International Journal of

Pharmaceutical and Clinical Research

ISSN: 0975 1556 Peer Review Journal

Print-ISSN 2820-2643

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1.Intussusception in Elderly Patient with Classical Triad of Presentation-A Case Report
Anupam Ranjan, B. K. Suman, Sweta Rani
Intussusception is the invagination of one segment of the bowel into another. It is common in children, rare in the elderly age group (1). Most of the causes in children are idiopathic whereas leading point pathology exists in the elderly age group[2]. In 54–69% of adult cases, the precipitating cause is bowel malignancy [3]. We are presenting a case high level of suspicion was required to reach at the diagnosis as the patient has only complaint of intermittent pain for the last 20 days relieved on taking analgesic and has passed mucous mixed bloody diarrhoea 2 days back with no history of nausea or fever.

2.The Role of N-acetylcysteine in Diabetic Nephropathy Patients
K Vijay Kumar, Jagan Nadipelly, Reena Verma, Thamizharasan S, Chandrasekhar Reddy Bolla, Sandeep Adwal, Anila Sadipirala
Background: Diabetes is a big issue in both developed and underdeveloped countries. The progression of the disorder results in extended hyperglycemia exposure of vascular tissues, leading in long-term microvascular/ macrovascular consequences in the health, one of which is nephropathy.
Objective: The goal of this study was to see how N-acetylcysteine affected microalbuminuria and HbA1c levels in diabetic nephropathy patients.
Materials and Methods: A randomized, open-label experiment with 58 diabetic nephropathy patients (50 men and 8 women) between the ages of 35 and 60 who have had diabetes for at least 5 years. Positive control and N-acetylcysteine groups were used to split the patients. For both the positive control and the N-acetylcysteine groups, there are 29 patients in each group for examination of the parameters during a three-month period.
Results: When compared to the positive control group, there was a substantial decrease in levels of microalbuminuria and HbA1c (glycosylated hemoglobin) after 4 months of N-acetylcysteine supplementation.
Conclusion: According to the findings of the study, N-acetylcysteine reduces microalbuminuria and HbA1c in diabetic nephropathy patients. As a result, N-acetylcysteine supplementation may help to avoid diabetic nephropathy.

3.Study of Haematological and Hemodynamic Disorders in Chronic Liver Disease Patients in Central Rajasthan
Anil Kumar Sharma, Mohammed Riyaz Bhati, Sayed Wasim Ahmad, Rajesh Jain
Introduction: The liver plays an important role in homeostasis. Chronic liver disease including cirrhosis, hepatic failure, jaundice and portal hypertension may affect hemopoiesis. The abnormalities in RBC, WBC, and platelet functions in patients with CLD are well documented. It is thus important to detect and manage these abnormalities to reduce overall morbidity and mortality of patients with CLD. Method: This is prospective study conducted for the period of 2 years at a tertiary care centre. A total of 100 patients of chronic liver disease were included and analysed for their haematological dysfunction and haemostatic abnormalities. Results: In our study out of total 100 patients, there were 79 male and 21 female patients. The ages ranged from 20 years to 60 years. There were two patients with Wilson’s disease, 61 of alcoholic liver disease, 15 patients were positive for HBsAg and one patient was positive for anti HCV antibody. Eight patients had severe anemia, 80 patients had anemia and only 12 patients had normal hemoglobin above 12 gm%. Fifty patients had normochromic normocytic anemia, 28 patients had microcytic anemia and 10 patients had macrocytosis. On account of WBC parameters, the TLC ranged from 1150/mm3 to 16,100/mm3. Forty-four patients had leukocytosis, out of which 12 patients had lymphocytosis. Eosinophilia was found in only 4 patients. Leucopenia was seen in 9% of patients. Thrombocytopenia was found in 42 patients. These patients had a history of at least an episode of hematemesis. Among the patients with severe thrombocytopenia 9 patients were found to have disseminated intravascular coagulation. Among the 58 patients with normal platelets level about 16 patients had mild splenomegaly and 12 patients had moderate splenomegaly. In 10 patients, splenomegaly was observed only on USG. In this study only 14% had total proteins more than 6 gm% and only one patient had total protein <4 gm% and others in the middle group. All the 100 patients had albumin globulin ratio reversal. Fifty-eight patients had prolonged prothrombin time. There was no correlation between the severity of jaundice and the prolongation of prothrombin time. Among the 58 patients with prolonged prothrombin time about 38 patients had history of at least one episode of hematemesis. Bleeding time was prolonged in 20 patients who had platelet counts less than 1,00,000/mm3. Conclusion: This study reflects that all the chronic liver disease patients must be evaluated for hematological and hemostatic abnormalities and should be monitored for any complication. Early treatment to correct these comorbidities can decrease the mortality.

4.Comparative Study of the Effects of Dexmedetomidine and Butorphanol as Epidural Adjuvants in Lower Limb Orthopaedic Surgery under Intrathecal Levobupivacaine Anaesthesia
Ghosh B, Chakraborty S, Majumdar S, Mondal A, Sil D, Pathak D
Objective: To evaluate the effect of Butorphanol versus Dexmedetomidine as epidural adjuvant to intrathecal Levobupivacaine block on the onset and duration of blockade, post-operative analgesia,  haemodynamic changes and minimal sedation in patients undergoing elective lower limb orthopaedic surgeries. Methods: Prospective, randomized, double blind, interventional study was conducted on 46 patients of 18-50 years age of either sexes having body weight between 40-70 kgs, ASA grade I-II, underwent elective lower extremity orthopaedic surgeries under spinal anaesthesia in orthopaedic operation theatre over a period of one year. Using computer generated randomization, the patients were allocated into two groups: Group LD (n = 23), Group LB (n = 23).Both the group received 15 mg of 0.5% Levobupivacaine (heavy) intrathecally plus Group LD received Dexmedetomidine 1 µg/kg in 10 ml saline and Group LB received Butorphanol 10 µg/kg in 10 ml saline epidurally. The haemodynamics block characteristics, sedation, VAS score and side effects were observed. The data was analysed using student’s t-test and Chi square test. P value of ≤0.05 was considered statistically significant. Results: Time taken for adequate sensory (p< 0.05), motor block (p< 0.001) was shorter for Dexmedetomidine group than Butorphanol group. Regression to S-2 level, duration of motor block, time for rescue analgesia was significantly more for Dexmedetomidine group (p<0.001). Sedation score was better in group LD than group LB. Conclusion: Epidural Dexmedetomidine is a better alternative than epidural Butorphanol when combined as an adjuvant to intrathecal 0.5% hyperbaric Levobupivacaine in terms of prolonged block duration,  post-operative analgesia with minimal adverse effects.

5.Combined Diagnostic Value of Modified Alvarado Score (MAS) and Ultrasound for the Diagnosis of Acute Appendicitis
Rita Singh, B. Shailendra
Introduction: Acute appendicitis is one of the most happened surgical emergencies, needs early diagnosis and immediate surgical management to prevent adverse events. In an attempt to increases the diagnostic accuracy, several imaging techniques and clinical scoring systems have been established. This study was designed to assess the sensitivity of modified Alvarado score and ultrasound in the diagnosis of acute appendicitis and correlating with operative and histopathology findings. Material and Methods: Eighty clinically diagnosed cases with acute appendicitis and getting admitted for the surgery belonged to age group >18 years were included. Preoperatively, Modified Alvarado score (MAS) and ultrasound abdomen findings were applied in the initial diagnosis. The outcome values of Modified Alvarado score and USG were correlated with operative and HPE findings. Results: Migration of pain from umbilicus to right iliac fossa was common presenting symptom, followed by anorexia and tenderness and nausea and vomiting. 37 cases had MAS score >7 and remaining had score <7. The overall sensitivity for cases with MAS score > 7 was 98.4%. The correlation of modified Alvarado score and ultrasonography together with operative and histopathological findings showed statistically significant value (p<0.0025) with sensitivity of 38.75%. Discussion and Conclusion: The Modified Alvarado score and ultrasonography together has better sensitivity and increases the diagnostic accuracy for acute appendicitis and reduces negative appendectomy rates. However, compared to the operative and histopathological findings the sensitivity was found to be low with notable specificity.

6.Establishment of Age and Gender Specific Reference Range for Thyroid Hormones Levels among Blood Donors of Northern Indians
Gupta Deepa, Nagtilak Suryakant, Agrawal Prateek, Deshmukh Kalyani, Jindel Aditi, Vinayak Kamini
Background: In clinical endocrine practices, it is difficult to differentiate thyroid diseases from subclinical hypothyroidism (SCH). Therefore, the present study focused on the establishment of age and gender specific reference ranges of serum thyroid hormones to discriminate SCH from healthy northern Indian control. Material and Methods: Present study was conducted on 1018 healthy individuals aged between 18-60 years who intent to participate in blood donation camps held at Medanta- The Medicity, Gurgaon, Haryana (India). Participants with clinical history of thyroid abnormality and related symptoms were excluded from the study. The circulatory levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormones (TSH) were analyzed using competitive immunoassay technique on dry chemistry fully autoanalyzer. Result: An establishment of age and gender-specific range, and corresponding 95% confidence intervals (CIs) were calculated for each age group. A significant change in thyroid hormone levels were documented with increasing age group in both genders, as well as significant correlation was also found between FT3, FT4 and TSH in respective hormones (p<0.05). Conclusion: The present study concluded that circulatory thyroid hormone levels alter markedly with growing age. An establishment of reference range for thyroid hormone is need of an hour for better understanding and differentiating individuals from SCH.

7.A Comparative Study of FNAC and Histopathology of Neck  Swellings
Sarita Kumari, Dharmendra Kumar, Deepak Kumar
Background: To understand the nature of the lesion and the precision of the diagnostic tools in making a conclusive diagnosis, the current study attempted to identify the prevalent pathologies presenting as neck swellings in our area and their clinical and histological correlation. Materials and Methods: This study was conducted from August 2021 to July 2022 at the J.L.N.M.C.H. Bhagalpur Department of E.N.T. and Department of Pathology. As a result, of the 50 cases examined, histology identified 81.9% of them as benign and 18.1% as malignant, while cytological analysis identified 89.4% of them as benign and 6.9% as malignant, leaving 3.8% of the cases with unclear results. 6.9% of cases had signs of cancer during surgery, while 93% of cases were benign. The most frequent benign neck swelling (70.2%) was thyroid. Conclusion: FNAC is the safe and simple modality in the investigation of neck swelling with high accuracy and specificity.

8.A Study about Prevalence of Refractive Errors, and Presbyopia in Muzaffarpur District, Bihar, India.
Manoj Kumar Mishra, Vaidehi Kumari, R. K. Singh
Objectives: The present study was to evaluate the sociodemographic profile and prevalence of vision impairment (refractive errors and presbyopia) in Muzaffarpur district, Bihar, India. Methods: A detailed epidemiological profile such as age, gender, locality (rural/urban), education, monthly family income, occupation, questionnaire about near vision problem and systemic history were noted in the prescribed pro forma. Modified BG Prasad classification was used for classification of socioeconomic status. Results: A total of 1000 subjects were screened for vision impairment. Prevalence of refractive errors was 122(12.2%). The prevalence of presbyopia was 55(5.5%). Most of the cases of refractive errors were seen in age 11-20 years 48(39.34%) and 40(32.79%) 21-30 years. 22(2.2%) patients had both presbyopia and refractive error. Among 22 patients of presbyopia and refractive error, most of the patients 18(81.82%) were in age group of 40-49 years. Conclusions: Vision impairment is more common in male population as compared to female population. And it is commonly seen in students, office bearer and middle socioeconomic population.  Preponderance of refractive error is greater in age 11-30 years where as presbyopia is greater in age >40 years. Myopia and hypermetropia are the most common refractive error. Hence, we should organize a medical camp for screening of vision impairment in rural as well as urban area for awareness and prevention and prompt treatment of vision disorder.

9.A Study on Maternal Risk Factors Associated with Term Low Birth Weight Infants
K. Margaret Punitha, Poornima Shankar, Vikram R
Background: Low birth weight (LBW) deliveries contribute to high neonatal mortality rates (NMR) in developing countries. Several maternal risk factors are associated with LBW newborns. Appropriate interventions will help to reduce the incidence of LBW deliveries in these countries and improve neonatal survival outcomes. This study aims to identify maternal risk factors associated with LBW in India. Materials and Methods: A cross-sectional study of 506 consecutive live newborns delivered between January 1st and June 31st 2022 was conducted in Kannigaa puram, MADURAVOYAL ,Chennai. Maternal data included last menstrual period, history of illnesses such as hypertensive disorders and anaemia during pregnancy, delivery date and time. The weights of the newborns were measured at birth. Data were analyzed with the Statistical Package for Social Sciences (SPSS) version 18.0. The relative risk of having a LBW newborn with maternal factors was calculated. Results: There were a total of 72 LBW newborns, giving an incidence rate of 14.2%. Eighteen (25%) of the mothers with LBW deliveries had malaria in pregnancy while 4 (5.6%) tested positive for human immuno-deficiency virus (HIV). The relative risk of having a LBW newborn was high in maternal HIV (RR=3.25, C.I=1.51-6.97), hypertension in pregnancy (RR=3.07, C.I=1.52-6.22), ante partum hemorrhage (APH) (RR=7.20, C.I=5.79-8.95), as well as primiparity (RR=1.35, C.I=0.88-2.08).Conclusion: Birth weight in infants depends  on  several  causes,  not a single cause. Drug Abuse, the interval between pregnancies, and the history of  bleeding  are  among the most preventable factors associated with LBW.

10.Efficacy of Cord Blood Transfusion in Children with Severe Acute Malnutrition Weighing Six Kilogram or Less
Shoaib Beg Mirza, Sumitra Varshi, Priyanka Shukla, Umesh Pandwar
Objective: To establish the efficacy of umbilical cord blood (UCB) as an alternative to adult human blood (AB) and to compare change in haematological parameters after transfusion in children with severe acute malnutrition (SAM). Study design: It was a prospective interventional study of UCB transfusions given to children with severe acute malnutrition requiring blood. UCB was collected in labour Room, under all aseptic precautions, and pretesting were done in blood bank. SAM children fulfilling inclusion criteria were included. UCB and AB was given as per availability and consent. Post blood analysis was done next day to transfusion, watched for reactions. Outcomes like death, discharge and duration of hospital stay were analysed. Results: A total of 90 blood transfusion were performed, out of which 40 received UCB and 50 with AB. Mean rise of haemoglobin in UCB transfused patient was 1.40gm/dl. Conclusion: In SAM children requiring blood transfusion whole UCB is a good and safe alternative of whole AB.

11.Correlation of Foot Length of Newborn with Gestational Age
Shoaib Beg Mirza, Deepshikha Namdeo, Umesh Pandwar
Objective: To measure the foot length of Newborns and to compare foot length to gestational age assessed by Ultrasound.Study design: It was a prospective Observational Foot length of Newborns fulfilling inclusion criteria was measured using electronic sliding caliper with an accuracy of one tenth of a millimetre. Head circumference was measured using flexible, non-stretchable measuring tape using cross tape method by Placing the measuring tape just above the eyebrows and ears, widest part of the head will be measured. Crown heel length will be measured using infantometer. All infection prevention, precaution standards were used during the time of measurement. Standard precautions were also applied for measuring equipment. All the measurements were taken within 24 hours of birth. After collection of data appropriate statistical test was applied. Results: The AUC score based on ROC curve was 0.90. The optimal cut-off foot length for full term categorization was 75.2 mm. The identification of preterm newborns with foot length < 75.2mm had a sensitivity of 92.0%, which means that 92% of preterm newborns (<37 weeks) can be detected by a foot length examination, specificity of 90.0% means that there is a 90% improbability of full term gestational age (more than 37 weeks) in newborns who have a foot length <75.2mm. Conclusion: In conclusion, newborn foot length can be used to predict gestational age. Longer newborn foot length is indicative of higher gestational age. The optimal cut-off point for diagnosing full term babies was 7.52 cm. Foot length <7.52 cm can be used to diagnose preterm babies. Newborn foot length is a reliable anthropometric measurement to diagnose preterm babies.

12.A Comparative Study of Safety and Efficacy of Azilsartan and Telmisartan in Newly Diagnosed Hypertensive Patients
Thota Madhu Chaithanya, Vatsala Maheshwari, Pushpraj Gour, Reena Verma, Nilam Nigam
Objectives: The antihypertensive medicine telmisartan and the angiotensin receptor blocker azilsartan are both frequently prescribed to people with hypertension. Azilsartan and Telmisartan were compared for their safety and effectiveness. Materials and Methods: The participants in this prospective, randomized trial were patients at Rama Medical College Hospital & RC, Kanpur. Severe hypertension >180 mm of Hg, pregnant women, cardiac arrhythmias, smokers, and alcoholics were excluded from this study. Patients with newly diagnosed hypertension of either sex within the age range of 25-60 years with a blood pressure of >140/90 mm of Hg were included in the study. Two groups of patients are created, with group 1 receiving Azilsartan and group 2 receiving Telmisartan. Results: 100 patients were randomly divided into two groups; of the 50 patients in each group, 1 received azilsartan, while the other 2 were lost to follow-up. Three of the 50 patients in group 2 who got telmisartan were unfollowable. Systolic and diastolic blood pressure were not significantly different between the two medications after 24 hours. Azilsartan decreased mean systolic and diastolic blood pressure more than Telmisartan.

13.Comparative Study of Electrolyte Imbalance between Hemorrhagic and Non-Hemorrhagic Stroke Patients at a Tertiary Care Teaching Hospital
Renu Khamesra, Vinod Kumar Mehta, Rajat Talesra
Background: There are mainly two types of stroke patients viz; non-hemorrhagic stroke and hemorrhagic stroke. The electrolyte imbalances of sodium and potassium are the most common electrolyte abnormalities in patients with acute stroke. Objectives: To compare electrolyte imbalance between acute hemorrhagic and non – hemorrhagic stroke patients. Materials and Methods: This cross sectional observational study was conducted in department of Neurology and General Medicine of Geetanjali Medical College and Hospital, Udaipur, Rajasthan for a period of two years. Acute stroke was diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) of the brain. Patient’s demographics, investigations and clinical profile data were entered in the performa sheet. All acute stroke patients were divided in two groups hemorrhagic (S-H) and non-hemorrhagic (S-NH) for analysis and comparison. Results: Hyponatraemia was observed in 12 (26.08%) of S-H group and 46 (25%) in S-NH group (p>0.05). Hypernatremia was seen in 4 (8.69%) of S-H group and 9 (4.89%) in S-NH group (p>0.05). Hypokalemia was observed in 3(6.52%) of S-H group and 11(5.97%) in S-NH group (p>0.05). Hyperkalemia was seen in 3(6.52%) of S-H group and 18 (9.78%) of S-NH group (p>0.05). Conclusion: This study concluded that electrolyte imbalance in the form of hyper or hypokalemia and hyper or hyponatremia are common in hemorrhagic and non- hemorrhagic acute stroke and they should be screened immediately irrespective of stroke type.

14.Drug Prescribing Pattern of Antifungal Drugs for Local Fungal Infections at a Tertiary Care Hospital, Palanpur, Gujarat
Jay Shah
Aim: Present research was performed to know the pattern of dermatological diseases in this area and to study the prescription pattern of antifungals in this organization. Material and Methods: Present research was performed at Banas Medical College And Research Institute, Palanpur, Gujarat. Data of drugs prescribed were taken from subject’s prescription. Prescriptions incorporated all recently diagnosed subjects with cutaneous fungal infection of both genders who attended Dermatology OPD. Factors measured were sociodemographic parameters, number of subjects with combination and monotherapy, number of single topical agents and Fixed Dose Combination (FDC) details of prescribing indicators. Results: The findings of current research described that out of 2700 prescriptions studied, 1000 prescriptions were of fungal infection. Clotrimazole and Terbinafine were the most frequently prescribed drugs in single topical agents followed by Ketoconazole and Luliconazole. Average number of drugs prescribed per encounter is 3.18. Average number of antifungals prescribed per encounter is 2.01. Conclusion: Most frequent oral antifungal drug and topical antifungal drug were Clotrimazole and Terbinafine respectively. Combination antifungal therapy was more commonly used than monotherapy.

15.A Retrospective Study to Evaluate the Surgical and Pharmaceutical Management of Diabetic Foot Infection
Dhiraj Bhambhani, Manish Kumar, Anurag Jain, Mohit Kulmi
Background: With expensive medical care and lengthy hospital stays, diabetic foot infection is a leading cause of patient disability and decreases the need for limb amputations. Aim: The purpose of this study was to assess the effectiveness of surgical wound care combined with antibiotics in the management of mild and moderate diabetic foot infections. Methods: 60 individuals with diabetic foot infections, either with or without osteomyelitis, participated in this retrospective analysis. The patients were divided into groups 1 and 2, mild and moderate, respectively. Local wound debridement and systemic antibiotic treatment were used to treat both groups. Patients in Group 1 (16) received treatment with two oral antibiotic regimens for 10–14 days each: regimens A (amoxicillin/clavulanate + metronidazole) and B (clindamycin + metronidazole). A (ampicillin + cloxacillin + metronidazole) and B (lincomycin + metronidazole) were the two regimens used to treat the 42 patients in Group 2 for a total of six weeks. Three months of patient follow-up with neighbourhood wound care experts allowed for evaluation of the effectiveness of the therapy (cure, improvement, or failure). Results: Group 1 had a cure rate of 80% with regimen A and a cure rate of 100% with regimen B. Patients in group 2 receiving regimen A had a 61.5% cure rate and improved by 11.53%, whereas those receiving regimen B had a 68.75% cure rate and improved by 12.5%. In 20 osteomyelitis patients treated with both regimens, failure was 23.8%; over the trial period, cure rates were 35% and improvement rates were 20%. Conclusion: Local surgical wound treatment for three months followed by six weeks of antibiotic regimens produced good cure rates, lower expenditures, and fewer hospitalizations. For mild diabetic foot infections, intravenous lincomycin and oral metronidazole had better cure responses.

16.A Cross-Sectional Clinical Comparison Study of Patient Satisfaction with Regional Anaesthesia and General Anaesthesia during Upper Limb Procedures
Nishant Trivedi, Dimple Makhija, Ranjeetsinha Kakasaheb Jadhav, Anurag Jain
History and Objectives: Patient happiness is a crucial indicator of the quality of healthcare. However, there aren’t many research that look into this issue. The main goal of this study was to assess patient satisfaction in patients undergoing upper limb procedures under regional anaesthesia (RA) and general anaesthesia (GA). The secondary goals were to compare the duration of analgesia and hospital stay between the two procedures. Methods: This cross-sectional investigation was conducted in a teaching hospital for tertiary care. The study comprised patients undergoing upper limb procedures who were between the ages of 18 and 60 and had an American Society of Anesthesiologists (ASA) grade 1-3 physical status. A 10-item pre-designed post-operative questionnaire was used to gauge patient satisfaction with anaesthesia in patients getting GA and RA, with 100 patients in each group, at least 24 hours following the procedure. The Mann-Whitney-Wilcoxon test was used to compare continuous variables between groups, while the Chi-square test was employed for categorical data. Results: Regarding each of the 10 questionnaire questions individually as well as the overall score, the patients in group RA demonstrated noticeably greater satisfaction levels than those in group GA (P 0.001). Additionally, the analgesic duration was noticeably longer in RA than GA (P 0.001). Additionally, the time spent in the hospital was much longer in GA than in RA (P 0.001). Conclusions: In addition to prolonged analgesia and a shorter hospital stay, RA for upper limb procedures offers better patient satisfaction than GA.

17.A Cross-Sectional Research on the Financial Impact on Family Members of Alcohol-Dependent Care Givers
Anil Korade
Introduction: In India, the primary source of treatment for patients, especially those with alcoholism, is family. Almost all facets of family life—personal, social, and psychological—are impacted by an alcoholic. This results in issues, challenges, or undesired procedures that affect family members and put a tremendous load on those who are caring for them. The study’s objective was to evaluate how much family responsibility fell on the patients’ primary caregivers who were also alcohol-dependent. Methods: A hospital-based study was carried out in a training and treatment facility for drug addiction in India. A purposive sample strategy was used to choose 200 alcohol-dependent patients from the outpatient department (OPD) at tertiary care centre in Ahmednagar who had access to main caregivers. 200 caregivers (one form per patient) were enrolled in the study with the patient’s and caregiver’s informed consent. Using the Family Hardship Interview Schedule, the pattern of burden experienced by family members of those with alcoholism was evaluated (FBIS). Results: According to the findings, most carers were housewives. There was a moderate to severe level of load across all care domains. Alcoholism was linked to financial stress on the family. It revealed a significant burden for low-income households living in rural areas. Conclusion: Alcoholism negatively impacts both the patient and their life.

