International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Perception and Practice on Different COVID-19 Vaccines and Precautionary Dose: A Study among Health Care Workers
Manasa C R, Kalpana L, Veena R M
Background: Health care workers (HCW’s) belong to high-risk group and at the same time being the role model to the general population. Current study was undertaken to assess the general level of trust, acceptance and fear on different COVID-19 vaccines among them. Materials and methods: An online questionnaire were distributed to all the HCW’s through WhatsApp link between 1 March 2022 and 30 April 2022 to evaluate the perception and practices on different COVID 19 vaccines and precautionary dose using a snowball sampling method using self-designed structured questionnaire. Results: A total of 434 HCWs participated, with doctors (38.5%) and nursing staff (44.30%) nursing students (9.50%), medical students (6%) and others (1.70%). 96% were vaccinated for both first and second dose with only 32.3% for precautionary dose. The main reason for not receiving second dose is that 30 were recently positive for COVID infection and 17 respondents were not convinced with study results. Only 2% took different vaccine for second dose due to non-availability of first vaccine, doubt regarding the efficacy of the vaccine, belief in taking two different vaccines for stronger immunity. Participants took different vaccine for precautionary dose due to non-availability of the vaccine (15.4%), belief in taking two different vaccines provides stronger immunity (76.9%) and shift of residence (7.7%). Conclusion: Majority of the HCW’s in our study have a modest acceptance towards second dose and precautionary dose. Institutions and other health care set up should scale up educational efforts to disseminate reliable information about different COVID vaccine and provide recommendations about receiving a vaccine booster to promote herd immunity.

2. Evaluation of the Pterygium Size on the Corneal Astigmatism Pre and Post Excision
Apurva H Suthar
Background and Aim: Pterygium is a disorder in which the subconjunctival tissues proliferate as vascularized granulation tissue to invade the cornea, damaging the bowman’s membrane and the superficial layers of the stroma. The conjunctival epithelium covers the entire area. This study’s objective is to use keratometric readings from an automated keratorefractometery to assess how pterygium-induced astigmatism changes after pterygium removal. Material and Methods: The study comprised 104 patients who had been given a pterygium diagnosis in total. Before enrolment, a written agreement was obtained from each patient who met the eligibility requirements after being informed about the study. An automated keratorefractometer was used to obtain keratometric results. Calculating corneal astigmatism was done using the difference between K1 and K2. Results: According to the current study, the mean preoperative K1 value in the study group was 42.260.26 and decreased to 41.550.23 on the first postoperative day (P 0.001). A follow-up after one month revealed a statistically significant (P 0.001) decline in the mean K1 value to 40.310.23. According to the current study, the study group’s mean preoperative K2 value was 39.271.01 and increased to 40.070.52 on the first postoperative day. Conclusion: Pterygium has a significant impact on corneal refractive state, which has been assessed by effraction, keratometry, and corneal topography in numerous investigations. For the evaluation of corneal astigmatism brought on by pterygium, the total area and percentage of the pterygium’s expansion onto the cornea are crucial criteria. Early detection and treatment of pterygium reduces its deleterious impact on visual acuity.

3. Otorhinolaryngological Manifestations in Covid 19: A Prospective Study
Aju Ravindran, Sandeep Sreedhar, Mithun Krishna R, Abdul Manaf V K, P Muraleedharan Nampoothiri
Introduction: Otorhinolaryngological manifestations in COVID-19 were not rare and not much emphasized. The aim was to know the prevalence of Otorhinolaryngological manifestations among confirmed SARS-CoV-2 patients in a tertiary care hospital, Northern Kerala. The objectives were to study Otorhinolaryngological problems during COVID and post COVID period and to determine the duration and recovery of smell/taste disturbances. Materials: This was a prospective study of 470 covid-19 patients (categorized into A, B and C as per COVID severity classification by WHO), from March-01-2021 to June-30-2021 in a tertiary care hospital. A pretested semi-structured questionnaire was administered via telephonic interview after explaining the purpose of study and obtaining verbal consent. It included history of ENT symptoms, olfactory and gustatory function. Patients who were unresponsive, unsound and unreachable were excluded. Chi-Square test was used for statistical analysis; p value< 0.05 was considered as significant. Results: In this study, 241(51%) were males and 229(49%) were females, 61 (13%) patients in category-A, 329(70%) in category-B and 80(17%) in category-C. The commonest symptoms were anosmia/ hyposmia (80%), headache (74.89%), ageusia/ dysgeusia (76.38%), cough (71.3%). Commonest problems in post-covid period were dyspnea (51.5%), anosmia/ hyposmia (42.1%) and ageusia/ dysgeusia (76.38%). 8.4% and 7.7% of patients were not recovered from smell and taste disturbances during this period. Conclusion: Results showed that the commonest symptoms were headache, anosmia, ageusia, cough and dyspnea. This study confirmed high prevalence of smell/taste disorders in COVID-19 infection with self-recovery among half of the cases after nearly 2 weeks. Hence the symptoms could be considered as early identifiers/ markers and those helped in early detection and isolation of the patients for further management.

4. Retrospective Observational Research Comparing the Results of Non-Operative and Surgical Treatment for Displaced Clavicle Fracture
Kumuda Bandhu Sahoo, Braja Sundar Sahoo, Laba Kumar Naik
Introduction:  Conservative care has been used for ages to treat clavicle fractures. Clavicle fractures seldom fail to heal, and they were formerly thought to primarily have radiological significance. The situation has altered, and operational treatment is now preferred for reasons of union, cosmesis, and quick recovery. Both approaches are contrasted while taking into account the patient’s happiness, early recovery, cosmesis, and functional results. Method:  90 patients with displaced clavicle fractures (AO B1 & B2) in total were split into two groups: non-surgical and operational. Voluntary informed consent was given. The cost, process, results and complications of both modalities were presented to the patient. The trial was conducted until 45 patients were included in each group, after which the patient was assigned to Group I (conservative) or Group II (operative). Patients in both groups underwent follow-up exams at 5, 2, and 8 months utilising their subjective assessments, DASH scores, ranges of mobility, radiological evaluations, and any complications that may have arisen. Result: All 90 patients ranged in age from 21 to 65, with a mean age of 34.4 years. Twenty (65.6%) of the conservative group’s participants and 25 (74.1%) of the group that underwent surgery exhibited dominant side involvement. Compared to the operational group, the non-operative group experienced higher complications. At 5 weeks and 2 months, Group II’s DASH score was higher than that of Group I. The overall satisfaction rate for non-surgical patients was 20 (62.83%), whereas the satisfaction rate for operational patients was 27 (81%) and 7 (21%) respectively. A follow-up period of 8.4 months on average was used (5-17 months). Conclusion: Even though operative treatment offers advantages over non-operative treatment in terms of early mobilization, union, absence of mal-union, and cosmetic acceptance, it also has drawbacks that should be considered when deciding between the two modalities. When it comes to patient satisfaction with regard to functional results, conservative treatment is crucial for underprivileged individuals.

5. Prevalence of MDR TB in North Bihar
Shailendra Kumar
Background: MDR tuberculosis (MDR TB) is a major public health concern in India, however there is a scarcity of data on the prevalence of MDR TB in the country. The objective of this study is to use a molecular diagnostic method to establish the prevalence of MDR TB in North Bihar and to facilitate early diagnosis and treatment. Also, to determine the number of diagnosed cases that were successfully started on treatment at the MDR TB Centre of Shri Krishna Medical College. Methods: This six-month observational study was conducted at Shri Krishna Medical College’s DR TB centre in Bihar, India. 256 sputum samples were collected from suspected cases of multidrug resistant tuberculosis in 6 districts of North Bihar near Muzaffarpur between March and August 2022. To detect Mycobacterium tuberculosis, these samples were treated to normal microscopy and culture. Positive cases were subjected to drug sensitivity test using a molecular diagnostic approach, Using Genotype MTBDR plus kit. Result: Microscopy confirmed tuberculosis in 122 of 256 sputum samples from probable MDR TB individuals. In 114 of the 122 cases, TB was verified by PCR. Finally, using the Line Probe Assay (LPA), 39 (15%) of the samples were found to be resistant to both INH and Rifampicin. Male female ratio was 4:1. Conclusion: North Bihar has a 15% prevalence of multidrug resistant pulmonary TB. To decrease the spread of MDR TB cases, early diagnosis using molecular diagnostic methods and timely treatment are required.

6. A Study to Develop Empiric Antibacterial Therapy for Diabetic Foot Ulcers in Rural India
Gorachand Murmu, Saswat Soumya Shasamal, Shiba Prasad Senapati, Harapriya Soren
Introduction: In order to evaluate the clinical features, range of microbial flora, antibiotic susceptibility, and develop an empiric antimicrobial therapy, this study was conducted on patients with diabetic foot ulcers (DFU). Method: Between December 2020 and November 2021, clinical information and tissue samples were gathered from 100 diabetic foot ulcer patients. Clinical and microbiological data was evaluated after the samples were handled in accordance with Clinical and Laboratory Standards Institute recommendations. Results: Males in their fourth and fifth decades of life had the highest prevalence of DFU in this sample of 100 patients. The majority of patients experienced neuropathy and poor glycemic control. Gram-negative bacteria made up 73.6% of the 105 bacterial isolates isolated from 96 samples, while Gram-positive bacteria made up 27.2%. The majority of samples (48.5%) revealed the growth of a single bacterium, followed by the growth of two bacteria and polymicrobial growth in 28.5% and 15.1%, respectively, of tissue samples. The most common isolation (27.2%) was Pseudomonas, which is responsive to imipenem (91%), amikacin (86.5%), gentamicin (83.2%), and cefotaxime (81%). Staphylococcus aureus (19.0%) is the next most common isolate, and it is sensitive to amikacin and gentamicin (99%), as well as ofloxacin (91%). Ampicillin, amoxicillin-clavulanic acid, Proteus, and Klebsiella were all very resistant to these medications. Conclusion: This study demonstrated that DFU are typical in the fourth and fifth decades of life. Most infectious organisms are gram-negative bacteria. The majority of bacteria, both Gram positive and Gram negative, are sensitive to aminoglycosides and have varying degrees of resistance to routinely used antibiotics. DFU infections can be treated with amikacin and gentamicin as empiric antibiotics.

7. Significance of Tiotropiumin Early Chronic Obstructive Pulmonary Disease
Umesh Teltumbade, Likhit Gandhi
Introduction: Chronic inflammatory lung disease (COPD) can be affected around 4% to 10% of people. Cigarette smoking is the main cause of COPD along with the environmental and genetic variables which also increase the disease burden. On the other hand, the intention of COPD management, through different kinds of activities they want to prevent quitting smoking as well as enhance environmental sustainability. In addition, due to this COPD, people are several kinds of difficulties such as tiotropium lowering air trapping, alleviating exertional dyspnea, increasing exercise tolerance and others. Aims and Objectives: To find out the efficacy of tiotropium in managing exacerbation of COPD. Methods: This prospective and placebo-controlled  research was conducted on the patients of COPD in four phases. Additionally, the research study regarded patients who came hospital to the outpatient units with GOLD stage 1 or 2 COPD. This study considered 40 to 85 years age of patients who diagnosised with COPD. The patients were classified into 2 groups including, placebo and tiotropium group. The study considered 2 groups, placebo and tiotropium group. The patients in tiotropium group was administered with tiotropium inhalation at a dosage of 18μg for 24 months. The outcome was assessed by the analyzing the symptoms of COPD after 24 months of tiotropium treatment. Results: This research discovered that FEV1 happened before bronchodilation. Similarly, this placebo group would be higher than the tiotropium group. In addition, at the same, it would be noticeable the bronchodilation can p<0.05. Therefore, this research illustrated that patients feel exacerbation significantly higher within two years. Even this Placebo group is compared with the Tiotropium group (p<0.05). Conclusion: This research concluded that tiotropium can prevent COPD exacerbations compared to a placebo, through previous case studies. On the other hand, from dry mouth or pharynx discomfort, equally, if this trial did not indicate any significant differences between tiotropium and placebo in the duration of any negative circumstances, such as cardiovascular effected or urinary tract infection.

8. To Compare the Diagnostic Accuracy of Non-Fasting DIPSI with Fasting WHO Criterion for Diagnosis of Gestational Diabetes Mellitus
Swati Sheoran, Pinkey Lakra, Sunita Siwach, Shivani, DNB, Vijayata Sangwan
The aim of our study was to compare and correlate DIPSI criteria based test with conventional WHO OGTT for diagnosis of GDM. 200 healthy pregnant women attending antenatal clinic of B.P.S. Government Medical College underwent 75 gm OGTT between 24 – 28 weeks of pregnancy irrespective of their last meal on first hospital visit. After 2 hours venous blood sample was obtained and analysed. Three days later all of them were made to undergo 75 gm OGTT after an overnight fasting of 10 – 12 hours as recommended by WHO. Two blood samples, one fasting and then 2 hour after glucose load were obtained and analysed. GDM was diagnosed if fasting plasma glucose > 126 mg/dl and > 140 mg/dl of post glucose load 2 hour value by either test. Of the 200 women evaluated, 4 were diagnosed to have GDM by DIPSI alone, 8 by WHO alone and 21 by both criterion. The sensitivity and specificity of DIPSI compared to WHO99 was 72.4 % and 97.7 % respectively. The diagnostic accuracy was 94.0 %. The area under the ROC curve for DIPSI was 0.850 (p < 0.05) (95 % confidence interval: 0.751 – 0.950). The results of present study support DIPSI as a simple, convenient, economical test which can be used as both diagnostic as well as screening test with good diagnostic efficacy.

