed method (group C) was 9.0 seconds while by open method (group O), it was 7.7 seconds with p value <0.001 which is significant Lap incisional hernia repair was seen in 3 cases of closed method and 2 cases in open method and diagnostic laparoscopy was observed in 1 case of close method. Conclusions: Even though the open method takes less time to create pneumoperitoneum, both methods are similar in terms of time taken to complete the operation and major and minor complications because there was no statistically significant difference in the frequency of these parameters between the two techniques.

70.Evaluation of Hepatic Parameters in Individuals with Heart Failure and its Short Term Prognostic Significance: A Prospective Study
Vikas Vashisth, Amit Kishor, Vibhash Kumar
Aim: A prospective evaluation of hepatic parameters in congestive heart failure patients. Methods: The prospective analytical study was conducted in the Department of General Medicine, Narayan medical college and Hospital, Jamuhar, Rohtas, Bihar, India, Patients with heart failure all age and both sexes were included in this study. Sample size based on exclusion and inclusion criteria 50 patients with heart failure were included in this study. All patients enrolled for this study was evaluated clinically and echocardiographically. Various demographic parameters like age sex duration of disease were recorded on predesigned Performa. The hepatic biochemical parameters like serum bilirubin (direct, indirect and total), serum AST and ALT, Serum alkaline phosphatase, Serum proteins and Prothrombin time were estimated. Results: In our study mean age of patient was 56.87±10.69 years. Number of patients below than 16-30 years was 2 (4%), from 31-50 years were 9 (18%). Maximum number of patients was from above 50 years of age that is 39 (78%). There was male predominance (40/10). As per NYSA classification maximum number of cases were class II (44%) followed by class III (28%). Percentage of patients with class I were 18% and class IV were 10%. Regarding hepatic biochemical parameters there is significant variation in serum bilirubin (mg/dl) parameter as per progress in class of heart failure (p=0.001). Serum bilirubin was 3.55±1.74 mg/dl in class IV and least in class I that is 1.06±0.54 mg/dl. Serum AST was highest in class IV 159.14±21.26 IU and least in class I that is 38.78±10.87 IU (p=0.001). Serum ALT was highest in class IV 187.29±31.98 IU and least in class I that is 34.14±10.69 (p=0.001). Serum ALP was highest in class IV 59.79±14.59 IU and least in class I that is 40.17±8.69 (p=0.03). Conclusion: The present study concluded that congested hepatomegaly was common presentation jaundice and ascites was also common. Change in biochemical parameters was increased with severity and duration of heart disease.

71.Prospective Observational Evaluation of Metabolic Urolithiasis and Assessment of the Prevalence of Various Abnormalities: A Hospital-based Study
Shashank Abhishek, Vir Abhimanyu Pandit
Aim: Study of the prevalence of metabolic abnormalities in a tertiary care centre in Bihar region. Methods: This was a prospective observational study conducted in the Department of Urology, Narayan Medical College, Jamuhar, Sasaram, Bihar, India, for the period of 1 year. Total 50 patients over 18 years old admitted in the urolithiasis outpatient clinic of a tertiary centre were included in this study. Results: The majority of the population was women, making a female/male ratio of 1.5:1. 2% of patients were underweight, 38% presented normal BMI and 60% were overweight or obese. Taking other comorbidities into account, 24% had hypertension, 14% had diabetes mellitus and 28% presented with dyslipidaemia. Metabolic abnormalities (considering any of these hyperoxaluria, hypercalciuria, raised PTH, hypercalcemia, hyperuricosuria, hypomagnesuria or hyperphosphaturia) were found in 94% patients (Confidence Interval 95%: 87.2–99.8%). Almost a quarter (26% [CI95%: 16.0–36.8%]) only had one metabolic abnormality, and 68% patients CI95%: 56.9–79.4%) had multiple metabolic abnormalities. Hypercalciuria was the most commonly observed metabolic abnormality and was found in 54% (CI95%: 43.5–67.6%) of patients. Other significant metabolic abnormalities were hyperoxaluria (34% [CI95%: 22.4–49.8%]), hyperuricosuria (32% [CI95%: 21.9–44.7%]) and hypomagnesuria (30% [CI95%: 21.3–44.2%]). Several sociodemographic and clinical variables with the most frequent metabolic abnormalities found in our study (hypercalciuria, hyperoxaluria, hyperuricosuria and hypomagnesuria). Patients with hypercalciuria were older (55.8 ±12.9 years vs. 48.8 ±6.8 years, p = 0.022), family history of stone disease was significantly more frequent among patients with hyperoxaluria (70% vs. 30%, p = 0.011) and there was a higher prevalence of present and former smokers among patients with hyperoxaluria (p = 0.012). Conclusion: Immediate metabolic evaluation is the key for a better and individualized management, guiding the selection of proper pharmacological and dietary measures to prevent recurrent stone formation and to relieve all clinical and economic burdens behind this condition.

72.To Assess Pain through the Visual Analogue Scale (VAS) and the Requirement of Postoperative Opioid Consumption & Incidence of Postoperative Nausea and Vomiting (PONV)
Amrit Kumar, Vinod Kumar Verma, K.H. Raghwendra
Aim: To assess pain through the visual analogue scale (VAS) and the requirement of postoperative opioid consumption & incidence of Postoperative nausea and vomiting (PONV). Materials and methods: The present Randomized double blind, placebo controlled study was carried from September 2019 to August 2021 at Indira Gandhi Institute of Medical Sciences, Patna. After enrollment in the study all patients were prescribed 0.5 mg of alprazolam and ranitidine 150 mg orally the previous night. Patients were advised to be NIL oral from 10 PM onwards on the previous day of surgery. By the use of computer-generated random number patients were allocated to either lidocaine infusion (L) or Saline group (S) with 50 patients in each group. All patients were asked for pain sensation during postoperative period and incidence of pain was scored. Incidence of pain was scored on the basis of visual analog score (VAS). Also postoperative opioid requirement, incidence of PONV, any other adverse effects and vitals was noted. Assessment was done just after terminating the lignocaine infusion and thereafter 2 hourly for 6 hours and then 6 hourly till 24 hour. Results: Mean age of the study population in group L was 38.40±11.54 and group S was 34.14±11.78 (p<0.05). In both the groups female outnumbered male population. Majority of the patients in both the groups showed ASA grade I. Pain assessment time (Score) was statistically significant between the groups just after stopping normal saline infusion followed by 2 hr, 4 hr, 18 hr and 24 hr post operatively. Incidence of post operative nausea and vomiting was found more prevalent in group L (28%) and group S (16%). Conclusion: Perioperative infusion of nontoxic dose of lidocaine can be considered as an inexpensive, easy, relatively safe and effective modality as a part of multimodal approach for post operative analgesia in patients undergoing upper abdominal surgery.

73.Association of Lipid Abnormality with Newly Diagnosed Type II DM Patients
Sudhir Chandra Jha, Santosh Kumar, Kumud Kumar
Aim: To study the lipid profile abnormalities in newly diagnosed type 2 diabetics. Methodology: A cross-sectional study was carried out to determine the triglyceride levels in newly diagnosed type 2 diabetic patients. A total of 150 newly diagnosed type 2 diabetics were enrolled in our study. Relevant patient data was collected from the inpatient and outpatient Department of General Medicine, Darbhanga medical College & Hospital, Laheriasarai Darbhanga, Bihar, India, Fasting lipid profile levels were measured in these patients. All patients of age > 25 years who have been diagnosed as having type 2 diabetes mellitus within the last 3 months using the ADA (American Diabetes Association) criteria. Blood samples were taken of all the patients to analyze lipid profile and Blood glucose levels. Results: Out of 150 enrolled patients, the maximum number of patients belonged to the age group of 41-50 years (58%) and the least number belonged to the age group 20-30 years (9.33%). The gender distribution of the participants showed that 97 (64.6%) were females, and 53 (35.4%) were males. According to ATP III classification, 68 (45.3%) participants had normal serum triglycerides levels which are level of serum triglycerides. Among the 82 participants with abnormal triglycerides, 30% had borderline high levels (150-199mg/dl), 18.6% had high levels (200-499 mg/dl) and 6.1% participants had very high triglycerides (≥500 mg/dl). According to the NCEP ATP III criteria, HDL levels ≤40 is considered low for males and ≤50 is considered low for females. Based on this criterion, in our study, 31.3% participants had low HDL and 68.7% participants had normal HDL.  According to the NCEP ATP III criteria, 50 (33.3%) participants had an optimal level of LDL, 69 (46%) had near optimal levels of LDL, 20 (13.3%) had borderline high levels of LDL, 6 (4%) had high levels of LDL, and 5 (3.4%) participants had very high levels of LDL.  Among the 200 participants, 117 (78%) participants had desirable total Cholesterol levels of < 200mg/dl, 30 (20%) had borderline high levels of 200- 239mg/dl and 3 (2%) had high total cholesterol levels of ≥240mg/dl. Conclusion: This study found that lipid profile is associated with T2DM.

74.Association of Urinary Tract Infection with Diabetic Patients
Sudhir Chandra Jha, Kumud Kumar, Santosh Kumar
Background and Aims: The primary objective of the current study is to investigate the clinical, microbiological, and characteristic differences of urinary tract infections between diabetic patients and non-diabetic patients, as well as the influence of diabetes on the spectrum of URO pathogens and the antimicrobial resistance in patients with urinary tract infections. Methods: The current research is being carried out at Department of General Medicine,  Darbhanga medical College & Hospital, Laheriasarai Darbhanga, Bihar, India. during the months of 12 months. There are a total of 100 diabetics and 100 people who do not have diabetes in this study. An exhaustive inquiry and historical assessment was carried out. SPSS, a statistical tool, was used to do the final analysis on the data. The chi square test was used to compare the percentages of participants in the various groups, and the student t test was used to compare the means. Results: The patients with diabetes had a mean age of 60.2+/-13.79 years, whereas the patients without diabetes had a mean age of 53.47+/-18.56 years. The majority of patients will first come with a fever. In both diabetes and non-diabetes, BPH was the most prevalent predisposing factor, and indwelling catheterization was the second most common; however, there was no statistically significant difference between the two. The majority of diabetic patients diagnosed with UTI (87.14 percent) had glyco HbA1c levels that were more than 6.5 percent, and this difference was statistically significant. In diabetics, the incidence of recurrent UTI is greater than in non-diabetic populations; nevertheless, there was no statistically significant difference between the two groups. In both diabetics and those without diabetes, the risk of recurrent UTI is greater in females. When compared with those who do not have diabetes, the prevalence of E. coli in diabetics is much greater. The antimicrobial resistance pattern in E. coli was the same in both diabetes and non-diabetic people, with the greatest sensitivity to meropenem and the least sensitivity to ampicillin, and there was no statistically significant difference between the two groups. Conclusion: The presence of diabetes, inadequate glycemic management, fever, and female genital sex were the host variables that were shown to be related with urinary tract infections (UTIs). Age, length of diabetes, and type of diabetes therapy were not shown to have any link with one another. The presence of a urinary tract infection is correlated with an increased HbA1c. Escherichia coli, sometimes known as E. coli, was shown to be the most common uropathogen. People who have diabetes as well as patients who do not have diabetes have comparable levels of uropathogens that are resistant to antibiotics.

75. A Randomised Controlled Study of Dexmedetomidine, Midazolam, and Propofol for Postoperative Sedation in Mechanical Ventilator Patients
Vikash Bansal, Nidhi, Rajesh Meena
Aim: To study the Comparison of Dexmedetomidine, midazolam and propofol for sedation of post operative patients on mechanical ventilation. Methods: This single blinded, open label, randomized control trial conducted in Intensive care unit, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. 45 patients were equality divided into 3 groups, 15 in each groups. Primary variable will be sedation of the patient. Sedation will be assessed by Ramsay Sedation Score. (1=agitated; 2 = cooperative, tranquil; 3=responds to verbal command; 4=brisk response to loud voice or glabellar tap; 5 = sluggish response to glabellar tap or loud voice; 6=no response). Group M: Midazolam loading dose 0.04 mg/kg over 15 minutes, followed by maintenance infusion at a rate of 0.08 mg/kg/h. Group P: Propofol loading dose 1mg/kg over 15 minutes, followed by maintenance infusion at a rate of 1-3 mg/kg/h. Group D: Dexmedetomidine loading dose 1 mcg/kg over 15 minutes, followed by maintenance infusion at a rate of 0.4-0.7 mcg/kg/h. Results: The difference in mean age and ASA status among the three groups are not statistically significant (p= 0.29 & p=0.47). There is no statistical significance of sex & GCS status of the patients of these three groups(p= 0.49 & p=0.47). We found mean post sedation delirium was not statistically significant (p=0.078).  No statistical significant difference in SBP & DBP among all these groups. There is statistically significant difference in mean RSS at 5 min interval in group D. At 25 & 30 min interval it was higher in group P and at 60 min it was higher in group M and these are statistically significant (p<0.005). In our study the mean Opioid at 24th hour is more in Midazolam group and it is significantly less in patients receiving dexmedetomidine. In our study we found that difference of mean HR at different time interval was not statistically significant but compared to group M & P, HR falls more in group D and the mean HR is less in Dexmedetomidine group. Conclusion: Dexmedetomidine is safer and equally effective agent compared to propofol and midazolam for sedation of neurosurgical mechanically ventilated patients with good hemodynamic stability and extubation time as rapid as propofol.

76. A Comparative Study of Efficacy of Topical Olopatadine (0.1%), Bepotastine (1.5%) and Alcaftadine (0.25%) in Mild to Moderate Allergic Conjunctivitis at Sri Krishna Medical College, Muzaffarpur, Bihar, India
Manoj Kumar Mishra, Vaidehi Kumari, R. K. Singh
Objectives: This study was to compare the safety and efficacy of topical Olopatadine (0.1%), Bepotastine (1.5%) and Alcaftadine (0.25%) in mild to moderate allergic conjunctivitis at Sri Krishna Medical College, Muzaffarpur, Bihar, India. Methods: All of the 150 cases were divided into three groups. Each group had 50 cases of allergic conjunctivitis. Group A: Patients were received topical 0.25% Alcaftadine eyedrops OD. Group B: Patients were received topical 0.2% Olopatadine eyedrops OD and Group C: Patients were received topical 1.5% Bepotastine besilate eyedrops BID. All above topical anti-allergic medication was used for 14 days. Total Ocular Symptom Scoring System (TOSS) scoring was used to grade the signs and symptoms. Diagnosis of mild to moderate allergic conjunctivitis was made clinically according to the presence of classical signs and symptoms. Demographic data, ocular and medical histories, concomitant medications, physical examination, clinical examination, including recording of vital signs, Ophthalmological examination and details of drug prescribed by the treating ophthalmologist were recorded in the study pro forma at baseline visit (visit 1). Follow-up visits were done on day 3 (visit 2), day 7 (visit 3) and day 14 (visit 4) after administering the study drugs. Results: Mean age of group A patients was 28.43 ± 10.43 years, group B patients was 29.56 ± 9.76 years and group C was 28.97 ± 9.65 years. The total ocular symptom score (TOSS) showed a consistent decrease in subsequent visit in all the Groups and it was highly significant, when compared from baseline to 14th day in all the groups (p = 0.00001). Conjunctival hyperaemia was highly significantly (p=0.000001) reduced in all the treatment groups but there was greatly reduced in Alcaftadine and Bepotastine treatment groups at 14th day compared to olopatadine group. Conclusions: All three medicines (topical Olopatadine 0.1%, Bepotastine 1.5% and Alcaftadine 0.25%) are effective and safe for the treatment of allergic conjunctivitis. While, Bepotastine besilate and Alcaftadine are more efficacious as compared to Olopatadine for the management of symptoms of allergic conjunctivitis.

77. PCOS (Polycystic Ovary Syndrome) and its Correlation with Waist Circumference, Glucose Metabolism and Lipid Profile
Divya Sharma, Sonal Sharma, Anita Verma, Hemlata Purohit, Javed
Background: Polycystic ovarian syndrome (PCOS) is a multisystem endocrinopathy in women of childbearing age with ovarian expression of various metabolism disorder and a host of other clinical features such as infertility, obesity, irregular menstruation and hyperandrogenism. Objective: The objectives of this study found the association of PCOS with WHR (Waist hip ratio), Lipid profile and status of diabetic patients. Methods: This study conducted at Department of General Biochemistry, Department of General Medicine and the Department of Gynecology  Sardar Patel Medical College and P.B.M. Hospitals, Bikaner. The sample size of this study is 100. Results: 42.00% of patients with FBS was less than 90 mg / dl and 17.00% of patients with fasting blood sugar levels were above 110 mg / dl. The average BMI for patients was 26.44 ± 5.44 kg / mt2. The mean triglyceride level for patients was 113.68 ± 19.25 mg / dl, which means that LDL for patients was 95.24 ± 14.94 mg / dl, the cholesterol level for patients was 159.98 ± 18.26 mg / dl and the HDL level for patients was 56 ± 1. mg / dl. The relationship between waist circumference and fasting blood sugar and random blood sugar has been found to statistically significant. Conclusion: PCOS, which is a common condition in older women, is the cause of the problem in one in four patients who go to a gynecologist. Despite the treatment of infertility and the complaints of menstruation of PCOS patients, it is the physician’s job to take it as an opportunity to diagnose metabolic syndrome and healthy eating habits, exercise and weight loss. Changes in a healthy lifestyle not only improve their menstrual and ovulatory symptoms, but also prevent the future of cardiovascular and other diseases.