18.Supraclavicular Brachial Plexus Block for Upper Limb Surgery: Comparison of Dexamethasone and Fentanyl as Adjuvants to Bupivacaine and Lignocaine
Parul J. Oza, Kaushik D. Pragapati, Ashish Kharadi, Harsad Patel
Introduction: With patients having forearm procedures, the goal was to examine the effects of dexamethasone and fentanyl when added to a combination of lignocaine and bupivacaine for supraclavicular blocks. Methods: In a prospective, double-blinded, and randomly selected manner, 240 patients with ASA 1 or 2 were recruited. Their ages ranged from 20 to 60. Injections of bupivacaine (0.5%) 20 cc + injections of lignocaine (2%) 10 cc + injections of 0.9 percent normal saline were used to perform supraclavicular blocks under sonographic guidance in the three groups: Group S, Group D, and Group E. Injections of bupivacaine (0.5%) 20 cc + injections of lignocaine (2%) 10 cc + injections of dexamethasone (8 (Group F). Hemodynamic variables, sensory and motor block length, and their beginning and onset times were also noted. Results: Group D displayed a sensory and motor block length that was substantially longer than that of the other groups (P = 0.001). Hemodynamic variables were compared between groups, but no statistically significant differences were found. Conclusion: Fentanyl and dexamethasone are both effective adjuvants for the supraclavicular block, although dexamethasone is superior due to its quicker onset and longer duration of analgesia.

19.Pattern of Paediatric Dermatoses in a Tertiary Level Hospital in Lucknow-A Prospective Observational Study
Rohit Kumar Singh, Vishal Sharma, Sukant Mihir Pathak, Naveen Netaji Rao
Introduction: Diseases of the skin are quite common in the paediatric age group. Children present to the hospital OPD with varied forms of skin diseases with a pattern and presentation that is different from adults. The aim of this study was to study the prevalence and pattern of skin diseases in the paediatric population attending the skin OPD of a tertiary care hospital in Lucknow. Materials and Method: This study was conducted at a tertiary care hospital in Lucknow. 400 children who attended the skin OPD were enrolled in the study. Elucidation of history, clinical examination and lab investigations were done to arrive at a clinical diagnosis. Any possible association factors were studied. Results: Infestations (25%) were the commonest disease encountered. Scabies topped the list among all skin diseases (20.75%). Skin diseases were most commonly noted in school children of 8-12 years age group (44.75%). A higher family size (6-10 members) presented with more skin ailments (69.25%) as compared to a family size with lesser members. Seasonal trends were witnessed wherein infestations (42%) and papulo-squamous conditions (30%) were significantly higher in winters whereas vesiculo-bullous conditions (34%) were significantly higher in summers as compared to other seasons. Conclusions: This study has provided a general idea of patterns of presentation of skin ailments at the skin OPD in children. Preventive measures can be devised based on possible associations and trends observed which can reduce the morbidity by significant levels.

20.Comparison of Forehead Infrared Thermometry and Tympanic Membrane Thermometry with Axilary Digital Thermometry in Term Neonates Admitted in NICU at Tertiary Care Centre Gujarat
Ashwin Rasiklal Dangi, Dhaval Kantilal Chaudhary, Parth Babulal Patel, Gaurav J Desai
Background: Neonates are more thermo-labile, so precise temperature recording relics a necessary part of the neonatal care. The greatest technique to calculate temperature should imitate the accurate body temperature and should not be exaggerated by outside factors. Objectives: to evaluate the precision of digital axillary thermometer (DAT) with infrared tympanic thermometer (ITT) and infrared forehead skin thermometer (IFST) dimensions for term infants admitted in the NICU. Material and Methods: Present research was performed among 625 term neonates admitted in NICU at Paediatrics department of tertiary care hospital at Visnagar, Gujarat, India during November 2021 to July 2022. Three temperature readings were executed from each newborn in NICU by the investigator at interval of 24 hours. Total 225 neonates enrolled in this study. Results: In Axillary and tympanic temperature, maximum difference was 1.50C and minimum -1.20C where in forehead method; it was 1.80C &-1.30C respectively. The body temperature measurements by axillary and forehead techniques did not concur well. The body temperature dimensions by axillary and tympanic methods did not concur well. Conclusion: Forehead infrared, tympanic infrared with axillary digital thermometer dimensions did not concur fine. Forehead infrared thermometry is not precise adequate and cannot substitute axillary thermometry for body temperature dimension in neonates.

21.Clinico-Hematological Parameters in Dengue Fever: A Retrospective Study in a Tertiary Care Hospital
Vasundhara, A. Lavanya, B. Venkata Rajeswari
Introduction: Dengue viral infections are among the most important mosquito-borne disease of the Indian subcontinent. Clinical manifestations of this illness range from a typical fever to dengue shock syndrome and death. The study was aimed to determine the clinical and haematological characteristics of patients with Dengue fever. Materials and Methods: This retrospective cross-sectional study was conducted at a tertiary teaching hospital, Kurnool over duration of one year. All the patients above the age of 14 years who were diagnosed with Dengue with a positive result for NS1Ag or IgM or IgG antibodies were included. All the necessary clinical and laboratory investigation parameters of the patients were obtained from the hospital’s medical records. The data was analysed by frequency and percentage. Result: During the study period, a total of 98 dengue cases were included in the study. Of these, there were 48 (49%) Males and 50 (51%) females between 15 and 76 year age. The most common clinical presentations were fever (100%), headache 87 (88.7%), myalgia 81 (82.6%), and nausea/vomiting 69 (70.4%). The common hematological findings were Thrombocytopenia 80 (59.8%), followed by Leucopenia 50 (26.5%), Anemia 39 (39.7%) and Hematocrit (10.2%). Conclusion: Fever, Myalgia, and Headache are the most prevalent clinical manifestations of Dengue fever. Low total leucocyte count, low platelet count, and a rise in haematocrit are the most prevalent laboratory abnormalities. These clinical and laboratory profiles of typical dengue viral illnesses should alert physicians to the possibility of dengue virus infections in the study region.

22.Study to Evaluate the Association of Hypothyroidism and Cholelithiasis and Complications Associated with Laparoscopic Cholecystectomy
Kamlesh Kumar Sahu, Pradeep Kumar, Pawan Kumar, Shivani
Aim: The aim of this study to evaluate the association of hypothyroidism and cholelithiasis and complications associated with laparoscopic cholecystectomy. Methods: The present study was conducted in the Fort U Mediemergency Hospital, Patna, Bihar, India. It included analysis of 100 cases and 100 controls for one year. Results: Ten of them (10%) found to have subclinical hypothyroidism and 90 (90%) found to be euthyroid. All patients with subclinical hypothyroidism were in the age group of 38–53 years. The patients with subclinical hypothyroidism had more prevalence of single gall stone than multiple stone. Most patients with subclinical hypothyroidism had positive family history (70%), and (30%) had negative family history. Conclusion: Thus, studies conducted in the last two decades, have found a relative association between thyroid dysfunction and cholelithiasis, especially in terms of gender. There have also been speculations about higher incidence of subclinical hypothyroidism in cholelithiasis and also varying results with respect to thyroid dysfunction being more prevalent in patients with choledocholithiasis.

23.A Hospital Based Randomized Clinical Assessment Of Deep Versus Superficial Erector Spinae Block For Modified Radical Mastectomy
Shiv Shankar, Vivek Ranjan, Akriti Singh, Nitin Kumar
Aim: We aimed to compare the techniques in terms of analgesia and sensory blockade in patients undergoing modified radical mastectomy (MRM). Methods: The present study was conducted in the Department of  Critical Care medicine(Anesthesiology), IGIMS, Patna, Bihar, India,   for 1 year. The study adheres to CONSORT guidelines. 100 American Society of Anaesthesiologist (ASA) I/II patients between the age group 20 and 60 years, who were scheduled to undergo unilateral MRM under general anaesthesia, were screened. Out of these, 50 patients were allocated in one of the two groups. Results: Morphine consumption within 24 h postoperative period in group I was 6.50 ±1.30 mg and in group II was 8.65 ±0.75mg. The difference was highly significant between the two groups (P < 0.001). The intraoperative fentanyl consumption (μg/kg) was more in group II (1.56 ±0.480), compared to the other group: 1.5±0.570. Conclusion: Injection of drugs deep to erector spinae muscle provides more cranio-caudal blockade of posterior and lateral chest wall than superficial group.

24.Assessment of the Perioperative Effect of Vasopressin in Patients Undergoing Laparoscopic Myomectomy a Double-Blind Randomized Study
Vivek Ranjan, Shiv Shankar, Nitin Kumar, Akriti singh
Aim: The present study was aimed to study the effectiveness vasopressin for the patients undergoing Laparoscopic Myomectomy. Methods: The present study was conducted in the Department of  emergency and Critical Care(Trauma and Emergency), IGIMS, Patna, Bihar, India, a study was conducted on 150 patients with uterine fibroid and American Society of Anesthesiologists (ASA) physical status I and II, undergoing elective laparoscopic myomectomy for 1 year. Results: The two groups were almost similar in respect to their past surgical and medical history. The two study groups were comparable with respect to the number of uterine fibroids. There was no significant difference in the pre-operative haemoglobin level in the two study groups. There is no statistical significance in the two groups with a ‘p’ value of > 0.05. The mean pre-operative Hb and mean post-operative haemoglobin in patients of group A was 11 (SD 1.124) and 10.4 (SD 1.485) respectively with a ‘p’ value of 0.06. Conclusion: Intra-operative blood loss was significantly more in cases where no measure was adopted for controlling blood loss. Use of vasopressin resulted in reduction of blood loss. Technically, the use of vasopressin is a safe and simple procedure. Vasopressin being cheap and easily available can be used routinely while doing myomectomy whether laparoscopic or abdominal.

25.A Hospital Based Clinical Assessment of the Predictive Factors Responsible for Difficult Laparoscopic Cholecystectomy
Pradeep Kumar, Kamlesh Kumar Sahu, Pawan Kumar, Shivani
Aim: The present study was conducted to evaluate the predictive factors responsible for difficult laparoscopic cholecystectomy. Methods: The present study was carried out on patients diagnosed as cholelithiasis/ cholecystitis who are clinically evaluated and confirmed by ultrasonography in Department of General surgery, ICARE Institute of Medical Sciences and Research & Dr. Bidhan Chandra Roy Hospital, Haldia,(W.B), and Fort U Mediemergency Hospital, Patna, Bihar, India, for the period of 1 year. Results: The result showed that the maximum numbers of cases were in the age group of 51-60 years (31.25%), followed by in 31-40 years (25%).  Out of 80 cases females (62.5%) were the most affected when compared to males (37.5%). The result revealed that USG findings among patients. It was observed that majority of patients with multiple calculi (50%) followed by gall bladder solitary calculi (18.75%), wall thickening (12.5%), impacted calculi (12.5%) and pericholecystic collection (6.25%). Conclusion: The preoperative scoring is statistically and clinically a good test for predicting the operative outcome in laparoscopic cholecystectomy.

26.Study of Vitamin D Deficiency in Hypothyroidism in a Tertiary Care Centre in Southern Bihar
Ananya Mohanty, Ranjan Kumar, Akash Singh
Aim: To Study vitamin D deficiency in hypothyroidism in a tertiary care centre in southern Bihar. Methods: This observational study was carried out over a  period of 6 months in the Department of General Medicine, Narayan Medical College and Hospital, Sasaram, Bihar, India. This research comprised  of 100 patients. They were classified as hypothyroid if their TSH level was greater than 5.0 mU/L and their T3 and T4 levels were lower than normal. Thyroid dysfunction patients’ serum T3, T4, and TSH levels with reference ranges (1.2 – 4.4 pg/ml for T3), (0.8 – 2.0 ng/dl for T4), and (0.5 – 5.0 mU/l for TSH). Results: The mean of all studied parameters, age and sex distribution in all studied groups. Overall mean age of the study population was 47.1 ± 7.29 years. Majority of the patients reported were female (60%). On comparing serum 25 (OH) vit. D levels according to the sex distribution, they were insignificantly decreased in females than those of male hypothyroid patients (t=-0.18, and t=-1.42, P >0.05) respectively. Conclusion: The patients with hypothyroidism suffered from hypovitaminosis D.

27.An Observational Assessment of the Various Indications of Laparoscopic Cholecystectomy for Acute Cholecystitis
Pradeep Kumar, Kamlesh Kumar Sahu, Pawan Kumar, Shivani
Aim: The aim of the present study was to evaluate the indication of laparoscopic cholecystectomy for acute cholecystitis. Methods: The present study was conducted in the Department of General surgery, ICARE Institute of Medical Sciences and Research & Dr. Bidhan Chandra Roy Hospital, Haldia,(W.B),and Fort U Mediemergency Hospital, Patna, Bihar, India. for 12 months. Total 100 acute cholecystitis patients at the hospital and routine daily worker of laparoscopic cholecystectomy in the Department of General surgery, ICARE Institute of Medical Sciences and Research & Dr. Bidhan Chandra Roy Hospital, Haldia,(W.B), and Fort U Mediemergency Hospital, Patna, Bihar, India . Out of 100 selected patients, 80 were males and 20 were females. Results: The result of the study showed that the maximum patients (25%) were from the 46-50 years age group and 20% from the 41-45 years age group, whereas the 51-55 years age group represents 22%. The minimum age was 30 years, and the maximum was 75. The mean age of the respondents who attended the acute cholecystitis was 48 years. Conclusion: In acute cholecystitis, post-operative morbidity, mortality and hospital stay were reduced by laparoscopic cholecystectomy. Moreover pneumonia and wound infection rate were reduced by LC. Severe hemorrhage and bile leakage rates were not influenced by the technique. Cholecystectomy in acute cholecystitis should be attempted laparoscopically first.

28.A Prospective Observational Study to Evaluate the Surgical Outcome in the Treatment of Lumber Disc Prolapse (LDP)
Pradeep Kumar, Pawan Kumar, Kamlesh Kumar Sahu, Shivani
Aim: The aim of the present study is to evaluate the surgical outcome in the treatment of Lumber Disc Prolapse (LDP). Methods: The present study was conducted in the Department of Neurosurgery Fort U Mediemergency Hospital, Patna, Bihar, India for the period of 1 year and 40 patients were selected. Results: Mean follow-up time of our study was 36.50 ± 15.60 months (minimum 12 months). Mean preoperative VAS for radicular pain and low back pain were 9.18±1.89 (standard deviation [SD]) and 6.90±4.31 SD, respectively. Mean preoperative VAS for back pain was higher in women than men. Out of 40 patients, 20(50%) had disc prolapse at level L4-L5, 10(25%) had at L5-S1, 3(7.5%) had L1-L2, 2(5%) patients had disc herniation at L2-L3 and 5 (12.5%) had at L3-L4. Conclusion: Regarding the subjective assessment of current study patients, it was observed that most (75%) of the patients had excellent functional outcome, 15% good, 7% fair and 3% had poor functional out-come according to modified Macnab criteria.

29.Outcome Analysis of Percutaneous Extensor Tenotomy by 18 Gauge Needle in Chronic Lateral Epicondylitis
Md Zuber, Suresh Uikey, Praveen Khatri, Vishal Nigwal, Brajesh Meher, Suneet Tandon
Background: Lateral epicondylitis is condition affecting tendons which causes chronic pain around lateral aspect of elbow. it affects 1 to 3% of general population. The study was outcome analysis of Percutaneous extensor tenotomy by using the bevel end of 18 Gauze needle. Material and Mathods: This was prospective study conducted at the department of OrthopaedicsIn Gandhi Medical College and hamidia hospital Bhopal from July 2019 to June 2021 on 20 patients who underwent percutaneous extensor tenotomy by using the bevel end of 18 Gauze needle. These patients who fails to respond by conservative treatment of duration 3 months underwent Percutaneous Extensor tenotomy. The outcome was evaluated according to rating of pain on visual analog scale. Results: In our study 20 elbows underwent percutaneous extensor tenotomy out of Which 17 patient (85%) achieved complete relief from pain (VAS= 0) with 8 patients at 3 months, 6 patients at 4 months,1 patient at 5 months and 2 patients at 6 months with mean duration at which complete pain relief was achieved at 3.8 months, 3 patients did not improve and hence were lost to follow up after 3 months. Conclusion: In our experience percutaneous extensor tenotomy of the epicondylar muscles for chronic lateral epicondylitis by using bevel end of 18 gauze needle has a high rate of favorable outcomes and is a viable treatment option after failed conservative management. Percutaneous extensor tenotomy is relatively simple to perform as a day care procedure. It can be considered in treatment protocols.

30.A Clinical and Demographic Profile of Tertiary Care Patients with Guillain-Barré Syndrome in Himachal Pradesh
Sanjeev Kumar Singh, Veena Gupta, Ashwani Kumar, Sudhir Sharma
Guillain-Barré syndrome (GBS) is a complex disorder characterized by immune-mediated, self-limiting, reactive peripheral neuropathies. GBS can produce life-threatening problems if it affects the breathing muscles or the autonomic nervous system. The present study was done to see the clinical profile and the epidemiological trends occurring among 30 diagnosed patients reported over a one-year duration during their hospital stay. Patients with Guillain-Barre Syndrome (GBS) were diagnosed using the Asbury and Cornblath criteria for case definition of GBS, as well as supporting laboratory and electrodiagnostic findings. A total of 30 cases were diagnosed, F: M ratio of the case was 1:1.3. The age range of the case was 19-80 years. The maximum number of cases was in the 31 to 40 years (n=7) age range. Maximum cases were reported from July to September (43.33 percent) during the summer and rainy seasons, whereas there were no reported cases from October to December. 80 percent (n=24) of cases were reported within the first week, 16.67 percent (n=5) during the second week, and only 3.33 percent (n=1) during the third week. There was a history of previous illness in the form of loose stools, fever, and respiratory tract infection, as well as other GI infections, in 46.67% of cases, the most prevalent of which was loose stools with fever in 30% of cases.In 24 cases, weakness was present in both the upper and lower limbs, whereas in 6 cases, weakness was predominant in the lower limb. In six cases, facial weakness was also present. The most frequently reported sensory symptom was numbness, followed by a tingling sensation and a burning sensation. Almost all the cases had areflexia, either total areflexia (14 out of 30 or 46.67%) or partial areflexia (16 out of 30 or 53.33%), with the majority lacking knee and ankle reflexes.

31.To Study the Functional Outcome of Proximal Femur Nailing Antirotation-II in Unstable Intertrochanteric Fractures in Elderly Population
Suresh Uikey, Praveen Khatri, Chetan Solanki, Rahul Verma, Suneet Tandon, GopalaRao Mundlapati
Background: Intertrochanteric fractures are a variant of peritrochanteric fracture. Management of intertrochanteric fractures is a major challenge. The focus of surgical research regarding internal fixation in the early 20th century was to minimize implant failure and cut-out of the femoral head and neck fixation components with acceptance of loss of reduction of the fracture. The current trend in hip fracture care relates to three main strategies (1)prevention by aggressive screening and treatment of patients at high risk for fracture; (2)standardization of hip fracture centers with early intervention and protocols; (3)optimization of fracture reduction and new implant component fixation in osteoporotic bone. Material and methods: This was a prospective study of 20 cases with intertrochanteric fractures admitted in department of orthopaedics, Gandhi medical College, Bhopal during the period from January 2020 to july 2021. Patients were evaluated clinically and radiologically every 4 weeks for the first 2 months and every 6 weeks there after until signs of radiological union appears. Clinical union was observed with the absence of pain and tenderness with full weight bearing and good range of movements. Result: In the present study we had good radiological and functional out come in all the cases managed by PFNA-II. We had implant related complications in 7 cases. Out of these cases only 1 case had revision surgery. All cases united well and had an average HHS of 83.5. We did not encounter any complication like nonunion and periimplant fracture. Conclusion: The proximal femoral nail antirotation (PFNA-II) was a superior implant for the treatment of intertrochanteric fractures owing to its ease of insertion, reduced blood loss, less complications, stable fixation and satisfactory functional and radiological outcomes.

32.A Prospective Study of Peripheral Vascular Disease
L Surender, Vimal Singh Thakur, Karur Jyothirmai
Background: Peripheral vascular Disease is an important cause of morbidity and limb loss now a days. It is a  blood circulation disorder that causes blood vessels outside the heart and brain to narrow or block. Currently the appropriate management of patients with chronic lower limb ischemia is a complex clinical issue. Aim and Objectives: To study the clinical presentation and management of Peripheral vascular diseases. Material and Methods: This was a prospective study conducted for period of one year, included 50 patients  of Peripheral Vascular disease in Department of General surgery, Bhaskar Medical College and General Hospital Yenkapally Village after approved by ethical committee and followed exclusion and inclusion criteria. Results: 88% of the participants were males and 12% were female, out of all maximum patients (72%) were from age group of 21 to 50 years of age  also we have found that 22% of the patients were from age group of > 50 Years of age. 72% of the patients had varicose veins followed by 18% had  Atherosclerosis and 10% were from TAO. Intermittent Claudication, Rest Pain, Gangrene were most common symptoms in Atherosclerosis and TAO and Prominent veins, edema, pain and pigmentation were the most common symptoms in varicose veins. All the patients were managed conservatively and surgically. Conclusion: Age group between  21 to 50 years was the commonest for the disease and there was Male Predominance. Initially patients were managed conservatively which include vasodilators and anti-coagulants for limb salvage. Surgical interventions include amputations, disarticulations and lumbar sympathectomy were adopted according to the complications. Also Ray amputation was the most commonly performed amputation in this study.

33.Etiological Assessment of Different Granulomatous Lesions: a Histopathological Study
Ragini Kumari, Ajit Kumar Chaudhary
Aim: To analyze different granulomatous lesions and to find the frequency and etiology of all granulomatous lesions. Materials and Methods: The present observational study was carried out in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India from June 2019 to may 2020. We include 100 cases of skin biopsies after histopathological confirmation of granulomatous lesions. Results: Among 100 cases were studied in which male predominance was noted with 60(60%) cases and females constituted 40(40%) case providing M :F ratio of 3:2. Most of the patients were noted in age group of 20 to 30 years i.e 36(36%) cases followed by 21(21%) case in 30 to 40 years. 83% of cases were seen below 50 years of age in our study. Infectious granulomatous dermatoses were very common, only 1 cases of sarcoidosis was found.  Most cases of infectious dermatoses were noted in 20 to 30 years comprising 36(36%) cases. Leprosy remained the significant causative reason for infectious granulomatous dermatoses succeeded by tuberculosis of skin. Borderline tuberculoid leprosy was found to be predominant, constituting 27 (27%) cases followed by indeterminate and lepromatous leprosy both had 22(22%) cases, tuberculoid leprosy 18(18%) case and 8(8%) of borderline lepromatous. Lupus vulgaris constituted 1 cases (1%) and only 1 (1%) case of sarcoidosis was found. Conclusion: The granulomatous lesion is common in third decade of life with male predominance. Leprosy was the most common cause of cutaneous granuloma followed by Tuberculosis, fungal infection and foreign body reaction.