9. A Pilot Randomized Controlled Trial on the Efficacy and Safety of Increased Dose and Duration of Oral Itraconazole Therapy in Chronic and Recurrent Tinea Corporis et/or Cruris at a Tertiary Care Hospital in Eastern India
Jnana Ranjan Dash, Kiran Vinayak, Ratikanta Tripathy, Laxman Besra, Mitanjali Sethy, Hemanta Kumar Kar
Introduction: Oral antifungals are being used increasingly for chronic recurrent dermatophytosis treatment but still there is paucity of an evidence based effective drug and dosage regimen for the same. This pilot study was done to evaluate the efficacy of oral itraconazole with higher dose and duration in chronic, recurrent tinea corporis and cruris. Material & Methods: A total of 120 patients divided into three groups were compared in this randomized controlled trial. Itraconazole 200mg twice daily was received by group A (for 4weeks), group B (for 8weeks) & group C (for 12 weeks). Both diagnosis and treatment efficacy was confirmed by microscopic examination of 10% potassium hydroxide (KOH) mount &Saboraud’s dextrose agar (SDA) culture of skin scrapings. Liver function tests (LFT) were done before drug trial & every 4 weeks. Results: At the end of follow up, the mycological cure (KOH negative & culture negative) was 75 % (group C) followed by 60% (group B) & 12.5% (group A) (P =0.000). Number of relapse cases were 4, 14 and 34 in group C, B and A respectively. There was no significant difference in the mean values of LFT parameters among the three groups. The rise of LFT parameters were more than 2 times in 3 cases (group B) and 1 case (group C). Treatment tolerability were good (more than 70%) in all groups. Conclusion: Group C showed highest clinical and mycological cure rate, lowest relapse rate with good treatment tolerability and safety profiles.

10. Characterization of Serum Progesterone Induced Blocking Factors Levels in Pregnancies with Preterm Delivery
Vijayta Singh, Deepshikha, Richa Yadav
Objectives: The progesterone-induced blocking factor may operate as a mediator for progesterone’s effects on preserving pregnancy (PIBF). In order to forecast spontaneous early preterm delivery, this study intends to investigate the potential benefit of monitoring the maternal blood PIBF concentration between 11 and 13 weeks of pregnancy. Methods: In 20 singleton pregnancies that later spontaneously delivered before 34 weeks and 50 control pregnancies that delivered at or after 37 weeks, the maternal blood levels of PIBF were measured between 11 and 13 weeks into the pregnancy. The values between the two groups were compared using the Mann-Whitney U test. Results: When compared to women in the control group who gave birth at term 167.2 (interquartile range: 105.7-211.6 ng/ml), among women who delivered before 34 weeks, the median maternal serum PIBF concentration was 158.1 (interquartile range: 99.9 ~ 208.8 ng/ml). milliliter). Conclusions: There is no effect on maternal blood PIBF levels at 11-13 weeks of gestation in preterm women.

11. The Connection between Sleep Deprivation and Being Overweight
Vijendra Kumar Painkra, Manoj Kumar
The importance of sleep in maintaining good health and well-being throughout one’s life can hardly be overstated. It is well established that sleep has an effect on a person’s physical and emotional health by bringing about significant alterations in their biological and psychosocial states. Few studies have looked at the relationship between the amount of sleep an individual gets and their body composition using a sample of young adults that is representative of the general population. When it comes to this age group, primary prevention is the most important factor to consider. As part of our research, we made the decision to look into the relationship between the amount of time spent sleeping and the composition of the body, as well as to make any applicable recommendations regarding changes in lifestyle. Materials and Methods: The purpose of the research that was conducted on 100 healthy young adults between the ages of 18 and 25 using the Bodystat Quadscan 4000 was to investigate the effect that sleep has on body composition after receiving ethical clearance from an institutional ethical committee. Results: The research concluded that there were statistically significant differences in both anthropometric and body composition parameters. Conclusion: The amount of time spent sleeping plays a significant part in determining changes in body composition.

12. Study to Assess the Performance and Safety of Welme Menstrual Pain Relief Device in Women Suffering from Primary Dysmenorrhoea
Baburao Vikram, Anusuya Davi, Rahul Chopra
Background: Many women consider menstrual pain as severe, incapacitating, and inevitable chronic pain during menstruation often accompanied by Primary dysmenorrhea, known for its negative effect on women’s quality of life. By saying no more to painkillers, the new TENS device, named Welme come up with instant relief for women who are suffering from this. Aim: This study is a Randomized, Controlled, Two-arm, Parallel, Sham-controlled, aimed to assess the performance and safety of the Welme menstrual pain relief device in women suffering from PD. Material and Methods: A total of 60 females aged between 18-35 years with dysmenorrhoeal pain participated in this study and were randomly divided into the intervention group and the sham group, with 30 participants in each group. Participants in the intervention group received TENS, whereas those in the sham group received sham TENS during the menstrual period of 5 days. Result and Conclusion: The pain intensity reduction measured by a Visual Analog Scale (VAS), the Cox Menstrual Symptom Scale (CMSS), mean data of analgesics usage, mean data of SF-12 patient questionnaire, patient global impression of change (PGIC) scale, mean data of diary card pain assessment were evaluated. The participants in both groups received the treatments for 2 menstrual cycles and throughout the study, adverse events were assessed and recorded. The study results show that the active TENS method is much more effective in managing primary dysmenorrhea compared to the sham device and gives immediate pain relief, and had no negative impact.

13. Low Dose Intravenous Dexmedetomidine is Effective in Attenuating Haemodynamic Stress Response Associated with Laryngoscopy and Intubation- Prospective Randomised Double Blinded Study
Pavithra Chandrappa, Sanchara M Paramesh, Yashoda Venkappa, Gurudatta K N
Background and Objective: Laryngoscopy and intubation cause an intense increase in heart rate, blood pressure and serum concentration of catecholamines leading to hypertension, tachycardia and dysrhythmias. These changes lead to advertisements in susceptible individuals. Dexmedetomidine, a novel alpha 2 agonist, has numerous applications in anaesthesia and ICU because it causes sedation, hypnosis, analgesia and sympatholytic. Hence the present study is undertaken to evaluate the efficacy of 0.5 µg/kg dexmedetomidine on haemodynamic responses to direct laryngoscopy and tracheal intubation. Also induction dose of propofol. Methodology: 100 subjects of Age group- 18- 60 years, of either sex.; ASA grade I & II admitted for elective surgeries from various departments of McGANN Teaching District Hospital were included after obtaining clearance from Institutional Ethical Committee. The study population were randomly divided into Group D [Dexmedetomidine group] (n=50) and Group S [Saline group] (n=50) received Dexmedetomidine 0.5 µg/kg and saline respectively. SBP, DBP, MAP, Heart rate, SpO2 were recorded at 1 min (T5), 3min (T6), 5min (T7), 10min (T8), 15 min (T9) and 30 minutes (T10) after laryngoscopy & intubation. Results: Group D showed statistically significant fall in the hemodynamic response after laryngoscopy and intubation compared to group S; it also showed decrease in induction dose of propofol. Conclusion: Dexmedetomidine in a dose of 0.5µg/kg body weight given over 10 minutes,10 minutes before induction significantly attenuates hemodynamic stress response to laryngoscopy and endotracheal intubation without any significant side effects.

14. Rabies Clinic at SRVS Medical College and Hospital, Shivpuri Central India: A Cross-Section Study of Rabies Knowledge
Manbahadur Rajpoot, Shailendra Rawal, Mahesh Dhoot
Background: We discovered preventable rabies cases in the Shivpuri area; the health agency is responsible for handling all rabies-related tasks. The government should create a policy for the prevention of rabies and provide information to the public regarding its prevention. The primary goal of this study was to increase public awareness of rabies in the community surrounding the Shrimant Rajmata Vijaya Raje Scindia Medical College & Hospital in Shivpuri, central India. Materials and Methods: From January 2022 to June 2022, participants in this observational cross-sectional study were those who visited the Shrimant Rajmata Vijaya Raje Anti-Rabies Clinic at Shrimant Rajmata Vijya Raje Scindia Medical College & Hospital Shivpuri in central India. 400 people participated in the study’s data sample, which was collected using a questionnaire. Result: Among the participants in this survey, 78 (19.5%) had good knowledge, 228 (57%) had moderate knowledge, and 94 (23.5%) had bad knowledge. The death rate for rabies was known to 72.2 percent of the participants. 33.3 percent of participants are aware that there is no treatment for rabies. Participants’ knowledge of rabies’ treatability was at 79%. Of the participants, 53% are aware that bites should be washed with soap and water. Of the participants, 32% are aware that it is an infectious disease. About 7.5 percent of the participants were aware that the rabies virus can be found in a rabid patient’s vomit, saliva, tears, and urine. One injection is sufficient in the opinion of about 18% of participants. Conclusion: In this study, we discovered that lack of awareness is a significant issue for both urban and rural populations in Shrimant Rajmata Vijya Raje Scindia Medical College & Hospital Shivpuri, central India. According to the study’s findings, government programmes in India should place a strong emphasis on raising knowledge of the rabies virus and its potentially lethal effects.

15. A Prospective Study on Exclusion of Axillary Lymph Node Dissection in Sentinel Lymph Node Negative Cases in Patients of Breast Cancer
Parikshita Dalai, Swapnarani Behera, Jyotirmaya Nayak, Chandan Das
Introduction: Sentinel Lymph node biopsy (SLNB) has become standard to stage the axilla in cases of clinically and Ultrasound negative axilla avoiding unnecessary axillary Lymph node dissection which is associated with higher morbidity in patients. Objective: (1) The Primary objective is to preoperatively detect axillary metastasis in USG confirmed node negative axilla and perform Sentinel Lymph node Biopsy. (2) To negate the need for axillary lymph node dissection and biopsy in the treatment of breast cancer patients with sentinel node negative. Materials and Methods: All 80 biopsy proven patients were subjected to USG. From which 32 patients had suspicious of metastatic deposits which were subjected to USG Guided FNAC. Rest 48 patients Normal Axilla. From 32 suspicious patients undergone USG Guided FNAC 15 showed deposits in Axilla which were subjected to ALND. Rest 17 Negative under USG guided FNAC along with 48 Normal Axilla patients were subjected to blue dye SLNB i.e., Total of 65 cases. From these 65 cases which undergone SLNB 4 cases (23.5%) showed metastatic deposit in USG guided FNAC Negative cases (17 total cases) and 8 cases (16.6%) showed metastatic deposit in USG Normal Axilla (48 Total cases) in frozen section. Which brings total SLNB of 18.4% (12 out of 65 cases). These 12 cases were subjected to Axillary Lymph node dissection. The Final HPE study showed 100% metastatic deposits. Remaining 53 cases were followed up for a period of 12 months. No local or Axillary recurrence could be observed in 53 patients who underwent SLNB without ALND. Conclusion: Short term results were very promising with combination of USG along with SLNB without ALND in SLNB negative cases and holds a strong future perspective.

16. Investigation of Antibiogram and Aerobic Bacteria in Pus Specimens
Amitav Mohanty, Shreeja Jajodia
Introduction: The advent of antibiotic resistant bacterial species has made pyrogenic wound infection a significant source of morbidity. In order to identify the proper antibiotics for the patient’s therapy, it is crucial to understand the antibiotic sensitivity pattern of the isolates from pus samples. in order to separate the aerobic bacteria from pus samples and analyse the pattern of their antibiotic sensitivity. Method: 200 samples were received by the Department of Medicine, Apollo Hospital, Bhubaneswar, and they were processed in the lab in accordance with the prescribed procedures. The Kirby Bauer disc diffusion method was used to determine the antibiotic sensitivity of each and every bacterial isolate, and CLSI guidelines were followed for interpretation. Result: Out of 200 samples examined, 140 (90.7%) had a positive culture and 40 (9.1%) had a negative culture. Gram negative bacilli made up 73.6% of the 140 culture-positive samples, whereas Gram positive cocci made up 26.2%. Klebsiella pneumoniae (29.4%), Pseudomonas (23.2%), Escherichia coli (14.3%), and Proteus (3.4%) made up the majority of GNB. Coagulase negative staphylococci (3.7%) and Staphylococcus aureus (21%) were identified. 88.1% of cultures were obtained as pure, while 11.7% were mixed. The majority of GNB were sensitive to fluoroquinolones, third-generation cephalosporins, piperacillin tazobactam, carbapenems, and aminoglycosides. 26 percent of Staphylococcus aureus isolates were MRSA. Conclusion: Antibiotics must be used empirically and appropriately if multidrug resistant bacteria are to be avoided. Therefore, these investigations are necessary to understand the current situation of bacterial aetiology and their antibiogram.

17. Microbiological Profile and Clinical Outcomes of Inpatients with Ventilator: Associated Pneumonia
Amitav Mohanty, Shreeja Jajodia
Introduction: In intensive care units, device-associated infections make up the bulk of healthcare infections (ICUs). Patients recovering from trauma are more likely to contract these infections, with ventilator-associated pneumonia (VAP) being the most prevalent. These infections can have major consequences, including increased morbidity, an extended hospital stay, and fatality. This study compares the clinicomicrobiological profiles of trauma patients with and without VAP in Level I trauma centres. Method: At the Department of Medicine, Apollo Hospital, Bhubaneswar a 1-year retrospective assessment of a prospectively maintained database was done between January 2020 and December 2020. VAP and non-VAP patients were two categories into which the patients were divided. The criteria used by the Centers for Disease Control and Prevention to define VAP patients. The information was gathered and examined. Statistical information was examined using the SPSS version 21 program. Results: In our research, we observed 395 (87%) non-VAP cases and 200 (13%) cases of VAP over the course of the study period. There were 210 ventilator days used by VAP patients in total, ranging from 3 to 80 days (median 41 days). The non-VAP category hospital stays ranged in length from 2 to 70 days (median 195.4 days). 60 (45%) individuals with VAP experienced in-hospital mortality. 85 (34%) patients with non-VAP have also experienced a fatal outcome. Gram-negative organisms were found in the fatal VAP patients, most frequently Acinetobacter spp. (13.20%). Conclusion: Patients with VAP had a higher death rate compared to patients without VAP who were both receiving mechanical ventilation. To prevent VAP, it is imperative to identify it early, apply effective VAP preventive bundle methods, and follow strict infection control procedures.