78. Assessment of INR to Albumin Ratio in Predicting Outcome during Hospital Stay in Patients with Cirrhosis of Liver with Sepsis
Sreemanta Madhab Baruah, Sanchu T.K. Sreeraj, Syeda Mohsina Rohman, Aparna Dutta
Background: Cirrhosis of liver with sepsis are at an increased risk of mortality. Our study aimed to estimate the international normalized ratio and albumin levels in patients of cirrhosis of liver with sepsis and to find out the association between PT-INR to Albumin Ratio (PTAR Score) on the day of admission with patients outcome during hospital stay. Patients and methods: A total of 93 patients were entered into the study, and all the participants were followed up during hospital stay. Clinical parameters on the day of admission were included to compare survivors with nonsurvivors. Results: The association between the risk of mortality during hospital stay and PTAR score remained statistically significant. The PTAR score showed good discrimination ability for predicting mortality during hospital stay. To improve its feasibility, we regrouped the PTAR scores into three levels of risk (low risk: <0.55, intermediate risk:0.55–1.00, and high risk: ≥1.00); the in-hospital mortality rates were 14.29% (4/28), 23.08% (9/39), and 76.93% (20/26), respectively. Conclusion: The PTAR score system is a convenient and practical tool for predicting the prognosis of patients with cirrhosis of liver with sepsis.

79. A Study of Clinical Profile of Acute Myocardial Infarction in 100 Elderly Patients Precisely Atypical MI, at Tertiary Care Center, Belagavi
Raju Talawar
Background: Cardiovascular diseases are major causes of mortality and morbidity in the Indian subcontinent, causing more than 25% of deaths. Acute myocardial infarction is a common medical emergency. It is consequent of atherosclerotic narrowing of coronary arteries. Among elderly patients with acute myocardial infarction (AMI) it is noted that although chest pain is the most common presenting symptom, they can also present with atypical symptoms such as giddiness, dyspnea, vomiting, sweating, and shoulder pain,  epigastric pain and diarrhea. Aims: This study aims to determine the clinical presentation, risk factors, and short-term complications in elderly patients with AMI. Materials and Methods: This study is an observational cross-sectional study done over a period of 1 year including 100 elderly patients admitted to the tertiary care center, Belagavi with the diagnosis of Acute MI. Results: Out of the 100 patients, 80 patients (80%) complained of chest pain while 20 patients (20%) did not have chest pain at the time of presentation. Among these 20 patients, atypical symptoms noted were dyspnea, giddiness, vomiting, sweating, epigastric pain and diarrhea in the absence of chest pain. Conclusion: Knowledge of these atypical presentations will help us to consider an acute cardiac event when the elderly present atypically and if present within 12 hours of symptom onsent had a better outcome.

80. Study on Lactate Levels in Critically Ill Patients with Septic Shock Admitted in Tertiary Care Hospital, AIMS, BG Nagar
Inbanathan J., Rakesh Raje Urs M. C., Sindhu Kumar S. N.
Background: Sepsis and septic shock are one of the leading causes of death worldwide. Rapid and precise diagnosis and appropriate antibiotic therapy are necessary to reduce mortality and morbidity in patients with septic shock. Acid and base abnormalities are common in critically ill patients. This study was carried out in patients with septic shock with single arterial blood gases and lactate levels admitted to medical intensive care in AIMS, BG Nagar. In this study, we wanted to evaluate the lactate levels in critically ill patients with septic shock patients and compare survivors and non-survivors. Materials and Methods: It is a prospective observational study that was conducted among 100 subjects admitted to MICU who met the criteria for sepsis and septic shock (according to Surviving Sepsis Campaign International Guidelines for Management 2018 update). Lactate levels with other relevant investigations were done within the first 24 hrs of ICU admission. Patients were followed up until the end points i.e., discharge by the treating physician or in-hospital death. Results: Out of 100 subjects, 50 were males and 50 were females. The majority of patients were in the age group of 20-40 years. The majority of sources of infection at presentation were lower respiratory tract infections (42%). SOFA Score was highest at 64%. Out of 100 critically ill patients, 53 were dead and 47 patients were discharged in stable condition. Out of 87 patients who had high lactate levels, 57 patients expired, and 30 patients were discharged. Conclusion: This study shows higher mortality in critically ill patients with high serum lactate on admission which is an excellent predictor of mortality.

81. The Pattern of Cervical Lesions Detected by Clinical Examination, Papsmear and Visual Inspection with Acetic Acid – A Community based Cross Sectional Study
Lokesh M, Lalithambica Karunakaran, Thanku Thomas Koshy
Background: Worldwide cancer cervix is the third most common female cancer and the cause of cancer related deaths. According to the International Association for Research in Cancer (IARC) 5,28,000 new cases occur worldwide every year. The progression to cancer generally occurs over a period of 10-20 years. This provides an excellent window for detecting and treating the disease. Early diagnosis means excellent prognosis. The discovery of the PAP test and VIA helps to prevent cancer cervix. Here an attempt was made to study the pattern of cervical lesions in women by clinical examination, PAP smear and VIA and confirm the lesions by biopsy. Methodology: In this cross-sectional study 670 people were screened for carcinoma cervix in a community by visual inspection of cervix, PAP smear and VIA in PHCs and training centres under the Govt. T. D. Medical College, Alappuzha. Results and Interpretation: The mean age of the study subjects and those with screen positivity were >45yrs. Majority (85.6%) of the patients with abnormal biopsy were in the age group of >40years. The mean age at marriage was 20-24years and majority screened positive were para 2 followed by para 4. Majority (62.3%) of the patients studied were permanently sterilized, among that 3 patients underwent biopsy. Chief complaint was lower abdominal pain followed by white discharge. Cervix was healthy in (87.4%) of the patients and unhealthy in the rest. Among the study population 2.8% (19) of the patients had positive VIA. Among the PAP smear cytology results, 0.6% ASCUS, 0.1% LSIL, 0.1% HSIL and the rest were normal. There was a statistical association between multiple sexual partners, PAP smear and VIA with biopsy. Conclusions: The coordinated screening programme provides a low-cost way of increasing the coverage of the female population and reduces the rate of invasive cervical cancer.

82. Modified Triple Assessment in the Diagnosis of Breast Lump
Ved Rajan Arya, Saurabh Kumar
Background: Women frequently complain about breast lumps to doctors. Since the majority of them are benign, a thorough examination, accurate diagnosis, and conclusive treatment are all required to exclude cancer. Clinical examination leads to the suggestion of a breast cancer diagnosis. To reliably diagnose all palpable breast masses, a combination of three procedures, including a clinical examination, radiological imaging (mammography, ultrasonography), and pathology, is now used. Together, they provide 100% sensitivity. If any one of the three components is positive or if there is a positive FNAC report, the triple assessment is deemed positive; it is only considered negative if all of its components are malignancy-negative. Methods: For six months, a descriptive cross-sectional study was carried out in the Department of Surgery at the M.G.M. Medical College, Bihar, India. This study comprised 300 patients with breast lumps in total. The patients were screened using a thorough history, focused clinical examination, radiographic imaging, and FNAC as diagnostic techniques. Results: The final histopathological examination was compared to the individual component results as a whole (M.T.T.). The physical examination’s findings indicated a 92.67 percent sensitivity and 96.67 percent specificity for identifying malignant breast lesions. The results of the ultrasonography showed a sensitivity and specificity of 91.33 and 98.66 percent, respectively. 96.25 percent sensitivity and 99.57 percent specificity were also revealed by FNAC. Conclusion: Therefore, the triple evaluation is a quick, painless, inexpensive, quick, and patient-acceptable diagnostic method for the diagnosis of breast lumps.

83. Clinical Profile of Periampullary Tumour in a Tertiary Care Hospital
Sanatan Behera
Background: The distal common bile duct (CBD), the ampulla of Vater, the duodenum, and the pancreatic head are all sites where peri-ampullary cancer can develop. Methods: Over a three-year period, patients with periampullary tumours who were sent to the department of gastroenterology for ERCP underwent a retrospective analysis of their ERCP (Endoscopic Retrograde Cholangio Pancreatography) records. Consideration was given to the patient’s demographic profile, clinical findings, and ERCP care. For continuous variables, the mean and standard deviation were utilised as statistics; frequencies and percentages were calculated for categorical variables. Results: 86 individuals who had undergone ERCP for periampullary tumours for three years were retrospectively examined. Data interpretation showed that the majority of cases (23.6%) were between the ages of 41 and 50. There were 66.3% more men than women. Ampullary growth (46.5%) was the highest incidence, followed by lower CBD stricture (32.6%). Jaundice (77.9% of the presenting symptoms) and stomach pain (54.6%) were the two main ones. At presentation, 12 patients (14%) had cholangitis. The current study’s mean bilirubin ranged from 11.76 to 23.72. In 98.8% of the instances, CBD cannulation was successful (precut sphincterotomy in 33.7% of cases, selective cannulation in 65.1%). In 84.7% of instances, a plastic biliary stent (PC) was used for biliary drainage, while in 15.2% of cases, a self-expanding metallic stent (SEMS) was used. Malignancy was discovered in 55% of ampullary growth biopsy cases and 35.7% of biliary brush cytology cases, respectively. Four patients with PC stents experienced block at three months. Conclusion: The most typical variety of periampullary tumours was ampullary growth. 14% of cases had cholestasis when they were presented. Biliary drainage was successfully treated with ERCP. Sensitivity rates for ampullary growth biopsy and biliary brush cytology are 50% and 35.7%, respectively. 5% or less of PC stents were blocked.

84. Retrospective Study of Histopathological Spectrum of Ovarian Sex Cord Stromal Tumours at Tertiary Care Hospital – A Three Year Study
Aditi Sanjay Sakarkar, Mukund Shivaji Unde
Background: Sex cord-stromal tumours of the ovary are rare tumours as compared to epithelial tumours of the ovary showing variable histological and biological patterns. Adolescence and young adults are the two age groups in which these tumours are frequently found except for adult granulosa cell tumour which is typically found to develop later i.e. at the age of 50 to 55 years. Objectives: This study has been done to find out the frequencies of various subtypes of these tumours and their histopathological spectrum. Methods: It is the retrospective observational type of study conducted over three years from June 2019 to May 2022. 20 cases of sex cord-stromal tumours of the ovary which were received in the histopathology section of our department are taken and their various histopathological features have been studied. Also, the frequency of occurrence of their various morphological subtypes has been estimated. Results: A total of 40 cases of sex cord-stromal tumours of the ovary received in our department were studied. Among different subtypes, the most common tumour was granulosa cell tumour (10) i.e. 25 % out of which one was showing bilaterality. Frequencies of other tumours were – Fibroma (8) i.e. 20% , Fibrothecoma (8) i.e. 20% , Thecoma (6) i.e. 15% , Sertoli cell tumour (4) i.e. 10% Steroid (lipid) cell tumour (2) i.e. 5 %, Sclerosing stromal tumour (2) i.e. 5%. Conclusion: According to this study, sex cord-stromal tumours of the ovary is a rare entity showing diverse histological features. Among them, granulosa cell tumours and fibromas were the most frequently occurring sex cord-stromal tumours of the ovary in favour of previously done studies.

85. A Comparison of Oral Nifedipine and Intravenous Labetalol for Severe Pregnancy Induced Hypertension
Santwana Baske, P Rai
Goal: To evaluate the effectiveness of oral nifedipine and intravenous labetalol in the management of severe pregnancy induced hypertension. Materials and Methods: Pregnant women with blood pressure ≥160/110 mm Hg participated in this double-blind, randomised, controlled trial. Between 01-01-2021 and 31-12-2021, a total of 75 patients were enrolled. Nifedipine (10 mg tablet orally up to five doses), an intravenous placebo saline injection, or an intravenous labetalol injection in doses of 20mg, 40mg, 80mg and 80mg together with a placebo tablet every 20 minutes were given to patients according to their assigned treatment groups. The study’s main finding was the amount of time needed to reach the desired blood pressure. Secondary outcomes were the number of doses needed, the start of labour, the method of delivery, any negative effects on the mother or the baby, side effects and perinatal outcome. Results: Nifedipine considerably shortened the time needed to reach the target blood pressure. In comparison to labetalol the nifedipine group needed considerably fewer doses. When compared to the labetalol group, the amount of urine produced by the nifedipine group was substantially higher and remained significantly higher 24 hours after first treatment. Nobody needed crossover treatment. The negative consequences weren’t common. Maternal age, gestational age, and blood pressure did not significantly differ across the groups. Conclusion: Both oral nifedipine and intravenous labetalol are effective in treating severe pregnancy induced hypertension; however, nifedipine works faster and requires fewer doses while also significantly increasing urine output.

86. Evaluation of Anti-Inflammatory Activity of Parthenium Hysterophorus [Congress Grass]: An Experimental Study in Rat Models.  (Carrageenan-Induced Paw Oedema Model)
Vipin Jain, Kawale SK, Sushil Kumar Varma, Megha Jain, Tiwari S, Prafulla P. Thaware
Background: Parthenium hysterophorus is an aggressive ubiquitous annual herbaceous weed with medicinal properties used by some tribes as a remedy for inflammation, eczema, skin rashes, rheumatic pain, and gynaecological ailments and found to be pharmacologically active as an analgesic in muscular rheumatism, therapeutic for neuralgia and as a vermifuge. The decoction of P. Hysterophorus has been used in traditional medicine to treat fever, diarrhea, neurologic disorders, urinary tract infections, dysentery, malaria and as an emmenagogue. Methods: The powdered aerial part of the plant was macerated with 70% v/v ethanol and hydroalcoholic extracts were obtained by percolation. A fresh solution was prepared by dissolving the extract in distilled water before the experiment. Carrageenan-Induced Paw Oedema Model used for evaluating anti-inflammatory activity. The albino Wistar rats of either sex were divided into 5 groups with six animals in each group and received either PH extract p.o. (200, 400,800 mg/kg), Aspirin (630 mg/kg) or control (1ml distilled water p.o.). 1% carrageenan solution was prepared and injected in the left hind paw (planter aspect) after 60 minutes of oral administration of standard and test drugs. Right hind paw kept as control. Results: Parthenium Hysterophorus extract showed significant inhibition of oedema at the dose of 400, 800 mg/kg at the end of 4 and 24 hours. Conclusion: Parthenium Hysterophorus extract exhibited significant anti-inflammatory activity in experimental analysis in Rats.

87. Assessment of Cognitive Impairment, Sociodemographic Factors and Comorbidities in Depressed Geriatric Patients Attending Tertiary Care Hospital
Ravi Thakkar, Naren Amin, Chetan Shah, Kamlesh Patel
Background: World Health Organization estimated that the overall prevalence rate of depressive disorders among the elderly varies between 10% and 20%. High levels of depression were significantly associated with cognitive decline in a prospective study. Individuals with Alzheimer’s disease have been found to commonly have depression early in the course of their illness. Method: Study was conducted in the Department of Psychiatry at tertiary care hospital. Written informed consent was obtained from cases who fulfilled the criteria. Socio-demographic data and clinical variables were recorded. Depression was assessed with the geriatric depression scale (GDS) and cognitive impairment was assessed with a standardised mini mental state examination scale (MMSE). Result: 100 Geriatric Depressed Patients were included in this study. 57% of geriatric patients had mild depression and 43% of geriatric patients had severe depression. Association between severity of depression and various socio-demographic factors were not found significant. 41% of patients had substance abuse. 59% of patients had one or more physical comorbidity. 47 patients had cognitive impairment. In patients with cognitive impairment, 29 patients (61.7%) had mild cognitive impairment, 14 patients (29.8%) had moderate cognitive impairment and 4 patients (8.5%) had severe cognitive impairment. Conclusion: Geriatric depression is affected by various socio-demographic variables. More severe depression is found in those who are illiterate, single or widow, nonearning, from lower socioeconomic class, using any substance and having physical comorbidities. Geriatric depression also affects cognitive impairment and vice versa. More cognitive impairment is seen in severely depressed patients. Association between different age groups and cognitive impairment is found statistically significant.