34.A Prospective Assessment of the Outcome in Terms of Radiology and Functions after Open Reduction and Internal Fixation of Distal Femur Fractures by Locking Compression Plate
Vikash M Harinandan, Kunal Shankar, Laljee Chaudhary
Aim: The aim of this study is to evaluate the radiological and functional outcome of distal femoral LCP used in these patients. Methodology: A prospective study was carried out where all the patients enrolled in the Department of Orthopaedics, Darbhanga medical College and Hospital, Bihar from July 2019 to June 2020  were included in the study based on the inclusion and exclusion criteria during the period of 1 year . The study involved both male and female patients with a supracondylar femur fracture. In present series 50 consecutive patients of supracondylar femur fracture operated with locking compression plate, satisfying the inclusion criteria were included. The study included those above 18 years with stable or unstable, comminuted or intra-articular fractures of the distal femur with no distal neuro-vascular complication and managed surgically. The Locking compression plate and screws are manufactured from 316 L stainless alloy with gun drilling technique were used. They are anatomically pre-contoured plate. Pre-operative work-up was done as required for fitness and anesthetic evaluation. Fractures were classified with the help of radiographs according to the AO-ASIF classification. Preoperative calculation was done on radiographs to ascertain the size of the plate, accurate size of locking, cortical and cancellous screws after subtraction of the magnification factor. All patients were followed up at 4th 10th 14th 18th week, 6 weeks, 6th month, 9th month and 1 year after surgery. During the follow up, patients were assessed clinically, radiologically and functionally by NEERS criteria. Results: Out of 50 patients,  31 patients were males and 19 were females. The patients’ ages ranged from 18 to 70 years with a mean age of 41 years. 32 fractures involved the right side, and 18 involved the left side. The causes of fractures were motor vehicle accident in 29 patients and a domestic fall in remaining 21. According to Muller’s classification of distal femur, 9 were Muller’s type A1; 14 Muller’s type C1; 16 Muller’s type C2; and 11 Muller’s type C3. 36 of them had closed fracture and 14 open type fractures. Of 50 patients, 43 Patients (86%) showed radiological union within 20 weeks.Full weight bearing was started on an average 3-4 months after surgery. Average flexion in this study was 116 degrees with more than 66% patients having knee range of motion more than 110º. The functional outcome was assessed at the end of one year using Neer’s scoring system as excellent in 31 (62%), good in 11 (22%), fair in 6 (12%) and poor in 2 (4%). Out of 50 patients, 42 patients had an excellent to fair results with no major complications. Conclusion: From the present study, it can be concluded that LCP in distal femoral fractures promotes early radiological union and good knee range of motion. In our opinion, open reduction and fixation by LCP, in skilled hands can achieve normal anatomy of the articular surfaces, allows early ambulation and joint mobilization.

35.A Hospital Based Observational Assessment of the Histopathology of Cervical Lesions
Ragini Kumari, Ajit Kumar Chaudhary
Aim: To study the histopathological features of cervical lesions. Methodology: The present observational study was carried out in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India from Jan 2019 to December 2019. A total of 100 cervical specimens were received in the department of Pathology and specimens were in the form of cervical punch biopsies, hysterectomies, Wertheim’s hysterectomy and cervical amputation. Results: In our study 65% patients presented with white discharge, 27% with Back ache + abdominal pain, bleeding per vagina in 3%. 4% with pelvic pain and only 1% presented with dyspareunia. In the present study according to Broder’s grading, moderately differentiated squamous cell carcinoma was most commonly reported, poorly differentiated in 25% and well differentiated in 17%. Conclusion: Histopathology study of cervical biopsy lesions is a valuable diagnostic procedure. Early detection of cervical lesions may provide an opportunity for appropriate interventions to prevent further complications such as progression from benign to malignant conditions. Adequate screening procedure with follow up cervical biopsies helps in early diagnosis and management of premalignant and malignant lesions.

36.Prospective Functional Outcome Assessment after Surgical Management of Fractures of Distal end Radius
Vikash M Harinandan, Kunal Shankar, Laljee Chaudhary
Aim: This study was conducted to assess the functional outcome of fracture of distal end of radius managed with locking compression plates. Methodology: A prospective study was conducted in Department of Orthopaedics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar during the period of 12 months (May 2019 – April 2020). All cases presenting to the outpatient and emergency department fulfilling the below mentioned criteria were recruited for the study. Patients more than 18 years of age presenting with simple and/or compound radial fractures without vascular injury were included in this study. The involved forearm was immobilized with a below elbow POP and kept elevated. X-rays of PA and lateral view were taken for confirmation of the diagnosis and to assess the type of fracture. The fracture fragments were analyzed and involvement of radiocarpal and distal radioulnar joints were assessed and classified according to the Frykman’s and AO classification. The duration from the date of injury to the date of operation ranged from 1 – 6 days. All the routine blood investigations were done and the fitness from physician and anaesthetist were obtained. All the patients were followed up for a period of 6 months to 1 year. Results: majority of the patients (51.7%) were in the age group between 30 and 50 years and the mean age was 36.4 years and the males outnumbered females with a male: female ratio of 3:2. Around 58.3% of the study subjects acquired the fracture through road traffic accident and only 41.7% had a fall on out-stretched hand. The distal end radius fractures were classified based on Frykman’s classification which has types and among them type III found to be more common (26.7%) in our patients which is intra-articular fractures involving the radio carpal joint followed by type I which is a transverse metaphyseal fracture. Fracture were also further classified based on AO classification and among them A3 (Extra-articular radius, multi fragmentary) and C1 (complete articular simple metaphyseal) were found to be the more common types. In 71.7% of the subjects, the fracture reunion had occurred in 2 – 3 months and for 11.6% patients it took more than 4 months for the union. 91.7% of the patients the results was in the range of good and excellent and for only 8.3% patients, it was fair and none of the patient had a poor result. Conclusion: The present study demonstrates good to excellent results in the majority of patients after locking plate fixation of the lower end distal radius with lower rate of complications. Hence locking plate fixation may be recommended for distal radius fractures.

37.Cerebroplacental Ratio as a Diagnostic Factor of Adverse Perinatal Outcome in 35-38 Weeks in Appropriate for Gestational Age Fetuses
Juhi Agrawal, Nitu Mishra, Priya Singh Suryavanshi, Nandini Singh Bhati
Objective: The objectives of this study were to evaluate the diagnostic abilities of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome (APO). Methods: This was a study of 200 high-risk fetuses attending the day hospital unit of a tertiary referral hospital that underwent an ultrasound examination at 34–38 weeks . APO was defined as a composite of abnormal intrapartum fetal heart rate or intrapartum fetal scalp pH <7.20 requiring urgent cesarean section, neonatal umbilical cord pH <7.10, 5-min Apgar score <7, and postpartum admission to neonatal or pediatric intensive care units. Results: It was observed that only 16 (43.2%) patients were delivered by cesarean section and 123 (75.5%) underwent vaginal delivery with CPR>1. On the other hand 21 (56.8%) women had cesarean delivery while vaginal delivery was performed for 16 (43.2%) women with CPR <1. The correlation was statistically significant (p =0.00).the sensitivity, specificity, Positive predictive value (PPV) and negative predictive value (NPV) were 34%, 90%, 60% and 76% respectively. The intrapartum fetal distress was the major cause for increased cesarean rate. Conclusion: CPR is an independent indicator in an obstetrician’s armamentarium to detect patients at risk (CPR <1) in primary stage, triage them, monitor their labor strictly and deliver them early in order to procure healthy fetus.

38.A Study of Clinical Profile of Dengue Fever, with Special Reference to its Complications
Anudeep Reddy K., Niranjan N.
Background: In this study, we wanted to evaluate the clinical profile of the dengue cases, assess the clinical manifestations of the disease and their incidence, evaluate the complications related to different organ systems and study the outcome of the dengue virus infection in patients enrolled. Materials and Methods:  This was a hospital-based study conducted among 301 patients who presented with dengue fever to the concerned department at Vijayanagara Institute of Medical Sciences, Bellary, over 18 months after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Most of the respiratory complications were seen among patients with severe dengue (54.2%) compared to the rest of the clinical types of dengue and dengue with warning signs (42.3%). Clinical types of dengue were found to be statistically significant (p < 0.001). Cardiovascular complications were seen among patients with severe dengue (12.2%). Complications among the different clinical types of dengue were found to be statistically significant (p < 0.012). Increased renal function test suggestive of acute kidney injury was the common complication in both severe dengue 16 cases (21.6%). The proportion of abdominal complications among the different clinical types of dengue was found to be statistically significant (p < 0.001). All CNS complications were seen among patients with severe dengue (32.4%). CNS complications among the different clinical types of dengue were found to be statistically significant (p < 0.001). The haematological complications were seen among patients with dengue with warning signs (45.5%) compared to the rest of the clinical types of dengue-like severe dengue (2.8%). Complications among the different clinical types of dengue were found to be statistically significant (p < 0.001). Conclusion: Clinical and experimental observations suggest that liver involvement occurs during dengue infections. Clinical evidence includes hepatomegaly and increased serum liver enzymes, with liver involvement being more pronounced in the more severe forms of infection. Dengue viral antigens have been found within hepatocytes, and the virus appears to replicate in both hepatocytes and Kupffer cells, and dysregulated host immune responses may play an important causative role in liver damage. Modulating these immune responses may have therapeutic potential.

39.A Comparative Study of Pre & Post Operative Specular Microscopy Counts of Cataract Surgery Patients-Phacoemulsification Vs Manual Small Incision Cataract Surgery in a Tertiary Care Hospital
Fatima S. Siddiqui, Chhaya A. Shinde, Swaranjali Gore, Shruti Shirwadkar
Introduction: The definitive treatment of cataract is surgical removal of the opacified lens.  The damage to the corneal endothelium during surgery  leads to corneal endothelial cell loss which if severe can eventually lead to corneal oedema. The study was  conducted in our hospital for the assessment of the corneal endothelium preoperatively and post operatively in cataract surgery patients  as it would help to provide baseline information for future studies and it would   contribute towards improvement of quality of care at our hospital. Methodology: This was a randomized prospective comparative longitudinal study of 200 eyes, who underwent cataract surgery by Phacoemulsification (Group A) and Manual Small Incision Cataract Surgery (Group B) with Posterior chamber intraocular lens (PCIOL) implantation. Each group had 100 cases selected by convenience sampling method. Endothelial cell count was measured on a non-contact photographing specular microscope, Tomey EM -3000. Endothelial cell count was measured preoperatively and postoperatively on day 1, day 7, 1 month, 3 months. Data master sheets were used to process and analyze collected data by using tables and figures using the Microsoft Excel 2013 software. The statistical software used was Graphpad InStat 4.0 . Demographic variables were presented using descriptive statistics like ratios, proportions and percentages. Unpaired t- test and One way ANOVA test were used to compare variables in 2 groups  respectively.Results: The loss of endothelial cells (%) on Day 1, Day 7, 1 Month and 3 Months in Phacoemulsification group was 9.9%, 11.8%, 13.7% and 13.9% respectively, depicting a small range of loss of cells between 9.9% to 13.9%.  In the Small Incision Cataract Surgery  group it was 10.7%, 12.7%, 14.6% and 14.8% respectively with a relatively larger range from 10.7% to 14.8%. Conclusion: At 3 months postoperative period there was no clinically or statistically significant difference in endothelial cell loss between Phacoemulsification and Manual Small Incision Cataract Surgery.

40.Role of Elective Neck Dissection in Clinically Negative Neck Nodes in Head and Neck Malignancies
Poonam S. Khairnar, Rajesh Kar, Mamata Sahoo, Vandana Thorawade, Dnyaneswar Ram Rohe, Mahesh D. Thikekar, Santosh Mane
Background: In this study, we wanted to evaluate accuracy of clinical intra operative lymph node assessment in patients with head and neck cancer, define the degree of correlation between clinical preoperative assessment and histopathological examination in patients with head and neck cancer, determine as to whether the use of a selective neck dissection used electively on all patients presenting with head and neck cancer and clinically N0 necks improve survival, disease-free survival and loco-regional disease control rates. Materials and Methods: This was a hospital-based study conducted among 50 patients who presented with head and neck malignancy to a tertiary care hospital, between August 2012 and August 2014 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: 42 (60 %) of 70 sides of neck in 30 patients were negative for lymph node metastases. 28 (40 %) of 70 sides of neck in 20 patients were positive (or suspect) for lymph node metastases. Histopathological examination was done for the 70 selective neck dissection specimens obtained in our study. Lymph nodes were positive for malignant metastases in 30 (43 %) of 70 sides of neck in 18 patients. Lymph nodes were negative for malignant metastasis in 40 (57 %) of 70 sides of neck in 32 patients. Stage III and IV patients had a higher incidence of lymph node metastases compared with stage I and II patients. 38 patients (60 %) received post-operative radiotherapy, 18 patients received post-operative radiation because post-operative histopathological examination was positive for metastasis. Conclusion: The neck must be properly managed at the same time with the primary tumour. The decision to use elective neck dissection or elective neck irradiation is guided by the treatment of the primary tumour. Intra operative lymph node assessment alone is not an effective method in clinical staging of the neck. Thus, we cannot depend on it in determining the type of neck dissection performed. Selective neck dissection is an effective method in management of N0 neck.

41.Profile of Acceptors and Outcome of Postpartum Intrauterine Contraceptive Device in a Tertiary Health Care Facility in West Bengal: A Prospective Observational Study
Benazir Ansari, Sib Sankar Murmu, Rajib Pal, Mandira Dasgupta, Subodh Kumar Hansda
Background: In this study, we wanted to evaluate and analyse acceptance, effectiveness and complications of PPIUCD insertion in the postpartum period, assess the proportion of women accepting immediate PPIUCD insertion, find out the reasons for acceptance and decline of PPIUCD, find out the complications among the acceptors, follow post placental insertion and its outcome after 6 weeks, 3 months, and 6 months, evaluate the effectiveness of PPIUCD, and determine the reasons for removal of PPIUCD. Materials and Methods: This was a hospital based prospective observational study conducted among 106 patients who presented with normal or assisted vaginal delivery, caesarean section to the Department of Obstetrics and Gynaecology of Deben Mahata Government Medical College, Purulia, West Bengal, from July 2019 to December 2020 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Out of 106 patients 6(14.7%) patients had reversible reasons of acceptance of PPIUCD and 2(4.9%) patients had no interference with breast feeding reasons of acceptance of PPIUCD, 4(6.67%) patients did not want contraceptives immediately reason of decline of PPIUCD. 13(31.7%) patients had a mode of delivery CS, 26(63.41%) patients had a mode of delivery VD and 2(4.89%). 14(34.2%) patients had a history of previous use of contraception, 14(34.15%) showed no complications of PPIUCD and 27(65.85%) showed complications. 36 patients came for follow up at 6 months out of which 30 (83.33%) showed no complications. No case of pregnancy was found at follow up visits. Conclusion: PPIUCD is a safe, convenient, and highly effective postpartum intrauterine contraceptive device, which can be encouraged in both vaginal delivery and CS; it can be integrated with maternal child health services ensuring an appropriate long term reversible family planning method before returning home. To improve acceptance of PPIUCD, there should be a separate unit of antenatal counselling for the couples regarding the possibility of conception during lactational amenorrhea, morbidity related to consecutive conception, and the importance of birth spacing. Even in the postpartum period effectiveness of PPIUCD counselling can only be ensured if the couple is counselled together. Misconceptions and negative attitudes related to PPIUCD should be addressed through community-based activities and government strategies to increase public awareness through different media sources as another way of promoting the programme.

42. A Prospective Clinicosonographic Study of Acute Abdomen
Preity Priyadarshini, Sanjeeb Kumar Pradhan, Siba Prasad Dash, Sulata Choudhury
Background: The acute abdomen is the main term for an unclear emergency situation of the abdominal cavity. The acute abdomen is an important reason for the admission of patients into the emergency room. In certain situations, abdominal pain may be a symptom of a severe, life-threatening disease process, which can be managed properly with help of clinical examination and ultrasound. In this study we take up the how the clinical examination and ultrasound help us to reach a final diagnosis and manage the cases accordingly. Aim and Objective: (1) Evaluate the diagnostic accuracy of ultrasound on acute abdomen and the way the ultrasound examination contributes to the diagnosis. (2) Evaluate under which circumstances ultrasonographic diagnosis of the acute abdomen, considering medical and economical quality classifications, the alternative choice to comparable diagnostic measures. Patients and Methods: Eighty patients attended and admitted to the M K C G Medical college and Hospital, Berhampur, Ganjam, Odisha, India from November 2020 to June 2022 were included in the study. Patients undergone detail clinical examination, X-Ray, Ultrasound and CT scan, the final diagnosis was made and accordingly managed. Results: Out of 80 cases of clinically diagnosed acute abdomen, 73 cases were diagnosed as having one or other pathology by ultrasound examination and in 7 cases, the ultrasound shows normal study which were further evaluated by X ray and contrast enhanced CT. Of the 73 cases, the ultrasound diagnosis of 62 cases coincided with clinical diagnosis. In the present study, the final diagnosis of 16 cases was acute appendicitis but, 20 cases were provisionally diagnosed clinically. Out of which the ultrasound examination confirmed the diagnosis of 15 cases. Total number of clinically diagnosed peritonitis cases were 20, in which ultrasound examination confirmed the diagnosis in 17 cases. The number of clinically diagnosed cases of acute cholecystitis were 6, in which ultrasound confirmed the diagnosis in 5 cases. The number of clinically diagnosed acute intestinal obstruction were 10 and the ultrasound confirmed 8 cases. The number of cases clinically diagnosed blunt injury peritonitis were 10, and ultrasound confirmed in all cases. Out of 10 cases the ultrasound examination shows hollow viscus perforation in 6 cases and solid organ injury in 4 cases. The number of cases clinically diagnosed liver abscess were 2 and which were confirmed on ultrasound. Conclusion: The acute abdomen is a syndrome of sudden onset that affects the abdominal and pelvic cavity and is generally accompanied by pain and other abdominal symptoms. Its severity and propensity for rapid progression demand prompt, systemic evaluation and in many cases surgical intervention. The evaluation of a patient with an acute abdominal pain requires an understanding of the aetiology and clinical symptoms and signs that may lead to the diagnosis of an acute abdomen. In the process of diagnosis of acute abdomen first and foremost importance is given to clinical diagnosis, based on history and thorough clinical examination. Ultrasound is the sole diagnostic modality in conditions where the diagnosis could not be made on the basis of clinical examination (head injury, unconscious patients, mentally ill patients). Liberal use and a clinical approach are the key points in Sonography of acute abdomen. Sonography is a variable tool to lower both the number of unnecessary laparotomies and the technique related to surgical delay.

43.Role of Ultrasonography in Evaluation and Management of Intra Abdominal Abscess
Subrat Kumar Biswal, V. Rajesh, Siba Prasad Dash, Sulata Choudhury
Background: Intra-abdominal abscesses continue to present therapeutic challenge to the surgeon. They are common complication of inflammatory bowel disease, malignancy and trauma. The objective of the present study is to manage the intra-abdominal abscesses by percutaneous aspiration under ultrasound guidance and placement of continuous catheter drainage wherever deemed necessary and to assess the efficiency, limitations and complications, if any of this method. Aim and Objective: (1) To evaluate and management of the intra-abdominal abscess by ultrasonography guided aspiration and pig tail catheter drainage. (2) To assess efficiency, limitations and complications associated with these methods. Patients and Methods: A total of 68 cases of intra-abdominal abscesses admitted to surgical unit of MKCG MCH Berhampur, Odisha from November 2020 to June 2022 were selected. The diagnosis of intra-abdominal abscess was confirmed by USG and/or CT. Patients were then subjected to ultrasound guided drainage/aspiration as a therapeutic measure. Post procedure patients were watched for signs of peritonitis. Systemic antibiotics were given, and analgesics were given on SOS basis. Follow up ultrasound after three days was done. Follow up was kept in all cases. Results: Out of 68 patients of intra-abdominal abscess, there were 51 males (75%) and 17 females (25%). Maximum number of patients present in fifth decade (20 patients) and sixth decade (25). Minimum number of patients were up to the age of 30year and above 70year.Most common intra-abdominal abscess was liver abscess (60.29%) followed by sub-phrenic abscess (11.76%). Total 59 patients were cured by ultrasonography guided aspiration (29 patients) and pig tail catheter drainage (30 patients). In 5 patients, laparotomy was done and 4 patients were treated conservatively. Out of 68 patients, the aetiology was not known in 32 patients (47.5%). 15 patients were having amoebiasis and 8 patients were having postsurgical intraabdominal abscess. Less number patients got intraabdominal abscess due to trauma (4.41%), enteric (4.41%) and tubercular (5.88%). The above table shows out of 41 cases of liver abscesses, 15 cases were amoebic liver abscess and 26 cases were pyogenic liver abscess as confirmed pus culture and cytology. Overall complication rate is 8.82%, among which bleeding (2.94%) is most common, followed by renal failure, respiratory failure and recollection as 1.47%. Out of 68 patients, 59 patients were undergone ultrasonography guided aspiration and pig tail catheter drainage. 5 patients were undergone laparotomy& surgical drainage and 4 patients were conservatively managed. There was no mortality due to this method. Conclusion: The method is associated with good success rate, low morbidity and mortality, better patient compliance, low cost, can be performed under local anaesthesia and should be used as an initial procedure in the treatment of intra-abdominal abscesses.

44. Study of Prevalence and Risk Factors of Inguinal Hernia
Sanjay Gawale, Golla Srujana, Krishna Girish Avanigadda
Hernia is the protrusion of an organ through an abdominal opening in the muscle wall of the cavity that surrounds it. Inguinal hernias are the most common form of abdominal wall hernias. It is common in men with life time risk of 27% and 3% for women. This observational study was done in Department of  Surgery of  RIMS Medical college and hospital, Adilabad. All the study subjects had come to the hospital with complaints of groin swelling with or without pain. The present study was conducted to assess the prevalence and risk factors of inguinal hernia. Data was expressed in frequency and percentage distribution. 53.33 % patients were in group of 36-50 years. 55 % patients had right sided hernia. 75 % were indirect inguinal henia. 66.66 % had Period of swelling for less than 1 year. Lifting heavy objects, Diabetes, Alcoholism, COPD were main risk factors for inguinal henia.

45. A Study on the Supratarsal Injection of Corticosteroids in the Treatment of Refractory Vernal Keratoconjuctivitis.
Ajay Kumar, Rajiv Kumar Singh
Objectives: This present study was to evaluate the effectiveness of supratarsal injection of corticosteroids for the treatment of refractory vernal keratoconjuctivitis in children and young age group population. Methods:  All the patients were randomly selected into three groups (group A, B & C). Each group had 16 patients. Group A: Patient eyes were received supratarsal injection of 2 mg dexamethasone. Group B: Patients eyes were received supratarsal injection of 10.5 mg triamcinolone. Group C: Patient eyes were received supratarsal injection of 50 mg hydrocortisone. Results: A total of 48 patients (96 eyes) with age group 5 to 25 years were enrolled in this study. Among them, 41(85.41%) were males and 7(14.58%) were females. Mean age of patients had 13.43±2.37 years. Majorities of patients 32(66.67%) were in age group of 11-15 years. clinical history of majorities of patients had seasonal variations 40(83.33%) followed by 30(62.5%) other systemic atopic features, 24(50%) palpebral, 18(37.5%%) family history of disorder, 16(33.33%) mixed, 8(16.67%) shield corneal ulcer and 7(14.58%) bulbar form of disease. There was significant (p<0.01) resolution of sign and symptoms seen in all three group of patients within three days of the supratarsal corticosteroid injection. Conclusions: Preponderance of refractory vernal keratoconjuctivitis is more in children and young population. And supratarsal injection of corticosteroids is the safe and effective mode for the initial and quick management of inflammation of refractory vernal keratoconjuctivitis.

46. Study to Analyse the Functional Outcome of Transforaminal Lumbar Interbody Fusion in Prolapsed Intervertebral Disc Patients.
Raja Yadav, Anil Chouskey, Kuldeep Dinkar
Background: Lumbar degenerative diseases, such as lumbar spinal stenosis, lumber disc herniation, lumbar degenerative instability, degenerative spondylolisthesis, etc. are common aetiologies of lower back pain and can have a significant influence on quality of life. Over 90 % of spine surgeries are performed because of degenerative disc diseases (DDD). Aims and objectives:  To analyze the functional outcome of transforaminal lumbar interbody fusion (TLIF) performed in terms pain relief using visual analogue scale (VAS) for pain for back and leg and quality of life using oswestry disability index (ODI) pre-operatively and post-operatively and during follow-ups. Material and Method: A prospective interventional study with a sample of 20 patients with prolapsed intervertebral disc having chronic lower back pain undergoing transforaminal lumbar inter body fusion were studied at tertiary care centre from January 2020 to June 2021 in the Department of Orthopaedics Gandhi Medical College and associated Hamidia Hospital, Bhopal, Madhya Pradesh. Pain relief was measured using VAS for pain for back and leg and quality of life using ODI pre-operatively and post-operatively and during follow-ups. Results: The preoperative mean VAS score was 7.9±0.85 which improved to 2.8±1.24 in postoperative group. Mean VAS score at final follow-up was 2.2±0.79 having statistically significant (p<0.0001). The preoperative mean ODI score was 64±8.1 which improved to 37.2±6.0 in postoperative group. Mean ODI score at final follow-up was 27.5±5.9. The improvement in mean ODI score was statistically significant with p value of < 0.001). Conclusion: The present study demonstrates that TLIF is safe and effective procedures for management of degenerative spine diseases with clinical improvement in pain and disability.