18. A Hospital Based Prospective Assessment of Sepsis and its Markers in Renal Failure Patients on Hemodialysis
Manish Kumar, Syed Yousuf Faisal, Sudhir Chandra Jha
Aim: To study the presence of bacteremia, markers of sepsis and Inflammation in renal failure patients on hemodialysis. Methodology: The present study was conducted at Department of Medicine, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for the period of 1 year. Total of 50 patients of both sexes who were diagnosed as case of renal failure which include both acute kidney injury (AKI) and CKD on basis of clinical history, examination, biochemical markers and were advised for hemodialysis were included in the study. Patients of renal failure with newly inserted hemodialysis catheter subclavian venous catheter, internal jugular venous catheter or femoral catheter who developed systemic signs and symptom of sepsis e.g. fever, chills and rigor, tachycardia, tachypnea, hypotension, confusion, disorientation, and agitation after hemodialysis catheter insertion and hemodialysis and patients with local swelling, redness, pain or pus discharge at the site of hemodialysis catheter were included in the study. After recruiting patient for study, clinical history and relevant blood and radiological investigation were performed. After 72 hours of the insertion of catheter, subcultures were done from Hartley‘s broth onto blood agar (BA) and MacConkey medium after overnight incubation at 370C and also on the 2nd, 4th and 7th days and were then discarded, if negative. Sample that yielded pure bacterial growth of ≥105 cfu/ml was regarded as significant bacteriuria. Counts between 104 and 105 cfu/ml repeated while counts ≤104 cfu/ml considered as negative. Results: Among 50 patients of renal failure on hemodialysis, the mean age in our study was 43.86±13.52 years with 36 male patients. Out of 50 patients, 9 (18%) had positive blood and catheter tip culture and 41 (82%) of patients had negative blood and catheter tip culture. 7 (14%) patients had urinary tract infection, 9 (18%) patients diagnosed as catheter related blood stream infection (CRBIS) and 2 (4%) patients had pneumonia. 5 (55.6%) patients’ blood culture was positive for S. aureus, and E. coli found in blood culture 2 (22.2%) patient, Acinectobacter in 1 (11.1%) patient and Candida in 1 (11.1%) patient. Among 9 patients of renal failure on hemodialysis with sepsis, 2 (22.2%) patients had internal jugular line for hemodialysis, 1 (11.1%) had subclavian line and 6 (66.7%) had femoral line for hemodialysis. Catheter duration of 7-14 days was found in 1 (11.1%), 2 (22.2%) patients had central line between 14–21 days, and 6 (66.7%) patients had central line >21 days. Conclusion: Use of vascular access to deliver haemodialysis therapy in renal failure patients has increased due to which they are prone to infections because of risk factors like advanced age, male sex, diabetes, anemia, hypoalbuminemia, hyperphosphatemia and prolonged duration of hemodialysis. Gram positive cocci (S. aureus) is the commonest cause of sepsis. Sepsis was most common in patients with prolonged duration of dialysis (>21 days).

19. A Hospital Based Retrospective Assessment of the Mesh Related Infections
Roshani Prasad, Sumit Raj, Ashok Rai
Aim: The aim of this study was to analysis of mesh related infections in a tertiary care centre. Methods: A retrospective descriptive study was conducted in the department of Surgery, JLNMCH, Bhagalpur, Bihar, India for one year and 50 patients were included in the study. Results: Mesh infection was more common in males. Among 50 patients, 40 were males and 10 female patients. Majority of the patients were in the age group 40-50 (40%) followed by 50-60 age group 30%. 80% cases were repaired with open PP and rest of the patients was repaired with Lichtenstein repair. In our study, mesh infection was more common in obese patients with a mean BMI of 32.70+/-1.78kg/m2. (Range 30.40-34.10). 40% patients had co-morbidities. The antibiotic protocol was followed in 48 cases out of 50. Antibiotic has used according to the protocol of our hospital; it was followed in 48 patients in the first surgery i.e., hernia repair surgery. Parenteral cephalosporin was used in 48 patients and amoxicillin-clavulanic acid in 2 patients. Antibiotic has repeated if the procedure was beyond 2 hours. After postoperative day 2, patients were switched over to oral antibiotics for three days. Likewise, during the second admission, i.e., when the patient was admitted with mesh infection, 48 patients were given cephalosporin, and 2 patients were given Piperacillin tazobactam. Conclusion: In our study incidence was more common after open surgeries because there was a lapse in the sterilization process of the instruments, which was rectified with timely culture sensitivity tests and stringent sterilization process.

20. To Evaluate the Weekly Antenatal Oral Iron and Folate Supplementation is an Effective Alternative to a Daily Regimen in Non-Anemic Pregnant Women: A Comparative Study
Priyanka Kumari, Rakhi Singh, Amrita Sharan
Aim: The aim of this study was to evaluate the weekly antenatal oral iron and folate supplementation is an effective alternative to a daily regimen in non-anemic pregnant women to prevent anemia and iron deficiency during the third trimester. Methods: The present study was conducted in the department of obstetrics and gynaecology, Patna medical College and Hospital, Patna, Bihar, India for 1 year. Women having periods of gestation (POG) between 14 to 16 weeks were recruited for the study. All women were first given single dose of tab albendazole 400 mg. Then they were randomly allocated to the three treatment groups and given a haematinic capsule i.e. 200 mg of ferrous sulfate (60mg elemental iron) with 1mg folic acid tablet either weekly (n=25), thrice weekly (n=25) or daily (n=25). Results: There were no significant differences in income, educational level, age, parity, POG, initial Hb and SF concentrations, Hct, and duration of previous haematinic prophylaxis between the three study groups. There is a reduction in the number of women with IDA in all three supplementation groups, but the number of women with ID is significantly increased in the weekly supplementation group and significantly decreased in the daily supplementation group. Conclusion: Prophylactic oral iron supplements when given intermittently were not effective in preventing iron deficiency anaemia in pregnancy. In non-anemic pregnant women, a weekly regimen is an effective alternative to a daily regimen for antenatal oral iron and folate supplementation for preventing anemia and iron deficiency during the third trimester.

21. A Hospital-Based Analytical Assessment of Neonatal Morbidity and Mortality between Late-Preterm IUGR and AGA Infants of the Same Gestational Age
Nayan Rukhaiyar, Snigdha Prasad
Aim: The aim of this study was to compare neonatal morbidity and mortality between late-preterm IUGR and AGA infants of the same gestational age. Methods: The present study was conducted in the department of Pediatrics, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar, India for six months and we analyzed 100 singleton pregnancies, including 50 pregnancies involving infants with a birth weight of or below the 10th percentile (IUGR) delivered between 34 weeks and 36 6/7 weeks of gestation due to maternal and/or fetal indications. The control group consisted of 50 singleton pregnancies with spontaneous preterm delivery at the same gestational age, in which the birth weight ranged from the 11th to 89th percentile (AGA). Results: There was no significant difference in maternal age which ranged from 16 to 45 years (mean ± standard deviation: 25.1 ± 5.5 years) (P > .05). Among mothers of the IUGR group, 39 (78%) presented some underlying disease or obstetric complication in addition to IUGR, whereas 11 (22%) did not. Hypertensive syndromes were the most frequent condition and were observed in 24 (48%) women of the IUGR group. Heart disease was observed in 5 (10%) mothers of this group, systemic lupus erythematosus in 4 (8%), and other underlying diseases in 6 (12%) (pulmonary disease, hepatitis, thrombophilia, anemia, etc.). Conclusion: In conclusion, our study showed that late-preterm IUGR infants present a significantly higher risk of neonatal complications and a significantly longer NCIU and hospital stay when compared to late-preterm AGA infants.

22. Evaluation of Platelet Count and Indices in Patients of Sepsis
Syed Yousuf Faisal, Manish Kumar, Sudhir Chandra Jha
Aim: To investigate the relationship between severe sepsis and platelet count, MPV, and PDW. Methodology: This is a retrospective cohort study that was conducted for nine months in Darbhanga medical college and Hospital, Bihar. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Patients diagnosed as sepsis, severe sepsis, and septic shock at the first medical examination were included. Control group/patients were selected from consecutive patients who were admitted to the outpatient clinic. The diagnosis of sepsis was made during the first examination. Sepsis was defined as SIRS with a proven or suspected source of infection. Demographic characteristics, such as age, gender, and the reason for hospitalization (medical or surgical) and laboratory results (whole blood count and CRP) at admission were obtained from patient files. Also, patient files were investigated for 28-day mortality. Patients who were discharged within 28 days after diagnosis of sepsis and who continued to have follow-up in the hospital at the 28th day of patient monitoring were accepted as survivors. Patients who died within the 28 days of patient monitoring were accepted as non-survivors. Results: A total of 100 sepsis patients were included in this study. The study population consisted of 41% females and 59% males, of which 16% were surgical and 84% medical patients. Also, 100 patients (35% females and 65% males) were included as a control group. Thrombocytopenia was observed in 34% patients with sepsis and in 3% patients in the control group (p<0.001). Age and gender were statistically similar between septic patients and the control group (p>0.05). However, a statistically significant difference was found in MPV and PDW between patients with sepsis and the control group (p<0.05). Among the 100 sepsis patients, 38% of them died within the 28-day follow-up. Thrombocytopenia was observed in 14 (36.8%) of the non-survivors and in 19 (30.6%) of the survivors. There was no statistical difference between survivors and non-survivors in terms of demographic characteristics and laboratory findings, except for PDW. PDW in non-survivors was significantly higher than in survivors (p=0.001). MPV levels higher than 8 fl have 55.24 % sensitivity and 89.26% specificity for sepsis diagnosis. Conclusion: It was concluded from this study that platelet indices may serve as an important tool to aid sepsis screening. Thrombocytopenia is an ominous sign that should be taken seriously in sepsis. Platelet indices and their ratios are readily available, sensitive, prognostic markers that can identify the severe sepsis patients with poorest outcome. So, we recommend platelet count, platelet indices and their ratios should be assessed in all sepsis patients upon admission.

23. Diagnostic Accuracy: FNAC versus Histopathology in Benign and Malignant Breast Lesions
Suryajita Kumar Singh, Deepak Kumar
Aim: The aim of the present study was to compare the diagnostic accuracy of fine needle aspiration cytology (FNAC) and with histopathological correlation in patients with detectable breast lesions. Methods: The study was conducted in the Department of Pathology, Jawahar Lal Nehru Medical College, Bhagalpur, Bihar, India  for a period of 8 months. During this period, 120 fine needle aspiration were performed for various breast lumps. Out of these, 60 patients underwent surgery and form the material of the study. Results: A total of 60 patients presenting with palpable breast lumps were included in this study. The maximum number of patients attended were in 41–50 years of age group ( 18 cases, 30%), followed by 51–60 years (25%) with mean age of the patient was 46.93 years. The maximum number of benign lesions (12 in number) occurred in 31–40 years of age group and the maximum number of malignant lesions (18 in numbers) occurred in 41–50 years of age group. In FNAC, 57 cases were labelled as benign and 3 cases were malignant. Out of the 60 cases, 40 patients had fibroadenoma, 2 patients had phylloid tumor, 1 tubular adenoma, 3 fibrocystic disease of breast, 4 patients had inflammatory or breast abscess, 2 patients had gynaecomastia and in 2 cases no opinion was given. Out of the 4 malignant cases in HPE, 2 patients had a diagnosis of ductal cell carcinoma and 4 patients infiltrating ductal carcinoma. Conclusion: Fine needle aspiration cytology is a comfortable, easy, reliable, rapid and simple diagnostic test. The FNAC of breast lump should be used with” triple test” for preliminary investigation in outdoor patient department, which will further enhance the diagnostic accuracy of breast lumps.

24. A Hospital-Based Assessment of the Impact of Corrected Maternal Anemia on Perinatal Outcome its Comparison with Babies Born to Anemic Mothers
Snigdha Prasad, Nayan Rukhaiyar
Aim: The aim of the present study was to assess impact of corrected maternal anemia on perinatal outcome in terms of birth weight and gestational maturity and its comparison with babies born to anemic mothers and burden and severity of anemia in pregnant women. Methods: Total 120 pregnant women of 20 ±4 weeks of gestation with singleton pregnancy attending OPD of Department of Obstetrics & Gynaecology at Lord buddha koshi medical college & hospital for one year and were enrolled after taking informed consent. A brief medical history and examination was done before enrolling the patient. Results: A total of 120 women with pregnancy around 20+4 week’s gestation were included in this study. As per hemoglobin levels and WHO definition of anemia, 6 (5%) antenatal mothers had severe anemia, 78 (65%) had moderate anemia and 36 (30%) had Hb levels >10gm/dl. 78 women with moderate anemia i.e. hemoglobin level between 7-10gm% constituted our study group. Out of 78 women 4 were lost to follow up, one who developed PIH, one with bleeding and 12 who did not show improvement in hemoglobin level due to irregular intake or intolerance were excluded from this study. Conclusion: From the present study we concluded that; anemic mothers had higher chance of delivering preterm and low birth weight baby, which again is an important determinant of survival and quality of life a child.

25. To Evaluate Maternal Vitamin D Levels in Patients with Hypertensive Disorders of Pregnancy: A Case-Control Study
Priyanka Kumari, Sangeeta Sinha, Amrita Sharan
Aim: The aim of the present study was to evaluate maternal vitamin D levels in patients with hypertensive disorders of pregnancy. Methods: The present study was conducted in the department of Obstetrics and Gynaecology, Patna Medical College and Hospital, Patna, Bihar, India. The duration of the study was 2 years with a sample size of 120 case and 120 control subjects. One hundred twenty patients with hypertensive disorders of pregnancy and satisfying the inclusion criteria were enrolled and profiled as a part of this study. Results: In the present study, 240 women were included. 120 women who had hypertensive disorders of pregnancy were included as “cases” group and the other 120 women without any hypertensive disorders. Majority of women (83.34%) in hypertensive group had severe vitamin D deficiency as compared to 12.5% with moderate and 4.16% with mild deficiency of vitamin D. The difference among two groups was statistically significant (p<0.001). Whereas among normotensive women only 3.34% had severe vitamin D deficiency, 75% had moderate deficiency and 16.66% had mild deficiency of vitamin D. The sub-classification of women on the basis of type of hypertensive disorders of pregnancy was done and the majority of women. Serum vitamin D was determined for every participant. Conclusion: Our study showed that serum vitamin D levels were low in women with hypertensive disorders of pregnancy as compared to normal normotensive pregnant women. Prevalence of vitamin D deficiency was significant in women with hypertensive disorders of pregnancy as compared to normal normotensive pregnant women.