88. Patterns of Internet Usage and it’s Association with Psychiatric Morbidity Amongst Medical Interns
Rohit Agarwal, Naren Amin, Chetan Shah, Kamlesh Patel, Ravi Thakkar
Background: Internet Addiction Disorder is characterized by excessive preoccupations, urges or behaviour regarding internet use that leads to distress. People use the internet in order to manage negative mood states. It becomes an escape route to quickly relieve oneself of stress. Internet addiction is associated with depression, anxiety, loneliness, less satisfaction with life, law self-esteem and other psychiatric comorbidities. Method: The study was conducted in Department of psychiatry at tertiary care hospital.. Informed consent of medical interns was taken, socio-demographic details, purpose of internet usage was noted. Internet addiction test (IAT), depression and anxiety stress scale (DASS), differential loneliness scale (DLS), satisfaction with life scale (SWLS) and Rosenberg self-esteem scale (RSES) was fulfilled. Collected data was subjected to statistical analysis using the SPSS software. Result: Mean score on the IAT was 24.88. 65% of the respondents were average online users.3% of the respondents experienced frequent problems because of their internet usage. Scores on the IAT correlated positively and significantly with the depression, anxiety and stress domain scores of the DASS. No significant correlation was found between scores on the IAT and SWLS and RSES scores, but significant co relation was found between scores on IAT and DLS scores. Conclusion: This study suggests that most common reason for using internet is browsing social networking sites and for online entertainment. Problematic internet use in medical interns is associated with higher scores on questionnaires investigating depression, anxiety, stress, loneliness, and lower scores on questionnaires investigating satisfaction with life and self-esteem.

89. Survival Prediction in Heart Failure using Machine Learning Algorithms
Amit Tak, Puran Mal Parihar, Shikha Mathur, Bhaskar Das, Divyanshu Sahwal
Background: Heart failure is the final stage of various cardiovascular diseases. Statistical models and machine learning (ML) algorithms have been proposed to predict heart failure. However, the present study used ML classifiers to predict survival in heart failure patients. Materials and Methods: The study dataset consists of a random sample of medical records of 299 heart failure patients. The dataset is publicly available on the Machine Learning Repository website of the University of California Irvine (UCI ML). Thirteen predictors and one response variable (‘Event’) were present in the database. Except for ‘Time’, other predictors were used in predicting survival in heart failure patients. Oversampling methods were employed to balance the dataset using the ROSE package in R. Predictors differed and contributed significantly to prediction and were used to train ML classifiers on MATLAB classifier application with 5-fold cross-validation. The performance metrics of the machine learning classifier were expressed as accuracy, the area under the receiver operator characteristic (AU-ROC) curve, sensitivity, and specificity. Results: The predictors used to train machine learning classifiers were hypertension, age, creatinine concentration, CPK, ejection fraction, and sodium concentration. The best model was the ensemble-based Subspace K-nearest neighbor model. The accuracy, AU-ROC, sensitivity, and specificity were 89.5%, 93%, 87%, and 92%, respectively. Conclusion: The present study used biostatistical tests and a logistic regression model to optimize feature selection. The features that contributed significantly to the logistic regression model were used to train machine learning classifiers. The study showed better performance metrics in predicting survival in heart failure patients.

90. A Comparative Study of Supraclavicular Brachial Plexus Block using Bupivacaine-Lignocaine and Bupivacaine, Lignocaine with Dexmedetomidine in Patients Undergoing Forearm and Hand Surgery
Gunjan Arora, Yogesh Narwat, Chirag Sethi, Ujjwal Sourav
Introduction: When used with local anaesthetic in different regional blocks, dexmedetomidine lengthens both the duration of the block and the duration of postoperative analgesia. The effectiveness of intrathecal, caudal, and epidural anaesthesia has reportedly been improved by it. Recently, its application in peripheral nerve blocks was described. Aim and Objectives: To compare the effects of Bupivacaine- Lignocaine and Bupivacaine- Lignocaine with Dexmedetomidine combination in Supraclavicular brachial plexus block. Methodology:  This prospective comparative study was conducted between June 2021 to June 2022 on patients undergoing elective upper limb surgery in Al-Falah school of medical science & Research centre Faridabad, Haryana on total of 60 study subjects (30 from each group) who follows inclusion and exclusion criteria, were included in our study. Result: The mean duration of the motor block in group A was 6.80±0.407 hr, and in group B it was 9.53±0.94 hr. The mean duration of the sensory block in group A was 7.67±0.479hr, while the mean duration of the sensory block in group B was 11.20±1.24hr, and there was a significant difference between the two groups, with a p-value of 0.001, when the two groups were compared. Conclusions: We conclude that there has been a statistically significant lengthening of the sensory and motor block in the dexmedetomidine group. Both groups’ hemodynamic parameters fell within the normal range. The Dexmedetomidine group experiences much longer postoperative analgesia. In our study, there were no side effects recorded.

91. Practices and Awareness among Nurses in Medical College towards Post Exposure Prophylaxis of HIV
Dhiraj Kumar Mahajan, Kripa Shankar Nayak, Jyoti Mehra
Background: Hospital staffs, especially the nurses who have direct contact with patients and body substances are at higher risk of occupational hazards. Objectives: To assess the knowledge and practice regarding post-exposure prophylaxis of HIV among the nurses and to find out the association between Knowledge and selected demographic variables. Methods: The study was conducted among the nurses working in medical-surgical units of GMC, Orai. 80 Nurses working in medical and surgical units were selected by stratified random sampling technique. Data were collected by using a semi-structured questionnaire. Chi-square was used to find out the association. Result: The majority of the respondents fall in the group of 20-25 years, mean age=24.28, 81.2 % were staff nurses. Regarding the knowledge about PEP, 87.5 % knew the meaning of post-exposure prophylaxis of HIV. 81.2 % had knowledge regarding first aid for occupational exposure. Conclusion: Knowledge regarding PEP was found to be satisfactory in the majority of respondents but the practice was found to be less.

92. An Analysis of Airway obstruction Registry in ICUs of a Tertiary Care Hospital during COVID Pandemic
Vijay Kumar, T. Kalyani
Introduction: During the COVID pandemic in India many patients were under mechanical ventilation for a prolonged period requiring Tracheostomy to eliminate the physiological dead space. The timing, indications, and priority were not well followed due to the fear of aerosol spray and the spread of the virus. This study aimed at describing the clinical features, indications, and method of prioritizing Tracheostomy in patients with acute respiratory distress syndrome of COVID-19 disease. Aim of the Study: To observe and analyze the clinical features of Acute Airway Obstruction patients and formulate the timing, protocol, and fix up the priority of undertaking Tracheostomy in ICUs of a Level-I COVID Hospital in Telangana. Materials: 46 patients with airway obstruction admitted to ICUs during the COVID-19 pandemic were studied. Indications of Tracheostomy related and unrelated to COVID were included. Demography, clinical features, SOFA score, and APACHE II scores were noted. The predictive values of mortality by these scores were observed. Results: Among 46 patients with COVID-19 and acute respiratory obstruction during the COVID-19 pandemic, 28 (60.86%) were males and 18 (39.13%) were females. The male to female ratio was 1.55:1. The mean age was 62.85± 4.10 years. Early tracheostomy at a mean of 08.55±3.25 days and late tracheostomy group at a mean of 18.35± 4.15 days were performed. Conclusions: During the COVID-19 pandemic ICU admissions consisted of COVID positive in association with non-COVID-19 conditions. SOFA score and APACHE II scores were useful in predicting the outcome and reduced scores certainly indicated decreased mortality. Early Tracheostomies had a certain edge over the late Tracheostomies in hastening the recovery as well as preventing organ failure by improving the oxygen saturations and usage of little sedation.

93. Effect of Pterygium on Corneal Astigmatism at BMIMS, Pawapuri, Nalanda, Bihar
Ajit Kumar, Farmood Alam
Background: Pterygium is one of the oldest diseases known in the history of Medicine. It is a degenerative condition of the subconjunctival tissue, which proliferates as a triangular sheet of vascularised granulation tissue to invade the cornea, destroying the superficial layers of the stroma and Bowman’s membrane, the whole being covered by conjunctival epithelium. The aim of this study was to use keratometric readings of the automated Bausch and Lomb keratometer to determine the change in pterygium induced astigmatism following pterygium excision and also to determine the relationship between pterygium size and corneal astigmatism after it is removed from the corneal surface. Methods: This study was conducted in Department of Ophthalmology, BMIMS, Pawapuri, Nalanda, Bihar from August 2021 to July 2022. Thirty eyes of 30 patients were selected for the study. Patients aged 25 – 65 years with nasal primary pterygium and a length of 2.5 mm or more were included in the study. The exclusion criteria were pseudopterygium, recurrent pterygium, corneal scarring from any cause and any previous ocular surgery. Results: The median (mean rank) pre-operative astigmatism of 2.25 (15.50) reduced to a median (mean rank) postoperative astigmatism of 1.30 (14.96). This decrease in the postoperative astigmatism was statistically significant (p < 0.001). There was a statistically non-significant correlation between the postoperative astigmatism and the pterygium size (rs = -0.29, p = 0.12). Conclusion: Pterygium removal from the corneal surface caused significant improvement in astigmatism.

94. A Comparative Study between Open and Laparoscopic Cholecystectomy at AGMC and GBP Hospital, Agartala, Tripura
Biswajit Paul, Chinmoy Biswas, Pradip Sarkar
Background: The most popular laparoscopic procedure worldwide and the gold standard for the treatment of gall stones, laparoscopic cholecystectomy has transformed the way gall bladder disease is managed. The study’s objective is to compare the Laparoscopic Cholecystectomy with the Open Cholecystectomy in terms of case selection, technical challenges, length of surgery, postoperative complications, postoperative hospital stay, morbidity & mortality, patient attitude after operation, operative costs, and overall costs. Methods: In this comparative study conducted on 80 patients who admitted through Out-door department or in emergency as acute cholecystitis, 40 patients were admitted to Laparoscopic Cholecystectomy and the other 40 to traditional Open Cholecystectomy, at AGMC and GBP Hospital, Agartala, Tripura from January 2016 to December 2016. All patients were thoroughly assessed and necessary investigations carried out. The patients were randomly assigned to either one of the procedures. All the patients were examined and underwent routine blood investigations with LFT wherever necessary. Abdominal USG was performed in all the cases. Results: The patient selection between the two groups did not differ significantly. Both groups did not experience any mortality, however the open treatment had greater problems than the laparoscopic one. Laparoscopic surgery results in reduced pain, shorter hospitalisation, early mobilisation, and an early return to work. Conclusion: When it comes to outcomes, laparoscopic cholecystectomy is preferable than open cholecystectomy. As a result, it is advised to perform this procedure first.

95. A Prospective and Comparative Study of Desarda Repair and Lichtenstein (Mesh) Repair for Inguinal Hernia, at AGMC and GBP Hospital, Agartala, Tripura
Biswajit Paul, Chinmoy Biswas, Pradip Sarkar
Background: Inguinal hernia is very common health problem worldwide. The estimated prevalence of 7%, the estimated lifetime risk for inguinal hernia is 27% for men and 3% for women. Annual morbidity rates in various countries vary from 100 to 300 per 100,000 citizens. The aim of study to compare the outcome of Desarda repair and Lichtenstein (Mesh) repair for Inguinal hernia. Methods: Study period from July 2016 to June 2017; total 138 cases were operated in our surgery unit at AGMC and GBP Hospital, Agartala, Tripura. This prospective comparative study in 138 cases was allocated into two groups randomly: Group A (Desarda) and Group B (Lichtenstein) included 62 patients and 72 patients respectively. The primary outcome measures were Operating time, post-operative scrotal hematoma, surgical site infection and Time in days to return to Normal activity. Results: During the follow up period, Mean Operating time in Desarda group was 38.29 minutes and 44.30 minutes in Lichtenstein group (p value 0.004). 93.5% patients resumed routine activities on 1st Post-operative day in Desarda group whereas in Lichtenstein group 92.1% patients resumed routine activities on 1st Post-operative day (p value 0.745). In Group A Scrotal Hematoma was developed in 4.8% patients and in 1.3% patients in Group B (p value 0.22). Surgical site Infection was seen in 1 patient in Group A (1.61%) and 1 patient in Group B (1.31% p value 0.88). Conclusion: Our study concludes that Desarda repair is superior to Mesh repair in terms of operating time and the results of Post-operative complications in both techniques are statistically insignificant.

96. A Comparison of Fibrin Glue with Sutures for Conjunctival Autografts in Pterygium Excision Surgery
Farmood Alam, Ajit Kumar
Background: A pterygium is a triangular-shaped conjunctival growth that extends onto the cornea, and is usually located nasally. Surgery is commonly used to treat this condition. Pterygium surgery involves excision of the pterygium, and the harvesting of a conjunctival graft from the same eye, which is then placed over the defect. The graft, known as an autograft, is either sutured or opposed with fibrin glue. This study has assessed whether one technique is superior to the other when comparing the patient’s post-operative comfort and graft adherence. Methods: A prospective randomized comparison of 60 patients undergoing primary pterygium surgery in Department of Ophthalmology, BMIMS, Pawapuri, Nalanda between October 2020 and March 2021. A post-operative comfort scale was used to assess foreign body sensation, sensitivity to light, tearing and itchiness. Graft success was defined as a graft that was still adherent at one month following surgery. Results: Patients in the Tisseel glue group experienced significantly less foreign body sensation (p=0.038) and itchiness (p=0.018) on day-one after surgery, compared to those in the suture group. At one-month follow-up patients had significantly less foreign body sensation (p=0.042), sensitivity to light (p=0.001), and itchiness (p=0.009) in the Tisseel glue group compared to the suture group. Autograft adherence was seen in all 60 patients at the one-month follow-up visit. Both the surgical time and the indirect costs of the procedure were reduced in the Tisseel glue group. Conclusions: The use of Tisseel glue for attaching autografts in pterygium surgery is an effective method with global autograft success, less post-operative discomfort and shorter operating times.

97. Long-Term Follow-Up of Adults with Nonsevere Initial Disease Affected with Rheumatic Mitral Stenosis
Manish Kumar Arya
Background: Regarding the normal course of rheumatic mitral stenosis (MS) in adults presenting with mild illness, there is no universal agreement. Methods: Patients with rheumatic MS who were seen at one facility underwent a retrospective cohort analysis. 85 MS patients who were under 30 years old on their initial echocardiogram and had mild to moderate disease were included. A computerised database was accessed to retrieve information on demographics, medical history, echocardiographic results going back at least ten years, and related problems. Results: In 75 patients (88%) after a period of 13.1±2.38 years, there was no discernible progression in the degree of stenosis. The final echocardiographic evaluation revealed two groups with a significant difference in the mean valvular pressure gradient (6.27±2.52 vs. 8.5±2.69 mm Hg, p = 0.01) and mitral valve area (1.58±0.44 vs. 1.1±0.26 cm2, p = 0.001). Conclusions: In our investigation, an indolent natural course of rheumatic MS was noted. Despite this discovery, it could still have negative consequences. Patients who are Bedouin are more likely to get progressive diseases.

98. A Study of Potential Comparison of N-Acetyl Cysteine with Metformin on Clinical Profile in an Ovulatory Infertile Woman with PCOS.
Tara Sweta Arya
Aim: Comparison of the effects of metformin and N-acetylcysteine on the clinical, metabolic, and hormonal profiles in polycystic ovary syndrome patients. Methods: For one year, a prospective, comparative study was carried out in the Obstetrics and Gynaecology Department at the M.G.M. Medical College in Kishanganj, Bihar, India. In this study, 120 women with PCOS (diagnosed using Rotterdam criteria) between the ages of 18 and 37 were enrolled. Enzyme immunological assay was used to evaluate serum levels of TSH, prolactin, follicle-stimulating hormone, luteinizing hormone (mIU/L), LH/FSH ratio, fasting insulin, fasting glucose level, fasting glucose/insulin ratio, and serum total testosterone (EIA). Results: 20 of the 120 cases had follow-up lost. 50 cases in Group M and 50 cases in Group N were among the remaining 100 patients. Group M individuals were given a 500 mg tablet of metformin three times per day, while Group N cases were given a 600 mg tablet of N acetyl cysteine three times per day. Clinical characteristics, metabolic parameters, and hormonal profiles were reevaluated 24 weeks after starting treatment with metformin or NAC, depending on the individual case. After treatment, neither group’s weight was significantly reduced, but Group N, who received NAC, saw a significantly lower BMI, WC, and WHR. Significant reductions in fasting insulin and glucose were observed in both groups. The fasting glucose/insulin ratio significantly improved in both groups. In Group N, total testosterone levels were noticeably lower. Conclusions: In the N acetylcysteine group, the metabolic and hormonal profile improvement was more significant. NAC can replace insulin-sensitizing agents in the treatment of PCOS because it has less negative effects than metformin.