47. Evaluation of the Effect of Supplementary Nutrition through ICDS in Children below 6 Years
Saba Mohammed Mansoor, Shrivathsa D N, K. G. Kiran, Hemant Kumar
Introduction: Malnutrition is one of the biggest issue in India and other parts of the world. From United Nation to World Health Organization and other International Councils and formal bodies are well concerned about this issue. Although, it is being pressurised and many programmes are running to reduce the effect and prevalence of malnutrition, the result shows it is hardly been tackled efficiently. There is a need to udnerstand the depth of the problemn and government needs to formulate policies and modifies the current programmes to suit the need of the problem, instead of formulating new programmes. Around 157.86 million children, or 15.42 % of India, are under the age of six, making it the country with the greatest pediatric population in the world. Malnutrition in the form of under-nutrition in children is now recognized as a vulnerable group in need of targeted intervention. Aims and Objectives: To find out the health status of children under Integrated Child Development Scheme (ICDS) by analyzing the weight and height gain. Materials and Methods: The study considered 250 children from 5 Anganwadi Centres (AWC) in Mangaluru region. Also, a control AWC has been considered. The anthropometric measurements have been taken and height and weight gain have been compared with that of control AWC.  The outcomes and findings of this study were analyzed to find out the main objectives by employing ANOVA. Results: It is shown that all the selected AWCs have shown significant (p<0.05) improvement in weight gain as compared to the control AWC. Regarding height gain, only 1 AWC showed that the gain is not significant as compared to the control and another proved to be equal to that of control while 2 AWCs showed that their children had significant increase in gain in height as compared to the control AWC. Conclusion: The study has concluded that there is significant improvement in weight and height due to the application of the awareness and education to the parents as intervention. Hence, providing education and awareness to the parents should be made mandatory as part of ICDS programme.

48. A Study on the Evaluation of Current Prevalence of Malaria in India
Saba Mohammed Mansoor, Shrivathsa D N, Mahendra Khatri, Hemant Kumar
Introduction: The World Health Organization (WHO) estimates that malaria poses a threat to 93% of India’s population.  One of the main issues with the nation’s public health is malaria. The National Vector Borne Disease Control Programme (NVBDCP) reports around 1.5 million confirmed cases each year, of which 40-50% are caused by Plasmodium falciparum. If proper therapy is initiated early, malaria can be cured. Early case detection and prompt treatment (EDPT), active case detection, and passive case detection through fever treatment depots and village link workers in inhospitable and distant locations are the main tactics for controlling malaria in India. India’s malaria prevention methods emphasize the employment of long-lasting insecticidal nets, chemical insecticides, bacterial pesticides, larvae fish, and indoor residual spraying to effectively control vectors. It has been seen that there is an association of typical socio-demographic characteristics with vulnerability of malaria infection. There is a need to properly analyze and evaluate the associative factors for proper formulation and implementation of policies and preventive strategies. Aims and Objectives: This study is intended to evaluate the significant parameters that contribute in current prevalence of malaria infection. Materials and Methods: This is a retrospective cross-sectional study which is conducted in two phases, namely, extraction of patients’ information and surveying the same patients with structured questionnaire to gather their knowledge, behaviour and attitude towards malaria and its prevention. The gather information and data was properly evaluated and statistical analysis was done to conclude the associative parameters contributing to the current prevalence of malaria. Results:  The result shows that age and gender are not significant factor which correlates with Malaria occurrence (p>0.05). Education status is found to have significantly correlated with Malaria occurrence (p<0.05). Again, it was found that immigrant workers and people with less family income (with annual income of Rs. 0-100,000) were significantly infected with Malaria as compared to other sub-groups (p<0.05). Conclusion: The study has concluded that irrespective of the age and gender, malarial cases have been occurring. Education and income is playing a significant role in getting malaria. The study also concludes that there is a need to improve the well-being of immigrant workers.

49. A Clinico Pathological Study of Solitary Thyroid Nodule
Mohammad Fazelul Rahman Shoeb, Mohammed Shahid Ali
Introduction: The thyroid disorder is the most common endocrine disorder seen in clinical practice. Lesions of thyroid are predominantly confined to females in the ratio of 5:1, and this has been attributed to variations of thyroid hormone demand during female reproductive function and physiological events such as puberty, pregnancy and lactation. Materials and Methods: The present study of  has been conducted by utilizing the cases diagnosed clinically as solitary nodule of thyroid and treated on inpatient basis in the Department of General Surgery at Bowring and Lady Curzon Hospital & Victoria Hospital, Bangalore. All patients who were clinically diagnosed to have solitary thyroid nodules from November 2012 to October  2014 were included in the study. Results:  The age of the patients with solitary nodule in the present study varied from 20 years being the youngest to 57 years being the oldest. The peak age incidence was found in 3rd and 4th decades of life. The mean age of all patients was 36.4 years. The mean age for females was 37.11 years and that for males was 31.75 years. Conclusion: Solitary nodule of thyroid gland is a common clinical entity, more common in females than in males. Multi-nodular goitre is the most common etiological cause for a solitary nodule of thyroid, its incidence being 57% of all solitary thyroid nodules, followed by follicular adenoma, accounting for 27% of all solitary thyroid nodules.

50. Role of D-Dimer Values for Predicting Disease Severity and Mortality in Covid-19 Patients – A Hospital Based Observational Study
Surabhi Jangid, Veeram Parmar, Mahendra Kumar, Mohammed Tarik
Introduction: Corona virus disease 2019 (COVID-19) was identified as an outbreak in December 2019 in Wuhan, China and declared global pandemic by WHO on March 11, 2020. The disease has a wide spectrum of symptomatology and out of which coagulopathy is a common manifestation amongst critically ill patients. We aimed to explore risk factors associated with mortality in COVID-19 patients and association of D-Dimer values for predicting disease severity and mortality. Methods: In this observational study, 260 COVID RT-PCR positive patients admitted from September 2020 to March 2021 in covid dedicated wing, were recruited and stratified on the basis of their clinical characteristics into mild and moderate and severe illness groups on the day of admission and recategorized similarly on day 5 on the basis of MoHFW guidelines of India. D-Dimer levels were obtained on the day of admission and on the day 5 of admission. Association of D-Dimer values on the day of admission and on day 5 of admission with increasing or decreasing severity of disease, recovery and in-hospital mortality were analysed. Receiver operating characteristic curve was used to determine the optimal cut off level for D-dimer. Results: The optimal cut off of D-dimer for predicting the severity and mortality of disease on Day of admission and Day 5 were 1106ng/ml FEU (AUC 0.699) and 1795ng/ml FEU (AUC 0.787) with sensitivity of 74% and specificity of 65.71% (p value<0.0001) on the day of admission and also on the Day 5 with a sensitivity of 80.43% and specificity of 71.02% (p value<0.0001). Out of 150 patients below cut off on the Day 1, 13(8.6%) patients died and 137(91.33%) patients were discharged from hospital. Out of 110 patients above cut off, 37(33.63%) patients died and 73(66.36%) patients were discharged from hospital. Out of 133 patients below cut off on the Day 5, 9(6.7%) patients died and 124(93.23%) patients were discharged from hospital. Out of 89 patients above cut off, 36(40.44%) patients died and 53(59.55%%) patients were discharged from hospital. The patients with D-dimer level less than cut off showed better recovery, less in-hospital mortality and majority of patients from this group were discharged satisfactorily as compared to the group of patients with D-dimer level above cut off. The patients with D-dimer values more than cut off were sick and high in-hospital mortality was noted. Conclusion: The mean D-Dimer values are found to be elevated on Day 1 and Day 5 as 1374.5 and 2000.5 respectively. The serial D-Dimer levels are higher in the non-survivors than the survivor’s i.e.  Those patients, who were recategorized in moderate and severe illness groups on day 5 of admission, were showed rising titres of D-Dimer.

51. Association between Pasteurized Donor Human Milk and Neonatal Complications in a Tertiary Care Centre
Keshav Bansal, Dhaval Bhatt, Harshida Vagadoda, Yesha Prajapati
Objective: To study neonatal complications associated with Pasteurized Donor Human Milk (PDHM) 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). 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. 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”.

52. Prospective Observational Assessment of the Compliance to Anti-Diabetic Drugs at a Tertiary Centre in Bihar, India
Hirendra Kumar, Dinesh Kumar, Pant Suresh Keshava
Background: Poor glycaemic control among patients with type 2 diabetes constitutes a major public health problem and a major risk factor for the development of diabetes complications. Aims and objectives: To study the compliance rate of patients with type 2 diabetes to the prescribed medications; to find out its correlation with different socio-demographic factors and other characteristics of the patient; and to determine the causes of the non-compliance,  if any. Methods and Materials: A cross-sectional study was conducted on a random sample of 270–type 2 diabetic patients (M:F 178:92). The patients who reported taking less than 80% of their prescribed anti-diabetes medicines in the preceding week and had an HbA1C of > 7% were considered to be non-compliant. Results: The compliance rate for the anti-diabetic drugs was found to be 57.78%, while 42.22% were non-compliant. A univariate analysis showed that the compliance with the anti-diabetic drugs decreased significantly with an increase in age and that it was lowest in the age group of 60 years and above. The compliance rate was also significantly lower among males, those who were illiterate, and young males, those who were illiterate, and those who had a monthly per capita income of less than Rs. 1200. The compliance with the prescribed drugs varied significantly depending on the prescribed drug regimen (p = 0.001), being highest among those who were put on OHA alone at 68.94% and lowest among those who were prescribed both OHA and insulin, at 43.43%. Also, compliance with the prescribed drugs was significantly lower among those who had diabetes for five years or more (p = 0.004). It was not, however, significantly associated with following the prescribed diet or exercise schedule (p > 0.05). The common reasons behind the non-compliance were forgetfulness (35.96%) and financial constraints (28.07%). Conclusion: It can be concluded that the compliance with anti-diabetic drugs was quite poor among the participants. Increasing age, the male sex, illiteracy, a low monthly income, and a longer duration of diabetes were significantly associated with non-compliance. A more concerning finding was the significant link between noncompliance with the types of drug regimens and a lack of knowledge about diabetes complications, underscoring the importance of repeated patient education about the fundamentals of diabetes.

53. Awareness and Acceptance of Screening Methods of Cervical Cancer in Gynaecological Patients
Rajpinder Kaur, Amrit Pal Kaur, Permeet Kaur Bagga
Aims and Objectives: To assess the awareness and acceptance of screening methods of cervical cancer. Materials and Methods: A cross sectional study was conducted among 500 gynaecological patients of the age group of 20-50 years at Bebe Nanaki Mother and Child Care Centre, Government Medical College, Amritsar. Data were collected using a predesigned questionnaire which included specific sections to test the participant’s knowledge and practices related to cervical cancer and its screening. Results: The mean age of the participants was 35.06 years. A total of 60 (12.0%) participants had knowledge of cervical cancer while only 35(7.0%) participants had underwent Pap test previously. The study also showed strong association between the participants knowledge of cervical cancer with the educational status (p=0.01), socioeconomic status(p=0.01)and the living area, whether rural or urban (p=0.01). Conclusion: Poor knowledge about cervical cancer in women of reproductive age group highlights the need for education, communication strategies and screening programmes to reduce the phobia and improve the level of awareness among women on cervical cancer.

54. Prospective Observational Assessment of the Role of Vitamin D as an Adjuvant to Oral Hypoglycemic Drugs in the Treatment of Type-2 Diabetic Patients
S.M. Inamul Haque, Mukesh Kumar, Sanjay Kumar, Maheshwar Prasad
Background: Diabetes mellitus type 2 and the metabolic syndrome seem to be related to vitamin D deficiencies. Vitamin D may affect glucose homeostasis. Vitamin D levels have been found to be inversely related to glycosylated haemoglobin levels in diabetes mellitus. Aims and Objective: The aim of the study was to evaluate the role of vitamin D as an adjuvant to oral hypoglycemic drugs in the treatment of type 2 diabetic patients. Materials and Methods: The study was done on 80 patients diagnosed with T2DM. Out of 80 patients were in the control group, type 2 diabetic patients on oral hypoglycemic drugs without vitamin D supplementation (n = 40), and the study group was type 2 diabetic patients on oral hypoglycemic drugs with vitamin D supplementation (n = 40). Results: The mean age of patients was 42.25±8.60 in the control group and 45.92±8.40 in the study group. The family history of diabetes mellitus was 52 patients. HbA1C, FBG, and postprandial were decreased in the study group as compared to the control group from baseline (0 day) to 90 days, respectively. Other parameters like hemoglobin, serum creatinine, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase showed slight changes in the study group as compared to the control group from baseline ( 0 day) to 90 days, respectively. Conclusion: The study concluded that glycemic control in type 2 diabetes mellitus is correlated with vitamin D levels and that vitamin D acts as an adjuvant to oral hypoglycemic drugs in the treatment of diabetic patients. These findings might have therapeutic implications as cautious vitamin D supplementation may improve glycemic control in diabetes mellitus type 2.

55. A Comparative Study of the Incidence of Inguinodynia after Open and Laparoscopic Inguinal Hernia Mesh Repair at a Tertiary Centre in the Eastern Region of India
Mohammad Nehal Ahmad, Mohamed Ashraf Ali, Kunal Parasar, Md Mazharul Haque
Background: Inguinal hernia repair is one of the most frequently performed procedures in general surgery, with approximately 20 million repairs every year worldwide. Either open surgery or minimal access laparoscopy is used to repair the hernia. The most common laparoscopic techniques for inguinal repair are transabdominal preperitoneal (TAPP) repair and totally extraperitoneal (TEP) repair. Aims and Objective: To compare the incidence of inguinodynia in both methods of inguinal hernia repair, Lichtenstein’s and the laparoscopic method. Materials and Methods:  The present prospective and observational study comprised 100 patients who were operated on for inguinal hernia repair, which included 50 cases of open inguinal hernia mesh repair and 50 cases of laparoscopic inguinal hernia repair of both genders. All patients with an elective inguinal hernia repair were carried out over a two-year period, from July 2018 to June 2020, at the Department of Surgery, All India Institute of Medical Science, Patna, Bihar (India), and the Department of Surgery, Katihar Medical College and Hospital, Katihar, Bihar (India), after receiving approval from the institutional ethical committee and permission from the heads of the departments. Consent was taken from all enrolled patients. The scores for pain were evaluated using a Visual Analogue Scale (VAS). Results: There was no statistically significant difference between the incidence of inguinodynia after open Lichtenstein’s and laparoscopic repairs of inguinal hernia. No statistically significant difference was observed in the incidence of inguinodynia in the two groups with respect to age, gender, duration, and complications. There was no difference in the incidence of inguinodynia after open Lichtenstein’s and laparoscopic repairs of inguinal hernia. Conclusion: In the present study of inguinal hernia repair, there was no difference observed between the incidences of inguinodynia with respect to the method of inguinal hernia repair used; open Lichtenstein’s repair and laparoscopic repair.

56. Assessment of Pre-Operative Factors Predicting Difficult Laparoscopic Cholecystectomy at a Tertiary Centre in the Eastern Region of India
Mohamed Ashraf Ali, Mohammad Nehal Ahmad, Kunal Parasar, Md Mazharul Haque
Background: Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. The present study was conducted to assess pre-operative factors predicting difficult laparoscopic cholecystectomy. Materials & Methods: 58 patients of laparoscopic cholecystectomy of both genders were enrolled. Randhawa and Pujahari scores were given based on history, clinical examination and sonological findings, 1-day prior to surgery. Results: Out of 58 patients, males were 32 and females were 26. Patients with >2 attacks had significant high rates of difficulty and conversion compared to patients with 2 and less than 2 attacks. Sensitivity, specificity, positive predictive value and negative predictive value of no. of attacks >2 in predicting difficult laparoscopic cholecystectomy was 37.6%, 96.5%, 87.2% and 78.4%. The sensitivity, specificity, positive predictive value and negative predictive value of no. of attacks >2 in predicting conversion laparoscopic cholecystectomy was 50.6%, 89.4%, 20.8% and 96.4%. The difference was significant (P< 0.01). Conclusion: The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis.

57. A Study of the Assessment of Morphometric Analysis of Dry Adult Human Humeral Condyles Bone
Premjeet Kumar Madhukar, Jay Prakash Bharti, Soni Kumari, Manish Kumar
Background: Morphometry of the long bones is important for the identification of unknown bodies, estimation of height, age, gender in forensic science. The present study aimed at morphometric analysis of dry adult human humeral condyles in dry bone. Materials & Methods: 62 dry humerii of adults of both genders were studied and parameters were measured in both left and right side. Results: Out of 62 humerii, 38 were of males and 24 were of females. The mean (mm) length of right and left humerus was 294.3 and 294.5, transverse diameter was 36.5 and 38.7, vertical diameter was 43.1 and 41.0, diameter of girth was 136.5 and 124.1, breadth of trochlear was 26.4 and 26.3, maximum shaft diameter was 31.5 and 32.4, minimum shaft diameter was 26.5 and 27.1, antero- posterior diameter of trochlea was 28.9 and 28.7, distance between medial and lateral epicondyle was 57.3 and 56.2, surface area of head of humerus was 23.5 and 23.9. The difference was non- significant (P> 0.05). Conclusion: The morphometric measurements of segments of humerus is important for identifying the relationship between length of long bones and height of living as well as unknown bone fragments.

58. A Study of the Assessment of Morphometric Evaluation of the Mental Foramen of Dry Adult Human Mandibles
Jay Prakash Bharti, Premjeet Kumar Madhukar, Manish Kumar, Soni Kumari
Background: The identification and precise location of the mental foramen is of great importance to dental surgeon during the surgical procedures on the mandible. The present study performed morphometric evaluation of mental foramen of dry adult human mandibles. Materials & Methods: 86 dry dentulous adult mandibles of both genders were included and parameters such as the distance between the MF to symphysis menti (SF), posterior border of the ramus (FR), alveolar crest (AF) and base (FB) were taken by a metallic wire parallel to the standard horizontal plane was measured by using a standard scale. Results: Out of 86 mandibles, 52 were of males and 34 were of females. The mean (mm) SF on right side was 27.5 and on left side was 27.1, FR on right side was 70.4 and on left side was 70.2, AF on right side was 13.2 and on left side was 16.8 and FB on right side was 16.8 and on left side was 14.5. The difference was non- significant (P>0.05). The mean size of right mental foramen was 2.8 mm and left foramen was 3.0 mm. Location was at the level of apex in 20, above the apex in 18 and below the apex in 48. Shape was oval in 46 and round in 40. The difference was non- significant (P>0.05). Conclusion: The most common shape of mental foramen was oval and in maximum cases it was found below the apex of premolars.

59. A Hospital Based Observational Study of the Clinical Profile and Outcomes among Neonatal Pneumonia
Amit Kumar, Binod Kumar Singh, Saroj Kumar
Background: Neonatal period (0-28 days of life) is the most susceptible period of life due to different diseases, which in most cases are preventable. In the developed countries, the main cause of morbidity and mortality in the neonatal period is congenital abnormalities which are mostly non-preventable, but in the developing countries the common causes such as infections, jaundice, birth asphyxia and pneumonia predominate. Aim: To study the clinical profile and outcome of neonatal pneumonia. Material & Methods: This descriptive observational study enrolled 168 neonates admitted to newborn intensive care unit(NICU) Department of Pediatrics, NMCH, Patna, Bihar, India. The study was conducted during one year of time period. Neonates were observed on day of admission, on day of deterioration and on day of discharge from NICU. Neonates in NICU evaluated for clinical profile of pneumonia and for maternal and neonatal risk factors for pneumonia. Results: In our study out of 168 neonates, total 50 patients classified as a pneumonia patient as per definition criteria mentioned in methodology section. Low birth weight (LBW)  ,birth weight (BW <2.5 kg) neonates found to have pneumonia significantly as compared to non-pneumonia patients (p=0.001). Hence low birth weight was one of the risk factors for development of pneumonia. Conclusion: There was no single parameter which can be used for diagnosis of neonatal pneumonia. Clinical features with chest X-ray with sepsis markers have to be considered in diagnosing pneumonia.

60. An Observational Study to Determine the Prediction of Significant Hyperbilirubinemia using 24 Hour Serum Bilirubin
Manoj Kumar, Sunil Kishore, Shalini Sinha
Background: Neonatal hyperbilirubinemia (NH) is a common problem that affects about 60% of full-term babies and 80% of preterm babies in their first week of life. In places with few resources, it is common for healthy full-term babies to be sent home from the hospital early. This study was done to find out how well serum bilirubin levels at 24 hours can predict significant hyperbilirubinemia later on and to find risk factors in healthy term newborns. Methods: Serum bilirubin was estimated for all enrolled cases within 18 to 30 hour of life spectrophotometrically using twin Beam method. The babies were then followed up clinically by 2 observers for the appearance and progression of jaundice every 12 hour till discharge from the department of obstetrics and gynaecology and were then admitted with their mothers in step down of NICU. Here they were followed up daily upto fifth day of life. TSB estimation was repeated if the clinical assessment of jaundice was more than 10 mg/dl by any observer using Kramers Rule. Hyerbilirubinemia was defined as TSB level 12 mg/dl between 24 to 48 hour of life 15 mg/dl between 48 to 72 hour of life and 17 mg/dl beyond 72 hours of life. Results: A total of 150 neonates were enrolled in the study. Caesarean delivery was recorded 70%, parity 1 and 2 was found in 25.3% and 36% cases, oxytocin was found in 80% cases and ABO incompatibility was found in 36% cases. A TSB of <6mg/dl at 24 +6hours was present in 100 infants (66.7%). Out of these only two infants developed hyperbilirubinemia subsequently. Specificity was 90.3%, Specificity was 75.4%, Positive predictive value was 56.5% and Negative predictive value was 95%. Conclusion: TSB at 24+6 hours <6mg/dl has a high predictive value in identifying those infants who are unlikely to develop subsequent hyperbilirubinemia.

61. An Observational Assessment of the Requirement of a Booster Dose of Hepatitis B Vaccine in Children with Thalassemia 5 Years after Primary Vaccination
Amit Kumar, Bankey Bihari Singh, Ravindra Kumar
Background: Due to the frequent blood transfusions, thalassemia patients are more vulnerable to hepatitis than the general population. Aim: To determine anti-HBs antibody levels in multi-transfused children with beta thalassemia major who had received primary hepatitis B vaccination ≥5 years ago, and to document their antibody response to a booster dose of hepatitis B vaccine. Material & Methods: This study was conducted in the Department of Pediatrics, Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India, over a period of one year. A total of 60 children with beta-thalassemia major and 60 age-matched healthy controls who had documentary evidence of completion of primary hepatitis B vaccination schedule with three doses given more than five years ago, and without subsequent booster were recruited. Depending on how long it had been following the primary vaccination, participants were split into three groups. Group 1: 60–120 months, Group 2: 121–180 months, and Group 3: 181–240 months. Results: A total of 63 children with beta-thalassemia major aged 5- 20 years were assessed for eligibility in the study; of which 60 (31 males) were included in the study; three subjects were excluded as two were HBsAg positive and one was anti-HBc positive. 60 age matched controls (38 males) were also recruited. Among the 14 seronegative children with beta thalassemia major, CD4 counts were normal in all except 1 children, IL-2 was detectable in only 2 children and IFN-γ was undetectable in all children. Even following antigenic stimulus (HBV booster), only 11 children had detectable IL-2 and five had detectable IFN-γ levels. Conclusion: A single booster dose of hepatitis B vaccine after 5 years of primary immunization is adequate to provide seroprotection to multi-transfused children with beta-thalassemia major.

62. A Cross-Sectional Observational Identification of the Adherence to Various Elements of the Modified WHO SSC for Neurosurgery
Anantu Kumar, Jitendra Kumar, Pankaj Kumar
Aim: The primary aim of this study was to identify the adherence to various elements of the Modified WHO SSC for neurosurgery by the perioperative care team. The secondary aims were to evaluate how a mandatory speciality-specific checklist implementation practice can help in early identification of those therapeutic aspects that are pertinent and specific to neurosurgery. Methodology: A cross-sectional observational study was conducted to evaluate the adherence to various elements of the Modified WHO SSC for neurosurgical procedures. The study was conducted in IGIMS Patna for 1 year . Informed written consent was obtained from participating patients. The study was conducted in the neurosurgical ORs of our institution. We selected a total of 100 consecutive patients undergoing neurosurgery for the study. The observed cases formed a sample of patients undergoing cranial or spinal surgery for their primary disease. The nursing personnel follow a written pre-operative checklist in our institution. Results: A total of 63 cases undergoing craniotomy and 37 cases undergoing spine surgery were studied. The performance of the modified SSC was 100% among the checklist co-ordinators. With the 40-point modified SSC applied in 100 cases, we analysed a total of 4000 observations. The team member’s participation reported by checklist co-ordinators was as follows- Excellent 78%; good 21%; and poor 1%. Distraction levels during checklist conduct were as minimal in 83%; moderate in 15%; and maximum in 2% of the cases. Conclusion: The implementation of a speciality-specific neurosurgical checklist by a designated checklist co-ordinator can rectify in time anaesthetic and surgical facets without increasing the OR time. It also improves communication among the team members and results in a smooth workflow in the neurosurgical OR.