26. A Prospective Assessment of the Role of Diabetes Mellitus in Causing Posterior Subcapsular Cataracts
Rajeev Kumar, Abhilasha, Jawed Iqbal
Aim: This study aimed to determine the role of diabetes mellitus in causing cataracts, especially posterior subcapsular cataracts. Methods: The present study was conducted in the Department of ophthalmology, ANMMCH, Gaya, Bihar, India for the period of 10 months. The consecutive sampling method used in this study the overall data of cataract patients treated by the Department of ophthalmology, ANMMCH, Gaya, Bihar. This data is a medical record containing a history of diabetes mellitus and the types of cataracts suffered by 200 patients. Results: In this study, 200 patients’ data were used; it is known that there were 70 patients with a history of diabetes mellitus (35%) and history of non-diabetes Mellitus as many as 130 patients (65%). As for 200 patients who suffer from cataract eye disorders or diseases in this study, it was found that 40 patients or 20%, had PSC type cataracts, and 160 patients, or 80%, had non-PSC type cataracts. From the cross-section analysis results, it is known that as many as 38 patients or 19% had a history of diabetes mellitus and had PSC cataracts, while two patients or 1%, did not have a history of diabetes mellitus but had PSC cataracts. In addition, the results of the analysis also showed that there were 32 patients, or 16% had a history of diabetes mellitus and had non-PSC cataracts, while 128 patients or 64%, did not have a history of diabetes mellitus experiencing non-PSC cataracts. Conclusion: As the number of people with DM is estimated to continue to increase, cataract surgery will remain important for diabetic patients. Patients with diabetes have multiple issues to be evaluated preoperatively, perioperatively, and in the postoperative period.

27. Comparison of Bolus Ephedrine, Mephentermine and Phenylephrine for the Management of Hypotension during Spinal Anaesthesia for Caesarean Section: A Clinical Study
D.V. Ravi Kumar, Suryasnata Sahoo, Anija Pattnaik, Udaynath Behera, Parimita Goud
Background: In this study, we wanted to compare the efficacy of ephedrine, mephentermine and phenylephrine in treating the hypotension for caesarean section and their undesirable side effects. Methods: This was a hospital based prospective double blind randomized manner study conducted among 90 patients who underwent elective and emergency lower segment caesarean section (LSCS) in the Department of Obstetrics, S.C.B. Medical College& Hospital, Cuttack from June 2021 to July 2022, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: The mean value of heart rate was generally the highest in Group II followed by Group I and Group III. The mean variation of heart rate values between the three groups was statistically significant at 2 mts. Pair wise comparison of groups showed that the differences in mean values were statistically significant between Group II and III and between Group I and III at 2-mts. The mean value of diastolic BP was greater in Group III than Group I or Group II values at 2nd and 4th minute. The variation in the mean values of diastolic BP between the three groups was statistically significant at 2-mts (p = 0.01) and between 20 and 30 minutes. Pair wise comparison of groups revealed that the mean differences were statistically significant between Group I and Group II at 8-mts (p = 0.02). The mean differences in MAP values between the three groups were statistically significant at 2-mts (p = 0.003), 4 mts (p < 0.001) and 25-mts (p = 0.04). The pairwise comparisons between Group I and Group II were statistically significant at 25-mts (p = 0.02) and between Group I and Group III at 30-mts (p = 0.03). Conclusion: All the three vasopressors namely ephedrine, mephentermine and phenylephrine are effective in IV bolus form in maintenance of maternal arterial pressure within 20 % limit of base line values, though phenylephrine has quicker peak effect, in comparison to ephedrine and mephentermine and it causes reduction in heart rate, which may be advantageous in patients in whom tachycardia is undesirable. All the three vasopressors had no significant adverse effects on neonatal outcome.

28. Etiology of Papilledema and Visual Outcome Following Treatment: A Prospective, Observational Study
Shyam Savith, Bharat Kumar Jain, M. V. Bhavani, N Padmavathi
Background: Papilledema is an ophthalmic emergency which requires immediate medical attention. Most patients with elevated intra-cranial pressure (ICP) present to ophthalmologist with headache, nausea, vomiting, abducent nerve paresis, transient obscuration of vision (TOV). Papilledema serves as an important indicator and warning signal of intracranial pathology and needs timely intervention. Materials and Methods: An observational study of 50 patients with Papilledema was done. All patients were between 10 to 60 years, clinically diagnosed as papilledema were included in the study. Results: In the present study of 50 patients, females were more than males. The maximum number of patients belonged to 21- 40 years age group ( 56%) followed by 11-20 years (16%) age group. Intracranial space occupying lesions (52%) was most common cause of papilledema followed by idiopathic intracranial hypertension (18%). Conclusions: Papilledema occurs more commonly in the age group of 21- 40 years,  females were affected more than males. Intracranial space occupying lesions (52%) was most common cause of papilledema followed by idiopathic intracranial hypertension (18%). Visual prognosis depends upon the history, stage of papilledema, duration, timely intervention and early management.

29. Perceived Risks and Perceptions of Covid–19 Vaccination in Patients with Autoimmune Skin Diseases Attending a Tertiary Care Centre in South India: A Questionnaire Based Study
Lomine Karain R., Akila Kumaraguru, Bandhala Rajan M., Jansy R., Seethalakshmi R.S.
Background: COVID vaccines against the SARS-CoV2 infection helped in reducing the devastating effects of the COVID pandemic. Many studies have portrayed the efficacy and safety of vaccines, there are people who are hesitant to get vaccines due to the fear of side effects and the fear is especially high in patients with autoimmune disorders on systemic immunosuppressant possibly due to lack of awareness and proper counselling. Material and Methods: This is a cross sectional study done in the Department of Dermatology, Tertiary care centre in India. The study participant who fulfilled the inclusion and the exclusion criteria were included in this study. COVID vaccination details were obtained from 50 patients with autoimmune skin disorders attending the skin OPD. Results: Age of the patient ranged from 18 – 70 years in which 45-60 years of the age group were predominant 18(36%)]. The most common autoimmune disease among the study participants was Psoriasis vulgaris 24(48%). Patients taking immunosuppressant were about 20(40%) study participants. About 72% were vaccinated for COVID-19. The most common reason for getting vaccinated is due to its Free of cost (91.6%) followed by confident on the vaccine protection (41.7%). Among those who are not vaccinated, most common reason was found to be ignorance regarding vaccine (64.3%) followed by personal superstitious belief (57.1%). Conclusion: Our study concluded that 72% of study population got COVID 19 vaccination and the common reason is due to its free of cost in our country followed by confidence in its efficacy. The rest hesitated due to their personal superstitious beliefs and their ignorance. Overall, during the study period, no major adverse effects related to the vaccine were noted in our study participants.

30. Comparative Study of Laparoscopic versus Open Pyeloplasty in the Management of Primary Uretero-Pelvic Junction Obstruction
Guda Manohar, Augustine Shitiri, Amrit Preetam Panda, G. Manogna
Pelviureteric junction obstruction (PUJO) is a functional or anatomic obstruction of urine flow from the renal pelvis into the ureter. The causes of PUJO are congenital, acquired, intrinsic and extrinsic. Pelviureteric junction obstruction ultimately will lead to hydronephrosis which can progress to permanent renal impairment. The standard procedure to relieve obstruction is open, laparoscopic or robotic pyeloplasty.
In our study 30 patients with primary PUJO were randomised into two groups of 15 each using a computer-generated randomised table. Anderson Hynes Open pyeloplasty was performed on 15 patients, and laparoscopic pyeloplasty was performed on 15 patients. Both procedures were compared for efficacy in terms of subjective outcomes (post-operative pain, activity level) and objective outcomes (operative time, complications, recovery time/hospital stay, improvement in renal function, cosmesis, success rate). Standard inclusion and exclusion criteria were followed.
Laparoscopic pyeloplasty has a comparable success rate to open pyeloplasty and is an effective minimally invasive treatment option for PUJ obstruction. Laparoscopic pyeloplasty is emerging as the new standard of care for PUJ obstruction.

31. Correlation of Serum Fasting Blood Glucose, Hba1c & Serum Electrolytes in Type 2 Diabetes Mellitus
Vandana Varma, Deepak Verma, Meenal Vaidya, Swarn Surbhi, Bhavna Tiwari, Purnima Dey Sarkar
Objective: The study aims to identify the relationship of serum electrolytes Na+, K+ Mg+ and Ca+ with FBG and HbA1c levels in T2DM patients treated with insulin, oral hypoglycemic agents. Methodology: The study was done on 239 type 2 Diabetes mellitus patients selected randomly aged between 18 and 65 years for both Group- I (FBG >100 mg%; HbA1c % >6.5) and Group-II (FBG <100 mg%; HbA1c % <6.5). HbA1c, fasting blood glucose (FBG), Sodium (Na+), potassium(K+), magnesium (Mg+) and calcium (Ca+) were assessed in all samples and compared between two groups. Results: In the present study, 149(62.3%) were male and 90 (37.7%) were female cases. The use of oral hypoglycemic agents was found in 145 subjects (60.6%) and insulin therapy was in 62 (25.9%) and 32 (13.5%) were newly diagnosed cases. In Group-I Na+ and Mg+ negatively correlated with FBG and HbA1c. K+ & calcium showed insignificant relation with FBG & HbA1c for both groups respectively, but it was significant when taken as a total of both the groups with a P value of 0.001. The K+ showed negative correlation with HbA1c alone when taken as a total of both groups. Conclusion: The present study showed significant reduction in serum Na+ and Mg+ level among T2DM patients especially when FBS >100 mg% and HbA1c % >6.5. Serum K+ also demonstrated significant association with HbA1c. Therefore, the FBG, HbA1c and serum electrolytes, considering the multifactorial origin of electrolyte imbalance, a cause-specific treatment is required to avoid any risk.

32. Effectiveness of LMA Protector in Non-Paralyzed Patients for Laparoscopic Surgeries
A Poornima, Swati Injineri, Sushmitha Biradar, Shashikala. T. K.
Background: Laryngeal mask airway LMA protector is a second generation perilaryngeal sealer type supraglottic airway device possessing functional separation of the respiratory and digestive tract. This study comprises the ease of insertion, fibrotic assessment, oropharyngeal leak and complications associated. Methods: we conducted this study using LMA protector in 30 ASA grade 1 and 2 patients undergoing laparoscopic surgeries by assessing the ease of insertion considering the number of attempts, oropharyngeal leak pressure, fibrotic inspection of airway for vocal cord visibility, successful gastric tube placement, blood staining on the device after removal. Incidence of postoperative sore throat and complications if any were noted. Results: Insertion was successful in the first attempt. Mild resistance was associated with insertion with median insertion time 16.8 (6-30) seconds. Airway leak pressure was 29.5cmH2O(20-30)On fibrotic examination, vocal cords were visible in all 30 patients. No alternative airway or manipulations was required during the maintenance of anaesthesia. Two patients had sore throat 24 hours after the procedure. Blood traces were present on LMA after removal. There was no dysphasia or hoarseness. Conclusion: this study proves LMA protector to be safe, and has high first attempt and overall insertion success rate. rapid achievement of effective ventilation and reliable airway seal and low rates of complications. Potentially can be considered for use in laparoscopic surgeries.

33. A Study to Evaluate the Outcome of Conventional and Endoscopic Septoplasty
Atal M, Agarwal S R, Nirwan S, Singhal P, Jat K S, Sharma M P
Objective: To evaluate and compare the results of conventional and endoscopic septoplasty. Methodology: A hospital-based comparative study was performed at SMS Medical College, Jaipur over a period of one year. In this study, 62 patients suffering from deviated nasal septum were divided into two groups of 31 each that underwent conventional and endoscopic septoplasty respectively, and were evaluated in terms of the outcome. Result: The endoscopic group reported 93.5% post-operative satisfaction rates, 12.9% experienced hemorrhage, 12.9% synechiae, and 9.6% mucosal tear, compared to 80.6%, 25.8%, 16.12%, and 19.35% respectively in the conventional group. Conclusion: The patients who underwent endoscopic septoplasty fared better than those who underwent conventional septoplasty in terms of success, complications, morbidity, and overall satisfaction.

34. Comparative Analysis of Various Antibiotics in Surgical Site Infections Caused by Various Causative Microorganisms
Shrikrishna A. Joshi, Rahila Khan, Abhay Chowdhary
Introduction:  Surgical Site Infections could involve an organ or bodily space, a shallow or deep incisional infection, or both. The third most frequently reported nosocomial infection in the hospital population, postoperative SSI is one of the most frequent issues for patients, who receive cesarean sections. The prevalence of postoperative SSI varies significantly across procedures, hospitals, doctors, patients, and geographical locales. It makes things more difficult worldwide including Ethiopia (21%), India (2.85%), and Nigeria (7-9.6%). Aims and Objectives: To analyze the efficacy in terms of sensitivity and resistance of various antibiotics in the management of surgical site infection with respect to the causal organisms. Methods: This is a prospective study conducted on 430 patients. In addition, out of 430 patients were operated on for clean surgeries, clean-contaminated surgeries, contaminated surgeries. The postoperative wound discharge was collected and bacterial pathogens were isolated. The plates were incubated at 37°C overnight for 24-48 hours. A hand lens was used whenever necessary to inspect all plate cultures. Results: The study found that a total of 430 patients were studied for the development of Post-Operative Surgical Site Infection. It has been found that 32 out of 430 cases showed growth of 36 isolates, with overall post-operative surgical site infection rate of 7.47%. The study found 100% resistance is present in Klebsiella, E. coli with ampicillin while amikacin and gentamicin have 100% resistance with Acinetobacter. Conclusion: The study has shown sensitivity and resistance of different antibiotics with different micro-organisms and have brought forward an image of epidemiological view of surgical site infection, all of which, would contribute in the postoperative management efficiently.