99. A Cross-Sectional Study of Various Factors Defining Metabolic Syndrome and Association between Patients with Metabolic Syndrome.
Manish Kumar Arya
Background: One of the major concerns with global public health is the metabolic syndrome (MetS). Clinical illnesses like metabolic syndrome, which increases the risk of developing cardiovascular diseases, can be brought on by risk factors. Methods: This study took into account all of the patients who were referred to the department of medicine at the M.G.M. Medical College, Kishanganj, Bihar, India over a period of 22 months. Results: Out of 100 patients in the current study, 62.9% had metabolic syndrome and a positive family history of hypertension and diabetes mellitus. 70.8% of the patients had metabolic syndrome and a smoking history that was favourable. Patients with a positive history of alcohol use had metabolic syndrome in 64.3% of cases. Patients in 73.9% of cases had metabolic syndrome and positive IHD family history. SBP >130 mmHg in 87% of individuals with metabolic syndrome, while DBP >85 mmHg in 78.85%. Furthermore, metabolic syndrome was seen in 71.8% of individuals using antihypertensive medications. In people with MS, the mean levels of LDL cholesterol, triglycerides, and total cholesterol are higher, whereas the mean levels of HDL cholesterol, an anti-atherogenic lipid, are lower. In more than 95% of patients, there was at least one lipid abnormality. Out of 62 individuals, approximately 81% had metabolic syndrome. Conclusion: The metabolic syndrome’s many elements all had a favourable correlation with abdominal obesity. In participants with abdominal obesity, systolic blood pressure values were noticeably greater than diastolic blood pressure. There are numerous risk factors for metabolic syndrome, which are influenced by different factors such as race, lifestyle, and geography. To comprehend the correlation between the many elements defining it, a larger investigation is required. This high-risk group needs to be encouraged to have a healthy lifestyle that includes avoiding tobacco use and managing their weight in a healthy way.

100. Efficacy of Clomiphene Citrate and Letrozole in Intrauterine Insemination Cycles
Tara Sweta Arya
Clomiphene citrate and letrozole are the two major oral contraceptives used for superovulation. the amount of oocytes and sperm density increase during superovulation during intrauterine insemination (IUI), which reinforces the likelihood of pregnancy. Endometrium and cervical mucus are negatively impacted by clomiphene, a selective oestrogen receptor modulator with a predominately anti-estrogenic activity. An aromatase inhibitor, Letrozole, works by preventing the conversion of testosterone to oestrogen in peripheral tissues, including the ovary, without harming the endometrium or cervical mucus. When infertile patients undergo IUI, we assessed the effectiveness of letrozole (85%) vs. Cloniphene (71.1%) because the first line ovulation induction medicine. This study deals with the efficacy of Clomiphene and letrozole in several patients. In IUI cycles, our study concludes that letrozole includes a higher pregnancy rate than clomiphene (C. C.) and lower risks of anovulation, thin endometrium, and multi-follicular development.

101. Clinical Comparison of Extraction Socket Following the Use of Autologous Platelet-Rich Fibrin Matrix (PRFM) Employing Demineralized Freeze Dried Bone Material and Membrane
Anil Kumar Yadav, Birendra Kumar Yadav, Vikas Kumar Gupta, Rajesh Pandey
Background: Platelet rich fibrin (PRF) is a fibrin matrix in which platelet cytokines, growth factors, and cells are trapped and may be released after a certain time and that can serve as a restorable membrane. Objectives: To evaluate healing of the facial bone defect with both these among two groups using DFDB and the outcome. Methods: The present study was undertaken in the Department of Oral & Maxillofacial Surgery, Career Dental College & Hospital, Lucknow to compare.  A total of 40 patients with maxillofacial defects fulfilling the inclusion criteria were enrolled in the study. Out of these, 20 cases were treated with use of DFDB and other 20 were treated with use of DFDB with PRF. Analysis of data was done by using SPSS software ver. 22 Chi-square test was used. Results: Difference in age of both the groups was not found to be statistically significant. In the present study, a total of 14 females and 26 males were enrolled. Group A constituted of 8 (40.0%) females and 12 (60.0%) males while Group B constituted of 6 (30.0%) females and 14 (70.0%) males. majority (n=36; 90.0%) of patients did not complain of post-operative pain. Difference in proportion of patients suffering different grades of pain was not found to be statistically significant (p=0.368). There was no post-operative infection. Difference in proportion of patients in both the groups with different evidence of calcification was not found to be statistically significant (p=0.136) but was significant at 6 weeks. Conclusions: DFDB is a predictable homologous graft material which is less expensive than synthetic material and easily available.

102. An Analysis of Association between Socio-Demographic Determinants and Health Status of Geriatric Population in Rural Area Siddharthnagar District (UP)
Neelam, Gaffar, Hasmatullah, Rakesh Chakraborty, Sudhir Kumar Chaurasia
Introduction: The aged person’s quality of life is known to be threatened by several issues and factors including social factors, psychological or physical. Usually, there is a rise of several health issues with increasing age and deterioration of quality of life. It has been observed that 7.7% of the whole population in India is over 60 years and there is a serious situation to understand the health status of the geriatric population of India to determine the overall status of the population. The determination of the health status can be done by employing and effective use of several determinants including some already constructed tools or questionnaires. There is a need to evaluate the variation of several determinants with the health status of the population. Aims: The study is intended to find out the variation of health determinants with that of the health status among the geriatric population. Materials and Methods: This is a cross sectional study employing interviews, physical examinations, analysis of the records, etc for collection of data from geriatric population. Several tools have been used in this study to determine their quality of life including their socio-economic status and mental status and correlating with their health status. Results: The study has found that the daily activities are affected with increasing age and with decreasing educational status (p<0.05). Conclusion: The study has concluded that with increasing age, the daily activities are affected significantly (p<0.05) and are less affected in people with more education which is also found to be statistically significant (p<0.05).

103. Prevalence of Patients with Anorectal Diseases Presenting to RIMS Adilabad Hospital
Sanjay Gawale, Golla Srujana, Krishna Girish Avanigadda, Shyam Prasad Parimala
Anorectal disorders result in many visits to healthcare specialists. These disorders include benign conditions such as hemorrhoids to more serious conditions such as malignancy; thus, it is important for the clinician to be familiar with these disorders as well as know how to conduct an appropriate history and physical examination. The patients do not often discuss perianal symptoms leading to late diagnosis and treatment. There is a need of doing systematic questioning and clinical evaluation of the population to assess the prevalence of anorectal disorders. This study was done to find prevalence of patients with Anorectal diseases presenting to RIMS Adilabad hospital. The patients with benign anorectal diseases presenting to surgery department OPD  with ages more than 20 years old, both genders were included.  All patients were examined by surgeon . 100 patients with anorectal diseases were included in study . Most common presenting complaints were anal pain (85 %) , constipation (70%)  and anal itching (60%) .Most common anorectal diseases were Anal  Fissure (40%) , Haemorrhoids (25%) , Fistula in Ano (10%).Out of 100 patients with anorectal disease , 58 were given surgical treatment and 42 were managed with conservative treatment. This study may contribute to epidemiological knowledge about the prevalence of anorectal disorders.

104. A Prospective Study of Efficacy of Nebulized L-Adrenaline versus Salbutamol Comparison in Infants with Acute Bronchiolitis
Preeti Garg, Radesh Pathak
Background: One of the most common baby illnesses, bronchiolitis necessitates hospitalisation for many infants, especially during the winter months. Respiratory syncitial virus (RSV) is the main pathogenic organism that causes the disease. Although none of the therapeutic techniques is specifically targeted, the major goal of management is to relive symptoms. Salbutamol, adrenaline, anti-cholinergic medications, ipratropium bromide, and saline nebulization have all been used as bronchodilators with varied degrees of success. Methods: To compare the effectiveness of nebulized salbutamol and adrenaline in treating bronchiolitis, this prospective study included 52 infants (2-12 months, male:female ratio 2:1) with bronchiolitis (with 1st episode of wheeze, previously healthy baby, physical findings with cough, running nose, fever, coryza, and inflation of lungs). The cases were randomly assigned to groups receiving nebulized salbutamol (n = 25) and nebulized adrenaline (n = 27). Three nebulizer treatments were administered following randomization, one every 20 minutes. Respiratory rate, MRDAI (Modified Respiratory Distress Assessment Instrument) score, and O2 saturation were used to assess the effectiveness of the therapy. Results: Cough (100%), respiratory discomfort (100%), feeding trouble (90.3%), running nose (98%) and wheeze (100%) were all observed in the study cases in both groups. Most of the cases are urban dwellers from non-smoking families. After three nebulizations, the salbutamol group’s respiratory rate, MRDAI score, and O2 saturation all significantly improved from their pre-nebulization values (RR-67.56.1, MRDAI score-14.61.3, SaO2 93.91.6) to their post-nebulization values (RR-52.54.9, MRDAI score-6.41.7, SaO2-97.11.5). Respiratory rate, MRDAI score, and O2 saturation all significantly increased after 3 nebulizations in the adrenaline group (pre-nebulization RR-64.95.9, MRDAI score-15.00.8, SaO2-94.11.4, and post-nebulization RR-50.02.9, MRDAI score-7.71.0, SaO2-97.91.5). Improvement was greater in the group taking adrenaline. Both groups’ heart rates (salbutamol group-151.810.6 and adrenaline group-160.210.1) increased, with the adrenaline group experiencing a greater increase. Nebulized adrenaline therapy was shown to be considerably more effective than nebulized salbutamol therapy at relieving symptoms when comparative efficacy was assessed (p=.004). Conclusion: According to the study, nebulized L-adrenaline is considerably more efficient than nebulized salbutamol at relieving symptoms in infants with bronchiolitis. Both nebulized salbutamol and nebulized L-adrenaline are beneficial.

105. A Study of Clinical Profile and the Incidence of Non Alcoholic Fatty Disease in Patients with Type 2 Diabetes Mellitus
Jay Prakash Himanshu, Jyoti Prakash
Background: People, who are overweight or obese, have diabetes, high cholesterol, or high triglycerides are more likely to develop NAFLD. NAFLD may also be caused by rapid weight loss and poor eating habits. The study’s objectives were to determine the prevalence of non-alcoholic fatty liver disease in patients with diabetes mellitus as well as the clinical and biochemical alterations in this condition. Methods: A total of 109 patients, 60 females and 49 males, older than 40 years, who attended the outpatient department of the Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar, between February 2021 and July 2021 and had been diagnosed with type 2 diabetes mellitus for at least three years, were included in the current study. A thorough medical history was obtained, including information on the duration of diabetes and symptoms related to the hepatobiliary system. All systems had a thorough clinical examination, during which organomegaly, ascites, and symptoms of liver cell failure were sought after. The patient’s height, weight, and body mass index were all noted. laboratory testing such as CBC, urine for albumin, sugar and deposits, random, fasting, and post-meal blood sugar, Blood urea, serum creatinine, and serum sodium and potassium electrolytes. LFT and fasting lipid profile were also done. Results: 109 patients in all were enrolled in the trial once the selection criteria were used. Out of the 109 type 2 diabetics included in the study, 60 were female and 49 were male; the difference between the sexes was caused by the fact that alcohol consumption was used as an exclusion criterion, which resulted in a large number of males being left out. According to several reports, the prevalence of fatty liver in people with diabetes mellitus is higher than that of the general population. Numerous studies have shown that the prevalence of NAFLD in people with type 2 diabetes mellitus was up to 70%. Of the 109 diabetics included in this study, 53 (48.6%) of them had ultrasonographically detectable fatty liver. Conclusion: Non-alcoholic fatty liver disease affects 48.6% of type 2 diabetics, making it a frequent condition in this population.

106. Emphysematous Pyelonepheritis– Clinico-Radiological Correlation
Manju, Desh Raj, Gopal Singh, Hasseb Ishan, Minu
Emphysematous pyelonephritis (EPN) is an uncommon necrotizing infection characterized by gas in the renal parenchyma and surrounding tissues. It is rapidly progressive and life endangering condition, requiring strong suspicion and appropriate therapy to salvage the infected kidney. We have delineated clinical, laboratory and imaging characteristics outcomes of patients with EPN admitted in hospital. Methodology: This prospective observational study was carried out in medicine wards of rural tertiary care hospital and medical college named DR. RPGMC Kangra at Tanda Himachal Pradesh. They presented with a clinical, laboratory and radiologic diagnosis of EPN. Each patient had a unique predisposing factor for developing EPN. Result: We studied 32 patients (mean age 48.6 years; females 71.87%). Risk factors for EPN were diabetes mellitus (in 93%) and renal stones (in 9%). Fever, loin pain, vomiting and dysuria were common. Complications included acute kidney injury, 74%; mostly stage 1, (77.5%), hyponatraemia (54%) and bacteraemia (28%).  Escherichia coli was the most common (66%) urinary isolate. Most patients (78%) had class 2 EPN, with 12% class 3B and 10 % class 3A. Besides medical management, one (3.12%) required surgery (nephrectomy). Nephrectomised patient had a higher radiological class and one death occurred. Early goal directed therapy with intravenous fluids and antibiotics was given. This was followed by less invasive urologic interventions in an attempt to avoid nephrectomy and thereby salvage the infected kidney. Out of 32 patients, 30 patients were discharged in clinically stable conditions. One patient was referred to higher centre PGIMER Chandigarh for further management. Where he was managed conservatively initially, but condition kept on deteriorating, subsequently nephrectomy was done and he was discharged after 21 days of admission on oral antibiotics. Discussion and Conclusion: This study provides practice-based support to available literature for managing EPN. Early goal directed medical therapy for sepsis coupled with interventional urologic procedures is a useful alternative to avoid forthcoming emergent nephrectomy except in cases where a fulminant infection may be present at the time of admission or develop later on in the course of the illness despite conservative line of therapy. It also high points the importance of considering a diagnosis of EPN in patients with urinary infections who have certain predisposing factors like diabetes mellitus.

107. Etiological Profile, Clinicomycological Correlation and Risk Association in Onychomycosis
Anita Balakrishnan Nair, Anil Arjun Gaikwad, Ajit Shriram Damle, Vaibhav Vitthalrao Rajhans
Background: Onychomycosis may manifest itself in various forms, notably onychodystrophy, onycholysis, subungual hyperkeratosis, or nail-plate discoloration. Aims & Objectives: The study was conducted to formulate baseline data for various fungal etiological agents, its clinical correlation and to understand the risk factors associated, in patients with suspected onychomycosis. Materials and Methods: 113 clinically suspected cases of onychomycosis were subjected to mycological studies& diagnosis was confirmed with help of direct microscopy and culture. Results: Overall isolation rate of onychomycosis in suspected cases was 75%. Most common age affected was 21-40 years (53.9%) and males (60.1%) were more affected than females (39.8%).Majority of suspected patients were farmers (24.7%), followed by students (19.4%). Housewives contributed to 16.8% of cases. Disease was limited to fingers in 78.7% cases, followed by toes which amounted to 18.5% of the cases. 2.6% had both, fingers as well as toes affected. Distal Lateral Subungual Onychomycosis was the most prevalent clinical pattern found in 68.1% participants. This was followed by Proximal subungual Onychomycosis, Total Onychomycosis, Candidial onychomycosis, Superficial White Onychomycosis in 9.7%, 7.9%, 7% and 7% participants respectively. None of the participants were having endonyx. Associated risk factors included trauma (36.2%) which is also a part of etiological process, followed by use of occlusive footwear (15.9%), diabetes (13.2%). Positive family history was given by 2.6% cases. Predominant organism turned out to be T. mentagrophytes with 45.7%followed by T .rubrum with 40.6%. Dermatophytes, thus being the leading causative agent with 86.4% of the total agents isolated. Nondermatophytes contributed to 3.3%and yeasts were causative agents in 10.1% cases. Conclusion: The results show that relying only on the clinical manifestation in the diagnosis of onychomycosis is often misleading. The present study tries to highlight the need for microbiological confirmation in case of onychomycosis.