63. Clinical Outcome in Children Suffering from AES: An Observational Study
Sunil Kishore, Manoj Kumar, Shalini Sinha
Objective: Acute encephalitis syndrome is a big reason why people get sick and die in India. Even though it was thought that Japanese encephalitis virus (JEV) was a major cause of acute encephalitis syndrome, more cases of non-Japanese encephalitis virus are being reported. Different things happen to people with acute encephalitis syndrome. Our study was designed to study the clinical profile and outcome of patients with acute encephalitis syndrome. Methods: The record of patients admitted with diagnosis of acute encephalitis syndrome, They were classified clinically as meningitis, encephalitis and meningoencephalitis. The clinical details and reports of the patients were recorded and analyzed. Results: Less than 1 year and 3-7 years children were found 19 (31.6%) and 20 (33.4%). Male (75%) was higher than female (25%). Rural residency was higher 81.7%. Meningeal signs were 91.7% followed by motor deficit (66.7%), cranial nerve involvement (25%) and involuntary movements (16.7%). Total mortality was found in 25% children. Conclusion: Acute encephalitis syndrome is still a major public health problem in India. Few of these patients have Japanese Encephalitis.

64. An Observational Assessment of the Clinical Profile of Raised Intraocular Pressure in Closed Globe Injury and its Management
Sudhanshu Kumar, Jawed Iqbal
Aim: We studied the clinical profile of patients with raised intraocular pressure (IOP) in closed globe injury and outcome of medical and surgical management. Methods: The present study was conducted in the department of Opthalmology, Anugrah Narayan Magadh Medical College & Hospital, Gaya, Bihar, India between July 2020 to June 2021, 50 patients attending the glaucoma department with closed globe injury followed by raised IOP of > 21 mm Hg willing to give a written, informed consent were included in the study. Results: 10 patients (20%) were ≤20 years. 25 patients (50%) belonged to 21-40 years and 15 patients (30%) belonged to 41 to 60 years. Minimum and maximum age being 10 and 60 years respectively. Mean age distribution of study participants SD 16.06) years. Most common mode of blunt injury was industrial accidents (22%), followed by injury while playing (18%) and home accidents (18%). Injuries while farming accounted for 16% of total injuries. The least common causes being assault (12%) and road traffic accident (14%). Conclusion: There was no significant difference between medical and surgical intervention while treating glaucoma secondary to closed globe injury.

65. Study of Coronary Angiographic Profile in Young Patients Less than 45 Years of Age with Acute Coronary Syndromes a Single Centre Study from South India
Karun Khanna, Jaisankar Perumal, T. Balasubramanian
Background: CAD is one of the leading causes of death globally. With increase in incidence of premature Coronary Artery Disease (CAD) in Indians, we planned to assess the angiographic profile in patients aged less than 45 years who presented with Acute Coronary Syndromes in our hospital in Tiruchirappalli from May 2021 to April 2022. Aims and Objectives: To study the angiographic profile in young patients less than 45 years of age. Methods: After obtaining consent all patients were subjected to coronary angiogram which was assessed and reported. Results: Among 172 patients included in this study, majority were males, STEMI (77.32%) was the most common presentation with Anterior wall MI (60.15%) being most common among them. Angiographically, 52.2% patients were found to have Single Vessel Disease. Conclusion: The increasing occurrence of CAD in younger population necessitates the study of risk factors and pathogenesis of CAD in this population to guide early screening and prevention in this subset.

66. The Assessment of Speckle Tracking Echocardiography and Coronary Angiography in Patients with Suspected Stable Angina Pectoris with Normal Conventional Transthoracic Echocardiography a Single Center Study from South India
Syed Imran Hussain, Jaisankar Perumal, T. Balasubramanian
Background: With current burden of suspected stable angina pectoris patients, there is need for evaluation with appropriate diagnostic modality. Aims and Objectives: With the above concern, we aimed to observe speckle tracking echocardiography for presence and extent of coronary artery disease in patients with suspected stable angina pectoris. Materials and Methods: 43 patients of suspected stable angina pectoris with normal resting electrocardiogram and resting conventional echocardiography with normal cardiac biomarker were subjected to speckle tracking echocardiography and coronary angiography. Global Longitudinal Peak Systolic Strain (GLPSS) and Segmental Longitudinal Peak Systolic Strain (SLPSS) and coronary angiography was interpreted. Results: Measurable difference in the mean of global longitudinal peak systolic strain between normal coronaries and different extent of coronary artery disease (CAD) (-19.76±0.58 for normal, -17.01 ± 0.46 for single vessel, -15.47 ± 0.46 for two vessels, -14.27 ±0.54 for three vessels, -13.80 ± 0.14 for left main disease). GLPSS had considerable difference in mean value for single vessel CAD; two vessel CAD, three vessel CAD and isolated Left main disease . Also segmental LPSS showed significance for localization of the affected vessel. Conclusion: GLPSS and SLPSS are useful in suspected stable angina patient who have normal resting electrocardiography and conventional echocardiography, to select patients for coronary angiography.

67. Assessment of Psychiatric Comorbidities Related to Cases with Cannabis Use
Santhosh Reddy
Introduction: Cannabis is the third most commonly used psychoactive illicit substance globally after alcohol and tobacco. Cannabis use was associated with robust increases in risk for psychiatric comorbidities. The present study was designed to evaluate psychiatric comorbidities among cases with cannabis use. Material and Methods: Fifty eight cases under cannabis use attending the outpatient department of psychiatry and fulfill criteria for cannabis dependence as per ICD-10 above 15 years of age was included. Participant details were collected using semistructured patient proforma and details of cannabis dependence were collected by using marijuana problem scale, and the cannabis withdrawal scale. Results: Onset of cannabis abuse was below 18 years in 34.48% cases and above 18 years in 65.52% cases. Psychotic disorders (55%) were the common psychiatric comorbidity associated followed by Nonalcoholic psychoactive substance use disorders (NAPSD) (19%), manic episode (14%), ASPD (7%) and Depression (5%). The mean difference of comparison between duration of cannabis abuse and symptoms of cannabis withdrawal and duration of illness was statistically significant (p<0.05). Discussion and Conclusion: Cannabis abuse is a serious public health concerns requires active implementation of preventive and rehabilitation programs and educate the adolescents on the risks associated with its use.

68. A Comparative Study of Endoscopic Tympanoplasty Cartilage vs Temporalis Fascia in CSOM with Tubotympanic Disease
Krishna Sumanth Kotagiri, B Krishna Santosh, V. Chandra Shekar, M Ravikumar Raju, T Jaya Chandra
Introduction: Surgical treatment is the main stay to treat CSOM. With this a study was taken to find the hearing improvement among the individuals undergoing tympanopalsty with conchal cartilage and temporalis fascia. Materials and methods: This was a prospective randomized study, conducted in the department of Otorhinolaryngology, KIMS, Amalapuram, from March to December 2021. Study protocol was cleared by the Institutional ethics committee. Informed consent was taken from all the participants. Individuals aged >18 years with CSOM, those with non-discharging ear were included in this research. Those not willing for surgery, pregnant women, history of ear surgery, immune supressed were excluded. To group A, cartilage shield tympanoplasty and temporalis facia tympanoplasty to group B. First postoperative visit was on day 7, sutures were removed. At 3rd and 6th month, tympanic membrane, pure tone audiogram and impedence audiometry were assessed. P<0.05 was considered as significant. Results: Total 40 participants were included, group wise, 20 (50%) each, respectively. Gender wise, most of these participants were female; statistically there was no significant difference.  The mean preoperative AB gap was 26.20±8.2, 22.5±8.9; after 3 months, 12.45±8.173, 11.39±9.23 and after 6 months 14.66±9.9, 12.01±8.2 respectively among the groups; statistically there was no significant difference, respectively. Conclusion: For successful closure of tympanic membrane perforations, cartilage shield as well as temporalis facia material both are acceptable. However, there was better hearing improvement with cartilage shield material.

69. Maternal and Fetal Outcome of Gestational Diabetes at Tertiary Care Hospital, Gujarat, India
Arun Makawana, Niyati Gosai, Sanket Mathukiya, Gaurav Desai
Background: The Prevalence of GDM is increasing around the world due to multiple risk factors. GDM is associated with maternal complications and fetal complications which adversely affects outcomes in both. Method: This retrospective study was carried out among 40 patients with 24-28 weeks of gestational age diagnosed with gestational diabetes mellitus through a 75gm oral glucose tolerance test and admitted & delivered at the department of obstetrics and gynecology in tertiary care hospital, Gujarat during February 2020 to May 2022. Results: In our study, 67.5% of patients with gestational diabetes mellitus (GDM) underwent cesarean delivery and 32.5% had a normal vaginal delivery. Prevalence of Hypertension was 52.5% and Hypothyroidism was 17.5% in patients with GDM. In this study, 47.5% of neonates were small for gestational age. 22.5% of neonates developed complications and were admitted to NICU out of which 12.5% had respiratory distress. Macrosomia and Hyperbilirubinemia were seen in 10% and 12.5% cases respectively. Conclusion: GDM is associated with higher maternal and fetal morbidity. Early detection, treatment, monitoring and intervention are essential for short and long-term maternal and fetal complications.

70. Epidemiology of Benign Eyelid Lesions in Patients presenting
to a Tertiary Eye Care Hospital of Saurashtra Region
Nikunj Amin, Kishan Makwana
Background and Aim: Eyelid tumours are the most common neoplasms encountered by oculoplastic as well as plastic surgeons. Therefore, this study will be aimed at evaluating the relative frequency of benign eyelid lesions presented to a medical college in indian population to help clinicians prioritizing their presumed clinical diagnosis according to the commonly presented lesions in the community. Materials & Method: The present study is the descriptive and analytic study done in the tertiary care hospital. The reports of patients having eyelid lesions and who gave consent for research purpose use were included in the study. A total of 320 histopathological reports of the surgical specimens of eyelid lesions obtained from patients admitted in the hospital were analysed. Results: A total 320 cases of the different eyelid lesions were analysed, the highest prevalence of eyelid lesions i.e., 80 was observed in the age group of 31-40 years. Owing to the gender distribution it was found that Males were more affected than females. Right upper eyelid was the most commonly involved and right lower eyelid was the least commonly involved location. Conclusion: The demographic features of a lesion observed at the first patient examination are of great importance in directing the ophthalmologist to the diagnosis. Most eyelid lesions are benign and are more common in the younger population. A detailed examination using these data will facilitate the recognition of malignant lesions that may be life-threatening and will speed up the procedures required for definitive diagnosis and treatment.

71. Clinical Profile and Histopathological Spectrum of Oral Cavity Malignancies in Central Rajasthan
Nitin Gupta, Chandrika Gupta, Saumya Katiyar, Hema Udawat
Introduction: Oral cavity lesions are frequently encountered in India. An oral cancer stands at number two position in India and is only behind Breast cancers. The increase in number of cases of oral cancer is an important concern for community health as it is one of the common types of cancers in India. Because of detection in the late phase, the chances of cure are also low almost negligible; leaving 5-year survival rates of 20% only. On suspicion of malignancy, histopathological examination of oral cavity lesions is the gold standard for confirmatory diagnosis. Histopathological evaluation gives us the information regarding type of malignancy and its differentiation. Methods: This is a retrospective study conducted over a period of two year. The biopsies of lip and oral cavity lesions received from ENT department, Surgery department and Dental department at the Department of Pathology during the study period were included in our study. The tissues were processed as per protocol. All the patients with histopathological diagnosis as malignant lesion were included for analysis of this study. Statistical analysis was done using Microsoft Excel 2019. The analysis was done by calculating ratios, proportion, and percentage. Results: We received a total of 278 biopsies of oral cavity lesions during the study period, out of which 115 cases (41.36%) were diagnosed histologically as malignant lesions and were included in this study. Remaining 58.6% patients were diagnosed with inflammatory and benign lesions. 68% patients were males and 32% were females. The age ranged from 30 years to 83 years with mean age was 63 years. Maximum number of patients were in their sixth decade of life with 28% cases. Maximum patients were laborers and agriculturists with lower middle class. The most common presenting symptom was oral ulcers. 63% of patients had history of bidi or cigarette smoking, 61% are chronic consumers of smokeless tobacco. 25% patients were using both smoking and nonsmoking tobacco. Alcoholic history was there in 32% patients and 20% patients were both smokers and alcoholics. Most common site of lesion was buccal mucosa in 28% cases followed by alveolus in 14% cases. On histological examination, squamous cell carcinoma was the most common type of malignancy. Among SCC, most common was well differentiated tumors. Conclusion: Malignancy of oral cavity and oropharynx is a important concern in developing countries specially in male population. Population in lower social economic strata are more at risk and tobacco both smoking and nonsmoking form is potential risk factor. Histological examination plays a important role in early detection of malignancies so that early treatment can be started and improve the prognosis of patients.

72. Assessment of Awareness and Knowledge of Psychosomatic & Urogenital Symptoms and Non-Hormonal Treatment in Indian Postmenopausal Women
Priyanka Jain, Monika Gupta, Rashmi Tripathi, Malini Bhardwaj, Shesha Sinha
Objective:  Assessment of awareness and knowledge of psychosomatic & urogenital symptoms in Indian postmenopausal women and to access the use of HRT and other non-hormonal treatments for the post-menopausal symptoms. Methods: Prospective observational study in which menopausal psychosomatic and urogenital symptoms were assessed using Modified Menopause Rating Scale (MRS). The questionnaire was interviewed face to face in the language they   understood by trained professionals. They were explained the various somatic, the psychosexual and urogenital symptoms and women were asked whether or not they had experienced these symptoms and their responses were recorded. Each of the symptoms contain a scoring scale from “0” (no complaints) to “4” (very severe symptoms). Counselling and benefits of non-hormonal methods were explained in detail. Women were followed-up again after 6 weeks for reassessment of symptoms using the same Modified MRS   SCALE. Results: The mean age of menopause in this   study was -50-55 years. Majority of them were married (70%), illiterate (50%), belongs to lower class of socioeconomic status (71%). The most prevalent menopausal symptoms for all women were joint and muscular discomfort – 210(80.76%), irritability -189(72.69%), physical problems /mental exhaustion -182(70%). In the women taking treatment, there was significant improvement in symptoms like hot flushes, physical and mental exhaustion and joint and muscular pain. Conclusion: Women when present with such problems, need acknowledgement, comprehensive assessment and adequate support by family members. In the women taking treatment, there was significant improvement in symptoms like hot flushes, physical and mental exhaustion and joint and muscular pain. They can improve their quality of life by adopting nonpharmacological practices.

73. Epidemiology of Chronic Pain Patients Attending Pain Clinic:   Prospective, Observational Study
Varchaswa Pandey, Bhuvaneshwar Minj, Deepak Khare, Shruti Dubey
Objective: To study epidemiology and impact of chronic pain on life of patients and to find choose  treatment modalities for chronic pain. Methods: A random sample of 200 patients, aged 35 and over, was drawn and surveyed by a self-completion questionnaire. The questionnaire included case-screening questions, a question on the cause of the pain, the chronic pain grade questionnaire, the level of expressed needs questionnaire, and sociodemographic questions. Results: About 72% of the GPs had awareness about pain clinics, but only 32% actually referred patients to pain clinics. Sixty percent of the GPs referred patients to other specialists, mostly orthopedic surgeons. Forty percent of the GPs were aware of few techniques of pain relief; however, 65% answered negatively about techniques at pain clinics. GPs showed interest in knowing more about such clinics (88.2%). Respondents with chronic moderate and chronic severe pain were 37% and 63%, respectively. Pain in knees (32%), legs (28%), and joints (22%) was most prevalent. Respondents with chronic pain were no longer able to exercise, sleep, maintain relationships with friends and family, and maintain an independent lifestyle. About 32% of patients lost ≥4 hours of work in the past 3 months. Majority (68%) of respondents were treated for pain with over the counter (OTC) drugs, and most were taking NSAIDs (95%). Conclusion: Chronic pain is a major problem in the community and certain groups within the population are more likely to have chronic pain. A detailed understanding of the epidemiology of chronic pain is essential for efficient management of chronic pain in primary care. The high frequency of patients with chronic pain in practices of specialists demonstrates the necessity of a special qualification also on this level of our medical system.

74. Role of Artificial Intelligence, Big Tech and Machine Learning in Accelerating Biologics Development and Clinical Trials
Tarun Chawla, Amit Kumar Tomar
Modern healthcare is being revolutionized and strengthened by artificial intelligence-based technologies that can grasp, learn, and act, whether they are used to identify novel correlations between genetic codes or to guide surgical robots. Vaccines, blood and blood components, allergic somatic cells, gene therapy, tissues, and recombinant therapeutic proteins are only a few examples of biological products, according to the US FDA. Most biologics are complicated mixes that are difficult to identify or classify, in contrast to the majority of medications, which are chemically manufactured and have a known structure. Biotechnological products, including those produced by them, have a propensity to be heat sensitive and microbial contaminated. Because of this, and in contrast to the majority of conventional pharmaceuticals, it is vital to adopt aseptic principles from the first manufacturing processes. A biologic drug (biologic) is a product that is produced from, or contains components of living organisms. Biotechnology has given rise to these organic derivatives which are sourced from humans, animals or microorganisms. As internal modifiers, biologic drugs either enhanced or inhibit biological processes that are part of the key mechanisms of action for critical pathways in healing. The study specifically focuses on the three newest applications of AI-ML in healthcare: AI-ML driven discovery and process development, clinical trials, and patient care. According to the research, companies have highly benefited from the use of AI-ML in health industries i.e. in Pharmaceuticals, Biotechnology, Clinical Trials and Digital Health by automating target identification and thus accelerating the drug discovery lifecycle. We finally anticipate potential recent interventions of AI-ML in several steps of the biological landscape, focusing on clinical trials and clinical research aspects. In this context, artificial intelligence (AI), and especially machine learning (ML), have great potential to accelerate and improve the optimization of protein properties, increasing their activity and safety as well as reducing their development time and manufacturing along with clinical trial costs.

75. A Clinicopathological Study of Tubo Ovarian Masses at SRMS, IMS, Bareilly, U.P.
Swati Kumari, Krishan Nandan
Background: In gynaecological practise, an adnexal mass is a frequent clinical manifestation. The differential diagnosis of an adnexal mass presents a diagnostic challenge for the treating gynaecologist since it can range from a life-threatening emergency like an ectopic pregnancy to a malignant lesion with a high mortality rate to investigate the histopathology of adnexal masses. Material and Methods: The study comprised 110 cases of adnexal masses that underwent surgical surgery over the course of a year. A specimen that was obtained by the pathology department was examined histopathologically. Results: 110 instances altogether made up the study group. In our analysis, ovarian pathology accounted for 79% of adnexal mass cases, tubal pathology accounted for 15.45%, and combination pathology, or endometriosis and tubovarian abscess, accounted for 5.45%. 9.1% of ovarian lesions were non-neoplastic cysts like corpus luteal cysts or endometriosis, while surface epithelial lesions were present in 50% of cases. Out of a total of 110 cases, 77 were of ovarian origin, with 57 (74%) being benign, 05 (6.5%) borderline, and 15 (19.5%) being malignant. Conclusion: Finally, an adnexal mass frequently presents a diagnostic challenge to the treating doctor. Patients in the reproductive age range who experience adnexal mass frequently have an ectopic pregnancy. The most frequent benign ovarian lesion is a serous cyst adenoma, while the most frequent malignant ovarian lesion is a serous cyst adenocarcinoma. Ovarian neoplasms are another important factor in the development of adnexal masses.

76. Study of Serum Calcium and Magnesium levels in Pre-eclampsia at DMC, Laheriasarai, Bihar
Reetu Rani, Santosh Kumar, Sude Kumar Singh
Background: Pre-eclampsia (PE) is a pregnancy disorder characterised by hypertension and proteinuria after 20 weeks of pregnancy in patients who were previously normotensive and non-proteinuric. If an emergency delivery is not performed, pre-eclampsia may progress to eclampsia, seizures, and maternal and foetal death. The aetiology of pre-eclampsia may be influenced by environmental and dietary variables. In impoverished nations, pregnant women consume fewer critical minerals and vitamins in their diets. Among other things, there is a change in the metabolism of calcium (Ca) and magnesium (Mg) during pregnancy, which may be a cause of pre-eclampsia. The goal of the current study was to evaluate, compare, and correlate the levels of serum total calcium, magnesium, and uric acid in pre-eclampsia and normotensive pregnancy. Materials and Methods: This comparative cross-sectional study, which was situated on hospitals, was carried out between August 2021 and July 2022. Ca, Mg, and uric acid in the blood, as determined by an automatic analyzer. SPSS version 21.0 was used to analyse the data. Results: Mean serum calcium and magnesium levels were considerably lower in PE than in normotensive pregnant women (8.69±1.59 mg/dL and 1.91±0.36 mg/dL versus 10.13±0.66 mg/dL and 2.08±0.12 mg/dL, respectively). In contrast, serum uric acid and creatinine levels were higher in PE than in control women. Conclusion: The results of this study show that pre-eclampsia has lower serum total Ca and Mg levels than normal pregnancy does. Although the conclusion was statistically insignificant, the amount of serum total Ca was observed to decrease with the severity of pre-eclampsia.

77. A Prospective, Randomized, Double-Blinded Control Study on Comparison of Tramadol, Clonidine and Dexmedetomidine for Post Spinal Anesthesia Shivering
Satyendra Kumar, Sanjay Kumar Thakur, Bijoy Kumar, Ashok Kumar
Background: Shivering, a typical intraoperative issue with spinal anaesthetic, causes discomfort and anguish for the patient, the anesthesiologist, and the surgeon. It also significantly increases oxygen use. The goal of the current study was to determine whether tramadol, clonidine, and dexmedetomidine are useful in treating post-spinal anaesthetic shivering as well as to identify any potential negative effects. Methods: Ninety patients who experienced shivering while under spinal anaesthetic participated in this prospective, randomised, double-blind control research. They were divided into three groups at random and given different medications: Group T received tramadol 1 mg/kg, Group C received clonidine 1 mcg/kg, and Group D received dexmedetomidine 0.5 mcg/kg. The duration of shivering control, recurrence rate, hemodynamic factors, sedation score, and negative effects were tracked. Results: Tramadol took 6.76±0.93 minutes and clonidine took 9.43± 0.93 minutes to reduce shivering, respectively. Dexmedetomidine was faster, taking 5.7± 0.79 minutes. Dexmedetomidine had a substantially lower recurrence rate (3.3% vs. 10% and 23.3%, respectively) than clonidine and tramadol. Dexmedetomidine provided a more comfortable level of sedation than clonidine or tramadol. Four extra occurrences of vomiting occurred in the tramadol group, while six episodes of hypotension and two cases of bradycardia occurred in the dexmedetomidine group. The bradycardia and hypotension were experienced by two of the clonidine patients. Conclusion: Due to its quicker start and lower recurrence rate, dexmedetomidine performs better in the control of shivering than tramadol and clonidine. The dexmedetomidine group experiences complications, but they are manageable.

78. Study of Clinico-Epidemiological Profile of Acne Vulgaris at JLNMCH, Bhagalpur, Bihar
Vikas Anand, Rajeev Ranjan Jha
Background: The pilosebaceous follicle is affected by the multifactorial illness known as acne vulgaris, which is characterised by comedones, papules, pustules, nodules, cysts, and scars. Methods: From March 2021 to December 2021, this study was carried out at Department of Dermatology, Venereology, and Leprology, JLNMCH, Bhagalpur, Bihar. A total of 75 acne vulgaris outpatient department patients were collected for the investigation. Results: All 75 respondents (100%) had acne on their face, 22 (29.3%) had it on their back, 65 (86.7%) had it on their cheeks, 16 (21.3%) had it on their chest, and 3 (4.0%) had it on their scalp. The majority of cases of acne vulgaris occur in areas with a high density of pilosebaceous units. In the current study, all of the participants (100%) had facial lesions, 23 (7.7%) had facial and back lesions, and 7 patients (2.3%) had facial, back, and chest lesions. Conclusion: The age range of 16 to 20 years saw the highest frequency, while females were more frequently impacted. The face is most frequently impacted. The use of cosmetics, stress, and seasonal variations all contribute to the aggravation of acne. To support the findings, additional clinic-epidemiological research in the Indian population is needed.