35. MDCT Evaluation’s Role in Identifying and Classifying Hepatic Mass Lesions
Sushil Kumar Chaudhary, Poonam Mehrotra, Ravindra Mohan Katiyar
Introduction: Multiphasic Computed Tomography (CT) has become the chief imaging modality for recognition and characterisation of focal liver lesions. CT has assumed primary role in evaluating hepatic masses. Objective: To assess the imaging features of focal hepatic lesions on Multidetector Computed Tomography (MDCT) and its comparative assessment with histopathological results. Materials and Methods: For 15 months, the Department of Radiodiagnosis of a tertiary care hospital hosted this cross-sectional study. The study included all patients presenting with abnormal liver function or known cases of liver mass lesions as well as adult individuals in the age range of 20–60 years with localized hepatic lesions on abdominal imaging (USG). Along with the histological and biochemical study report, all values for the arterial phase, venous phase, portal phase, and delayed phase were recorded and analyzed. For the analysis, SPSS (Version 22.0) was utilized. Results: 90 focal liver lesions were discovered by MDCT, of which 70 (85%) were benign and 12 (14.3%) were malignant. The MDCT’s diagnostic effectiveness (accuracy) was determined to be 95% with a predicted value (95% CI: 84.20- 96.75%). Highly significant agreement (p0.001) was discovered between MDCT and biopsy methods for the hepatocellular carcinoma cases. Malignant lesions were shown to have an overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 83%, 97%, 83%, 97%, and 95%, respectively. Conclusion: MDCT is highly sensitive in classifying the hepatic lesions into clinically relevant categories, making diagnosis and evaluation of lesion.

36. A Study of Histopathological Spectrum of Oral Lesions in Tertiary Care Hospital, Raigarh, Chhattisgarh
Naik Reena, Bansal Aarti, Khunte Rakesh K., Bhagat Kiranlata, Gajendra Megha, Minj Manoj K
Background: Lesions of the oral cavity are generally asymptomatic. Different sites of oral cavity show predominance for different types of lesions. Carcinoma of oral cavity is the most common type of cancer among males in India. In our study benign lesions were more common than malignant. Material and Methods: A  four year retrospective study conducted from August 2017 to September 2021. The study included total 110 number of cases. All the oral cavity specimens received in the Department of Pathology,  LSLAMMC and Hospital, Raigarh , C.G, during the study period was included. Archival records for retrospective cases were procured and demographic details were noted and analysed. Result: 110 cases of oral lesions during the study period were included. Oral  lesions were predominant among males having M:F of 1.3:1. Non neoplastic , benign and malignant cases were most common in male with 23(20.9%), 21(19%) and 19(17.2%) cases each. Most common age group affected in non-neoplastic lesion were between 31-40 years in 9(8.1%). In benign lesion most common age group is 21-30 years in 12(10.9%) cases and in malignant lesion 31-40 years of age group is most common in 10(9.0%) cases. The most common site for oral lesions was buccal mucosa in 41(37.2%) cases and benign lesions of 40(36.3%) cases with the predominance of hemangioma in 14(12.8%) cases. The  malignant  oral lesions were 37(33.6%) cases with predominance of squamous cell carcinoma in 34(30%) cases. Conclusion: Usually most of the oral lesions are asymptomatic. Therefore it is necessary to examine the patient properly and differentiate the premalignant and malignant lesions for the proper management of the patient. So, there is importance of  correlation between clinical and histopathological study.

37. Clinicopathologic Profile of Peripheral Lymphadenopathy in Children
Swati Handralmath, Bolde S A, Sonawane Susheel
Introduction: To devise a diagnostic modality for lymphadenopathy which is both cost-effective and has a high accuracy. Aims and Objectives: To find out diagnostic accuracy of FNAC as compared to the “GOLD STANDARD “of excisional LN biopsy as well as to understand the limitations of the technique. Materials and Methods: 215 pediatric cases up to 12 years age presented during a duration of 5 years with node size preferably more than 1 cm located peripherally. FNAC was done in all cases and biopsy was done to determine the accuracy of the technique and where needed. Results: Diagnostic accuracy of FNAC was 90.16%, being 100% for TB & lymphoma. Conclusion: FNAC as a diagnostic modality is almost as sensitive & specific as excisional biopsy with an adequate smear and examination by expert eyes.It can obviate the need for biopsy in majority of the cases minimizing the need for hospitalization, trauma and scars of surgery.

38. A Case of Distal Femur Giant Cell Tumour Treated with Excision Curettage and Sandwich Technique
Sunil Handralmath, Swati Handralmath, Nayan Chaudhari
Giant cell tumors (GCTs) are primary bone tumors that occur most commonly in long bones, with half such tumors occurring in the distal femur, proximal tibia, and fibula. Around 12% of patients present with a pathological fracture indicating more aggressive disease. Arthrodesis after tumor resection is a popular choice due to its affordability and early postoperative mobilization, as well as low risks of implant loosening, infections, malignant lesions, or mortality. In developing countries, the cost of the mega prosthesis, around lakhs means many patients cannot afford the treatment. We describe a case of a GCT of the distal femur treated by excision of the tumor with sandwich technique and reconstruction using iliac crest bone graft. The result was satisfactory, knee movements were initiated at 4th week and partial weight-bearing was allowed two months after the surgery. At the one-year follow-up, there was no recurrence, and the patient had the full weight-bearing ability with complete range of movements.

39. Clinical Characteristics and Follow-Up of 19 Children under 3 Years Old Diagnosed with Hashimoto’s Thyroiditis
Mitulkumar B Kalathia, Zalak Upadhyay
Aim: The purpose of this study is to investigate the clinical manifestations of Hashimoto’s thyroiditis (HT) in children less than three years old in order to acquire a better knowledge of the illness, prevent incorrect diagnoses, and achieve earlier diagnosis and therapy. Methods: The clinical information of 19 individuals who were diagnosed with HT in the first three years of their lives was investigated via a retrospective analysis. Results: The patients had an average age of 26.1 8.2 months, with 12 females and 7 males in the group (range 10–36 months). One patient had hyperthyroidism, ten patients had hypothyroidism, seven patients had subclinical hypothyroidism, and one patient had euthyroidism at the time of presentation. Thyroid enlargement (21.1% of visits), global developmental delay (21.1% of visits), and regular thyroid function testing in patients with type 1 diabetes (26.3% of visits) were the most prevalent causes for patients to seek medical attention. Data on follow-up was collected from sixteen patients, and the mean follow-up period was 23.31 months with a standard deviation of 16.44 months (range 1–48 months). One of the patients receiving therapy for hypothyroidism quit taking levothyroxine (LT4) after two months; the other patients had been taking LT4 continuously from the time of their diagnosis. In the group of patients identified with subclinical hypothyroidism, one patient’s thyroid function reverted to normal one month after being diagnosed, and this patient did not receive treatment. The remaining patients were either treated with LT4 at the time of their diagnosis or when they were being followed up on. Following diagnosis, the patient who had hyperthyroidism was given methimazole as therapy; however, medication was stopped 11 months later, and LT4 was started 26 months after diagnosis. After therapy with LT4, about one in every four patients diagnosed with global developmental delay made progress toward normal mental development. Patients diagnosed with short stature saw an increase in their height in four out of every six cases. Conclusion: The majority of the children had either overt hypothyroidism or subclinical hypothyroidism at the time of their first HT diagnosis. Even if the child’s thyroid function was normal after delivery, the child should still be screened on a regular basis to establish whether or not they have HT-induced hypothyroidism. This is because children with global developmental delay are more likely to have the condition. The clinical symptoms of hypothyroidism may be alleviated to some degree by the administration of thyroxine, and early identification and treatment are very necessary in order to improve a patient’s prognosis.

40. Effect of Years of Exposure on Micronucleus Frequency in Buccle Epithelium Cell through Micronucleus Assay in Subjects Exposed to Formaldehyde
Shabina, Nand Lal, Shilpa
Background: The stratified squamous cell epithelium continuously loses superficial buccal cells, which are replaced by cell division. When these cells split, chromosomal fragments or full chromosomes may be left behind during mitotic anaphase and manifest as tiny nuclear particles, or micronuclei, in the cytoplasm of daughter cells. The cytogenetic changes can only be examined from the exfoliated cells after the cells have matured and migrated to the surface. A novel genotoxicity method that shows promise for the investigation of epithelial carcinogens is the micronuclei assay (MA) on exfoliated buccal cells. For detecting tissue-specific genotoxic damage in people exposed to carcinogenic combinations, micronuclei (MN) are ideal internal dosimeters. Aim: To analyse effect of years of exposure on micronucleus frequency in buccle epithelium cell through micronucleus assay in subjects exposed to formaldehyde. Methods and Materials: After obtaining informed consent, 50 male and female participants who are exposed to formaldehyde were chosen for the study. The duration of formaldehyde exposure in days, months, and years was recorded. After properly washing the mouth, buccal cells were scraped off the inside of the cheek. The cells were moved into centrifuge tubes with 5ml of 0.9% saline, and they underwent two centrifugal separations. 2 drops of fixative (3:1 Methanol and acetic acid) and the supernatant trash were added. The cells were dropped onto a cooled slide using a Pasteur pipette before being air dried. Per sample, two slides were created. The slide was air dried, labelled, and fixed in fixative for 20 minutes before being stored for 24 hours before staining. Giemsa staining solution was used to mark the slides. The criteria provided by Tolbert et al that were used to identify the MN. Results: There was positive correlation of various parameters of degree of exposure to formaldehyde with MN count /500 cells but statistically significant correlation was with year of exposure and total exposure only. (p=0.004 & p=0.003 respectively). Conclusion: It was concluded that years of exposure to formaldehyde were significantly correlated to the frequency of micronucleus. Micronucleus assay in human epithelial buccal cells is most reliable and attainable method to assess occupational menace resulting in genetic abnormality due to environmental and chemical factors.

41. Safety and effectiveness of Oral Misoprostol for Induction of Labour
Dhanya, T. Dhiviya Narbhavi, T. Harini, R. Sankareswari, S. Revwathy
Background: In low-resource areas, oral misoprostol is replacing dinoprostone and oxytocin as the drug of choice for inducing labour since it is less expensive, more stable at room temperature, and less complicated to administer. The study’s goal was to quantify the proportion of pregnant women who gave birth within the first 24 hours after ingesting misoprostol orally. Successful vaginal delivery, induction-delivery delay, induction failure ending in caesarean section, retained placenta requiring manual removal, uterine hyperstimulation, and uterine rupture were the noted maternal outcomes. Methods: This six-month retrospective observational study was conducted in a tertiary care teaching hospital. 50 patients who met induction requirements according to induction guidelines received 50 mcg oral misoprostol after bimanual pelvic examination for estimating modified bishops score and reactive CTG. The patient was monitored for six hours. If the cervix is still unfavourable, a second oral dosage of 50 mcg misoprostol may be repeated every 4-6 hrs up to three times. Patients who delivered birth within 24 hours were noted. Results: Mean (SD) of their age was 27.78 (2.98) years. 45 patients gave birth vaginally within the first 24 hours of pregnancy. The modified Bishop’s score of the 5 women, who did not undergo delivery within 24 hours was less than 3, with the majority of them (80%) having a score of 0. The mean (SD) gestational age was 39.74 weeks (1.44). The median amount of time that passed between the induction of labour and the delivery of the baby was 13.38 (4.84) hours. Conclusion: Oral misoprostol is a safe, effective and easily available, low cost drug leading to more number of vaginal deliveries within 24 hours of induction with less maternal and perinatal complications. This can be delivered easily in low resource situations.

42. A Cross-Sectional Study on the Knowledge, Attitude and Practices of Pharmacovigilance among Nursing Staff at a Medical College Hospital, Karamsad, Gujarat, India
Nitin Kothari, Mahesh Kumar Choudhary, Twinkal Upadhyay, Punita Kumari Patera
Objective: This study aimed at investigating the knowledge, attitude and practice toward pharmacovigilance and ADRs reporting among nursing staff at a teaching training hospital. Methods: This was a cross-sectional, observational, questionnaire-based study conducted in Shri Krishna Hospital and Medical Research Centre, attached to Pramukhswami medical college, Karamsad, Gujarat. Results: Total 43 nursing staffs completed the questionnaire and were included for the study. The demographic profile of participants in our study includes 62% women and 38% men. The Mean age of the respondents was 35 years. 83 percent of the nursing staff have heard the term ‘pharmacovigilance’ but only 58 percent were aware of it accurately. Nearly half of the nursing staff were aware about any drug that has been banned due to ADRs. The awareness about Pharmacovigilance Programme of India was found very limited in the nursing staff. Majority of the nursing staff admitted that ADR reporting is very important and compulsory, they also felt that pharmacovigilance should be taught actively to students as a part of the nursing curriculum. More than three-fourth of the nursing staff replied that they have free access to ADR reporting forms and nearly half of them only have taken training for the same. Our study also revealed that only 49 percent of the nursing staff have reported ADRs. Conclusion: Nursing staff are often the source in alerting the responsible physician about possible ADRs. There is thus a logical reason to involve nursing staff and encourage them to contribute in ADR reporting system.

43. A Hospital-Based Assessment of the Effect of Serum Magnesium Concentration on Clinical Outcome of Critically Sick Patients: An Observational Study
Amit Kumar Singh, Soumya Singh, Uma Shanker Singh
Aim: To determine the usefulness of admission serum magnesium levels with regards to patient outcome in critically ill patients admitted in ICU. Methodology: The present prospective observational study was conducted in the Department of General Medicine, AIIMS, Patna, Bihar, India for three months. The patients were selected for study based on inclusion and exclusion criteria. All patients with APACHE 2 score of more than 20 or less than 6 admitted in ICU, and patients aged more than 18 years were included in the study. Demographic data such as age and sex were recorded. Patients were assessed for presenting complaints, history of other diseases and habits through an interview with the patients or care giver. Further these patients underwent a thorough clinical examination for vitals (pulse rate blood pressure and respiratory rate) and other clinical signs including Glasgow coma score (GCS) followed by systemic examination. These findings were recorded on a predesigned proforma. Patients were followed up for the outcomes such as mortality, need of ventilator support, duration of ICU stay and APACHE 2 score. The selected patients underwent the following investigations: haemoglobin, total white blood cell (WBC) count, haematocrit, platelet count, blood urea nitrogen (BUN), serum creatinine, serum sodium, serum potassium, serum calcium, serum bilirubin, serum albumin, arterial blood gases and serum magnesium. Results: 50 patients admitted in the medical intensive care unit with various critical medical conditions were enrolled for this study. Regarding clinical presentation, fever was common in both group (56% patients in >1.7 mg/dl group and 72% in 1.7 mg/dl group. In present study, 24% patients with magnesium level <1.7 mg/dl were diagnosed to have pneumonia with septicaemia, 8% acute exacerbation of COPD, 4% acute myocardial infarction, 8% have acute pulmonary oedema, 4% patient have RVF, 16% patients have CVA, meningitis and liver abscess was present in 8% patients, urinary tract infection (UTI) with septicaemia, malaria and dengue haemorrhagic fever was present in 4% patients each. Both groups were comparable to each other regarding GCS (p=0.438). Most of the patients in both groups have GCS score was in between 11 to 15 at the time of admission. In present study, 44% patients with magnesium level <1.7 mg/dl have APACHE 2 score between 21 to 25, APACHE 2 score was between 26 to 30 in 8 (32%) and above 30 in 6 (24%) patients. Similarly 68% patients with magnesium level >1.7 mg/dl have APACHE 2 score between 21 to 25, APACHE 2 score was between 26 to 30 in 28% and above 30 in 4% patients. This finding is significant statistically. Conclusion: From present observational study we can conclude that Hypomagnesemia is a frequent electrolyte deficiency in critically ill-patients. We also have observed that hypomagnesaemia is associated with high APACHE 2 score, poor outcome and more requirement of ventilatory support. Physicians should be alert to the high incidence of hypomagnesemia in critically ill elderly patients and should consider a routine monitoring program, as hypomagensemia may be associated with adverse outcomes.