108. A Cross Sectional Assessment of Psychological Parameters (Depression, Anxiety and Stress Scores) in Male and Female Students
Pallavi Anand, Jai Ram Singh
Aim: The present study was undertaken to observe the selected psychological parameters that are depression, anxiety, and stress in young adults. Methodology: A cross sectional study was conducted among students of NSMCH, Bihta, Patna, Bihar, India in which a total of 100 (males =50, females =50) young adults studying undergraduate allied health courses both males and females were part of the study after obtaining the written informed consent. Apparently healthy individuals within the age group of 18-24 were recruited in the study. Participants with health issues or undergoing any treatment or therapy and unwilling participants were excluded from the study. Depression, anxiety, and stress levels were assessed using the DASS-42 questionnaire which is a standard questionnaire to assess the negative psychological aspects stress, anxiety, and depression. Each item comprised a statement and the answers were reported on a four-point scale, with the score 0 representing “did not apply to me at all”, and score 3 “applied to me very much, or most of the time”. By summing the scores for relevant items, the values of depression, anxiety, and stress revealed the degrees of severity of the three scales in question. Informed consent was obtained from all the participants before the study. Results: Out of 100 participants, 50% were males and 50% were females. 76% participants belonged to 18-21 years of age group and 24% were more than 24 years of age.42% belonged to first year, 35% belonged to second year, and 23% belonged to third year of study. The P-value equals 0.0015 for the depression score. By conventional criteria, this difference is considered to be very statistically significant. P-value equals 0.1806 for anxiety score. By conventional criteria, this difference is considered to be not statistically significant. P-value equals 0.0140 for the stress score. By conventional criteria, this difference is considered to be statistically significant. Conclusion: To sum up, it is of great significance for colleges to adopt collegiate policies reflecting the gender differentials and offer female and male students more proper guidance in freshman and sophomore years in order to promote their psychological well-being.

109. A Questionnaire-Based Assessment of the Association between Subjective and Objectives Parameters of Septoplasty
Santosh Kumar, Umesh Kumar, R.P.Thakur
Aim: The objective of this study was to assess the disease outcomes of patients undergoing septoplasty by means of a questionnaire using modified NOSE scale. Methods: A prospective study was conducted at, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar in the department of ENT for a period of 1year in 60 patients who underwent septoplasty. Preoperative and postoperative data were documented and analysed to get the results. Results: Post-op subjective evaluation by evaluating mean modified nose obstruction symptom evaluation (NOSE) score also depicted a significant improvement (p<0.5). Most common type of patients seen in our study was type II (36%) followed by type IV (27%) and type VII (12%). There was no patient which fell into type V of this classification. Conclusions: There was improvement in both subjective and objective outcomes postoperatively. Study concluded that modified NOSE scale addresses wider range of symptomatology and is a good tool for subjective assessment of septoplasty.

110. Assessment of Microbiological Diversity in Patients Suffering from Chronic Suppurative Otitis Media (CSOM): An Observational Study
Santosh Kumar, Lessily Frenco, R.P. Thakur
Aims: The aim of this study was to isolate the organisms associated with CSOM. Materials and Methods: This community based, prospective study was conducted in a Department of ENT, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. A total of 100 patients clinically diagnosed of CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. Results: The most common causative organisms isolated were MSSA (86%) and Pseudomonas aeruginosa (40%) from aerobic isolates. Anaerobes accounted for clostridium species (20%) and peptococcus species (19%). Fungi accounted for aspergillus and candida species. Conclusion: Knowing the bacteriological profile of CSOM is essentially important for an efficient treatment, prevention of both complications and development of antibiotic resistance and finally, the reduction of the treatment costs.

111. A Prospective Observational Clinical Research on Non-Venereal Genital Dermatoses in Adult Males
Sahil Kakkar, Mugdha Mohan, Rashi Agrawal, Poonam Kumari, Pradeep Yogiraj Phad, Punit Kumar Singh
Aim: A clinical study on non-venereal genital dermatoses in adult males at a tertiary care center. Methods: The prospective analytical study was conducted in the Department of Dermatology venereology and leprosy Narayan Medical College and Hospital, Sasaram, Bihar, India. A total of consecutive 100 male patients with genital lesions of non-venereal origin were included in this study. All male patients >18 years of age who presented with genital complaints were screened for non-venereal dermatoses.  The external genitalia was examined, and findings were noted. A detailed physical examination was done to see any associated lesions elsewhere in the body. Investigations such as Gram-stain, KOH mount, venereal disease research laboratory test, HIV test and histopathological examination were done as and when required establishing the diagnosis. Results: Most patients belong to the age group of 20-30 years (45%), followed by the age group of 30-40 years (22%). 75 patients (75%) were from the urban area while 25 patients (25%) belong to rural background. 57 (57%) patients were married and the remaining 43 (43%) patients were   unmarried.   Scrotum   was   involved in 62% and penis in 30% while both scrotum and penis were affected in 8% cases. 28 % patients were farmers while 18% patients were students. A total of 16 types of non-venereal dermatoses were noted in this study. The most common disorder was vitiligo present in 20 cases, followed by pearly penile papule, which accounted for 15 cases. The other disorder encountered included fixed drug eruption (FDE) in 13; scabies in 8, scrotal dermatitis and lichen planus in 8 cases each etc. Conclusion: Contrary to normal belief all the lesions on genitalia are not sexually transmitted.  It is very important to distinguish between venereal and non-venereal genital dermatoses, as these non-venereal disorders are a considerable concern to patients causing mental distress and feeling of guilt.

112. A Hospital Based Epidemiological Assessment of Coronary Artery Disease (CAD) at Tertiary Care Hospital in Darbhanga Region
Amitesh Kumar, Rakhi Kumari
Background: Coronary artery disease (CAD) among CVDs is the largest killer in the developed world and is rapidly becoming one in developing countries. CAD is a leading cause of mortality, morbidity and disability with high healthcare costs. Material & Methods: It was a hospital-based cross-sectional study, conducted at Darbhanga Medical College & Hospital, Darbhanga, Bihar, India over a period of one year. Study subjects consisted of old and newly diagnosed CAD cases attending the hospital. Information was collected on a pre-structured, well designed scheduled questionnaire. A total of 200 study subjects were included in the study. Results: The gender influence when studied separately, it was observed that the mean age of the study subjects among females 54.71 ± 1.006 was slightly lower than males 55.63 ± 1.182. Only 17 of the CAD subjects had post graduate education, while only 8 had professional degrees.  The majority of smokers and Ex-smoker were males as compared to females. Conclusions: The findings of the present study suggest that several modifiable risk factors and non-modifiable risk factors are responsible for Coronary artery disease like age, past history of diseases and education level.

113. An Analytical Assessment of the Perceptions of Undergraduate Medical Students towards Acceptance of E-Learning Vs Conventional Methods in an Integrated Curriculum in Physiology
Pallavi Anand, Jai Ram Singh
Aim: To assess their perceptions of undergraduate medical students towards effectiveness of the E-learning platform in comparison with traditional methods of learning. Methodology: A cross-sectional design was conducted under the Department of Physiology, NSMCH, Bihta, Patna, Bihar targeting first and second year medical undergraduate students who utilized e-learning module during the Covid-19 pandemic closure time. The same set of students were taught earlier using traditional methods. An online written consent was taken from each participant through the invitation to participate in the study. Data was collected in the period for three months by using a structured online questionnaire on Google forms. The questionnaire was available in English language. Results: Out of 200 participants, 39.5% were males, and 60.5% were females. 47.5% belonged to second year and 52.5% were third year students. Mean age of the students was 20.16 ± 1.46. Only 34.5% students had previous experience in online learning. The students in the study group have observed that the course of the schedule had been framed appropriately (62%) and clearly defined (60%) in e-learning platform compared to conventional methods (26%&29% respectively). 52% E-learning students agreed that Virtual lectures should be taken as complementary to the traditional teaching methods while only 41% offline learners agreed the same. According to 47% E-learners and 40% offline learners, Blackboard teaching should be used for the entire course rather than complementary. Conclusion: According to this study, there was mixed response regarding advantages and disadvantage of virtual vs traditional learning. In our study, approximately half of virtual learners and less than half of traditional learners agreed that blackboard teaching should be used for the entire course rather than complementary. While approximately half of students agreed that virtual lectures should be taken as complementary to the traditional teaching methods.

114. An Observational Study to Estimate the Coverage of MR Vaccination Campaign and to Determine the Reasons for Non-Immunization of the Children
Rakhi Kumari, Amitesh Kumar, Amit Kumar
Aim: To estimate the MR vaccination campaign coverage and determine the reasons for non-immunization of the children. Material & Methods: A Community based cross sectional study was conducted under the urban field practice area of Darbhanga Medical College, Department of Community Medicine by using purposive sampling technique 500 children aged less than or achieved 15 years of age were included. Results: 88% of the children have been immunized with the MR vaccine and 12% of the children have not been immunized. A majority (69.3%) of the children were immunized in the schools, while 24.2% get vaccinated at Anganwadi and 6.5% in the government hospitals. Conclusion: In our study, we conclude that campaign performance was below the target coverage of 90% set by the Government of India. Enhancing awareness about rubella disease and its prevention is an important mechanism for increasing understanding of the rationale of the MR vaccine over traditional measles vaccine.

115. An Observational Assessment of the Prevalence  of  Malnutrition  among  Children  Aged  6-59  Months  and  its  Associated  Socio-Demographic  Factors
Umesh Kumar, Bankey Bihari Singh
Aim: To  assess  the  prevalence  of  malnutrition  among  children  aged  6-59  months  and  its  associated  socio-demographic  factors. Material & Methods: The study was conducted in Department of Pediatrics, ANMMCH, Gaya, Bihar, India over a period of 2 years. Overall 650 children were screened. Results: Out of total 650 children screened, 32.1% were found underweight, 47% were stunted and 9.5% were wasted. Children with all three types of malnutrition showed statistically significant association with growth monitoring and immunization status. Conclusion: The absence of strong individual risk factors in our study suggests that a combination of life course factors, particularly those associated with pregnancy and birth, which we could not accurately measure, and collective exposures, over which individuals have little control, likely play a predominant role. Thus, a joint and coordinated effort between government, community, and nongovernmental organizations operating in the country is necessary to improve the nutritional status of children, focusing on effective programs and policies that reinforce the removal of collective risk factors such as lack of safe water and basic sanitation, and the provision of adequate and accessible education and health services to the population to enable effective health education actions as well as prevention and treatment of child malnutrition at the individual level.

116. A Hospital Based Cross-Sectional Assessment of the Risk Factors of Hearing Loss in Systemic Hypertension Patients
Umesh Kumar, Santosh Kumar, R.P.Thakur
Background: To find out risk factors of hearing loss in systemic hypertension patients. Methods: This is a hospital based cross-sectional study conducted at Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, for 1 year. A sample of 100 hypertensives were studied. They were subjected to pure tone audiometry after detailed history and physical examination including recording of blood pressure. Results: Out of the 100 hypertensives, 60 patients were detected to have sensorineural hearing loss. In our study, age, stage of systemic hypertension and duration of systemic hypertension were the risk factors found to be associated with sensorineural hearing loss. Conclusions: In our study we have identified a high prevalence of sensorineural hearing loss in patients with systemic hypertension. Age, duration and stage of systemic hypertension were found to be risk factors for hearing loss in the study population.

117. Evaluation of Audiological Profile and Graft Uptake by Endoscopic Composite Cartilage Graft Tympanoplasty in Chronic Otitis Media Patients
Lessily Franco, Santosh Kumar, R.P.Thakur
Background: The aim of the study was to determine the functional outcome of endoscopic composite cartilage tympanoplasty in patients having chronic otitis media with safe central perforation (small or medium). Methods: This prospective study was conducted on 100 chronic otitis media cases with safe central perforation (small/medium)in the ENT Department of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. All the patients were selected as per the described inclusion and exclusion criteria. All cases underwent endoscopic composite cartilage graft tympanoplasty (type-I) under general anesthesia. Audiological outcomes were assessed by comparing mean pure tone average pre-and post-operatively and morphological results (successful graft uptake) were evaluated at 3 months. Results: The result of this study showed graft uptake success in 94 cases and failure was seen in 6 cases. The pre-operative ACT was 44.8±6.1 dB whereas postoperatively it was 29.61±6.31 dB and the difference between the pre-operative and post-operative values was found to be statistically significant. Conclusions: we conducted an endoscopic composite cartilage graft tympanoplasty (type-I) in 100 cases and observed a graft uptake success rate of 94%. There was good uptake of graft along with improvement in the audiological profile of the patients.

118. Detection of Subclinical Peripheral Neuropathy by High-Resolution Ultrasonography of Median and Ulnar Nerves: A  Cross-Sectional Study Done On Diabetic And Hypertensive Patients  and its Comparison with Normal
Tushar Kumar, Mithlesh Pratap, Vinod Kumar Mishra
Introduction: In the modern era, diabetes as well as hypertension, separately or combined, especially with obesity, are found to be associated with an increased incidence of peripheral neuropathy. Early detection of peripheral neuropathy by Ultrasonography is of paramount importance to aid in early treatment by physicians and get maximal benefits to prevent morbidity caused by it. Aims and Objectives: Our study aims to use ultrasonography as the first modality for evaluation of changes in peripheral nerves ( Ulnar and median) for early diagnosis of peripheral neuropathy in these conditions and early intervention by physicians to prevent the severe neuropathic changes in peripheral nerves resulting in co-morbid conditions. Method And Materials: In this study, we have focussed on median and ulnar nerves of diabetic and hypertensive patients alone or in combination. We included 150 diabetic cases, 125 hypertensive cases, 125 cases with coexisting diabetes and hypertension & 100 normal as control. The cross-sectional areas of median and ulnar nerves were studied with ultrasonography and changes were detected in the nerves of these groups of patients. Study were done at BMIMS, Pawapuri, Nalanda. Results: There was a higher cross-sectional area (CSA) in both median and ulnar nerves in all the above groups of patients as compared to normal. Hypertensive and diabetic group (coexisting) patients had higher CSA than the hypertensive or diabetic group alone. Conclusion: On comparing the CSA with those in the normal group, we concluded that the prediction of neuropathies can be made at an early stage by high-resolution ultrasonography (HRU), and hence appropriate measures can be taken at a suitable early stage to alleviate their symptomatic problems.

119. Pregnancy Outcome in Patients with Threatened Miscarraige and Corelation with Early Sonographic Parameters in a Tertiary Care Hospital of West Bengal
Rajib Pal, Suman Das, Anwshka Kumari, Mrinalkanti Ghosh
Background: Threatened miscarriage comprises 15–20% of pregnancies. It is one of the commonest gynecological emergencies in early pregnancy. The study examines the pregnancy outcome in patients with threatened abortion and correlation with early sonography parameters. Materials & Methods: An observational study with longitudinal design was conducted for a period of one year. Total 160 pregnant women with a history of vaginal bleeding in their first trimester attending both inpatient and outpatient department who fulfilled the inclusion criterias were included in this study. A Structured Proforma was prepared to collect data and followed till their pregnancy terminated. Results: Out of 160 pregnant women majority (68.1%) were belonging to 21-30 years age group and 11.9% of women were above 30 years. Most of them (65.0%) were primigravida. Majority (38.1%) had vaginal bleeding at gestational age <8 weeks. In most of the individuals (85.0%) gestational sac was implanted at upper segment, only 15% implanted in lower segment. Subchorionic hemorrhage with >4 cm2 was observed in 11.2% cases. 21.9% had undergone spontaneous abortion and rest continued pregnancy beyond 20 weeks. Among all PROM/PPROM occurred in 9.4% cases, 6.9% study subjects developed hypertension, 6.9% cases had placenta previa and 5.6% cases had placental abruption. Baby of 5% mothers suffered from birth asphyxia, 6.9% suffered from RDS, and 9.4% had Apgar score <5 at 5 minute, 13.1% and 8.1% was preterm baby and IUGR respectively. While baby of 13.1% mothers had to admit in NICU, 1.9% reported as dead in perinatal period. Conclusion: Pregnancies complicated by threatened miscarriage are associated with adverse maternal and perinatal outcome. So proper antenatal care of these mothers and timely intervention prevents both maternal and perinatal complications.

120. How to Deal the Displaced Scapula Fracture
Anant Kumar Garg, Rajesh Kar, Nitin Kumar, Sanjay Kumar
Background: The aim of this study was to assess the functional outcomes of open reduction and internal fixation of displaced intra-articular and extra-articular scapula fractures. Materials and Methods: This was a prospective study comprising 16 patients from 2014 to 2017 with displaced scapula fractures, out of which 6 were intra-articular and 10 were extra-articular, with 14 males and 2 females. All patients were operated using a modified judet approach. Intra-articular and extra-articular fractures were analyzed in separate groups. Results: The mean follow-up period & patients average age was 3.6 years& 40.6 years for intra-articular group and 3.2 years & 32.1 years for extra-articular group respectively. None of the patients in our series was treated conservatively. The mean constant score for the intra-articular group was 85.5±11.3 (65-98) and for the extra-articular group was 84.8±8.5 (68-100) at the final follow-up. Individual comparison of the range of motions and strength in different positions with that of the contralateral non-injured shoulder also showed good outcome. Among the different parameters of Constant score, compared to contralateral normal shoulder, external rotation for the extra-articular group (p<0.05) and abduction for the intra-articular group (p<0.05) were the most affected, whereas pain, activities of daily living, strength and range of movements were the least affected (p>0.05). Conclusions: Operative management seems to be a good treatment option for displaced scapula fractures, not only for intra-articular fractures but also for extra-articular fractures if it meets certain criteria. All parameters of constant score showed gradual improvement throughout the follow-up period.