79. A Comparative Study of Vitamin D Deficiency and Psoriasis at JLNMCH, Bhagalpur, Bihar
Rajeev Ranjan Jha, Vikas Anand
Background: An inflammatory condition that affects the skin and joints is psoriasis. Occasionally, hypocalcemia and vitamin D insufficiency affect psoriatic individuals. Our study’s objective was to assess the calcium and vitamin D levels in psoriasis patients. Materials and Methods: 110 psoriasis cases and 110 non-psoriatic patients (controls) were included in a comparative study between January 2022 and June 2022 at the outpatient department of JLNMCH in Bhagalpur, Bihar. Both groups’ serum concentrations of 25-hydroxyvitamin D3 [(25OH) D3], calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALK), and other substances were assessed. Utilizing version 19 of SPSS software, data were examined. For statistical analysis, the chi square test and T-test were performed. Results: Among 110 psoriasis patients, 74 (67.3%) men and 36 (32.75%) women were affected. The serum levels of calcium (P-value: 0.563), phosphorus (P-value: 0.381), PTH (P-value: 0.364), and ALK (P-value: 0.639) did not significantly differ between the two groups. 64.5% of psoriatic patients and 60% of controls had vitamin D deficiency (P-value = 0.45); however, 30.9% of psoriatic patients and 17.3% of controls had severe hypovitaminosis D. The statistical significance of this difference was 0.014 (P value). Conclusion: We found a substantial link between psoriasis and severe hypovitaminosis D. This result demonstrated the necessity of testing psoriatic patients for vitamin D insufficiency.

80. Functional Outcome and Improvement in Pain Following Autologous Platelet Rich Plasma Infiltration in Lateral Epicondylitis Patients
Sandeep Vellarakkat, Rijesh Pottangadi, M K Ravindran
Introduction: Platelet Rich Plasma (PRP) is prepared from autologous human plasma and has higher platelet concentration. Injections of PRP have been found to be effective in treating tendinopathies. Only a few studies focused on using PRP injection in patients with lateral epicondylitis (tennis elbow). Hence functional outcome and improvement in pain following treatment with PRP injection needs to be further studied. Aim of the Study: To assess the relief of pain and functional outcome after PRP injection in patients with tennis elbow. Materials: A prospective study on 65 patients diagnosed with tennis elbow, aged between 18 to 65 years with symptoms of pain not relieved with oral analgesics or physiotherapy was conducted. Patients were evaluated using a Patient Rated Tennis Elbow Evaluation (PRTEE) Score and Visual Analogue Pain Scale (VAS) before and after autologous platelet rich plasma infiltration in the tendon. Results: Among the 65 patients participated the mean age was 37.72±4.10 years. There was statistically significant difference in the pain scores measured by PRTEE score and VAS before and after injection of PRP. Paired t test of both PRTEE score and VAS scores was found to be statistically significant with the difference of means of score at 2 weeks, 4 weeks, 8 weeks and 12 weeks (p < 0.001).  Repeated measures of ANOVA of PRTEE scores and VAS scores at pre procedure, 2, 4, 8 and 12 weeks also found that there was a significant difference in mean values of PRTEE scores and VAS scores at pre procedure, 2, 4, 8 and 12 weeks and was statistically significant (p < 0.001). Conclusion: In tennis elbow patients, PRP injection can be used an alternative treatment option as it shows an effective reduction in pain and improves functional outcome according to PRTEE Score and VAS Score in the short term.

81. Clinico-Etiological Profile of the Elderly Population with Altered Mental Status (AMS) in a Teaching Hospital
Minakshi Dhar, Birata Debbarma, Anirudh Mukherjee, Senkadhir Dasan
Introduction: This study is aimed at evaluating the clinico-etiological profile of AMS among elderly patients and to make recommendations regarding management based on etiologies, thereby to improve both morbidity and mortality outcome. Methods: This retrospective observational study was conducted in a teaching cum tertiary care hospital. Two years’ data (from July 2017 to June 2019) were extracted from the medical records section and 172 eligible subjects were analyzed using descriptive statistics for clinical outcomes, demographic profile, and various etiological factors. Results: A total of 1,784 elderly inpatients (age >60 years) were screened from the records and 172 eligible elderly AMS patients were found eligible for the study. The male elderly population consisted of 110 (63.95%), and the female elderly was 62 (36.04%). The mean age of the study population was 67.82 years. The etiological factors of AMS in the study population were neurological- 47.09% (n = 81), infection- 30.23% (n = 52), metabolic/endocrine- 16.27% (n = 28), pulmonary- 2.32% (n = 4), fall- 1.74% (n = 3), toxic cause- 1.16% (n = 2), and psychiatric illness- 1.16% (n = 2). The total mortality rate was 9.30% (n = 16). Conclusion: The main etiological factors of AMS in the elderly population were predominantly of neurological, septic, and metabolic causes. These factors were preventable and treatable by training physicians, staffs (as most of the physicians in the developing countries are not trained in managing this fragile group of population with multiple comorbidities), and by decentralizing Geriatrics healthcare setups.

82. Anatomical and Radiological Study of Coronary Dominance
Sireesha, B. Lalitha, D. Taraka Lakshmi, G. Sailaja
Background: The coronary arteries are the first vessels that branch from the aorta In 90% of the individuals, the posterior descending interventricular artery arises from the terminal portion of the right coronary artery –right dominance. In almost 10%of the hearts, there is left dominance i.e., the left circumflex artery provides the posterior descending interventricular artery. The left dominance is associated with high mortality rate. Aims & Objectives: To observe the dominance pattern of the coronary arteries. Method: For the present study 40 embalmed cadaveric heart specimens were collected and studied for the coronary dominance pattern. The study was done on 102 angiograms and their reports at Cardiology Department Different views of angiograms were studied, Dominant pattern of Coronary Arteries were seen. Conclusion: In this study, it was found that in most cases Males (85%) and Females (90%) were Right Dominant. Co-Dominance and Left Dominance are of small percentage in both the genders.

83. Generalized Pruritus among Elderly Attending Dermatology OPD in a Tertiary Care Centre – A Descriptive Study
Keerthi Joy Irimpan, Athira Sudhesan, Balachandran P.K., Kunjumani Sobhanakumari
Background: Pruritus is the most common cutaneous symptom in geriatric population. Pruritus in aging skin may reflect primary skin disease, systemic disease or arise idiopathically. Aim of the study is to describe the various clinical patterns of presentation and etiological factors of generalized pruritus among elderly patients attending dermatology OPD, and to determine the quality of life in elderly patients with generalized pruritus. Materials and methods: A descriptive study was conducted among 95 elderly patients with generalized pruritus, who attended the outpatient department of Dermatology of a tertiary care hospital in Kerala, South India from November 2018 to May 2020. Detailed history and complete clinical examination and investigations were carried out. Severity of pruritus was assessed using 5-D itch questionnaire. Quality of life was assessed using dermatology life quality index (DLQI). All data were analyzed using SPSS statistical software. Results: This study highlights the various etiological factors, co-morbidities associated with generalized pruritus in elderly and how it affects their quality of life. Conclusion: Generalized pruritus among elderly can be an important dermatologic clue for the presence of a significant underlying systemic disease. Proper examination of skin and relevant investigation would help in finding the etiology and optimising management.

84. A Prospective Study of Intestinal Stoma Surgery in Tribal Region of Rajasthan at M.B. Hospital, Udaipur
Krishna Gopal Sharma, Bheru Singh Hariyawat, Alokik Bharaduvaj, Jamil Mohammad
There are many indications for which stomas (both ileostomy and colostomy) are constructed. The aim of study to analyze the indication of various intestinal stomas, complications encountered during and after the creation of stoma and their management and to review the outcome. This study carried out for prospective evaluation of the patients admitted in various general surgery wards of Maharana Bhupal Government Hospital attached to RNT Medical College, Udaipur which caters tribal population of Rajasthan. The study was conducted on all patients who were operated in this institution only for creation of an intestinal stoma either as an emergency or as an elective procedure were included in the study. Total 115 cases from July 2019 to May 2022 were included in the study.  In conclusion stoma constructions were high in adult and old age group, mostly surgery done as an emergency procedure compared to elective procedure. The main cause for surgery were diversion for obstruction /perforation and perforation in trauma patients. The most common stoma constructed was loop ileostomy followed by end ileostomy with mucus fistula. There is high incidence of peristomal skin excoriations complication. The complication better managed with proper preoperative planning with effective stoma care in post operative period.

85. Correlation of C-Reactive Protein Levels with Glycemic Control in Diabetic Foot Patients and it’s Outcome at RNT Medical College, Udaipur
Bheru Singh Hariyawat, Krishna Gopal Sharma, Vaibhav Kumar, Jamil Mohammad
Diabetic foot complications are major sequelae of diabetes and contribute to most causes of non-traumatic lower-extremity amputations worldwide. For clinicians, if the risk stratification of DFU can be obtained earlier in diabetic patients, the hospitalization, disability and mortality rate will be reduced. The objectives were to evaluate the association between blood glucose levels and serum CRP levels in type 2 Diabetes mellitus patients presenting with diabetic foot and to correlate the level of CRP with outcome of diabetic foot in the study population. This prospective observational study carried out for a period of one year. Total 64 patients who were admitted with diabetic foot in the Department of General Surgery, MB Govt. Hospital at Udaipur were studied. The proportion of subjects with higher fasting blood sugar and post-prandial blood sugar showed increasing trend with increasing level of CRP level. 9 out of 22 patients with elevated CRP level more than 40 mg/dl went for amputation. Rest 13 patients had slow rate of wound healing. We concluded that poor glycemic control and CRP has definitive correlation with outcome.

86. Comparison of Biochemical Parameters Pre and Post-Hemodialysis among Patients of Acute and Chronic Renal Failure in Jamnagar, Gujarat
Sharma P, Mewani M, Saini SK, Goyal S, Agarwal B, Haritwal A, Desai N
Background: Hemodialysis is one of the effective measures performed to correct hyperkalemia, uremia, and abnormal levels of  serum sodium and creatinine in patients with renal failure. The present study determines the changes in biochemical parameters between the pre and post-renal stages of dialysis. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology, MP Shah Medical College, Jamnagar (Gujarat, India). Patients above 18 years of age were enrolled after informed consent. Biochemical parameters of fifty and hundred patients with acute renal injury and chronic renal failure respectively were collected. Biochemical parameters include serum sodium, potassium, urea, and creatinine. The comparison of biochemical parameters pre and post-dialysis was performed using paired student t-test with a 5% level of confidence. Results: The patients suffering from acute renal failure showed a significant decrease in serum potassium [t = 38.07; p < 0.0001], serum urea [t = 23.06; p < 0.0001], and serum creatinine [t = 23.47; p < 0.0001] in post-dialysis patients compared to pre-dialysis levels. However, serum sodium did not differed significantly between the two groups [ t = 0.8; p = 0.42]. In patients of chronic renal failure, a significant decrease in serum potassium [t = 32.58; p < 0.0001], serum urea [t = 21.91; p < 0.0001], and serum creatinine [t = 31.99; p < 0.0001] was present in  post-dialysis patients compared to pre-dialysis levels. However, serum sodium did not differed significantly between the two groups [ t = 0.94; p = 0.35]. Conclusion: Hemodialysis is a preferred technique to correct biochemical abnormalities in renal failure at the tertiary center, and it is cost-effective.

87. Correlation of Endometrial Thickness by Transvaginal Sonography with Endometrial Histopathology in Evaluation of Postmenopausal Bleeding: a Prospective Study
Rinku Adarshi, Suman Das, Rajib Pal, Koushik Bose
Background: Postmenopausal bleeding (PMB) accounts for about 5 percent of patients attending Gynecology Outpatient Department visits. Any postmenopausal bleeding should require prompt and thorough evaluation to exclude endometrial carcinoma particularly in presence of risk factors. The aim of the present study was to evaluate endometrial thickness (ET) by transvaginal sonography in endometrial causes of postmenopausal bleeding (PMB) and its correlation with endometrial tissue histopathology. Methods: A total 100 patients with PMB fulfilling the inclusion criteria and giving informed consent were selected in this prospective study. Each patient was subjected to transvaginal sonography (TVS) first in which uterus, adnexa and endometrial thickness (ET) were assessed. Dilatation and curettage was then scheduled at subsequent visit as an inpatient procedure. Endometrial tissue was collected and sent for histopathological examination. Results: Majority (38%) of patients with PMB was in the age group of 46-50 years. Among the risk factors 18% of patients had diabetes mellitus; hypertension was present in 15% of cases and obesity in 14% of cases. Atrophic endometrium (40%) was most common endometrial cause of PMB. Both proliferative endometrium and endometrial hyperplasia without atypia were observed in 18% of cases. Endometrial polyp was found in 5 cases. Endometrial hyperplasia with atypia was observed in 8% of cases. Endometrial carcinoma was seen only in 2 cases. Conclusions: TVS is an important tool for evaluation of endometrial pathology in all cases of postmenopausal bleeding to exclude endometrial carcinoma. The risk for abnormal endometrial pathology could be ruled outwhen ET<=5 mm. Histopathological diagnosis of endometrium is the gold standard.

88. Role of Magnetic Resonance Imaging in Evaluation and Staging of Colo-Rectal Carcinoma
Samvab Mishra, V. Rajesh, Sanjeeb Kumar Pradhan, Sulata Choudhury, Siba Prasad Dash, Sekh Ansar Alli
Background: Currently colorectal cancer is staged with computed tomography (CT). However, magnetic resonance imaging (MRI) is giving superior results in the detection of colorectal liver metastasis and in local staging of colorectal cancer. Optimal (local) staging of colorectal cancer could become crucial in selecting patients for neoadjuvant treatment (FOXTROT trial). In this study, we find out the diagnostic performance of MRI in staging the disease and compare with histopathological study and thus find the accuracy of MRI in staging colorectal cancer preoperatively. Aim and Objective: (1) To study the role of MRI in staging of Colo-Rectal carcinoma. (2) To assess its impact on evaluation and management pattern. Patients and Methods: It is a prospective study taking 44 number of colorectal cancer patient who were admitted to the MKCG Medical and Hospital during the period from August 2020 to May 2022. All the patients were undergone MRI scan (1.5 Tesla: T1, T2 and diffusion weighted imaging) of the abdomen and pelvis. Patients were staged accordingly. Early staged cancer patients were selected for surgery and locally advanced cancer patients were undergone neoadjuvant chemotherapy and again restaged after completion of chemotherapy and then again surgery was performed. The results were recorded on various parameters like size and extent of tumour, serosal involvement, extramural vascular invasion, circumferential resection margin (CRM), mesorectal fat invasion and compared with histopathological reports. Results: The overall accuracy of T-staging when all cases were combined was 77.9% in our study with 69.4% sensitivity and 79.3% specificity. All cases combined (N=44): N-staging showed accuracy of 81.2%, sensitivity of 74.2% and Specificity of 85.5%. The specificity of predicting CRM invasion was 91.7% and negative predictive value was 84.6%. Accuracy of 80.7%, 68.2% sensitivity and 87.5% specificity were noted in prediction of presence of extramural vascular invasion for the whole study population. For detecting serosal involvement and extramural vascular invasion MRI had a high sensitivity and moderate specificity and a moderate sensitivity and specificity in the detection of nodal involvement. Conclusion: Our study shows that MRI has the potential to become a valuable tool in preoperative staging and restaging post chemoradiation therapy in locally advanced disease of colorectal cancer, Identification of invasion of mesorectal fascia and anal sphincter complex is therapeutically more important than the tumor stage. Combination of diffusion weighted images with high resolution oblique axial T2 weighted image perpendicular to the rectal wall, gives good accuracy for T staging and identification of malignant lymph nodes, mesorectal fascia invasion and extramural vascular invasion. High resolution T2 oblique coronal sections parallel to anal canal helps in planning sphincter sparing surgery thereby improving the quality of life. In addition, MRI seems to have a high sensitivity for additional risk factors, such as serosal involvement and EMVI. Combined with its known superiority in detecting liver metastasis, MRI could become the most optimal abdominal staging method for colorectal cancer patients.

89. Ante Grade Balloon Occlusion for Treatment of Renal Cell Carcinoma with Inferior Vena Cava (IVC) Thrombus
Deepak Bolbandi, Shubhatara Swamy
Background: RCC with venous tumour thrombi (VTT) is managed conventionally by radical nephrectomy with tumour thrombectomy; if needed, repair of IVC and metastasectomy may be necessary. Level I and II thrombi are managed with low complication rates by laparotomy alone. Level III and IV thrombi are managed surgically by standard technique i.e. thoracoabdominal tumour resection with cardiopulmonary bypass (CPB). However, it requires hepatic mobilization and is associated with complications based on high morbidity and hence less invasive techniques have been developed. Materials and Methods: We present 11 cases of renal cell carcinoma with hepatic and sub hepatic IVC thrombus from 2015 to 2019. We have operated 64 cases of radical nephrectomy, out of which, there were 11 cases of RCC with IVC thrombus. The average age was 61 years. Out of 11 patients, 9 were males and 2 were females. Ten cases were on the right side and one case was on the left side. Results: Of the eleven patients, nine patients needed observation in the intensive care unit (ICU) for one day only. The remaining 2 patients needed observation in ICU for 3 days as they developed pneumonia. 6 patients needed one unit of packed red blood cells (PRBC) transfusion and 5 patients needed 2 units of PRBC transfusion. The average post-operative creatinine was 1.8. The average days of hospitalisation were 10 – 12 days. There were no wound infections or mortality. Conclusion: For the surgical treatment of RCC with retrohepatic IVC tumour extension, transjugular balloon occlusion of the suprahepatic IVC offers an alternative to extensive hepatic mobilization to obtain suprahepatic thrombus control. Advantages over traditional surgical methods may include decreased surgical time, lower risk of liver injury and tumour embolism. We suggest this method for further evaluation.

90. Study of Cytological, Radiological and Histopathological Correlation in Bone Tumours: A Prospective Study from a Tertiary Care Centre
Benazear Farooqui, Prafful Badholia, Mohd Belal Farooqui
Introduction: Though bone tumors are not very common, an accurate diagnosis is required. Various investigational methods like cytology, histopathology, fine needle aspiration cytology (FNAC), and radiology are employed. Aim and Objective: To study cytological, histopathological, and radiological correlations in patients with bone tumours. Material and Methods: This prospective observational study was carried out on 52 patients with bone tumours who were referred to the Pathology Department of the NSCB medical college for diagnosis from 2018 to 2019. All specimens had been examined by plain radiography, FNAC, biopsy, and if required, computed tomography (CT) and magnetic resonance imaging (MRI) with suspected primary bone tumours. The data was collected in a specially designed proforma for the study. It was transformed into a master chart and then subjected to statistical analysis. Results: The concordance rate of histology and cytology was 82.69% (43 out of 52 cases). The discordance rate of histology and cytology was 17.3% (9 out of 52 cases). The sensitivity and specificity of cytology was 92.3% and 73.1% respectively. False positive rate of radiology in the bone tumour was 29.03%. Diagnostic accuracy of radiology in bone tumours was 75%, and concordance with histopathology was 75%. The discordance with histopathology was 25%. Conclusion: Findings showed a good correlation between cytological, histopathological, and radiological techniques in patients with bone tumours.

91. A Prospective Study to Determine the Effectiveness of Delayed Umbilical Cord Clamping in Preterm Infants in a Tertiary Care Hospital
Minesh Bhikadiya, Dhaval Bhatt, B. Adithya Nikhileshwar, Pranav Punasanvala
Objective: To investigate the safety, feasibility and efficacy of delayed cord clamping (DCC) compared with early cord clamping (ECC) at delivery among preterm infants born before completed 37 weeks’ gestation.Study Design: This is randomized, controlled trial in which women in labor with singleton pregnancies before completed 37 weeks’ gestation were randomly assigned to ECC (cord clamped before 30sec) or DCC (cord clamped after 120sec). Results: When analyzing the 100 cases performes per protocol, there were no significant difference in morbidities like RDS (p=0.45), NEC (p=0.31), IVH(p=0.31), duration of hospital stay (p=0.22) between two randomization groups of DCC and ECC. There is no significant difference in mortality rate (p=0.6) as well. DCC significantly reduces requirement of blood transfusion and incidence of anemia at birth, at 1 month of age and at 4 months of age. Conclusion: The requirement of blood transfusion is reduced with delayed cord clamping up to 4 month of age significantly. Infant morbidity was not affected of delayed as compared to early cord clamping, neither when regarding the neonatal period (hyperbilirubinaemia/jaundice, respiratory symptoms, polycythemia), nor the first 4 months of life (infection symptoms, gastro intestinal problems, contact with doctors) It offers hematological and circulatory advantages compared with ECC. A more comprehensive appraisal of this practice is needed.

92. Correlation between Anemia and Severity of Retinopathy of Prematurity in Preterm Infants in South Bihar
Priya, Nidhi, Amresh Kumar, Ashish Kumar Sharma, Prakash Kumar
Introduction: Premature infants have avascular or incompletely vascularized retina at birth, and ROP evolves over 4–5 weeks after birth. This relatively slow evolution gives a small window of opportunity to effectively conduct retinal examinations and timely interventions to improve visual outcome and avoid irreversible blindness owing to retinal detachment from progressive untreated ROP. Aim and objectives: The aim of the study was to estimate the incidence, to identify the corelation of anemia to ROP, in preterm infants. Material and methods: A retrospective analysis study was performed on the preterm infant with anemia in Narayan medical college Jamuhar, on 50 premature during July 2021 to june 2022 in the NICU on the neonates weighing <2000g and/or with a gestation ≤34 weeks admitted to our NICU. All the infants were screened by the same ophthalmologist (VP). Ethical clearance was obtained from the hospital ethics committee and informed consent of the parents was also obtained. Results: Incidence and severity of ROP in babies with anemia at 3 weeks of life was higher in those with severe anemia. 10 out of 14 study subjects in babies with Hb <8 mg/dl had stage 2 or higher ROP, 8 out of 19 study subjects in babies with 8-10 mg/dl, and 8 out of 17 study subjects with haemoglobin more than 10 had ROP grade more than 2. Conclusions: On the basis of our study we can conclude that anemia and number of blood transfusions are significant risk factors in the development of retinopathy of prematurity.

93. Anti-Inflammatory & Anti-Arthritic Activity of Aqueous Extract of Aloe Vera in Wistar Albino Rats
Pradhan Rashmita, Singh Subhasish, Singh Nipa, Upadhyay Rajlaxmi
Objective: Currently NSAIDs, selective COX-2 inhibitors, glucocorticoids which are used for treatment of inflammation &arthritis associated with adverse effects like peptic ulcer, renal toxicity and haematological toxicity, and amounts to be expensive when used on long term basis. Hence there is a necessity to find out the new cost effective as well as less toxic drug as an alternative. The present study was taken up to evaluate the systemic anti-inflammatory & antiarthritic activity of Aloe vera aqueous extract in wistar albino rats. Method: The anti-inflammatory activity of Aloe vera aqueous extract in the doses of 125mg/kg, 250mg/kg was evaluated by using carrageenan induced rat paw oedema model for acute inflammation, cotton pellet granuloma for subacute inflammation and Freund”s Complete Adjuvant (CFA) induced adjuvant arthritis for chronic inflammation. The antiarthritic activity was evaluated by using biophysical parameters (arthritic score, paw volume and joint diameter) hematological parameters (ESR, RF) and histopathological study of joints (arthritic index). Results: The Aloe vera aqueous extract in the doses 250mg/kg, showed significant anti-inflammatory activity on acute, subacute models of inflammation &CFA induced arthritis as that of Indomethacin and antiarthritic property like Dexamethasone. Conclusion: Aloevera aqueous extract at 250mg/kg has better anti-inflammatory property along with good antiarthritic property.