44. A Hospital-Based Assessment of Various Platelet Indices in Patients of Sepsis and Correlation of Platelet Count and Indices with Severity of Sepsis
Mohd. Khizre Hussain, Vinayanand Jha
Aim: The objective of the study was to assess the various platelet indices – Mean platelet volume (MPV), Platelet distribution width (PDW), Plateletcrit (PCT) and Platelet large cell ratio (PLCR) in patients of sepsis and correlation of platelet count and indices with severity of sepsis. Methods: The present study was conducted in the department of General medicine, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India and total of 60 patients of either sex admitted to a tertiary health centre in Darbhanga Medical College and Hospital with clinical features, lab investigations and/or radiological features suggestive of sepsis were enrolled over a period of one year. Results: Mean Respiratory rate in Group I patients is 22.69±1.61 and among Group II patients is 29.92±3.407. On statistical analysis it was found to be significant (p <0.01). Mean values of diastolic B.P in groups I & II (80.66±10.5 & 62.42±4.97 respectively) were also statistically significant. Similarly, mean values of systolic B.P. among the two groups were also found to be statistically significant. Mean hemoglobin in the Survivors group and Non-survivors’ group was 12.62±2.21 and 9.51±1.16 respectively. The values on statistical analysis were found to be significant (p <0.01). Mean Total Leucocyte count value among the two groups was 13.22±1.31 and 17.78±2.601 respectively. It also came out to be statistically significant. Conclusion: Our study reported statistically significant decreased levels of mean platelet counts among the patients who expired (Non-survivors) due to sepsis as compared to the patients who Survived sepsis (Survivors). The study also reported statistically significant increased levels of Mean platelet volume and Mean platelet distribution width among the Non survivors’ group as compared to the Survivors group.

45. Prospective Observational Study to Evaluate the Clinical and Laboratory Profile of Anaemia Patients at a Tertiary Care Hospital
Rajeev Ranjan, Md Naushad Alam
Aim: Aim of this study is to determine the clinical and laboratory profile of anaemia among patients admitted to our hospital. Background: Anaemia is a major public health problem worldwide especially in developing countries like India. Nutritional cause of anaemia continues to predominate as the most common cause of anaemia. Methods: Our study was a prospective study in which thirty-nine patients of anemia admitted to Medicine ward in NMCH hospital, Patna were studied for their clinical and laboratory characteristics. Duration of the study was 8 months. Results: Anaemia was more common among females (70% of total patients). Patients aged 20-30 years contributed to 85% of patients. Pallor was the universal finding present in 100% of patients. On examination generalized weakness was the commonest (46.5%) presenting complaint followed by per vaginal bleeding (13.2%). Microcytic (48%) and dimorphic (28%) anaemia constitute the bulk of anaemia. Conclusions: Nutritional anaemia particularly iron deficiency anaemia is the most common cause of anaemia. It tends to affect the working age group and females predominantly. Patients continue to present with severe anaemia to the hospital.

46. Ocular Complications of Severe VKC in Gaya District
Ashutosh Kumar Anand, Arjun Choudhary
Objective: The objective of this study was to assess the ocular complications and visual loss among patients with severe VKC. Method: Four hundred patients with VKC seen at ANMMCH, Gaya. This was a retrospective non-comparative observational study conducted between 1st January2021 to 31st December 2021. Results: Out of 400 patients, 300 were male and 100 were females. The majority of the patients were in 5-9 age group (167) followed by 135 in 10-14 age groups. Conclusion: Severe VKC in developing countries including Yemen is a potentially blinding disease. Visual loss may be due to keratoconus and corneal scars, as well as complications of the unsupervised use of topically administered corticosteroids.

47. Anemia Study in Elderly Population
Aruna Dubey, Mini Bhatnagar, Krishan Kumar
Anemia is very common in elderly people. Anemia is a sign and not a diagnosis and evaluation is always warranted to identify the etiology in this age group. The purpose of the study was to find the clinical profile of the elderly patients with anemia and to study the characteristics of the hematological type of anemia and the closest possible etiological profile. Total of 110 patients above the age of 60 attending OPD/IPD/emergency were included in the study. Detailed clinical history taken and physical examination done followed by relevant laboratory investigations were conducted on all the patients. Most of the patients had normocytic type of anemia on peripheral smear examination, renal failure was the most common underlying chronic disease. A significant proportion of the patients was on long term use of NSAIDs which could contribute to gastrointestinal blood loss and microcytic anemia in the elderly. 73.3% of the patients in microcytic group had an underlying GI legion on endoscopy. 14% of the patients had an underlying malignancy. So, it is clear anemia in the elderly should not be considered an ageing process and its detection should prompt the physician to plan the relevant investigation to detect the etiology and treatment plan. Early detection and management of anemia in elderly people would improve the quality of life as well as decrease morbidity and mortality.

48. A Study to Assess the Atopic Status on Autonomic Function among the Bronchial Asthma Individuals
Raghavendra Sherikar, Vydadi Seetharamaraju, Shivakumar. J, T Jaya Chandra
Introduction: Increased parasympathetic activity reported to be an important factor in pathogenesis of bronchospasm, oedema in airways and excessive mucous secretion among the bronchial asthma (BA) individuals. With this, a study was taken to assess the atopic status on autonomic function among the BA individuals and its comparison with the non-atopic BA individuals. Methods: It was a prospective case control research. The study protocol was approved by the Institutional ethical Committee. Individuals with BA for >2years as per the American Thoracic Society guidelines, both gender, aged 18 to 50 years, at least 2 acute episodes in any given year were included. Those with history that can bring autonomic dysfunction were not considered.  The detailed procedure and the purpose of the study was explained in their own language. Participants were made to relax and comfortable prior to the tests. Atopic status was determined by history provided by the patients. Heart rate (HR) response to valsalva ratio, heart rate variation during deep breathing and immediate HR response to standing were used to assess autonomic function. Sympathetic function were analysed using blood pressure (BP) response to standing and BP response to sustained hand grip. Simultaneously these tests were carried on the normal individuals with similar age, gender. The ratios and differences were calculated, and the results were interpreted. Unpaired test was used for statistical analysis; P< 0.05 was considered to be statistically significant. Results: In this research, 24 members were included in each group. Statistically there was no significant difference between atopic asthmatics (AA) and non-atopic asthma asthmatics (NAA) in all the 5 parameters, respectively.  Conclusion: Atopic and NAA did not differ in the autonomic status; this suggest that the pathophsiology is same. However small sample size and short duration of the study are the limitations of the research.

49. A Observational Study on the Effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) for Stone Disintegration in Children at a Tertiary Care Hospital
Sharanabasappa Rudrawadi, Gaurav Kochhar, Keshavamurthy R
Background: Urolithiasis affects 1-5% of children. Renal stone therapy using extracorporeal shock wave lithotripsy (ESWL) is non-invasive. In this study, we assessed the effectiveness and variables that predicted the success of ESWL for stone disintegration in paediatric patients. Material and Methods: In this retrospective analysis, 58 paediatric patients under the age of 18 who were receiving ESWL were included. The stone size, stone location, density were assessed by appropriate investigations. The disintegration of stones was performed by ESWL. Stone-free status or the presence of clinically insignificant residual fragments (CIRF) at the end of three months (5mm) were used to define ESWL success. Results: the mean age was13.26±3.82, and mean size of the stones was 10.33±0.364mm (9.6-11.06). Post ESWL, the success rate i.e stone free rate was 54 (93.1%) patients with no residual stones. There is significant strength of association of size of stone, density of stone administration of anaesthesia and complications with number of session/sittings, number of ESWL shocks received and stone free rate (SFR) in patients. Conclusion: ESWL has a good stone-free rate when used as the first line of treatment for paediatric urolithiasis stones that are smaller than 10mm in diameter, have less than 1000HU and are located in the upper ureter (SFR). The location of the stone and the SAV are independent indicators of ESWL success, and anaesthesia is useful when doing ESWL on children younger than 12 years old.

50. An analytical Study about the Streptococcus Mutans Load in the Pre School-Children of Local Schools
S.K. Gautam, Abhishek Agrawal, A. R. Tyagi, Neha Baid, Vivek Kumar, Mohammad Arif
Introduction: More than one third of children in the lower socio-economic group belonging to 2-9 years have untreated decayed primary teeth. Several studies have shown a direct relationship between dental caries and Streptococcus mutans. In this study, we report the comparative load / magnitude of Streptococcus mutans between preschool children attending local public and private schools. Methods: Samples of 200 subjects were taken. Children suffering from any previous Oral Pathology were excluded. Saliva sample was collected from the children with verbal consent from the school authorities on clarifying the sampling process being non-invasive and the data not used for commercial purposes nor any personal identifier collected except the age of the subject. Result: Among all the school children screened in this study, 39.5% were found to carry S. mutans in their oral cavity based on the bacterial recovery from saliva Children attending the private school had relatively low incidence of S.mutans in their saliva compared to those attending the Govt /public school . 51% of children had saliva with low pH, 35% at normal pH range and 14% of the children had saliva with basic pH. The children with low pH saliva had caries in their tooth. All S. mutans saliva isolates were found to be sensitive to the antibiotics tested viz. penicillin, amoxicillin, erythromycin and vancomycin. Conclusion: The oral health is crucial for pre-school children at the age of 2-7. Instituting suitable preventive measures such as awareness campaign on oral hygiene, dietary regulation and periodic medical screening can control the level of cariogenic ability of microorganisms and in turn ensure their dental wellbeing.

51. Identification of Malassezia Species from Clinical Cases of Pityriasis Versicolor in a Tertiary Care Hospital, Ahmedabad
Shrivastava Juhi, Padaria Nishita, Parul Shah
Introduction: Opportunistic yeast of the genus Malassezia have been recognized as members of the microbiological flora of human skin and many other warm-blooded vertebrates. These lipophilic fungi are associated with different types of diseases especially Pityriasis versicolor, a chronic, benign and recurrent superficial infection which is generally occur in tropical and temperate regions This disease occurs worldwide with prevalence as high as 30–40% in populations in tropical area. Warm and humid environment is considered to be among the important precipitating factors. Present study was undertaken to determine the incidence of Malassezia in patients, clinically suspected of having Pityriasis versicolor and speciate the identified isolates. Material and Methods: This study was conducted during June 2012 to October 2013 on 55 patients from the OPD and IPD of the hospital, with clinically suspected Pityriasis versicolor, either hypopigmented or hyperpigmented type. Direct KOH examination and culture was done on Modified Dixon’s Agar and Sabourauds dextrose agar and colony was identified by morphology, direct microscopy after Gram stain and other biochemical tests like esculin hydrolysis, urease, tween assimilation and catalase. Results: Total 55 cases of Pityriasis versicolor, of 1-65 years of age group and both sexes attending outpatient and inpatient department of dermatology were taken Out of 55 patients, 37 (67.3%) were males and 18(32.8%) were females, M: F ratio being 2.05:1. The highest prevalence of Malassezia was seen in young adults ie, patients with 21 -30 years of age. Lowest was seen in the age group 61-70 years. Majority of patients presented with hypopigmented lesion ie, 51 (92.7%) in which the maximum isolated specie was of M. furfur 27(52.9%). Hyperpigmented lesion was seen in 4 patients i.e., (7.3%) and M. globosa was isolated i.e., 1(25%). Malassezia species isolated were as follows: M. furfur, M. globosa, M. obtusa, M. pachydermatis, M. sympodialis. The predominant isolate was M. furfur, 27(67.5%) followed by M. globosa 7(17.5%). Conclusion: The procedure of culture and antifungal testing required to be performed as different species of Malassezia are involved in Pityriasis versicolor and susceptibility is different among different species. It would help in preventing recurrences, systemic complications and any cosmetological problems especially in younger age group.

52. Efficacy of Isobaric Levobupivacaine and Hyperbaric Bupivacaine under Spinal Anaesthesia in the Lower Limb Surgeries
Uday Kumar, Koti Sreenivasa Rao
Introduction: Spinal anaesthesia is more desirable choice for lower limb orthopedic procedures. Bupivacaine is a drug of choice for spinal anaesthesia and isobaric levobupivacaine is an enantiomer of bupivacaine has low central nervous system and cardiotoxic effect. The present was designed to assess the efficacy of isobaric levobupivacaine and hyperbaric bupivacaine in the elective lower limb surgeries under spinal anaesthesia. Materials and methods: Forty-eight cases between 21 to 50 years of age undergoing elective lower limb surgery belong to ASA grade I and II were considered. Participants were randomly divided in to group A (3 ml 0.5% intrathecal isobaric levobupivacaine) and group B (3 ml 0.5% intrathecal hyperbaric bupivacaine). Details of sensory and motor blockade, hemodynamic parameters and details of postoperative adverse events were recorded. Results: The total duration of sensory block was 181.95±2.89 and 209.36±4.58 and the total duration of motor block was 205.34±5.56 and 213.98±6.34 in groups A & B respectively. Hypotension was seen in 29.16% and 8.33%, bradycardia in 16.66% and 4.16% and nausea/vomiting in 20.83% and 8.33% of cases in hyperbaric bupivacaine and isobaric levobupivacaine groups respectively. Conclusion: The intrathecal isobaric levobupivacaine have shown less duration, slow onset of sensory & motor blockade, stable hemodynamic parameters and incidence of hypotension, bradycardia and nausea/vomiting was less than intrathecal hyperbaric bupivacaine.