121. Knowledge, Attitude and Practices of Healthcare Professionals towards Tuberculosis, Multi Drug Resistant Tuberculosis and Extensively Drug Resistant Tuberculosis: An Online Cross-Sectional Survey
Tarun Sharma, Garima Gupta, Shraddha Sharma, Anil Pandey, Rajendra Sharma
Introduction: Tuberculosis (TB) has been a scourge to the mankind from the time immemorial, and despite availability of anti-tubercular drugs since 1940s, TB has continued to plague mankind. Over the past few decades drug resistance in TB particularly the multi drug resistant (MDR) and extensively drug resistant (XDR) TB has emerged as a major public health concern. In order to treat any disease effectively and efficiently, it is very important to have thorough knowledge, positive attitude and good practices towards the same. Aim: To evaluate the knowledge attitude and practices of health-care professionals (HCPs) towards tuberculosis, MDR/XDR-TB and to gain insight into currently practiced tuberculosis infection control measures. Materials and Methods: This cross-sectional, questionnaire-based survey was conducted in May 2021. Data was collected online, via a self-reported questionnaire, using a Google form. A link to the Google form was distributed to respondents via WhatsApp groups and email. A total of 423 HCPs reverted back with the filled form, the data for the same managed on excel spread sheet. Simple descriptive statistics were used to generate frequencies, percentages, and proportions. Results: Out of the total study participants 51.8% were males whereas 48.2% were females. The participants were asked about the different aspects of TB, MDR/XDR-TB including the causative agent, modes of transmission, common symptoms, diagnosis, management and the course of treatment. The overall knowledge, attitude and practices of the HCPs towards TB was noted to be good, however level of awareness regarding the MDR/XDR-TB, particularly the diagnosis and management was noted to be slightly lesser. Majority of the participants were open for regular training programmes and to get tested for TB regularly. TBIC practices among the HCPs were also noted to be good, however majority of the participants believed that theere is still a scope for improvement in TB control programmes in their region. Conclusion: It was observed in our study that HCPs had an overall good knowledge level, attitude and practices towards the TB however there is a need to increase the knowledge and awareness about MDR/XDR-TB, particularly the basic definition, prevalence, transmission dynamics, available diagnostic modalities, duration of treatment and possible outcomes is very important, more so in high burden countries like India, where the risk of exposure to drug resistant strains is quite high.

122. Comparison between Effect of Conversation and Hand Holding Alone or with Premedication Midazolam on Preoperative Anxiety
Tushar R Baria, Maitri Patel, Harshil Shah, Bhoomika R Vala, Punit Patel
Introduction: Anxiety causing stress is most profound before surgery. Anxiolytics are used routinely to combat perioperative anxiety. Studies have shown that hand-holding and communication are useful in reducing anxiety levels intraoperatively. This study compares the effectiveness of the same with pharmacological interventions in allaying preoperative anxiety. Materials & Methods: Patients who underwent laparoscopic cholecystectomy or appendectomy under general anaesthesia during 12 months were sought out by a tertiary care centre. Total 100 patients in all were investigated. 50 of them received midazolam, while the other 50 received hand holding and conservation techniques. Result: The average age of those using midazolam handholding conservation was 61.6 (9), whereas it was 62.16 (23.6) in the other participants group. The reduction of heart rate, mean blood pressure, and APAIS score in participants who got hand holding and conservation with midazolam at demonstrated a statistically significant difference. Conclusion:For patients undergoing surgery, nursing interventions to lessen anxiety can be beneficial. For patients under local or spinal anaesthesia who are cognizant throughout the procedure, handholding is a noninvasive intervention that is safe, affordable, and simple to carry out. A successful operation depends on the patient’s cooperation, and handholding can boost comfort and patient compliance, which will ultimately help the procedure be successful.

123. Effect of Interpregnancy Interval on Maternal Anemia in Current Pregnancy and its Obstetric Outcome
Zoya Kausar, Varuna Pathak, Padma Bhatia, Priti Verma, Syed Misbah Ali, Payal Tiwari
Background: The interpregnancy interval is defined as the period between the date of the previous delivery and the first day of  last menstrual period for the index pregnancy. The IPI is considered to be an important  determinant of  adverse pregnancy  outcome. Aims and Objectives: To determine the effect of short interpregnancy interval on maternal  hemoglobin levels in current pregnancy and on its obstetric outcome. Material and Methods: The study design was prospective cohort study which was conducted at Obstetrics and Gynaecology Department, Sultania Zanana Hospital GMC Bhopal, MP between January 2020 to December 2020. 400 (A sample size of 384 which was rounded to 400 was calculated at 50% prevalence  as per NFHS 4)Anemic pregnant women were selected by systemic random sampling. Primigravidae and multiple births were excluded from the study. Result:  Out of 400 study participants  in 359 patients with IPI of ≤2  244 (68%) had moderate anemia (Hb-7.1-9 ) whereas 115(32%) patients had severe anemia (hb  ≤7). In Remaining 41 patients with IPI >2 14(34%) had severe anemia and 27 (66%) had moderate anemia. In 271 moderately anemic 193(71%) delivered vaginally and 78(29%) delivered by cesaerian section. all neonates of moderately anemic mother (100%) had apgar score >8. In severely anemic patients 95(74%) delivered vaginally and 34(26%) had cesaerian delivery. Of the 129 severely anemic deliveries there were 31(24%) NICU admissions , 4(3.1%) still birth and 22(17%) LBW newborns which was statistically significant ( p<.05). Conclusion: Anemia is a major public health problem in the study area.The study findings highlights the urgency of nutritional and family planning counselling to combat with IFA deficiency anemia. Thus helps to correlate an important risk factor i.e. interpregnancy interval with maternal anemia and its effect on fetal outcome.

124. Neurological Complications of COVID-19: A Prospective Study in Tertiary Care Centre, India
Vinod Kumar Mehta, Renu Khamesra, Rajendra Kumar Shukla, Ayushi Jain, Reena Chittora, Abbas Ali Mahdi
Introduction: Severe acute respiratory syndrome coronavirus-2, viruses primarily affects respiratory system but now it is well known to have direct neurological involvement. Our aim was to describe the neurological manifestations of corona virus disease 2019 pandemic. Methods: This was a prospective tertiary centre study to investigate the neurological manifestations of COVID-19 infection among in patients from a tertiary care centre, India from March 2020 to September 2021. Results: Out of 488 patients admitted with COVID-19, 385 (79.5%) had neurological manifestations. Neurological manifestations commonly seen were headache (49%), encephalopathy (32.4%) and dizziness (28.7%).  A statistically significant relationship was found between the presence of CNS manifestations and death (p < 0.0001). Conclusion: Severe acute respiratory syndrome coronavirus-2 induce many central and peripheral nervous system manifestations. Encephalopathy and stroke were the commonest neurological manifestation with progressively higher mortality in young patients. Research needs to be undertaken to study the pathogenesis of neurological manifestations which may further help to improve the treatment regime.

125. A Prospective Assessment of the Alterations in Serum Potassium Levels during Post Op Exploratory Laparotomy
Kamlesh Kumar Sahu, Pradeep Kumar, Pawan Kumar, Shivani
Aim: The present study was conducted for assessing the alterations in serum potassium levels during post op exploratory laparotomy. Methods: The present study was conducted in the department of general surgery of the Fort U Mediemergency Hospital, Patna, Bihar, India and it included assessment of alterations in serum potassium levels during postoperative exploratory laparotomy. A total of 60 subjects who underwent explorative laparotomy were enrolled in the present study. Results: In the present study, a total of 60 patients who underwent exploratory laparotomy were included. Mean age of the patients was 58.4 years. 66.66 percent of the patients were males while the remaining were females.(Table 1) Mean potassium levels at Baseline (before starting of surgery), One day after surgery, Three days after surgery and Seven days after surgery were found to be 4.50 mEq/L, 5.60 mEq/L, 4.55 mEq/L and 4.40 mEq/L respectively. A significant reduction in the potassium levels during the initial postoperative phase was seen followed by a significant rise; thereby returning to normal value 1 week postoperatively. Conclusion: We concluded that the significant rise in the potassium levels occur after exploratory laparotomy, followed by restoration to normal values by the end of first postoperative week.

126. A Prospective Study to Assess the Correlation between EVLWI and PVPI with the Severity of Lung Injury in Patients Admitted with Septic Shock in Intensive Care Unit
Shiv Shankar, Vivek Ranjan, Akriti Singh, Nitin Kumar
Aim: The aim of the present study was conducted in the Intensive Care Unit (ICU) of our institute, with an aim to assess the correlation between EVLWI and PVPI with the severity of lung injury in patients with septic shock. Methods: The present study was conducted in the Department of  Critical Care medicine (Anesthesiology), IGIMS, Patna, Bihar, India for 1 year. Results: The chest radiograph scores from both radiologists strongly correlated with EVLWI (r = 0.75 and 0.70 for observers 1 and 2, respectively, P < 0.0001 for both observers). A moderate correlation between chest radiograph scores and PVPI was obtained (r = 0.64 and 0.60 for observers 1 and 2, respectively, P < 0.0001 for both observers). The chest radiograph scores from the two independent observers correlated strongly with each other (r = 0.78, P < 0.0001). Conclusion: EVLWI and PVPI may have a prognostic significance in the assessment of lung injury in septic shock patients with ARDS. Further research is required to reveal the usefulness of EVLWI as an end point of fluid resuscitation in the management of septic shock with ARDS.

127. Outcome Assessment of Patients of Non-CF Bronchiectasis Admitted with ARF and Managed with NIV as a Primary Mode of Ventilatory Support: An Analytical Observational Study
Vivek Ranjan, Shiv Shankar, Nitin Kumar, Akriti Singh
Aim: The purpose of the present study was to assess the outcome of patients of non‑CF bronchiectasis admitted to our institute with ARF and managed with NIV as a primary mode of ventilatory support. We also compared various physiological and clinical parameter between NIV and mechanical ventilation. Methods: The present study was conducted in the Department of  emergency and Critical Care(Trauma and Emergency), IGIMS, Patna, Bihar, India for one year . There were a total of 250 patients with bronchiectasis who were admitted during the above specified period. Among these, 130 patients were admitted with ARF. Totally, 120 patients who required either NIV or IMV. Results: The most common etiology of bronchiectasis was post-tuberculosis (66.66%) followed by idiopathic (16%), ABPA (11.12%), and immunodeficiency (5.55%). NIV was initiated as first line of ventilator support for 90 patients. Among these, 60(66.66%) were managed successfully with NIV. 30 (33.34%) patients failed NIV and required endotracheal intubation during the hospital stay. Conclusion: Our results suggest that utility of NIV should to be assessed in well-designed prospective studies for ARF in non-CF bronchiectasis patients.

128. A Retrospective Observational Assessment of the Surgical Management of Spinal Tuberculosis
Pawan Kumar, Pradeep Kumar, Kamlesh Kumar Sahu, Shivani
Aim: The aim of the present study was to evaluate the surgical management of spinal TB. Methods: The present study was conducted in the Department of Orthopaedics, Fort U Mediemergency Hospital, Patna, Bihar, India. We studied all the patients with spinal TB who presented with or without motor deficits due to spinal TB admitted and surgically treated in the hospital for 1 year. Results: A total of 100 patients were included in the study.  Out of which, 60 were males and 40 were females. The average age group is 45.5 years, the youngest being 18 years and the oldest 60 years. No gender‑related difference was seen in our study. The most common site of involvement was thoracic followed by lumbar, cervical, and thoracolumbar. Pain was the most common symptom, and weakness was seen in 40 patients, 25 of whom had epidural compression. Conclusion: Surgical treatment is a safe and effective approach to treat spinal tuberculosis infection. Although in less severe cases image-guided percutaneous aspiration and posterior percutaneous fixation can be an excellent therapeutic choice, in severe cases with large abscesses and extensive vertebral column involvement, aggressive treatment with direct aspiration and debridement, anterior reconstruction and posterior instrumentation can result in a rapid recovery and acceptable rate of complications.

129. Hospital Based Assessment of a Simple and Safe Technique of Creating Closed Pneumoperitoneum
Kamlesh Kumar Sahu, Pradeep Kumar, Pawan Kumar, Shivani
Aim: We described a simple technique which detects the precise entry point when the reusable metallic Veress needle enters the peritoneal cavity. This technique prevents overshooting of the needle inside the abdomen, thereby lessening the chance of any visceral injury. Methods: The present study conducted in the Department of General Surgery, Fort U Mediemergency Hospital, Patna, Bihar, India . 20 patients of either sex were selected who undergone operative procedure for laparoscopy surgery were included in this study. Results: Technical difficulties like multiple attempts, gas leak at port site and port site bleeding are less in closed method, which is attributed to larger size of incision in open method, Furthermore, a significant higher incidence of such minor complications is found in case of BMI >25 p=-5.33 (p<0.05) at confidence level of 95%). Conclusion: The closed (Veress needle) method for gaining access into the peritoneal cavity is safe. Further studies are needed in multiple centres and on larger samples for conclusive evidence. Since laparoscopic cholecystectomies are now routine procedures, the safest method should be sought and guidelines should be formulated.

130. A Study Assess the Cyto-Histopathological Findings and the Accuracy of FNAC in the Diagnosis of Breast Lesions
Ragini Kumari, Ajit Kumar Chaudhary
Aim: The aim of the present study was to correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. Methods: This retrospective study was carried out in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India from April 2019 to March 2020. Total 50 all cases of breast lump FNAC in which cytological impression could be given were included in the study.  Slides of the entire breast FNAC conducted during the above period were surveyed and those fitting in to C3 and C4 categories were selected for study. The cytological diagnosis was compared with histopathological diagnosis in the cases where biopsy was done subsequent to FNAC diagnosis. Results: A total of 400 breast FNAC were done in the above- mentioned period. Out of these, C3 and C4 categories constituted 30 (7.5%) and 40 (10%) cases respectively. Histopathological diagnosis was available in 20 cases of C3 (40%) and 30 cases of C4 (60%). All the malignant cases in both these categories were infiltrating ductal carcinomas (33 cases). Benign histological diagnosis between both categories included fibroadenoma (10 cases), fibrocystic disease (4 cases) and proliferative breast disease (3 cases). Among C3 category, 14/20 cases in which histopathological examination was available showed benign lesions (70%) and 6/20 cases were malignant (30%). Among C4 category, 3/30 cases available for histopathological examination showed benign lesion (10%) and 27/30 cases turned out to be malignant (90%). There was a significant statistical difference between benign and malignant diagnosis of C3 & C4 categories (p< 0.001). The accuracy of present study in diagnosing breast neoplasms is 96%. The specificity of 97% and the sensitivity of 96%. Conclusion: FNAC of breast is a simple, safe, rapid and inexpensive diagnostic modality and plays a very important role in diagnosis of breast lesions especially malignancies. However it is important that clinicians understand the limitations of FNAC. C3 and C4 categories should still be continued with, as there was a statistically significant difference in benign & malignant diagnosis for these categories in our study.

131. A Prospective Assessment of the Clinical and Radiological Outcome of Intralesional Methylprednisolone (1g in 10 Ml Distilled Water) in Aneurysmal Bone Cyst
Vikash M Harinandan, Kunal Shankar, Laljee Chaudhary
Aim: This study aims at comparing the hemodynamic variation between low dose oral clonidine (100mcg) and placebo group in laparoscopic surgeries. Material & Methods: 60 consecutive patients undergoing laparoscopic procedures of 90 to 180 minutes were enrolled into the study. Inclusion criteria was ASA (American Society of Anesthesia) I and II in the age group of 18 and 70 years. Exclusion criteria were patients of ASA III and IV, patients on antihypertensive medications and patients with known cardiac disease. Results: A statistically significant difference and reduction in heart rate was seen in clonidine group compared to placebo group at various interval. At 90 and 120 minutes, systolic and mean arterial blood pressure was similar between the clonidine and placebo group. Conclusion: Low dose oral clonidine is a very efficient, easy to administer and cost effective premedication drug during laparoscopic procedures.