94. Histomorphological Features of Leprosy: A Retrospective Study of 60 Cases at Tertiary Care Hospital
Jidnyasa K. Munot, Mukund Shivaji Unde, Sadhana Khaparde, Babaji Shinde
Introduction: Leprosy also known as Hansen’s disease is a contagious and chronic infectious disease. It has varied clinicopathological signs and symptoms. It generally affects the skin and peripheral nerves. It is still a major public health problem in India. Leprosy is being presented with wide manifestations. Histopathology has its own importance in the definitive diagnosis of leprosy. The objective of the study is to observe the varied histomorphology of leprosy. Aim: To analyse the different histomorphological features of leprosy and classify them as per Ridley-Jopling classification. Materials and Method: This is a retrospective analysis of clinically diagnosed cases of leprosy and their skin biopsies sent for histopathological evaluation between January 2021- June 2022 at a tertiary care hospital. Haematoxylin and eosin stained sections were studied to confirm features of leprosy and further classify as per Ridley-Jopling classification and Ziehl- Neelsen stained sections were studied to determine the presence of lepra bacilli. Observations and Results: 60 cases were included in the study. Male were affected more than female. The age group most affected was 20-40 years. Out of 60 cases, 22 (36.67 %) cases were of BT followed by BL 14 (23.34%), LL 10 (16.67), BB 9(15), TT 3(5 %) and IND 2(3%). Conclusion: This study confirms that histopathological examination gives an accurate diagnosis and typing of leprosy and must be done in every clinically diagnosed leprosy case.

95. Role of Multidetector Computed Tomography with CT Angiography as the First Line Imaging in Diagnosis of Acute Mesenteric Ischaemia – A North India Centre Experience
Rashmi Rekha, Aparajita Mishra, Prashant Sinha, Roopak Dubey, Aakriti Hans, Sreedhar Mohan Menon
Introduction: Acute mesenteric ischemia is a vascular emergency with critically important first few hours after the onset of symptoms for successful treatment. CT angiography with Biphasic contrast enhanced multidetector computed tomography is the first-line imaging test for its early diagnosis, detecting underlying causes and for excluding other causes of acute abdomen. CT angiography being non- invasive vascular imaging modality, help to localize the exact site and degree of occlusion that help to determine the choice of treatment. The main aims of this paper was to assess the role of Computed Tomography Angiography along with Multidetector Computed Tomography in the diagnosis of acute mesenteric ischemia and to recognize the characteristic MDCT find­ings of acute mesentric ischemia. Materials and methods: This prospective study was conducted in a tertiary referral centre and teaching hospital from North India (Uttar Pradesh) over a period of ~5 years from July 2017 to August 2022. 140 patients with high index clinical suspicion of having acute mesenteric vascular ischemia were examined with Multi Detector Computed Tomography and Computed Tomography Angiography. They were evaluated for abnormal mesenteric vascular changes and characteristic bowel wall changes. Results: MDCT combined with CTA showed abnormal findings in 30 patients diagnostic of mesenteric vascular ischaemia. MDCT findings alone were nonspecific for detection of acute mesenteric ischemia. Conclusion: The sensitivity & specificity of CTA along with MDCT in the diagnosis of AMI after surgical confirmation were 100% and 90% respectively.

96. Retrospective Assessment of the Outcome of the Stapled Haemorrhoidopexy for Haemorrhoids against Conventional Open Technique
Manoj Kumar Jayaswal, O.K.Maurya
Aim: To assess the outcome of the new procedure (Stapled haemorrhoidopexy) for haemorrhoids against conventional open technique. Material & Methods: The present retrospective study comparing Milligan Morgan open hemorrhoidectomy and Stapled hemorrhoidopexy for the management of grade 3 and 4 hemorrhoids was conducted in the Department of General Surgery, Nalanda Medical College and Hospital, Patna, Bihar, India for the duration of 1 year. Data of 100 patients who underwent surgery for hemorrhoids at our institute who fulfilled the inclusion and exclusion criteria was assessed. Results: A total of 100 patients (50 for each group) were included, randomized, and received treatment. There were no significant differences between the 2 groups with respect to sex, weight, history, or risk factors. At the 6-week postoperative visit, collected data showed that normal activity was restored earlier in the SH group (P = 0.001). No significant difference was observed in the incidence of complications in the 2 groups (P = 770). Conclusion: Stapled hemorrhoidopexy combined with an excisional technique was effective for more advanced hemorrhoid disease. The combination may have prevented symptomatic recurrence associated to stapled hemorrhoidopexy alone.

97. A Hospital Based Comparative Assessment of CRP against Blood Culture in Diagnosis of Neonatal Sepsis
Prem Prakash, Sanjay Kumar, Arjun Lal
Aim: The Aim of the study was to compare CRP against blood culture in diagnosis of neonatal Sepsis. Methods: The present study was conducted in the Department of Microbiology, Anugrah Narayan Magadh medical College and Hospital, Gaya, Bihar, India for 18 months from March 2019 to Aug. 2020. 100 neonates suspected of septicaemia were included in the study, information on demographic data, blood culture and the level of CRP was extracted. Results: Of the 100 neonates studied, 60 were blood culture positive while 40 were CRP positive. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of CRP were 84%, 40%, 44%, 82% and 65% respectively. Conclusion: The specificity and sensitivity of CRP against blood culture strengthen the use of this acute phase protein in the diagnosis of neonatal sepsis and would help the clinicians to fix the period of antibiotic treatment and medical management to reduce the liver damage due to antibiotic exposure, development of bacterial resistance and neonatal mortality.

98. A Study of Correlation of Pulmonary Function Tests and Body Mass Index in the MBBS Students and Health Care Workers of Bhagwan Mahavir Institute of Medical Sciences, Pawapuri
Paritosh Kumar, Sarbil Kumari, Swati Sinha, Amrita Narayan
Aim: To evaluate the prevalence of deranged BMI, pulmonary function tests and correlation between BMI and pulmonary function test. Material & Methods: A cross-sectional study was done on 200 MBBS Students and health care workers including 100 from rural area and 100 from urban area population in the age group of 18-35 years from Bihar Region. Results: In obese I and II groups, the mean value of pulmonary function tests were higher in rural population except FEV1/FVC, which was higher in urban population and statistically significant in obese II group. The differences of mean value of FVC and FEV1 were statistically significant in both obese groups. Conclusion: Prevalence of deranged BMI was significantly higher in urban population. Negative correlation found between BMI with Pulmonary function tests in both populations except FEV1 and FVC which showed positive correlation in rural population.

99. To Compare the Hemodynamic Changes after Priming Dosage and Induction Dosage of Propofol
Madhu Priya, Sudhir Tripathi, Ajit Gupta
Aim: Use of priming principle in the induction dose requirement of propofol and its hemodynamic stability. Methods: This prospective study was conducted in the Department of Anaesthesiology Narayan Medical College and Hospital, Sasaram, Bihar, India. 100 patients of age between18-55 years, come under ASA-I or ASA-II category undergoing surgery which requires general anaesthesia as a mode of anaesthesia chosen to determine effect of priming principle in relation to Propofol. Results: Two groups were comparable to each other with respect to age, weight, ASA physical status. There was no significant difference in baseline pulse rate & baseline SBP, DBP & MAP, oxygen saturation between group S & Group C (p value > 0.05).The mean induction dose in group S was 80.37±14.82 and in group C it was 112.27±17.68. Thus we observed a 30% reduction in induction dose requirement in group S. The rise in Pulse rate was highly significant at one minute after induction, during intubation, immediately after intubation & 5 minutes later. There was highly significant fall in MAP at one minute after induction, during intubation, immediately after intubation and 5 minutes later. The changes in SBP & DBP followed the same pattern as MAP. There were no statistically significant changes in SP02 in both the groups. Incidence of hypotension was more in group C while post-suxamethonium fasciculation’s was more in group S. Conclusion: The Priming principle when applied for the induction agent like Propofol is associated with significant reduction in total induction dose requirement of Propofol and improved peri-intubation hemodynamic stability.

100. Assessment of Cost Minimization Analysis of Antimalarials in India
Mithilesh Kumar, Deepak Kumar, Dinesh Kumar sah
Aim: To assess the cost difference of various branded and generic antimalarial drugs available in the Indian market. Material & Methods: The present observational research was carried out in the Department of Pharmacology, SKMCH, Muzaffarpur, Bihar, India for the duration of 6 months. The minimum and maximum cost in rupees (INR) of an antimalarial drug manufactured by different pharmaceutical companies in the same dose strength was noted among all the above sources. Results: Highest cost ratio was seen with Chloroquine 500 mg, Mefloquine 250 mg and Sulfadoxine – Pyrimethamine 500+25 mg. Lowest cost ratio was seen with Quinine 600 mg, Chloroquine 250 mg and Sulfadoxine – Pyrimethamine 750+37.5 mg. Conclusion: This study reveals the need to further improve the drug price regulatory mechanism concerning antimalarials available in India to improve patient compliance and thus cure rates of malaria.

101. To Study the Biochemical and Hematological Parameters of Adult Female Employees of ESICMCH, Bihta
Neelam Kumari, Manjulata, Soumya Chakraborty, Priyamvada
Aim: To determine the various vital biochemical parameters of level of Random blood sugar, vitamin D, TSH, FT3, FT4, serum iron and haemoglobin and assess the health status of female employee working at a tertiary care centre ESICMCH, Bihta, Patna. Methodology: A cross-sectional study was conducted by the department of Biochemistry in collaboration with the department of pathology at a tertiary care centre, on the 150 samples of plasma, serum and whole blood samples received in the central lab on the occasion of women Day. The subjects were the asymptomatic female employee without known co-morbidities. The parameters estimated were haemoglobin, random blood sugar, vitamin D, TSH, FT3, FT4, and Serum iron. The blood pressure was measured before taking the sample. Results: The mean age of 150 participants was 33.5 + 14.5 years. Mean height was 150.33 + 7.67 cm and mean weight was 53.33 + 11.67 Kg. Out of 150 participants, 40.7% had normal systolic B.P. and 72% had normal diastolic B.P. 59.3% and 28% had isolated elevated systolic and diastolic blood pressure respectively. Mean RBS levels were 96.87 + 21.13 mg/dl. Mean TSH levels were 2.91 + 2.59 mU/l. FT3 and FT4 had mean values of 4.67 + 0.87 pmol/L and 15.7 + 9.5 pmol/L, respectively. Mean haemoglobin level was 9.58 + 1.88 g/dl. (normal: 11.6-15g/dl) Mean vitamin D and serum iron levels were 23.40 + 21.5 ng/ml (normal: 20-40ng/ml) and 39.48 + 23.52 (normal: 60-170mcg/dl) mcg/dl, respectively. Conclusion:It was found in the study that majority of female employees had isolated systolic hypertension and moderate iron deficiency anaemia. Although the vitamin D and thyroid profile were found to be within normal range they were nearer the lower limit. Both the conditions may have detrimental effect on the health of the subjects in long run if not detected and treated on time. Routine haematological and Biochemical examination of employees should be done biannually to diagnose these conditions in asymptomatic employees to prevent not only the detrimental effect on the health status of the employee but also the work days loss which may happen in future if these conditions go undiagnosed and untreated.

102. Safety and Efficacy of Intravenous Iron Sucrose Therapy for Moderate Anaemia in Pregnancy: A Prospective Analysis
Veena Kumari Sinha, Vinita Kumari, Sanju Kumari
Background: Iron deficiency anaemia is most common nutritional deficiency in pregnancy. In India, pregnant women having low haemoglobin level resulting in high incidence of moderate to severe anaemia. Oral iron therapy can not meet this requirement and need parentral iron therapy. This study was conducted to evaluate safety and efficacy of intravenous iron sucrose in pregnant women with moderate anaemia. Methods: A prospective study was conducted (January 2021 to December 2021) in the department of Obstetrics & Gynaecology, Nalanda Medical College and Hospital, Patna. 200 pregnant women of gestational age 16-20 weeks with haemoglobin 7-10 gm/dL with diagnosed moderate iron deficiency anaemia attending routine OPD clinic were given intravenous iron sucrose therapy in a dose of 200mg in 100 ml of 0.9% normal saline after calculating the dose requirement. Results: The mean haemoglobin raised from 7.2±0.8 to 8.3±0.9 and 10±0.6 g% after 2 and 4 weeks respectively. There was significant rise in reticulocyte count from 1.5±0.9 to 4.9±0.5 and 5.0±0.6 after 2 and 4 weeks respectively. Other haematological parameters like haematocrit, MCV, MCHC were also improved significantly. Minor side effects were noted during study period. Conclusions: Intravenous iron sucrose was safe and effective in increasing the haemoglobin, reticulocyte count and other haematological parameters in pregnant women with moderate anaemia. Intravenous iron sucrose can be used in hospital on OPD basis and tertiary health centre where it can replace intramuscular iron therapy and blood transfusion due to serious side effects.

103. Prospective Comparative Assessment of Sociodemographic Profile and Fetal Outcome in Teenage and Adult Mother
Vinita Kumari, Veena Kumari Sinha
Aim: The present study aims to find out the incidence and to compare the various obstetric and fetal outcome of teenage pregnancy versus adult. Methods: The present study was conducted in the Department of obstetrics and gynecology, Nalanda Medical College and Hospital, Patna, Bihar, India. 100 cases of teenage pregnancy (1319 years) were compared with 100 cases of controls (20-26 years) for fetal outcome admitted in the Department of obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, Bihar, India for the period of 1 year. Results: The result showed that the mean age of teenage mother and adult mother was 18.75 and 23.65 years respectively. The maximum number of teenage mother belong to low socioeconomic status (55%), housewife (96%) by occupation, illiterate (70%), living in a joint family (60%) and belong to the rural background (70%). While in adult mother’s maximum number of females from middle (60%) socioeconomic class, housewife (85%) by occupation, educated up to primary level (40%), living in nuclear family (55%) and belong to urban background (55%). Statistically, we found a significant difference in mean age, socioeconomic status, occupation, education level, family and area in both groups (p < 0.05). Conclusion: Prevention of teenage pregnancy and reduced complications of teenage pregnancy can be achieved by improving the overall socioeconomic status of our female population and better nutrition especially during pregnancy.

104. Hospital-Based, Prospective Interventional Assessment of the Clinical Profile of Raised Intraocular Pressure in Closed Globe Injury and its Management
Ajay Kumar Bhardwaj
Aim: To recognize the causes of raised intraocular pressure (IOP) following blunt trauma, severity of disease and its management is made in this study. Material & Methods: This hospital-based, prospective interventional study was conducted at the Department of Ophthalmology, Madhubani Medical College, Madhubani, Bihar, India over a period of six months. After obtaining ethics clearance from Institutional Ethics Committee, 40 patients attending the glaucoma department with closed globe injury followed by raised IOP of > 21 mm Hg willing to give a written, informed consent were included in the study. Results: Most common mode of blunt injury was industrial accidents (32.5%), followed by injury while playing (25%). Out of 40 eyes, 29 eyes (72.5%) were managed by medical therapy alone. 11 eyes (27.5%) underwent surgical management.32 eyes, 5 eyes, 2 eyes and 1 eye had a vision of 6/6, 6/12, 6/18 and 6/24 respectively. Conclusion: There was no significant difference between medical and surgical intervention while treating glaucoma secondary to closed globe injury.

105. Evaluation of Microbial Flora Present in the Bile of Patients with Biliary Diseases and Non-Biliary Diseases: A Comparative Study
Abhinav Chaudhary, Abhishek Jina, Lalmani Pal, Mahesh Chandra Pandey
Background: Gallstone disease is one of the most common disorders affecting the digestive system. Despite evidence suggesting that normal bile is sterile, bacteria are regularly found in inflamed gallbladders and in cholelithiasis patients. Therefore, choosing the appropriate drugs is aided by knowledge of and familiarity with the microorganisms found in gallbladder bile. Methods: This prospective, single-center comparative study was conducted in Department of Surgery, in Maharashi Vashistha Autonomous State Medical college, Basti, for a period of 1 year from 15th March 2021 to 14th March 2022. In this study, total 100 patients were included and divided into study and the control group. The bile for culture was aspirated during the laparoscopic cholecystectomy and exploratory laparotomy. This bile was then cultured in the culture media and subsequently the sensitivity pattern was evaluated. Result: The study results showed that females had more incidence of gall stone disease. In the study group the microbial positivity was 48%, compared to 6% in the control group. In 2 cases of the study group polymicrobial positivity was reported. The most frequent species, either by itself or in conjunction with Bacteroides, was E. coli. None of the gall bladder carcinoma patients obtained a positive culture result. Patients with cholecystitis, cholelithiasis, and choledocholithiasis showed the highest levels of positive. Conclusion: This study showed that evaluation of presence bacterial species in the bile and subsequent the antibiotic management proved a key to achieve excellent results in patients with biliary diseases.

106. Maternal & Neonatal Outcomes in Pregnant Hypertensive Females in a Tertiary Care Hospital in Rajasthan – A Prospective Case Control Study
Keval Sondager, Pinkle Desai, Rishita Sondager
Background: Around 5-10% of the pregnancies are complicated by hypertension & its associated disorders which could result in significant maternal & fetal mortality & morbidity. Aims & Objectives: This case control prospective study evaluated the maternal and perinatal mortality rates, assess the association between adverse maternal and perinatal outcomes with the type of hypertensive disorder, degree of hypertension, gestational age, mode of delivery, and demographic characteristics and neonatal outcomes. Material & Methods: This prospective, cross-sectional study recruited 200 pregnant women(> 20 weeks of gestation) from January 2022 to April 2022 which were segregated in two categories. Group I which included 100 pregnant women with hypertensive disorders. Group II included 100 normal pregnancies without hypertension. Maternal & neonatal outcomes were recorded. Results: No statistically significant difference was observed between the two groups with respect to baseline demographic characteristics (age, parity, socioeconomic status, mode of delivery) (p>0.05). In Group I, 53% had gestational hypertension, 25% had mild preeclampsia, 15% had severe preeclampsia, 6% had eclampsia with 1% maternal mortality observed in woman with eclampsia. Maternal complications noted were HELLP syndrome (1.6%), 3.7% cases had pulmonary edema (2.8%), cerebral hemorrhage (3.2%), abruption placenta(6.3%) & postpartum hemorrhage (6.3%). In Group I, neonatal mortality was 5%, In Group I, 28% preterm neonates observed as compared to 8% in Group II. Neonatal weight was <1.5 kg in 7% in Group I  while 3% in Group II. In group I <7 Apgar score was observed in 26% cases and neonatal complications in 24% while in Group II theses were 12 % & 9% resp. Conclusion: Hypertensive disorders like eclampsia & severe preeclampsia are associated with significantly worst maternal & fetal outcome .Compromised utero-placental blood flow and ischemia could lead to fetal hypoxia & respiratory distress.

107. A Prospective Study to Assess the Raised Serum Bilirubin Levels in Cases of Acute Appendicitis and its Role in Predicting Complicated Appendicitis
Kishan A. V., Chandana P. Reddy, Mahit K. J., Siddesh Kumar M. Hiremath
Background: In this study, we wanted to evaluate the serum bilirubin levels in cases of complicated appendicitis, study the relationship between elevated serum bilirubin levels and acute appendicitis and assess its credibility as a diagnostic marker for acute appendicitis. Materials and Methods: This was a hospital-based cross-sectional prospective study conducted among 80 patients who presented with right iliac fossa pain to the Department of General Surgery, M S Ramaiah Medical College, Bangalore, from June 2015 to August 2017 after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: Of the 80 patients in our study who were diagnosed with acute appendicitis, 61 patients had increased serum bilirubin levels. The mean serum bilirubin level in the case of acute appendicitis was 1.28 mg/dl and in cases of complicated appendicitis, it was 2.40 mg/dl. Hence, serum bilirubin was much higher (P <0.001) in cases of gangrenous/perforated appendicitis. Conclusion: Serum bilirubin levels are significantly elevated in cases of acute appendicitis. Though clinical diagnosis remains the gold standard in diagnosing acute appendicitis, serum bilirubin levels can be used as a useful investigative modality. Serum bilirubin levels in our study have shown a two to three-fold rise compared to the normal range, especially in cases of perforated/gangrenous appendix. Hence, elevated serum bilirubin levels in clinically suspected acute appendicitis cases could be useful in predicting complicated appendicitis.

108. Anterior Decompression, Plate Stabilisation & Inter-Body Fusion in Sub Axial Cervical Spine Injuries
Kumuda Bandhu Sahoo, Braja Sundar Sahoo, Laba Kumar Naik, Roshan Ranjan Rath
Background: Cervical Spine injuries are one of the common causes of serious morbidity and mortality following trauma. Sub-axial cervical spine includes the C3 through C7 segments, a very mobile area of the spine with potential for serious injuries as a result of instability and risk of spinal cord injury. The treatment is to stabilize the spine and decompress and to promote the optimal environment for recovery. Objective: To evaluate the efficacy of anterior cervical decompression, fusion and titanium plate fixation in sub axial cervical spine injuries in respect of neurological outcome, postoperative stability and early rehabilitation. Goal of treatment is to stabilize the spine and decompress when necessary, in order to maintain the minimal environment for recovery. Methods: Patients with cervical spine injuries were admitted during November 2017-November 2019. All cases were evaluated for their clinical features. During initial phase, patients were analyzed on the basis of level and degree of neurological injury as per ASIA Scale(American Spinal Injury Association). All patients were initially managed with a Philadelphia collar. Injection Methylprednesolone Succinate was given if the patients has presented within 8 hrs of injury. Appropriated X-Ray, CT scan, MRI was taken and skull traction was applied. The patients were following up monthly for three months, thereafter at 3 months interval. Results: 20 cases of sub axial cervical spine injuries were taken during year 2017-2019. Age of patients were from 18-60 yrs with a mean age of 39 years. Out of these 15(75%) male and 5(25%) were female. Common Mode of injury was Road traffic accident. Post operative follow up showed good clinical and radiological outcome, bony fusion and favour early rehabilitation. Conclusion: Anterior decompression, fusion and titanium plate fixation is an effective method with good neurological outcome.

109. The Relationship between the Length, Diameter of the Umbilical Cord and Birth Weight of Neonate in Konaseema Area, East Godavari, Andhra Pradesh
Sailaja, K. Deepika, B. Lalitha, M. Sudhakara Rao
Background:  Umbilical cord plays a vital role in the development and growth of foetus. The perinatal outcome of foetus  mainly depends on the placenta and Umbilical cord growth. Method: 208 placentae with their umbilical cords from the women with uncomplicated pregnacies of age group between 20 to 35 years were collected from the obstetrics and gynaecology department .Umbilical cord length and diameter were measured at delivery .The birth weight recorded from parturition register. Study Type: Cross sectional Study. Conclusion: There was significant positive correlation between umbilical cord diameter and fetal weight.

110. Evaluation of Maternal Thrombocytopenia in Pregnancy and its Outcomes – A Prospective Study
Namrata Verma, Varnika Rastogi, Akanksha Srivastava, Govind Kahar
Background: Thrombocytopenia is a common hematological finding  during the last trimester of pregnancy. Appropriate differential diagnosis should be undertaken for adequate management. Regular monitoring of the condition is necessary to avoid adverse fetal & maternal complications. Aims & Objectives: To determine various causative factors of thrombocytopenia during pregnancy and maternal & fetal outcomes. Material & Method: This prospective observational study recruited 100 antenatal women with thrombocytopenia who visited the outdoor of Department of Obstetrics and Gynecology of G S Medical College and Hospital, Pilkhuwa, Uttar Pradesh  from Aug 2021 to Feb 2022. A written informed consent was obtained from all the participants and institutional ethics approval obtained. A complete medical history was undertaken .Venous blood samples were taken, platelet count noted & patients were followed up till delivery . Any complications arising were noted and treated accordingly , blood products transfused wherever necessary . Maternal and foetal outcome were recorded. Conclusion: Maternal thrombocytopenia arising out of medical conditions needs strict monitoring & medical management. This may avoid unnecessary fetal & maternal complications & promote maternal & neonatal wellbeing.

111. Association between Body Mass Index and Sleep Quality: A Study among Indian College Students
Shital M. Bamania, Hinaben K Banker, Shilpa K. Menat, Chhaya A Saraf
Introduction: The prevalence of sleep deprivation is rising globally as is that of obesity. The association between the two is also gaining much evidence. The college students may be specifically affected due to decreased sleep duration. Aims and Objectives: The aim is to study the association between decreased sleep duration and sleep quality with obesity by means of body mass index (BMI). Materials and Methods: This is a cross-sectional study among 150 college students. Weight and Height was measured and BMI was calculated from it. The participants reported their sleep duration and sleep quality was determined and assessed by using Pittsburgh Sleep Quality Index (PSQI). The correlation between BMI and selected variables was determined using chi square, and P < 0.05 was considered statistically significant. Results: About 24% of the participants had a BMI >25 kg/m2. Sleep duration of <6 h per night was observed among 58.3% obese and 37.5% overweight students. The duration of sleep was significantly associated with BMI (p<0.05). Extremely poor sleep quality as per PSQI score was found most common among obese (25.0%) student (p<0.05). Conclusion: Present study found significant negative association between decreased sleep duration and sleep quality with overweight and obesity in college students.