53. A Cross Sectional Study on Correlation of Serum C-Reactive Protein Level with Cognitive Deficits in Patients with Schizophrenia
Ramesh Babu, H. Ahamadu Nisha, M. Mangayarkarasi, S. Renganathan
Background: Serum levels of C-reactive protein (CRP) were thought to be altered in schizophrenia, the association between autoimmunity, chronic inflammation, and psychosis is not new. Hence this study was planned to confirm the association between CRP level and cognitive performance and to determine whether CRP was a new biological indicator with the potential clinical applications in Schizoprenia patients. Methods: This study was done as a Cross sectional study, in 60 cases of schizophrenia for period of one year done after obtaining ethical clearance, from the Institutional Ethics Committee, Government Mohan Kumaramangalam Medical College, Salem. The neurocognitive assessment tools used in this study are: a). Attention – digit span. b) Verbal memory – Rey auditory verbal learning test. C) Visual memory – Rey Osterrieth complex figure test d) Verbal fluency – COWAT – controlled oral word association test. For executive functions – Stroop colour test, Trail Making Test, were used. Assesment of CRP done by Nephelometry. Results: There were significant differences in the cognitive subdomain analyses among the two groups based on CRP level. Serum CRP levels were found positively correlated with neurocognitive assessment tools. Conclusion: This study supports the Neuroinflammatory theory of schizophrenia as evidenced by the rise in serum C – reactive protein values in the course of illness and there exists a positive correlation between serum C – reactive protein level and Cognitive deficits. Serial measurements of serum C – reactive protein and cognitive deficits are to be assessed, to know their fate longitudinally, over the period of time.

54. Study of Peripheral Nerve Dysfunction in Chronic Kidney Disease at DMCH, Laheriasarai, Bihar
Pankaj Mohan Shrivastava, U. C. Jha
Background: Chronic renal disease is known to have a consequence called peripheral nerve dysfunction (CKD). The primary aim of the study is the prevalence, clinical manifestation, and severity of peripheral nerve dysfunction in CKD patients admitted to our hospital. Our study’s objectives are to assess the prevalence of overt and subclinical neuropathy in CKD patients, as well as the clinical signs and symptoms of peripheral nerve damage. Methods: The research was carried out at the DMCH’s Department of Medicine in Laheriasarai, Bihar. Those with established clinical and biochemical indicators of CKD were included in this study, along with patients who were not receiving dialysis. Results: 48 of the 74 patients evaluated by the team were found to have peripheral nerve dysfunction by electrodiagnostic testing, and as the length of the condition increases, so does the number of individuals affected (more than 5 years). Conclusion: Peripheral neuropathy of the distal symmetrical mainly sensory motor variety is most frequently seen in CKD patients. The most prevalent clinical symptoms of peripheral neuropathy in CKD patients are loss of ankle reflex and loss of vibratory sensory function. When the creatinine clearance was under 15 ml/mt, there was a tendency for males to get peripheral neuropathy.

55. To Study the Association of Serum Uric Acid an Independent Risk Factor in Acute Ischemic Stroke at DMCH, Laheriasarai, Bihar
Pankaj Mohan Shrivastava, U. C. Jha
The aim was to investigate the relationship between acute ischemic non-embolic stroke and serum uric acid. 100 patients with the first acute ischemic stroke in their lifetime who were treated at DMCH, Laheriasarai, Bihar, were included. Within 24 hours of the stroke’s beginning, blood samples were collected, and CT scans were performed. Blood samples were provided for 2D ECHO and biochemical analysis. The presence of additional risk factors such hypertension, diabetes, a poor lipid profile, smoking, and drunkenness was also assessed in the individuals. 68 of the 100 patients were men, and 32 were women. 49% of people had uric acid levels more than 8 mg/dl. 35% of them had diabetes, and 53% had hypertension. 24% of people smoked, and 21% drank alcohol. This study demonstrates a substantial correlation between elevated uric acid levels and a higher risk of developing an acute ischemic stroke. While treating high risk populations, lowering blood uric acid levels can be regarded one of the stroke prevention strategies.

56. To Study the Aerobic Bacteria Found in Ear Discharges of Chronic Suppurative Otitis Media Cases, to Assess Antibiotic Susceptibility of Isolated Organism
Hena Shadiyah, Mukul Kumar Sinha
Background: In ENT practise, chronic suppurative otitis media (CSOM) is the most typical disease. It affects people of all ages and most frequently manifests as persistent ear drainage and ear pain. It should be handled carefully because it could even result in hearing loss and difficulties. In order to determine an isolated organism’s susceptibility to antibiotics, the study was conducted to determine the aerobic microbiological/bacteriological profile of ear discharge and chronic suppurative otitis media cases. Methods: The current study was conducted from August 2021 to October 2022 at the ENT-HNS Department of Madhubani Medical College and Hospital, Madhubani, Bihar. This study comprised 86 patients with discharge-producing ear infections. Results: Pseudomonas aeruginosa, Staphylococcus aureus, Coagulase-Negative Staphylococci (CONS), Klebsiella species, Proteus species, and Escherichia coli were the most frequently isolated microbes. Ciprofloxacin seems to be the first-line antibiotic for treating CSOM among the often prescribed topical antibiotics. Conclusion: Every age group experience ear infections. Among the several ear infections, CSOM is one that occurs frequently. Chronic suppurative otitis media, which manifests as recurrent ear discharges through a tympanic perforation, is an ongoing inflammation of the middle ear and mastoid cavity.

57. Audiological Evaluation of Various Factors Influencing Type 1 Tympanoplasty: A Preoperative and Postoperative Study
Hena Shadiyah, Mukul Kumar Sinha
Background: Studying several aspects of type 1 tympanoplasty that may affect the procedure’s outcome, such as the size of the perforation, the existence of active ear discharge, and the presence of a tympanosclerotic patch, and comparing the audiological outcomes of the two periods. Material and Methods: Between August 2021 and November 2022, a total of 106 patients with CSOM tubotympanic illness who underwent type 1 tympanoplasty at the Department of ENT & HNS, Madhubani Medical College and Hospital, Madhubani, Bihar, were examined. Each patient’s history, clinical examination, investigations, surgical procedures, postoperative period, and follow-up appointments were all recorded in a thorough proforma. Pure tone audiometry was used to evaluate the patient’s hearing before, during, and after operation. The results were collated. Results: The size of the perforation was found to correlate with the audiological benefit. Hearing gain was reported to increase surgically as perforation size increased. In our 106 case research, 101 (95.2%) cases showed improvement in speech frequency, and 83 instances (78.3%) showed improvement in high frequency; in 3 cases (2.83%), speech frequency and 19 cases (17.9%), high frequency, hearing deteriorated. The audiology of the rest didn’t alter. Active discharge from type 1 tympanoplasty does not statistically significantly alter the audiological outcome as long as it is mucoid, sparse, and culturally unfavourable. The postoperative speech frequency benefit is less (8.393 dB) in 27 of the 106 instances with tympanosclerosis than in the 106 cases without tympanosclerosis (13.949 dB), which is statistically significant. There is a statistically negligible difference in the audiological benefit at high frequency between cases with and without tympanosclerosis (7.872 dB vs. 7.143 dB). Conclusion: The size of the perforation, the existence of tympanosclerosis, and the condition of the middle ear at the time of surgery were discovered to have a significant impact on the surgical outcome.

58. Study on Surgery of the Tumors in the Ventricular System
Himanshu Kumar, Deepak Bandlish, A. K. Chaudhuri
Background: This area may be affected by various tumours. The clinical aspects include mental and visual problems, as well as signs of gradually increasing or intermittently elevated intracranial pressure. Due to their placement in relation to the crucial tissues surrounding the tumour, surgical treatment of ventricular tumours is frequently difficult to have a successful surgical outcome. study of the surgical results and clinical manifestations of ventricular system malignancies. Methods: The research involved 15 patients with ventricular tumours. Analysis was done on the clinical presentation, radiological findings, several surgical techniques, and outcome. Based on where they were found during an MRI, tumours were divided into three groups: lateral, third, and fourth ventricles. Transcortical approach, transcallosal approach, median suboccipital approach, and subfrontal approach were used during surgery on eight patients each. In 10 individuals, the gross complete removal was accomplished. The rest underwent partial resections. The surgical outcome was assessed using the Glasgow outcome scale. Results: The most common clinical manifestations included sudden onset of headache and altered level of consciousness in patients with tumours in the third and fourth ventricles, as well as chronic headache in individuals with tumours in the lateral ventricle. Patients with malignancies in the third ventricle were more likely to develop hydrocephalus. Postoperatively, 73% of patients had positive results (Glasgow outcome scale IV, V), while patients with tumours in the lateral ventricular tumour had better outcomes. Despite the lack of statistical validity, the differences in result according to surgical method were not detected. Conclusion: Postoperative results for ventricular tumour patients who experience abrupt headache onset, hydrocephalus, or high grade tumour are not favourable. Patients who have tumours in the lateral ventricle generally have positive outcomes. Depending on how the tumours are approached, the results are the same. In order to prevent neurological problems, it is also important to be informed of the various approach techniques to the tumours and the architecture surrounding the ventricle.

59. Study of Presentation, Management and Outcome of Patients undergoing Surgery of Spinal Dysraphism
Himanshu Kumar, Brajesh Kumar, A. K. Chaudhuri
Background: Three developmental stages gastrulation (two to three weeks), primary neurulation (four to six weeks), and secondary neurulation—can be used to summarise the development of the spinal cord (5–6 weeks). Spinal dysraphism is the term used to describe any deviation in any of these stages that results in abnormalities in the spine and spinal cord. Spinal dysraphism is estimated to affect 1 in 1000 live births. The current study focuses on the surgical outcomes, treatment, and various manifestations of spinal dysraphism. Methods: A 12-month study on the surgical management of spinal dysraphism was conducted at the Department of Neurosurgery, Bangur Institute of Neurosciences, IPGMER, Kolkata, West Bengal. The clinical features, treatment, and surgical results in cases with spinal dysraphism were described in the current study. Results: 54 patients in total were involved in the trial. Ages ranged from one day to seventeen. Incidence is higher in females (n=31; 57.40%) than in men (n=23; 42.60%). Out of a total of 54 instances, the most prevalent manifestation was a swelling across the middle of the back in 32 cases (59.2%). A ruptured myelomenigocele or myelocele sac affected 8 patients (14.81%). Dermal sinus, Hypertrichosis, and skin dimples—markers of spina bifida of the occult type—are found in 3 (5.55%), 2 (3.70%), and 1 (1.85%) of patients, respectively. All patients underwent a cranial-spinal MRI to assess any congenital defects connected to spinal dysraphism. All of them had one or more abnormalities. More individuals had spina bifida aperta (37), compared to 17 who had bifida occulta. 33 (61.11%) of the cases had myelomeningocele, while 4 (7.47%) had myelocele. Lipomyelomeningocele 7 (12.96%), meningocele 3 (5.55%), lipomyelocele 2 (3.70%), diastematomyelia in 2 ((3.70%), dermal sinus in 2 ((3.70%), and spinal lipoma in 1 (1.85%) instance were the most frequent findings in closed type. Prior to the ultimate operation, the majority of individuals with hydrocephalus need shunt surgery. The post-operative care is equally crucial for a successful recovery and to prevent problems. The sphincteric result of surgery must be evaluated using electro myographic and urodynamic investigations. The most common symptom to reduce is pain. Following surgery, motor deficits recover more quickly than sensory deficits and bladder dysfunctions. These patients’ outcomes are constantly susceptible to retething and delayed neurological decline. Conclusion:Spinal dysraphism is a complex illness that must be managed using a multidisciplinary strategy. According to the current study, surgery is the main treatment together with adequate post-operative care for the patient’s higher quality of life.

60. A Comparative Study was done on Oxytocin and Carbetocin in Order to Prevent Atonic Postpartum Hemorrhages after Repeated Elective Cesarean Sections
Aabha, Priya Verma, Jyoti Hosamani
Background: Postpartum hemorrhage, often known as PPH, is a very dangerous illness that continues to be the primary reason for mother morbidity and death. The purpose of this study was to evaluate the efficacy of carbetocin and oxytocin as preventative agents against atonic pulmonary hypertension (PPH) in patients who were having recurrent elective cesarean sections (CS) while under the influence of spinal anesthesia. Participants and Procedures: This comparative study was performed on 100 pregnant women after 38 weeks who underwent elective cesarean section under spinal anesthesia at Delhi between March 2020 and September 2021. Fifty patients received a single dose of 100 microgram intravenous carbetocin, and the other fifty patients received 5 IU of oxytocin IV followed by 20-40 IU of oxytocin infusion on 1000 ml saline with a rate of 150 ml per hour. Results: The findings showed that patients who were given carbetocin had a lower incidence of significant obstetric hemorrhage, needed less intervention in the form of uterine massage, and required fewer extra uterotonic medicines than patients who were given oxytocin. When compared to the oxytocin group, the carbetocin group had a considerable decrease in the amount of predicted blood loss. In addition, the carbetocin group demonstrated a lower frequency of severe anemia and the need for blood transfusions as compared to the oxytocin group; however, this difference did not reach statistical significance. Conclusion: It indicated that carbetocin was as effective as, if not more effective than, oxytocin for the prevention of atonic postpartum hemorrhage in individuals who were having elective cesarean section. When compared to the maximum permitted dosage of oxytocin, the administration of carbetocin after a cesarean section resulted in a decreased need for further oxytocics (5 IU). In addition to these benefits, carbetocin improved the patients’ hemodynamic conditions, reduced the frequency of severe anemia, and reduced the requirement for blood transfusions.