132. A Prospective Assessment of the Pattern of Cervical Pap Smear Cytology at a Tertiary Hospital and to Correlate it with Clinical Findings
Ragini Kumari, Ajit Kumar Chaudhary
Aim: Study to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital and to correlate it with clinical findings. Material and 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. The cellular material obtained on the spatula and cyto brush was quickly smeared on a clean glass slide, labeled, fixed in 95% ethyl alcohol immediately and subsequently stained by Pap stain. After staining, slides were mounted with DPX (Distrene dibutyl phthalate xylene), screened and reported by cytopathologist under light microscope. Results: Total 1200 cervico-vaginal smears studied during study period on patients, ranging from 18 to 65 years. Cytological findings broadly classified into unsatisfactory smears, normal and abnormal smears. There were 910(75.83%) abnormal Pap smears (benign cellular changes of inflammation as well as Epithelial Cell Abnormalities (ECA), with 265(22.08) normal cases and 25 (2.08%) unsatisfactory or inadequate samples. The age range of patients with epithelial cell abnormality was 22 to 65 years and the mean age was 44.1±12.7 years. They represented 2.5% of abnormal Pap smears and 1.67% of total smears taken. Total 623 (51.92%) showed inflammatory lesion, 14 (1.17%) showed atrophy, 10 (0.83%) showed ASCUS, 6 (0.5%) showed ASC-H, 6(0.5%) showed HSIL, 2 (0.17%) showed SCC, 3 (0.25%) AGUS, 193 (16.08%) showed metaplasia, 2 (0.17%) had radiation changes. Conclusion: Proper implementation of Pap screening program, incidence of invasive cervical malignancy can be prevented due to early detection of cervical premalignant lesions.

133. Outcome Assessment of Intra Articular Calcaneum Fracture Managed Surgically with Plate Fixation: a Prospective Study
Vikash M Harinandan, Kunal Shankar, Laljee Chaudhary
Aim: The aim of this study was to evaluate the functional and clinical outcome of intra-articular calcaneal fractures managed by open reduction and internal fixation with a plate. Methodology: This prospective study was carried out at Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India from March 2019 to Feb 2020 . A total of 50 patients with intra-articular calcaneal fractures meeting the inclusion and exclusion criteria were chosen for the study. After admitting the patients who met the inclusion criteria, relevant investigations were done and fitness for surgery was taken. Appropriate measures were taken to reduce the swelling, such as below knee slab with cotton padding, limb elevation, and ice pack application. Pre-operative x-rays-lateral and axial view of the calcaneam and CT scan of calcaneum were obtained and pre-operative planning was done. Pre-operative Bohler’s and Gissane’s angles were measured using radiographs and fractures were classified using Sander’s classification with the help of a CT-scan. Ankle range of movements were started at 2nd post-op week. Patients were followed up regularly in OPD at 6 weeks, 12 weeks, 24 weeks and 1 year and clinical and radiological assessments were done. Radiological assessment was done by measuring bohler’s and gissane’s angles, union rate. Functional outcome was measured using American Orthopaedics Foot and Ankle Society (AOFAS) score. A score of 90-100 is taken as an excellent outcome, 75-89 as good, 55-74 as fair and a score less than 50 is considered a poor outcome. Results: In our study, patients between the ages group 18-60 years with a mean age of 32.56 years were included. The majority of the patients in the study were males, with 90% of the study population. In this study, 54% of the patients had right side involvement and 46% of the patients had left side involvement. The most common mode of injury in the study group was falling from height (82%) followed by RTA (18%). The most common fracture type in our study was Sander’s type II (42%), followed by type IV (32%). Type III was the least common (26%). The average time period for the radiological union was 14.26 weeks in the study population. About 70% of patients had a bohler’s angle between 10 -20 degree and in 30% of patients, it was < 10 degree in the pre-operative period, with a mean bohler’s angle of 13.25 degree. Whereas in the post-operative period, 50% of patients had a bohler’s angle between 21-30 degrees and 50% had it between 30-40 degrees, with a mean post-operative bohler’s angle of 31.34 degrees. The difference between pre-operative and post-operative mean bohler’s angle and mean Gissane’s angle was statistically significant with a p value <0.01. Conclusion: In displaced intra-articular calcaneum fractures, open reduction and internal fixation with calcaneum locking plates and screws result in a good number of satisfactory outcomes. Hence, it can be a better option of treatment in displaced intra-articular calcaneum fractures.

134. The Effect of Using Artificial Intelligence and Machine Learning on Parameters of Clinical Trial Involving Anaesthetic Agents
Amit Kumar Tomar, Tarun Chawla
Introduction: Machine Learning and Artificial Intelligence has been in application in several fields including medical field and there is immense untapped opportunity that is yet to be explored in using machine learning models to provide better health care. It may range from pharmacy, medical diagnosis to surgical intervention or support. There have been several occurrence of hypotension post induction of anaesthesia which increases the deaths of the patients undergoing surgery. Therefore, this study has brought forward applicability and analysis of machine learning models in predicting hypotension after induction of general anaesthesia intra-operatively. Aims and Objectives: To find out the efficacy of performance between USG guided hypotension prediction post-induction and machine learning model by artificial neural networks. Methods: This retrospective study collected demographic data of the patients underwent cholecystectomy under general anaesthesia from the hospital. The patients were given general anaesthesia, after which each of them was predicted for post-induction hypotension by employing conventional prediction of Inferior Vena Cava (IVC) parameters by ultrasound (USG) guided to determine hypotension post induction and artificial neural network which is a new machine learning model. Evaluation and comparison between the models were done mainly by determining 3 parameters, namely, precision, recall and accuracy. Results: The study found that ANN is significantly (p<0.05) efficient as compared USG guided prediction by IVC parameters which was conventionally done. The study also pointed out that the age factor is significant in deciding the hypotension after general anaesthesia intra-operatively. Conclusion: The study has evidently proved the efficiency of machine learning model in this study (ANN) with that of conventionally used USG guided prediction.

135. A Clinical Study on the Prevalence of Foreign Bodies in the Oropharynx and Oesophagus in a Tertiary Care Hospital in Telangana
Venkatarathnam C, Nandini S, Sindhuja S.B, K. Priyanka
Introduction: Foreign bodies in the upper aerodigestive tract project a diagnostic and therapeutic challenge for an Otolaryngologist. Foreign bodies result in the death of patients before they arrive at a hospital. They form an emergency situation in the Hospital. Methods: A prospective study was conducted for two years at Mahatma Gandhi Memorial Hospital, Warangal. 187 Patients of all age groups with foreign bodies in the Oropharynx and esophagus, and meeting the inclusion criteria were added. Roentgenograms, C.T. scans, and Endoscopy were used to diagnose and treat. A rigid laryngoscope or esophagoscope with a rigid fiber-optic light carrier was used for laryngeal and hypopharyngeal and esophageal foreign body removal. Results: Out of 187 patients, 76 (40.64%) were children and 111 adults (57.75%). There were 99/187 males (54.01%) and 86/187 females (45.98%). The gender ratio, males to females was 1.1:1 in children and 17:1 in adults. The highest incidence was among 31 to 40 years old and the lowest incidence in the 21 to 30 years and above 61 years age group. Cricopharynx was the most commonest site of impaction of foreign bodies; in 78/187 (41.71%) patients, the middle third of the esophagus in 59/187 (31.55%) and in 18 (09.62%) FB was in the lower third of the esophagus. Conclusions: Foreign bodies were more common in adults than in children and more common in males than females. The most common age for throat and airway foreign bodies was in the 1st decade. In the digestive tract, mutton/chicken bones were the most common foreign bodies in the adults and Coins in the children. Throat pain and difficulty in swallowing were the most common symptoms in digestive tract foreign bodies. The most common site of foreign body impaction was cricopharynx in the digestive tract.

136. Assessment of Metabolic Syndrome in Women with Polycystic Ovarian Syndrome – A Cross-Sectional Study
Varnika Rastogi, Namrata Verma, Akanksha Srivastava, Govind Kahar
Background: Polycystic ovarian syndrome is a prevalent disorder among women of the reproductory age group. It results in an increased stress level in the body resulting in the rise of inflammatory markers. This leads to infertility, lipid derangement, risk of type 2 diabetes & atherosclerosis. Early screening is required for proper management & preventing the serious sequelae & reduce the disease burden. Thus, this cross-sectional study was undertaken to assess metabolic syndrome in women with the polycystic ovarian syndrome with the controls. Material & Methods: This cross-sectional study recruited 100 women in the age range of 15-35 years who visited the Department of Obstetrics and Gynecology in G S Medical College and Hospital, Pilkhuwa, Uttar Pradesh from January 2022 to June 2022. Group, I included healthy women in the age range of 15-35 years having documented features of PCOS (according to Rotterdam criteria, 2003) (n=50) & Group II included controls (n=50). Patients were excluded if they had diabetes, hypertension, cardiovascular disease, or pregnancy. Fasting plasma glucose, Systolic blood pressure, diastolic blood pressure, Waist circumference, Serum triglyceride & HDL cholesterol were recorded (according to NCEP criteria). Results: The mean age of the participants in Group I & Group II were 24.54±3.42 yrs & 26.23±6.71 yrs respectively. Thus, the mean age in Group I was lower than that of Group II but was not statistically significant (p>0.05). Waist circumference, SBP, DBP, fasting blood sugar & serum triglyceride levels were statistically significantly higher in Group I (p<0.05). HDL cholesterol levels were statistically significantly higher in Group II (p<0.05). In Group I, 71% of the patients had obesity, 76% presented with hyperandrogenemia,94% with Oligo/amenorrhea, 15% had primary infertility, 9% had secondary infertility & 65% had polycystic ovaries on ultrasonography. Conclusion: A positive association between polycystic ovarian syndrome and metabolic disorders in females has been demonstrated. The metabolic syndrome is common in polycystic ovarian syndrome, among women with hyperinsulinemia and obesity. Regular screening & timely intervention emphasizing the importance of a healthy lifestyle can prevent the development of metabolic disorders & polycystic ovarian syndrome in women.

137. Post Covid Pneumonia a Diagnostic Conundrum: Is it Fungal, Mycobacterial or May Be Both?
Vandana Tyagi, Shivadatta Padhi, Anand Derashri, Mohit Khandelwal, Sushil Kumar Saini
The SARS-CoV-2 was first detected and diagnose in several patients who had traveled to Wuhan city, China or went to a seafood market in Wuhan city, China. It  is a highly pathogenic and transmissible coronavirus type that emerged in year 2019 and has caused a worldwide acute respiratory illness, named ‘coronavirus disease 2019’ (COVID-19), which leads to high morbidity and mortality. The specific medical countermeasures for these human coronaviruses are still under research. Sometimes spread of false information regarding these human coronaviruses are also seen worldwide which result in panic in general public regarding the infection. Post-Covid upper zone cavitating pneumonia represents a diagnostic challenge, specially between Tuberculosis and aspergillosis, notably in this part of the globe with resource constrained settings.

138. A Comparative Study of Serum Phosphorus and Serum Calcium in Disorders of Prostate at SMS Hospital, Jaipur
Rakhi Pareek, Rekha Bagla, Gaurav Pareek, Alka Meena, Shakuntala Saini
Background: Benign prostatic hyperplasia (BPH) and prostate cancer are the most common disorders of prostate gland. Prostate cancer is the second most frequent malignancy (after lung cancer) in men worldwide. Calcium and phosphorus ions are essential for cell growth, proliferation and differentiation as their signaling is essential for regulating these physiological functions. The present study was thus undertaken with the main aim of comparing serum phosphorus and serum calcium level in patients suffering from disorders of prostate (BPH and Prostate cancer) with age matched healthy controls. Materials & Methods: After taking necessary permissions, a cross sectional study was conducted at Department of Biochemistry and Department of Urology, SMS Hospital, Jaipur. This study includes 35 patients suffering from BPH and Prostatic Cancer aged 40-75 years compared with 35 matched controls. Serum levels of phosphorus and calcium was measured by Spectrophotometry in fully Automated chemistry analyzer AU680 (BECKMEN COULTER). Results: Results were analyzed statistically by ANOVA test and Student’s t-test. Mean serum calcium level in cases was low (8.1 ± 0.64 mg/dl) compared to controls (10.0 ± 0.72 mg/dl). Comparison between prostatic disorders, serum calcium was high in BPH (8.6 ± 0.44 mg/dl) compared to Prostate Cancer (7.7 ± 0.42 mg/dl). Mean serum phosphorus level in cases was low (2.7 ± 0.43 mg/dl) compared to controls (3.7 ± 0.45 mg/dl). Comparison between prostatic disorders, serum phosphorus was high in BPH (3.0 ± 0.30 mg/dl) compared to prostate Cancer (2.5 ± 0.39 mg/dl). The difference observed in results above was statistically highly significant (p<0.001). Conclusion: The findings of this study conclude that there is biologic plausibility for a role of phosphorus and calcium in prostate carcinogenesis. Decreased serum calcium and phosphorus levels correlate with the severity of prostate cancer. Hence, it can be concluded that estimation of serum phosphorus and calcium levels can be used for early screening and diagnosis of disorders of prostate.

139. Prevalence of Antibody to Hepatitis B Core Antigen among Healthy Blood Donors in Western Rajasthan
Archana Singh, Gajendra Singh Rajpoot, Yogendra Singh
Background: Hepatitis B is a serious global infectious disease and a major cause of acute and chronic hepatitis, cirrhosis and primary hepatocellular carcinoma worldwide. Transfusion-transmitted HBV infection is increasingly becoming a major mode of transmission developing countries like India. Since the presence of HBsAg cannot be detected in the window period, detection of Anti-HBc can be useful in detecting infection. Methods: The study was conducted on 900 healthy blood donors using 5 mL of venous blood collected in a clean sterile glass tube. Anti-HBc was detected using an invitro detecting kit and confirmation of infection was done using NAT analysis. Results: There were 69 samples that were reactive for anti-HBc but negative for HBsAg. That is 7.6% of the total sample size (900).The incidence of HBV DNA positivity in anti HBc positive sample (77) was 29.87%. Conclusion: The blood donors should therefore be checked for anti-HBc in addition to HBsAg, and those found positive for anti-HBc should submitted to HBV DNA testing before giving their blood to the recipients.

140. A Retrospective Observational Assessment of the Clinical Profile of Patients Attending Ophthalmic Clinic during Peaks of COVID 19 Pandemic
Sudhanshu Kumar, Jawed Iqbal
Aim: The aim of the study is to evaluate the clinical profile of patients attending ophthalmic clinic during peaks of covid pandemic. Methods: The present observational study was conducted in the Department of Opthalmology, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India, for the period of 1 year. The demographic data and systemic history of the patients admitted on different dates were collected from hospital records. A total of 100 patients were included in this study. The median age of the patients was 40 years (range: 10–70 years); 70 (70%) patients were male and 30 (30%) were females. Results: The patients were predominantly males and adults. In our study, 20 (20%) out of 100 had COVID-19-related ocular manifestation. Rest of the three patients had associated symptom of watering and one of them developed periorbital rash and lid edema. Conclusion: Mild conjunctivitis manifesting as conjunctival congestion is common and is one of the major ocular manifestations in COVID-19 positive patients even with milder disease.

141. A Retrospective Observational Assessment of the Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children
Manoj Kumar, Sunil Kishore, Shalini Sinha
Objective: To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia. Methods: A retrospective observational study was conducted in IGIMS, Patna, Bihar, India. Children, 2 to 59 months of age, suffering from acute respiratory infection (ARI). Results: The prevalence of radiological pneumonia in the present study was 44%. Consolidation was found in 44 cases, Alveolar infiltration was found in 35 cases, Peribronchial thickening was found in 45 cases, Interstitial thickening was found in 24 cases and Atelectasis was found in 33 cases. Conclusion: Current WHO criteria based on fast respiratory rate and/or chest indrawing have poor sensitivity and specificity for diagnosing pneumonia. Adding 92% SpO2 to chest indrawing or WHO criteria enhances the chance of pneumonia diagnosis and is crucial in managing a kid with pneumonia.

142. Randomized Comparative Clinical Assessment of the Umbilical Cord Clamping Timing in Preterm Infants Delivered by Cesarean Section
Amit Kumar, Bankey Bihari Singh, Ravindra Kumar
Aim: To compare three different cord clamping timing (immediate cord clamping(ICC) delayed cord clamping(DCC) and umbilical cord milking(UCM) in preterm infants delivered by cesarean section (CS). Material & Methods: The randomized clinical trial was conducted at Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, over a period of one year. A total of 60 pregnant women at less than 32 week’s gestation admitted for cesarean section were enrolled in the study and randomly allocated to three group. Results: The mean gestation age of studied infants was 30.38±1.20 weeks and their birth weight was 1220±43 grams. Duration of O2 therapy in UCM group was 15.00±9.2, in DCC group was 12.50±3.96  and in UCM group was 11.50±7.68(p = >0.05 statistically  not significant). Conclusion: UCM may be as effective as DCC to increase hemoglobin in preterm infants delivered by CS. Although the hemoglobin of infants with DCC and UCM was significantly higher than infants with ICC, the rate of blood transfusion was not significantly decreased during hospital stay.