112. Association of Elevated Serum Ferritin Levels in Early Pregnancy and the Risk of Development of Gestational Diabetes Mellitus
Gayatri S, Shyamala Devi S, Babulal S, Madhuri S, Sudeepthi Reddy M
Background: Gestational diabetes mellitus (GDM) is an important cause of perinatal mortality and morbidity. The fact that the Asian Indian phenotype is at high risk for development of metabolic syndrome and its complications like GDM necessitates early diagnosis. The role of serum ferritin as an inflammatory marker is used in this study and its levels are measured in early pregnancy to predict the risk of developing GDM, thereby making it as a tool for early diagnosis and prevention of maternal and fetal morbidity and mortality. Methods: 75 antenatal women with gestational age less than 14 weeks attending out-patient department (OPD) of Obstetrics and Gynaecology at Government General Hospital (GGH), Guntur between December 2019 and December 2020. Samples obtained to measure serum ferritin level by fully automated bidirectionally interfaced chemi-luminescence immunoassay. Serum ferritin levels measured are groups in quintiles (<30, 30-60, 60-90 and >90 ng/ml). Patients underwent oral glucose challenge test (OGCT) with 75g glucose at 24-28 weeks and 32-34 weeks of gestation. All the women included in the study were followed up to monitor the risk of developing GDM. Results: 22 (29.3%) women were diagnosed with GDM. Among these 22 women, 10 were started with insulin, 7 with medical nutrition therapy (MNT) and 5 were started with Metformin. In the 10 women started on insulin, 3 had serum ferritin levels>90 ng/ml. Conclusion: High ferritin can be regarded as a significant risk factor for the development of gestational diabetes. Though significant association was seen in this study between high serum ferritin and risk of developing GDM, further prospective cohort studies are required to confirm the results.

113. Serum Vitamin E Levels in the Pregnant State and in Gestational Diabetes Mellitus
Gayatri S., Shyamala Devi S., Babulal S., Madhuri S., Karthik Reddy Y.
Background: In the recent years, the role of decreasing antioxidants and increasing superoxides is gaining importance as a cause of a number of medical disorders complicating pregnancy such as gestational diabetes mellitus (GDM) and pregnancy induced hypertension. Vitamin E is a naturally found antioxidant which plays an important role in the suppression of free radical-induced lipid peroxidation. The present study was undertaken to assess the levels of Vitamin E in normal pregnancy and in women with gestational diabetes mellitus. Materials and Methods: Fifty nonpregnant controls, fifty uncomplicated pregnant and 46 women with GDM aged 20 to 35 years attending outpatient department (OPD) of Government General Hospital, Guntur, were tested for serum vitamin E levels. Results: The mean serum vitamin E level was higher in nonpregnant women but significantly lower in women with GDM when compared to that in women with non GDM pregnancies. There is no difference in serum vitamin E levels of women with GDM who delivered macrosomic babies when compared to other GDM deliveries. Conclusion: Serum vitamin E levels are lower in insulin resistance states like gestational diabetes mellitus.

114. Effects of Isotretinoin on the Thyroid Gland Volume and Serum Thyroid Stimulating Hormone in Patients of Acne Vulgaris
Rohal Chandrakar, Raghav Gupta
Background: With an estimated 85% frequency, AV is a dermatological disorder that primarily affects adolescents. It affects women more than men; among women. Acne causes severe morbidity, including psychological problems including low self-esteem, sadness, and anxiety, as well as persistent scarring, which has a detrimental impact on one’s quality of life. A pharmacologically important derivative of vitamin A called isotretinoin chemically represented as 13-cis retinoic acid has been prescribed to treat moderate to severe nodulocystic acne, problems with the sebaceous glands of skin, and to avoid skin cancer. Aim: To evaluate effects of isotretinoin on the thyroid gland volume and serum thyroid stimulating hormone in patients of acne vulgaris. Methods and Materials: After 12 hours of fasting, a fasting blood specimen was taken through venipuncture of the big antecubital vein, and the sample was shipped to a biochemical lab to be tested for serum TSH. The linear volusons 6 pro high resolution ultrasound probe with an 8–12MHz is used to measure the thyroid. The patient was examined while lying flat on his back with his neck extended. Each lobe as well as isthmus had a transverse and longitudinal scan to determine its length, width, and depth in centimetres, from which the volume was determined. Results: Majority of the patients in present study belong to age group of ≤20 years (41%) followed by 21-25 years (40%).Majority of the patients were female (64%) followed by males (36%). Comparing FTSH level after 4 months of therapy with the baseline levels we found that mean FTSH level was significantly higher after 4 months (3.41±0.88 mIU/ml) of treatment as compared to initial levels (2.15±0.79 mIU/ml). Comparing thyroid volume after 4 months of therapy with the baseline levels we found that mean thyroid volume was significantly lower after 4 months (8.05±1.33ml) of treatment as compared to initial levels (8.42±1.40 ml). Conclusion: Acne Vulgaris is more common among the young age group female. Mean FTSH level was significantly higher and thyroid volume was significantly lower after 4 months of treatment.

115. A Study to Analyze Serum Alkaline Phosphatase, Total Calcium as Bone Turnover Markers among The Post-Menopausal Women – Case Control Study
Masood Ahmed Shareef , S. Sripriya, Khatija Shameem, Rida Fatima, Bayya Praveena, T Jaya Chandra
Introduction: During menopause, bone resorption slightly exceeds, results in osteoporosis. A study was conducted to evaluate the various hematological parameters in post-menopausal women (PMW) compared to healthy pre menopause controls. Materials and Methods: This was a prospective, case control study conducted in the department of Biochemistry, KMC, Warangal. Study was conducted from June 2012 to December 2014. Study protocol was approved by the institutional ethics committee. Informed oral consent was taken from all the members before considering into the study. Healthy postmenopausal women aged 50 – 70 years without history of smoking, alcohol intake were considered to be test group. Healthy PMW aged 25 – 40 years with no history of smoking and alcohol intake were considered in control group. Random blood samples were collected by venipuncture. Alkaline phosphatase (ALP), total proteins (TP) and albumin were estimated with serum. Chi square test was used to find the statistical significance. Results: Total 30 samples each were included in each group. Age wise, among the groups, statistically there was significant difference. There was raise in serum calcium in test group, statistically there was significant difference. ALP and TP levels were also increased in test group; statistically the difference was significant. Conclusion: Biochemical markers such as ALP, total calcium provide dynamic measure of bone remodeling and thus potentially useful in predicting the course of changes in bone mass and fracture risk in postmenopausal women. Markers also provide a representative index of overall skeletal loss compared to bone marrow density at specific skeletal sites.

116. Fingerprint Patterns in Relation to Gender and Blood Groups – A Cross Sectional Study 
C. Rohil Kumar, J. S. Arun Kumar 
Introduction: Various mental and physical features can be used for human identification in a variety of situations. Because each person’s fingerprints are distinct, they can be used to identify them. The objective of the study was to determine correlation between the fingerprint pattern, Gender and blood group. Materials and Method: The study was conducted on 100 subjects [50 males and 50 females] in the age group of 18-65 years in the time period of 2 months having different blood groups. The Fingerprints were taken of all ten fingers and observed by magnifying glass and its characteristics features were recorded and blood groups of the individuals were noted. Results: Amongst ABO blood group, the most common blood group was O (46%), followed by B (31%), A (14%) and AB (4%). Rh + ve were the most common Rhesus factor (95%). The loop was the most common pattern (60%), followed by whorl (32%) and arch (8%). Loops were higher in Males (56%) compared to females (44%). whorls and arches in females were 54%, 52%, and in males were 46%, 47.5% were found more in females. Highest frequency of Loops was seen in O positive blood group followed by B positive. Conclusion: The present study confirms that loop was the most common fingerprint pattern and its frequency was more in O positive blood group & in males.

117. Laparoscopic Cholecystectomy Study of Intraperitoneal Ropivacaine’s Post-Operative Analgesic Effects with or without Tramadol
Neha Soni, Sudipto Banerjee, Mahendra Kumar, Chandra Prakash, Leena Jain, Manish Jain
Background: The laparoscopic cholecystectomy surgery is frequently carried out. The intra-abdominal cavity is stretched, peritoneal inflammation occurs, and residual carbon dioxide in the peritoneal cavity irritates the diaphragm. Contrary to intravenous opioids, the use of intraperitoneal local anaesthetics for laparoscopic surgery postoperative pain treatment offers appropriate analgesia without any negative side effects. In the current study, our tertiary hospital’s laparoscopic cholecystectomy patients’ post-operative analgesic response to intraperitoneal ropivacaine with or without tramadol was studied. Materials and Methodology: The current study was a prospective, comparative study conducted on patients aged 19 to 65, of either sex, scheduled for an elective laparoscopic cholecystectomy and in physical status I or II according to the ASA (American Society of Anaesthesiologists) at tertiary care Centre, Nashik. Participants had to be willing to take part in the study. Prior to surgery, patients in the operating room were randomly divided into two groups (group R and group RT) using the chit technique. 20 ml of an intraperitoneal solution (18 ml of 0.5% ropivacaine and 2 ml of normal saline) were administered to Group R. The intraperitoneal 20 ml solution for group RT contained 2 mL (100 mg) tramadol and 18 mL of 0.5% ropivacaine IP. The Mann Whitney U test and the Chi-square test were applied. A p value of 0.05 or less was regarded as statistically significant. Results: A total of 60 patients were examined for this investigation. There were 30 patients apiece in each group (group R and group RT). Age, gender, height, weight, and ASA status were all general characteristics that were comparable across the two groups, and the difference was not statistically significant. It took the group R longer (in minutes) and required more paracetamol (grammes) than the group RT, with the difference being statistically significant. Conclusion: When combined with tramadol, intraperitoneal ropivacaine provides superior postoperative analgesia and requires less rescue analgesic dosage overall.

118. Clinical Profile of Childhood CNS Tuberculosis and Comparison of CSF-CBNAAT & Culture-Sensitivity as a Method of Diagnosis
Apurva Pareek, Anil Kumar Jain, Sandhya Bansal
Introduction: Central Nervous System tuberculosis, particularly tuberculous meningitis, is the severest form of mycobacterium tuberculosis infection, causing death or severe neurological defects. The recent introduction of Cartridge based nucleic acid amplification test (CBNAAT) has significantly transformed the diagnostics of tuberculosis in adults but its application for the diagnosis of paediatric tuberculosis is under evaluation. Therefore, this study was conducted on CSF samples to compare CBNAAT and culture-sensitivity as diagnostic methods in the diagnosis of childhood CNS tuberculosis. Methods: A prospective study was carried out between December 2018 to November 2019 consisting of 65 randomly selected patients suspected of CNS tuberculosis who had their CSF tested for CBNAAT and culture-sensitivity along with Mantoux test and other routine investigations. Statistical analysis was done using Chi square test. Results: The sensitivity, specificity, positive predictive value and negative predictive value of CBNAAT was 70.6%, 90%, 70.6% and 89.6%, respectively. Conclusion: CBNAAT is a rapid, sensitive, highly specific and accurate method for diagnosis of CNS tuberculosis in children. A positive CBNAAT should warrant commencement of full course of anti-tubercular therapy as per schedule. A negative CBNAAT does not necessarily exclude the diagnosis of tuberculosis and treatment should be guided based on clinical assessment of the patient as well.

119. Utilization of Advancement/Local Flaps for the Management of Severe Upper Extremity Burn Contractures
Pankaj Mehrotra
Introduction: Severe postburn contractures can lead to partial or total loss of function of the limbs, with devastating socioeconomic and psychosocial impact on the individual, especially in low- and middle-income countries. Objectives: To analyze all cases of post burn scar contracture and classify axillary contracture based on type and severity with duration of hospital stay, complication rate. Methods: A retrospective record-based study was done and analyzed data of all patients who have undergone surgery for severe burn contractures of elbow and axilla by means of our technique were retrieved. All patients who had post burn scar contracture (Axilla, elbow, wrist) and who underwent surgical management were included in the study. Results: In 30 patients (24 female,6 male) out of this 20 had right side axilla involved and 10 had left side involvement. The mean age of the patient with axilla contracture was 16.4 years (range 3 to 62 years) and there were 7 men (22.6 %) and 24 women (77.4 %). with a mean age of 16.4 years, shoulder range of motion improved significantly from preoperative 111.0° to postoperative 149.4° of abduction-adduction. The elbow range of motion improved from preoperative 76.6° to postoperative 108.6° of flexion-extension, with a significant reduction in the residual elbow contracture from 60.5° preoperatively to 18.5° postoperatively. The average follow-up was 3 months (range, 1.5-7 months). Conclusions: We conclude that this relatively simple and safe technique limits the risk for early postoperative healing complications and recurrence of the contractures in the long term.

120. Use of Obstetric Early Warning Score in Critically Ill Patients for Prediction of Maternal Death
Aruna Kumar, Farheen Fathima, Sona Soni, Ayushi Agarwal
Objective: To assess the performance of Early Warning Obstetric Score in predicting maternal death among obstetric patients who required admission in ICU. Methods: Prospective observational study on patients admitted in ICU. Information regarding sociodemographic variable and gestational age was gathered at the time of admission. Detailed clinical history regarding mode of presentation, clinical features, duration of symptoms etc. were obtained and entered in questionnaire. Further, patients were subjected to detailed clinical and general examination. Also, diagnosis upon admission and duration of stay in the ICU were noted and entered in questionnaire. The need for critical care interventions such as mechanical ventilator support, requirement of drugs if any was determined. Results: Majority of patients belonged to age group 21-30 years (46.5%) .Most of them belonged to rural areas (67.1%) and to lower socioeconomic status  ( 73.1%) .Majority of patients were referred 60% and only 0.5% were booked at our hospital .Majority of patients were primiprous (60.6%) and majority underwent LSCS (50.85%). OEWS was significantly higher in non survivors (>4 trigger in 86% of non survivors; p value<0.05. OEWS was significantly lower in patients who do not require any ventilatory or vasoactive support. Length of ICU was significantly greater in patient with higher trigger score. Conclusion: Delay in identification of complications during pregnancy is associated with higher odds of maternal mortality. Therefore, Early Warning System (EWS) have been proposed as a promising tool which may help in early identification of warning signs in pregnant female. This may aid in initiating rapid medical response and reducing maternal morbidity as well as mortality.

121. Incidence of Non Hodgkin Lymphoma and its Cytohistopathological Correlation at Tertiary Care Centre
Namita Kumari, Abhilasha Pallavi, N. K. Bariar
Background: Excision biopsy is frequently advised for lymphadenopathy, a relatively common disorder, when fine needle aspiration cytology is inconclusive. Non-Hodgkin lymphoma is a global epidemic with regional, racial, and geographic variations. With the exception of prostate cancer, melanoma, and lung cancer in women, Non Hodgkin lymphoma incidence has increased more quickly than all other cancers combined. The purpose of this study is to determine the prevalence of NHL at PMCH and its subtypes in various age groups with distinctions based on gender, cytohistopathological correlation, and occasionally immunohistochemistry correlation. Materials and Methods: The current study entails FNAC, histopathologic analysis of lymph node masses prospectively from September 2020 to August 2021, immunohistochemistry correlation in some cases depending on the availability of monoclonal antibodies, and immunohistochemical correlation in other situations. Giemsa and PAP would be used to stain FNA for cytology, and formalin-fixed, wax-embedded, H & E sides would be prepared for histopathology. In some circumstances, preparation and staining of slides for IHC would be done in accordance with procedure. Results: Out of the entire 92 cases, 22 (23.9%) had both metastatic lesions and TB, and 40 (43.4%) had chronic non-specific lymphadenitis. The overall sensitivity of lymph node imprint cytology was 96.73% for tuberculosis, 96.74% for chronic non-specific lymphadenitis, 96.74% for lymphoma, and 100% for metastatic lesions, respectively. Conclusions: Compared to histological and fine needle aspiration cytology, immunohistochemistry and the histopathological report correlate substantially better.

122. A Study of Fine Needle Aspiration Cytology of Hepatic Mass Lesions Using Image Method for Guidance
Abhilasha Pallavi, Namita Kumari, N. K. Bariar
Background: The correct clinical care of diverse hepatic mass lesions depends on precise diagnosis, which is a common clinical challenge. A quick, accurate, and affordable technique for identifying hepatic mass lesions is image guided FNAC. Methods: To assess the role of image guided fine needle aspiration cytology (FNAC) in hepatic mass lesions, a retrospective study was conducted. From September 2020 to August 2021, the Department of Pathology at PMCH, Patna, Bihar, performed 52 image-guided FNACs of hepatic mass lesions. Leishman stain and Haematoxylin and Eosin (H&E) were used to colour the wet fixed and air dried smears, respectively. Results: 42 (80.76%) of the 52 instances included in the study were malignant, 5 (9.51%) were benign, and 5 (9.51%) were insufficient for an opinion. Hepatocellular carcinoma and metastatic adenocarcinoma were the two most frequent diagnoses in 22 (52.38%) of the patients. Males made up 31(59.61%) of the hepatic mass lesions, which were more frequent. 61% of hepatocellular carcinoma cases tested positive for HBsAg. Ultrasonography (USG) guidance was used in 48 (92.30%) more cases than CT guidance was used in 4 (7.69%). Conclusion: Patients were given the appropriate care by the doctors based on the diagnosis of USG guided FNAC of liver lesions and other investigations. Due to the procedure’s ease, safety, low invasiveness, and OPD-based design, image guided FNAC is incredibly helpful in determining the diagnosis of hepatic mass lesions. As long as the patient was observed for two to three hours after FNAC and had a prior prothrombin time, there were no issues.

123. A Clinical Study on the Management of Sigmoid Volvulus at DMCH, Laheriasarai, Bihar
Pramod Kumar Sah, Anil Kumar
Background: A primary cause of big bowel blockage and a surgical emergency with a high mortality and morbidity rate is sigmoid volvulus. India has a higher prevalence of the condition, particularly among rural residents. 15% of all bowel blockages are due to it. This study examines several management strategies used in our facility, which mostly treats patients from the nearby rural areas. Methods: The current study examines 36 instances in order to determine the etiological causes, clinical characteristics, therapeutic options, and prognosis of sigmoid volvulus. The various treatments have received extra attention. The study took place at the Upgraded Department of Surgery, DMCH, Laheriasarai, Bihar, for a year between July 2021 and June 2022. Results: The male to female ratio was 2:1, with the mean age of sigmoid volvulus being 49 years (with a range of 19-75). Less frequently in people under 20 years old and older than 70. Constipation (88%) and abdominal distention (100%) were the two most frequent modes of presentation. With no mortality, 22% of patients underwent sigmoidopexy; 17% underwent primary resection and anastomosis. Infections in the wounds are a typical post-operative consequence. Conclusions: If the colon is still healthy, primary resection anastamosis has been proven to be a completely safe treatment. Only gangrenous bowels are eligible for Hartman’s technique. The absence of co-morbid conditions is a noteworthy aspect. X-rays taken before to surgery are useful for diagnosis. In our investigation, mortality was determined to be 17.5%.

124. A Prospective Study of Triple Assessment in Evaluation of Breast Lump
Pramod Kumar Sah, Anil Kumar
Both benign and malignant etiologies can cause breast lumps. Even though the majority of lumps are benign, breast cancer is the second most frequent cancer in women and the second greatest cause of cancer death. The purpose of the study is to evaluate the enhanced and unique dependability of modified triple testing in pre-procedural breast lump diagnosis. 150 patients who regularly attended the surgery outpatient department were chosen at random. Most of the 150 patients who presented with breast lumps were painless. Eighty-one percent (n=122), 10% (n=16), and 8% (n=12) of the lumps were accompanied by discomfort or nappy discharge. Experienced radiologists, a cytologist, and a clinician must work well together. When ultrasound replaces mammography, it is more thorough and serves as an imaging modality for breast masses that can be felt. The direction to the representative area provided by ultrasound breast assists biopsy techniques rather than improving yield. When FNA is inconclusive, CNB is a good backup and may provide more details. Therefore, it is deserving of adoption and further development to employ the Modified Triple Test (MTT) to supplement data in the differential diagnosis of a lesion in a symptomatic woman seeking medical attention. This might result in less treatment holdup when cancer is suspected and less surgical examination when a lesion is thought to be benign.

125. Study of Lipid Profile in Type 2 Diabetes Patients
Srinivas K, KallemVenkata Reddy, Ade Vittal, Dasari Kamalakar
Diabetes mellitus is characterized by chronic hyperglycaemia with disturbances in carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action or both. Many studies have proposed HbA1c to be used as a biomarker of both glycaemic control and dyslipidemia in type 2 diabetes mellitus. Thus, the aim of this study was to observe the lipid profile in type 2 diabetes mellitus patients. The study was a cross sectional, case control study done in department of medicine, RIMS  Medical College and Hospital Adilabad,  in which the patients were selected as per the inclusion and exclusion criteria. 30 patients of Type 2 diabetes mellitus and 30 non diabetic patients were included in this study. Lipid profile, HbA1c, Fasting blood sugar was measured in all subjects. Total cholesterol, LDL, VLDL, Triglycerides values were higher in diabetic patients as compared to normal subjects and this difference was highly significant. HDL values were less in diabetic patients as compared to normal subjects and this difference was highly significant. Fasting blood sugar and Hba1c values were higher in diabetic patients as compared to normal subjects and this difference was highly significant. Diabetic dyslipidemia  is characterized by low HDL, high TG and high small dense LDL. Early screening of diabetic patients for dyslipidemia and early intervention is required to minimize the risk of future cardiovascular mortality.

126. A Study on Neonatal Outcome Due to Placental Infection during Severe COVID-19
Alka Jaiswal, Ashvini Bhatnagar, Utsav Singh
Introduction: COVID-19 pandemic has severe consequences for the whole world. Each age group has been affected. Both the pediatric and geriatric populations have been worst affected by COVID-19. Even pregnant females were affected much and especially the neonates of pregnant women with COVID-19. The vulnerability increases in neonates of mothers with COVID-19. There is less literature and guidelines available which discussed the outcomes of neonates of mothers who had COVID-19 during gestation. Aims and Objectives: To find out the effect on the fetus of mothers, who were infected with COVID-19 during gestation. Method: This is a retrospective study which considered 120 pregnant women, comprising 60 pregnant females with COVID-19 (study group) and another 60 pregnant females without COVID-19 (control group). The baseline characteristics were obtained from the hospital in both groups and the outcomes were evaluated and analyzed. Results: The study found that there are significant differences between the two groups in gestational age at the time of delivery, premature delivery occurred and neonatal death (p<0.05). Conclusion: The study has concluded that the presence of COVID-19 in pregnant females caused placental infection affecting the fetus significantly, as evidenced by premature birth and neonatal deaths among the COVID-19 group.

127. Population-Based Cross-Sectional Study to Assess Alcohol Drinking Pattern and Subjective Health
Jagdeep Singh Rehncy, Gagneen Kaur Sandhu, Ruchi Goyal, Manjinder Kaur
Introduction: The World Health Organization indicates that alcoholic beverages are consumed by about 2 billion people all over the world amongst whom 76.3 million are reported to be diagnosed with alcohol use disorders. Various patterns of alcohol consumption tend to act as risk factors, leading to biochemical and biological effects, thereby producing long-term consequences on human health as well as affecting the day to day life. Materials and Methods: A questionnaire-based study was conducted to assess the patterns of alcohol consumption in a group of medical fraternity belonging to various Medical Colleges of Punjab. The Google Form based on The Alcohol Use Disorders Identification Test Questionnaire was prepared and randomly circulated for period of 3months and all responses were collected. Results: Frequency of participation of junior resident was found to be the highestfollowed by 26 senior residents, faculty and interns and majority of respondents belonged to age range of 25 to 50 years with male predominance was seen. Male junior residents are most likely to develop alcohol use disorders as the frequency of drinking is found to be the highest. Conclusion: The current study has helped to assess the frequency of alcohol drinking in the medical faculty which were well verse with the alcohol use disorders. As such, this study provides grounds for further researches which can be conducted to identify and assess the type of diseases that occur in alcohol drinkers due to high frequency of drinking.

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