143. An Analytical Study to Evaluate the Efficacy and Safety of High Flow Nasal Cannula Therapy as a Primary Mode of Respiratory Support in a Pediatric Intensive Care Unit
Amit Kumar, Binod Kumar Singh, Saroj Kumar
Aim: To assess efficacy and safety of High flow nasal cannula therapy (HFNC) as primary mode of treatment for children with respiratory distress. Material & Methods: This cross-sectional study was undertaken at Department of Pediatrics, NMCH, Patna, Bihar, India, over a period of one year.  Consecutive patients with respiratory distress necessitating admission to pediatric intensive care units(PICUs), in the age group of 1 month to 16 years of age were included. Results: A total of 220 (105 boys, 115 girls) children were commenced on HFNC therapy. HFNC failure occurred in 17 (8.3%) children at a median (IQR) time of 2 (1.75-24) hours. In univariate regression analysis, respiratory clinical score [Hazard ratio (95% CI) 4.1 (2.2-11.7), P=0.001]; SF ratio [HR (95% CI) 0.98 (0.94-0.98), P=0.01]; and COMFORT score, [HR (95% CI) 1.98 (1.6-2.0), P= 0.001] on admission were associated with HFNC failure. Conclusions: HFNC is an effective and safe primary mode of respiratory support in children with respiratory distress. Children who succeed on HFNC show a favorable clinical response within first few hours.

144. A Randomized Controlled Assessment of the Effect of Hand-Holding and Conversation Alone or with Midazolam Premedication on Preoperative Anxiety
Jitendra Kumar, Anantu Kumar, Alok Kumar
Aim: The current study compares the physical intervention hand-holding with conversation and the common pharmacological drug midazolam in relieving preoperative anxiety in adult patients undergoing laparoscopic abdominal surgeries. Methodology: It was a prospective randomised controlled trial in which patients undergoing laparoscopic cholecystectomy or appendectomy under general anaesthesia in IGIMS Patna for 1 year. Participants in the age group of 18–45 years and American Society of Anesthesiologists (ASA) grade 1–2 were enrolled. The patients were randomized to one of the three groups including 25 patients each: Group M- received 0.05 mg/kg of midazolam made up to a volume of 5 ml with normal saline intravenously (IV); Group HC received hand-holding and conversation with 5 ml of normal saline IV and or Group HCM received hand-holding and conversation and 0.05 mg/kg of midazolam made up to a volume of 5 ml with normal saline. Anxiety was measured using the Amsterdam preoperative anxiety and information scale (APAIS). The HR and MBP were measured at the brachial artery in the patient’s right upper arm by non-invasive automated devices. After recording the baseline parameters (HR, MAP and APAIS scores), the patients were given IV midazolam or saline as per the group allocation and then the patient’s hands were touched with warm hands and held with medium pressure by one of the three nurses and the readings were analyzed thereafter. Results: 75 patients, undergoing 56 laparoscopic cholecystectomies and 19 laparoscopic appendectomies were recruited in three groups (n = 25 each). The HR and APAIS scores were significantly different in the three groups after intervention but MBP was not significantly different in all the three groups. On pair-wise comparison, there was a significant difference in the HR between groups HCM and HC. However, the HR in group M did not significantly differ from HR in groups HCM and HC, as seen in the post-hoc analysis. The APAIS score showed a significant difference between the three groups with group HCM showing the lowest anxiety scores, followed by group HC and group M showing the highest anxiety scores. 5 patients complained of nausea (3 in group M, 1 each in groups HC and HCM), none of them had vomiting and 6 patients had mild sedation, i.e., 2/6 on the Ramsay sedation score (3 in group M and 3 in HCM). There were no adverse effects in terms of drug reactions. Conclusion: The study found that hand-holding and conversation, when included with midazolam, effectively reduced anxiety in preoperative settings. While hand-holding with conversation alone is effective, only midazolam as premedication for anxiolysis is inferior. So we suggest combining hand-holding and conversation with midazolam to effectively reduce preoperative anxiety.

145. A Diagnostic Approach on Role of C-Reactive Protein in Acute Appendicitis
Pankaj Mehrotra
Background: Acute appendicitis is one of the common surgical emergencies. Appendicitis is a common surgical emergency and diagnostic dilemma. Making the correct diagnosis is often difficult as the clinical presentation varies according to the age of the patient and the position of appendix. Objective: To investigate the efficacy of C-reactive protein in the diagnosis of acute appendicitis. Methods: A prospective study done on patients coming to hospital with clinical diagnosis of acute appendicitis and underwent appendectomy. The blood samples for C-reactive protein were drawn before taking the patient to the operating theatre. Removed appendices were sent for histopathological confirmation of diagnosis. The data was entered and analysed in SPSS 23. Results: A total of 100 patients were included in the study. CRP was more than 6mg/l in 89 patients 87 patients had histopathologically inflamed appendix and serum CRP estimation in diagnosis of acute appendicitis yield sensitivity of 94%, specificity of 50%, positive predictive value of 95% and negative predictive value of 74%. Conclusions: CRP was raised in patients with acute appendicitis and it aids as a marker for diagnosing acute appendicitis and decreasing the rate of negative appendectomy. CRP is helpful in making diagnosis of acute appendicitis.

146. Characterization of Renal Tumours Using Computed Tomography at a Tertiary Facility
Urvil A. Shah
Background: Clinical decision-making can be aided by an accurate evaluation of the morphology of renal tumours, the perinephric space, local lymph nodes, supplying arteries, and surrounding organs. Aims & objectives: In the current study, we evaluated the function of computed tomography in classifying renal masses at a tertiary facility. Material and Methods: Patients of any age group with suspected renal masses on clinical examination, confirmed renal masses on USG examination, or incidental renal masses found on USG/CT examination were included in the current prospective, observational study. Results: 86 patients with renal masses underwent radiological assessment for the duration of the research. Mean age was 51.3+11.2 years on average. The mean longest diameter of the renal mass was 5.35+1.45 cms, with a range of 3.4 to 8.35 cms, and there were 54 male and 32 female patients. While benign lesions were less common (13.16%), the majority of renal masses (86.84%) were cancerous. In the current study, the most frequent diagnosis of renal mass was renal cell carcinoma (74.42%). Other diagnoses were Bosniak II cyst (2.33%), transitional cell carcinoma (4.65%), Wilms tumour (4.65%), metastasis (4.65%), renal angiomyolipoma (9.3%). Out of 76 malignant lesions, the most frequent local extents were pelvicalyceal involvement (13.16%), perinephric extension (23.68%), and beyond perirenal fascia (28.95%). Regional lymphadenopathy (10.53%), renal vein thrombosis (10.53%), IVC thrombus (7.89%), and ipsilateral adrenal involvement (5.26%) were other less frequent local extents. Conclusion: When evaluating renal masses, either for diagnostic or preoperative purposes, computed tomography is a crucial tool for accurate patient management.

147. A Study of Utilization of Blood and Blood Components at a Tertiary Care Centre- A 5 Year Study
Farida Begum, Swathi Samalla, Mohd. Imran Ali, M. Lavanya
Background: Blood is the most precious and unique gift that one human being can give to another human being. The blood transfusion service is the very vital component of healthcare services. Till date we are not able to prepare whole blood artificially and no effective substitute is invented, so blood donor is very precious. The primary responsibility of blood transfusion services is to provide safe, sufficient and timely supply of blood and blood products. The component separation has maximized the utility of one whole blood unit. The emphasis has shifted from the use of whole blood to component therapy, as blood is a scarce and precious resource. Aim: Aim of the study is to analyse utilization of blood and blood products in government general hospital Nizamabad- A Tertiary care centre. Materials and Methods: This is a retrospective study conducted in government general hospital, Nizamabad. The data regarding request and utilization of blood and blood products by various speciality departments at blood bank Government general hospital, Nizamabad were analysed from January 2017 to December 2021, over a period of 5 years. Results: A total of 20983 blood units were issued over a period of 5 years. Packed red blood cell was the most utilized product. Supply of blood was maximum to the gynaecology wards followed by medicine ward. The patients of anaemia under obstetric care and those who have had surgery required packed red blood cells mostly. Most common indication for blood products was anaemia. Conclusion: The periodic review of blood component usage is essential to assess the blood utilization pattern in any hospital or community. This is useful for blood transfusion services to provide safe, sufficient and timely supply of blood and blood products in the community.

148. An Evaluation of Histopathological Changes of Gallbladder Mucosa in Cholelithiasis
Ekta Gupta, Deepali Gupta
Introduction: Bile deposits that have hardened into gallstones can form in the gallbladder. They come in sizes and shapes ranging from a golf ball’s size to a sand particle. Gallstones develop when one or more of the bile’s chemical components precipitates out as a result of an imbalance in the composition of bile. Although cholelithiasis is a medical disorder that can affect everyone, there is a substantial geographic variation in the prevalence rate, with African populations having the lowest incidence. There have been several attempts to diagnose gallstones early and to associate the condition of cholelithiasis with that of abnormal histology of gallbladder wall. Aims and Objectives: To find out the association between several parameters pertaining to the gallstone properties with that of gall bladder pathological conditions.  Methods: This prospective study considered patients who underwent cholecystectomy and had cholelithiasis. Biochemical histopathological examinations were conducted to assess the several properties of gallstones and histological status of the gallbladder. Results: The study has found that there is significant association between the size of the gall stones with that of histological diagnosis (p<0.05). The study has found no association between any characteristic and the histopathological condition of the gallbladder (p>0.05). Conclusion: The study has highlighted that there is a significant association between the size of the gallstones and mucosal response leading to abnormal histology of the gall bladder.

149. Comparative Assessment of the Efficacy of Collagen Dressing to Routinely Use Dressing Components Such as Normal Saline in the Treatment of Diabetic Foot Ulcers
Amit Anand
Aim: The current study compares the efficacy of collagen dressing to routinely use dressing components such as normal saline in the treatment of diabetic foot ulcers. Material & Methods: This Prospective comparative study was conducted in department of surgery at Shri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, over a period of one year. Results: Reduction in ulcer size was recorded on the day of admission, on the 7th day, 14th day and 28th day. In the normal saline-treated group, on the day of admission ulcer size reduction was found to be 18.53 ± 7.18, on the 7th day was found to be 17.32 ± 8.19, on the 14th day was found to be 15.18 ± 8.60 and at 28th day was found to be 13.55 ± 6.48. In collagen treated group, on the day of admission ulcer size reduction was found to be 15.38 ± 7.29, on the 7th day was found to be 14.26 ± 9.12, on the 14th day was found to be 12.20 ± 7.11 and on 28th day was found to be 10.09 ± 5.38. Conclusion: Collagen dressing speeds wound healing in diabetic foot ulcer patients, lowering hospital stay and the necessity for split-thickness skin transplantation. Our research has led us to the conclusion that collagen dressings are superior to conventional dressings.

150. Alexithymia and Suicidal Ideation in Alcohol Dependence
Chandra Bhushan Rai, Lokesh S Shekhawat, Arvind Kumar
Objective: Alexithymia is a multifaceted construct that was first described by Sifneos in 1973 as difficulty identifying and communicating feelings, differentiating feelings and somatic sensations of emotional arousal, a diminution of fantasy and imagination and an externally oriented cognitive style. Alexithymia is linked with multiple psychiatric comorbidities including substance use disorders and suicide. The objective of this study was to evaluate the relationship between alcohol use and alexithymia in Indian population. Methodology: The study was cross-sectional observational study with sequential recruitment. Patient’s aged 18-60 years who met ICD 10 criteria for alcohol dependence were recruited. Participants were assessed using sociodemographic proforma, AUDIT, TAS-20 and for presence of history of past suicide attempt and current suicidal ideation. The collected data was analysed using Jamovi Software and appropriate statistical methods were applied. Results: The prevalence of alexithymia was thus found to be 18% with another 23% being classified as having probable alexithymia. The prevalence of current suicidal ideation was found to be 16%. Prevalence of history of past suicide attempt was found to be 20%. No statistically significant relation was observed between alexithymia and history of prior suicide attempt. No significant correlation between scores of TAS-20 scale & AUDIT scale were observed. This study also had some limitations, namely lack of female participants, exclusion of people with depressive episode or recurrent depressive disorder, and potential impact of COVID19 pandemic as causes of selection bias. Conclusion: Prevalence of Alexithymia in users with alcohol dependence syndrome was much lower than that found by previous studies. TAS-20 scores were not correlated with AUDIT scores (and thus severity of alcohol dependence). The study gave valuable information on prevalence of alexithymia and suicidal ideation amongst alcohol dependent persons, however, no significant correlation was found amongst them.

151. A Hospital-Based Clinic-Pathological Assessment of the Soft Tissue Tumors
Kumari Rashmi, Rakesh Raushan Chaudhary
Aim: In the present study, we recorded detailed clinical history with examination of patients from records including age, sex, site of tumor. Methods: The present study was conducted in the Department of Pathology, Darbhanga medical college and Hospital, Darbhanga  Bihar, India. Total 200 Soft tissue tumors were obtained in the six months. We record parameter like age, sex, and anatomical location of tumor from clinical record and history. All these tumors we categorized under extremities, trunk-abdomen and head and neck region. Results: The highest prevalence of benign soft tissue tumors was in third decade while malignant tumors had in fifth decade. Soft tissue tumors had slightly male preponderance having male to female ratio been 1.3:1. Male to female ratio in benign tumors was 1.2:1 and among malignant tumors ratio was 2:1. Extremities were the commonest location for both benign and malignant soft tissue tumors there after head and neck region was common. The most common benign tumor in this study was Adipocytic (27.5%) form all benign tumors followed by vascular tumors (17.5%), peripheral nerve sheath tumors (14%), fibrous tumors (3%), fibrohistiocytic tumors (5%) smooth muscle tumors and tumors of uncertain differentiation (12.5%). Among the malignant soft tissue tumors Adipocytic (5%) was commonest, followed by vascular tumors (2.5%) malignant peripheral nerve sheath tumors (1.5%). Conclusion: The clinic-morphological evaluation of soft tissue tumors is gold standard in present days also for diagnosis and management especially in the institute where the new techniques like IHC & molecular pathology are not available. But the immunohistochemistry is needed for proper diagnosis, further management of patients and correct classification of tumors.

152. A Clinical Study of Assessment of the Various Risk Factors and Outcome of Two Different Management Methods of Lower Limb Cellulitis
Kashinath Pandit, Sumit Mishra, Chandra Mohan Sinha
Aim: The present study aimed at determining the incidence of cellulitis of lower limbs, demographic and clinical risk factors, clinical course and complications of the patients which helps healthcare professionals in better understanding of the condition and plan preventive treatment. Methods: The present prospective, observational, clinical study included 150 patients who were admitted to the department of general surgery, Jawaharlal Nehru medical college and hospital, Bhagalpur, Bihar, India, with lower limb cellulitis either unilateral or bilateral for a period of eight months. Results: One hundred fifty patients with cellulitis consisting 90 males and 60 females were included in the study. The age of the patients was between 20 years to 85 years and the average age of incidence was 54.61 years. The incidence of cellulitis is high among males (60%) than to females (40%). Unilateral limb is involved in 95% of the patients while bilateral involvement is seen in 5% of patients. Conclusion: TRAUMA is the most common cause of lower limb cellulitis in nondiabetics, young adults of 18-40 years of age are most commonly affected which can be due to trauma at work place or transit. Most of these patients are managed very well conservatively successfully. Surgical intervention if needed is also uneventful if no other comorbidities are associated.

153. A Comparative Evaluates and Analyze the Microbiomes Component of the Vagina in Females with Polycystic Ovarian Syndrome (PCOS)
Shashi Prabha Sinha, Amit Kumar Ambasta, Seema, Sangeeta Singh
Aim: The aim of the present study was to evaluate and analyze the microbiomes component of the vagina in females with polycystic ovarian syndrome PCOS, and compare it with that of healthy females. Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for 1 year. A case-control study in which the microorganisms settling in the vaginal area was compared for two groups of women, the first group suffering from PCOS and the second group being the control group. The study included 100 females. Results: We compared the sociodemographic data, the mean age of PCOS patient is (27.3±951) while mean age of control group is (29.1±0.786), (4%) were smokers in PCOS group and (2%) in controls, the PCOS patient tends to be obese (mean of BMI is 27.3±4.26) while the mean of BMI for control group is (22.8±2.12). We found that there is significant difference in mean of the frequency of menstrual cycle between both study groups (5.6±1.7) and (11.5±1.6) respectively (p- value < 0.0001, 45 cases of total 50 PCOS cases were have oligomenorrhea while 1 out of 50 control group have oligomenorrhea. All PCOS cases had Ultrasound feature of polycystic ovaries while control group have no case have this feature; for biochemical and clinical feature of hyperandrogenism, p-value was significant between both study groups. Conclusion: There is large diversity in the vaginal microbiota with disruption to normal flora in PCOS affected patients so we need further studies to evaluate the relationship between the microbiota.

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