61. A Study on Prognostic Outcome of Tocilizumab in Patients with COVID-19
Manoranjan Dash, Debashish Swain, Biswal Pradipta Trilochan, Nrusingha Charan Dash, Soumya Suvashish Sen, Jyoti Patnaik
Introduction: World Health Organization (WHO) received reports of above 149 million occurrences reported of COVID-19 as of April 29, 2022, including more than 3.1 million fatalities. Patients who have severe COVID-19 have significantly higher levels of interleukin (IL-6) and other proinflammatory cytokines. In COVID-19 individuals, elevated serum levels of cytokines such as interleukin-6 (IL-6), IL-10, tumor necrosis factor (TNF), and interferon may result in deadly ARDS and coagulation issues. Tocilizumab is a humanized recombinant monoclonal antibody being used in treating autoimmune and inflammation-related conditions. It was given FDA approval on January 8, 2010, primarily to treat several immune and inflammatory responses, including multiple types of arthritis, particularly cytokine release disorder. Aims and Objectives: To evaluate the maximal benefit of tocilizumab over the standard treatment in COVID-19 and to determine the effect of tocilizumab on the outcome predictors. Methods: This is a Retrospective and Observational Study which was conducted on 52 COVID-19 patients who were admitted to DCH of SCBMCH, Cuttack from June 2021 to November 2021. The patients were grouped into two, namely, the tocilizumab group and the control group. All the patients received standard treatment consisting of antibiotics and while, the tocilizumab group received a single intravenous dose of 400mg of tocilizumab. After the tocilizumab therapy, several outcome factors were determined for effective statistical analysis. Results: The study showed that 38.46% of the Tocilizumab group died while 53.85% of the control group had died (p<0.05). It also showed that 46.15% % of the patients in the control group had died and their SpO2 was less than 90% and CRP>200 mg/L. Most of the outcome predictors were significantly different (p<0.05) in the Tocilizumab group as compared to the control group, except clinical status after 1 week and IL-6>100 pg/ml. Conclusion: The study concluded that tocilizumab can be beneficial in symptomatic improvement in outcome predictors and decrease death rates among patients with COVID-19.

62. A Morphometric Assessment of the Position of Mental Foramen in Dried Edentulous Human Mandible and its Clinical Significance
Virwar Kumar Jha, Saif Omar, Prajna Jha
Aim: The present study had been undertaken to determine the morphological features and morphometrics of mental foramen with reference to surrounding anatomical landmarks in both dentate and edentulous mandibles. Methods: The present study was conducted in the Department of Anatomy, ESIC Medical College and Hospital, Bihta, Patna, Bihar, India for six months and 50 dried edentulous mandibles of unknown sex were selected for the study. Damaged and broken and congenitally malformed mandible was excluded. Shape of mental foramina were macroscopically observed and noted. Results: Out of 50 mandible 20 mental foramina on right and 20 on left side were oval in shape rest were round. Most common shape of mental foramen was round (70%). The result shows no significant difference in various measurements on right and left side. Correlation between distance of MF from symphysis menti and length of mandible and its analysis shows significant positive correlation. Conclusion: The MF plays a very important role in treatment planning and its location needs to be considered prior to placement of dental-implants, regional anesthesia, osteotomy-surgeries and during complete denture-fabrication in order to avoid MN injury and related complications.

63. A Hospital Based Prospective Assessment of Correct Axis and Good Depth in Gender Affirming Vaginoplasties by Penile-Perineoscrotal Flap Vaginoplasty
Pranav Kumar
Aim: The aim of the present study was to evaluate correct Axis and good Depth in Gender Affirming Vaginoplasties by Penile-Perineoscrotal Flap Vaginoplasty. Methods: The present study was conducted at Department of Burn & Plastic Surgery, ESIC Medical college, Bihta, Patna, Bihar, India for one year and 100 patients were included in the present study. Mean follow-up was 11 months and maximum follow-up 2 years. The case records of these patients were analyzed for intra and postoperative complications. The study was approved by Institutional Review Board. Results: There was one case of vaginal depth ranging from 7.5 to 9cm. Six (12%) patients had vaginal depth of 10 to 12 cm and remaining 43 (86%) being in the range of 13 to 14 cm (our largest dilator) or more at last follow-up. 38 (76%) patients had satisfactory penetrative sexual intercourse, 10 (20%) had not attempted intercourse, due to lack of a partner or being uninclined for various reasons. Two patients (4%) complained of poor sexual experience on account of inadequate vaginal depth. Conclusion: PPSFV addresses the limitations in PSFV and results in good vaginal depth and posterosuperior axis, which facilitates penetrative sexual intercourse, at the same time, avoiding potential complications of procedures such as intestinal vaginoplasties.

64. A Hospital Based Prospective Assessment of the Ocular Surface Disease in Glaucoma Patients on Topical Medications and its Relation to Duration of Treatment and Number of Medications
Abhilasha, Rajeev Kumar, Jawed Iqba
Aim: This study was done to check for the presence of OSD in patients of glaucoma on topical antiglaucoma medications and to analyze the severity of OSD with duration of treatment and number of topical antiglaucoma medications. Methods: The present study was conducted at department of ophthalmology, ANMMCH, Gaya, Bihar with 8 months of duration. In this study, a total of 50 glaucoma patients on antiglaucoma medications and 50 normal controls were included. Results: Among glaucoma patients, there were 60% (30) males and 40% (20) female patients. Among normal controls, 64% (32) were males and 36% (18) were females. Among glaucoma patients, 72% (36) showed the presence of OSD on OSDI questionnaire. Out of these, 58% (29) of patients had mild to moderate OSD and 16% (8) of patients had severe OSD. Based on Schirmer’s 1 test, 70% (35) of patients showed decrease in quantity of tears with 64% (32) and 6% (3) of patients showing mild‑moderate and severe decrease in quantity of tears, respectively. Tear film break up time (TBUT) was abnormal in 84% (42) of patients. On comparing increased number of medications from one or two and three or four drugs for OSDI score, it was found that mean OSDI score increased from mild (16.88) to moderate (24.00), respectively, which was statistically significant (P value 0.03). The mean OSDI score in patients using medications for <1 year and for 2 to 5 years was 15.69 and 18.59, respectively, which indicates mild OSD. It was 32.33 for patients taking medications for 6 years or more, indicating moderate OSD. The result was statistically significant (P value 0.0017). Conclusion: Our study shows that antiglaucoma medications contribute to the occurrence of dry eye symptoms. There is increase in OSD severity with increase in duration of treatment and increased number of topical medications.

65. An Analytical Observational Study to Assess the Role of Serum CA125 Levels in Predicting the Outcome of Threatened Abortion
Rubaiya Ahmad, Mahesh Prasad, Manoj Kumar
Aim: The aim of the present study was to evaluate the role of serum CA-125 in predicting potential pregnancy outcome of bleeding in early pregnancy (threatened abortion). Methods: This analytical observational study was conducted after clearance from the Institutional Ethical committee, in the Department of Pathology, SKMCH, Muzaffarpur Bihar, India during the period of one year. 100 patients met inclusion criteria and included in the study. Results: We found statistically significant increase of CA125 in aborted patients when compared to patients that continued their pregnancy after 20 weeks (48.36±36.94 and 116.28±81.04 respectively). Maximum number of patients was in primigravida. Out of the 50 patients in case, 45 (90%) were primigravida and 5 (10%) were multigravida. There was no statistical difference in distribution of patients based on parity and gestational weeks. 70% of patients of threatened abortion with maternal serum CA 125 level of more than 60 IU/ml in case while 28% of patients of threatened abortion with maternal serum CA125 level in control of more than 60 IU/ml continued to the period of viability. Statistically the difference was significant with p value of <0.001. Conclusion: Maternal serum CA-125 is concluded to be a hopeful biomarker to predict potential pregnancy outcome in threatened abortion.

66. A Hospital Based Observational Assessment of Radical Excision of HS of Bilateral Axilla and Reconstruction with Posterior Arm Flap
Radha Raman
Aim: This study presents the experience of radical excision of HS of bilateral axilla and reconstruction with posterior arm flap. Methods: The present study was conducted in the Department of Plastic Surgery, PMCH, Patna, Bihar, India for one year  and patients with HS in the axillary region who underwent reconstruction with posterior arm flap were included in the study. Results: Overall, 10 patients (7 male, 3 female) with axillary Hurley grade 3 HS were included in the study. Of these, 3 patients had left-sided, 4 patients had right-sided, and 3 patients had bilateral axillary HS. All of the defects were reconstructed, with 17 PAPF being utilised in total following wide excisions of the involved areas. The mean age of the patients was 31.1 years, with a range of 16 to 49 years. 4 of the patients had diabetes mellitus, 6 of the patients were smokers and one patient had diabetes with habit smoking. Majority of the patients underwent island flaps. The flap sizes ranged from a minimum of 20 cm2 to a maximum of 84 cm2 (mean 39.5 cm2). Follow-up of patients ranged from 12 to 42 months. Wound dehiscence was detected in one patient, and another patient developed marginal necrosis in the postoperative period; otherwise, no complications were observed. Conclusion: Radical excision of axillary hidradenitis must be considered early on presentation. After wide excision, simultaneous bilateral reconstruction with posterior arm flap is a simple and reliable technique with an excellent patient-reported outcome.

67. Efficacy of Intratympanic Injection of Methyl Prednisolone in Improving Idiopathic Subjective Tinnitus: A Major Leap in the Treatment of Idiopathic Subjective Tinnitus
Lakshmi Unnikrishnan, Siddharth Kumar
Aims: In this study, we have made an attempt to study the efficacy of intratympanic injection of methylprednisolone in the management of idiopathic subjective tinnitus. Materials and Methods: A prospective study was conducted in the ENT department, PMCH, Patna from May 2019 to March 2020. The patients irrespective of their age, gender and duration of tinnitus, were included in this study after a detailed history taking and thorough clinical examination, to exclude any cause of subjective tinnitus. The severity of tinnitus in the patients was assessed using visual analogue scale and THI scores. Results: A total of 50 individuals with age ranging from 23 years to 60 years participated in the study. Complete resolution of symptom was seen in 12 patients (24% of cases). Improvement in VAS scores seen in each age group was calculated. The average duration of tinnitus in patients, who got completely relieved from tinnitus was found to be ~2.6 months. Conclusion: From this study, we concluded that early intervention showed much better results. Maximum improvement in VAS scores seen in each age group was calculated. From this study data, we found that earlier intervention in younger patients, with intratympanic methylprednisolone injections gave better results in the treatment of patients with idiopathic subjective tinnitus.

68. Comparative Study of Efficacy and Safety of Ondansetron and Ramosetron in Patients undergoing Hysterectomy
Sachin B Patil, Sangeeta Saymote, Bhausahab B Jankar, Anjali R. Shinde
Introduction: Nausea and vomiting have been associated for many years with the use of general and spinal Anaesthesia for surgical procedures. With the change in the emphasis from an inpatient to outpatient, hospital and office-based medical/surgical enhancement, there has been increased interest in the ‘big little problem of PONV (Postoperative nausea and vomiting). The newest class of antiemetics used for prevention and treatment of PONV (Postoperative nausea and vomiting) are serotonin (5-HT3) receptor antagonists–Ondansetron, Granisetron, Tropisetron, Dolasetron and Ramosetron. In the present study, intravenous ondansetron and Ramosetron were compared in the prevention of postoperative nausea and vomiting undergoing hysterectomy. Material and Methods: This clinical study consisting of 100 adult patients slated to undergo elective surgeries was undertaken at Prakash Institute of Medical sciences and Research, Urun Islampur, and Hospital. In this randomized, single blind clinical trial, we studied 100 patients between the ages of 23- and 65-years undergoing hysterectomy under spinal anaesthesia. Approval was taken from the ethical committee and written informed consent was taken from all the patients. They were randomly divided into two groups. Group I: Patients included in this group will receive Inj. Ondansetron 4 mg just before surgery and after 12 hr. Group II: Patients included in this group will receive Inj. Ramosetron 0.3mg just before surgery only. Results: In our study, in initial 6 hours total 17 patients had nausea out of which 9 belonged to group I and 8 belonged to group II. When these groups were compared the difference was statistically non-significant (p>0.05). In next 6 to 24 hours 5 patients in group I and 4 in group II had nausea (p>0.05). However when the incidence of nausea was compared after 24 hours in group I (5 patients) and group II (1 patient) the difference was found to be statistically significant (p<0.05). Total number of patients in group I reporting nausea was 19 while it was 13 in group II, when compared it was found that group II has significantly lesser (p<0.05) occurrence of nausea. Conclusion: We have found that antiemetic therapy with Ramosetron at a dose of 0.3 mg is safer, well-tolerated, proved more effective and cheaper than Ondansetron 4 mg in the prevention of PONV.

69. A Study of Proximal Femur Locking Compression Plate in the Fixation of Extracapsular Proximal Femoral Fractures
Akhil R, K Kumaran Chettiar, Jacob Mathew
Globally, femoral fractures are of great interest. Because people are living longer, incidence has grown dramatically over the past few decades, and this trend is likely to continue in the foreseeable future. The therapy was primarily conservative before the development of adequate fixation devices. Due to the high likelihood of complications, this conservative approach has now earned a bad reputation, making operational management the preferable course of action. The goal of the current investigation is to examine the function of surgical treatment for proximal femoral fractures and evaluate its effectiveness. Between October 2019 and October 2021, the trial involved patients receiving treatment for a closed displaced proximal femoral fracture. The study comprised a total of 29 patients with proximal femoral fractures. There were 14 men and 15 women patients, ranging in age from 50 to 90. Intertrochanteric and subtrochanteric fractures were categorised in accordance with Boyd and Griffin and Seinsheimer’s, respectively. According to the Larson (IOWA) Hip Scoring System, the functional outcome was assessed. A score of 91–100 indicates an excellent result, 80–90 is good, 70–79 is reasonable, and 70 is a poor result. The aim of treatment for unstable proximal femoral fractures is stable fixation and less complicated early mobilisation. PF-LCP was used to accomplish this more successfully. Finally, in summarize PF-LCP represents a feasible alternative for unstable proximal femoral fractures.

70. Knowledge and Attitude towards Hand Hygiene and Study of Bacterial Flora on Hands of Health Care Workers at a Teaching Hospital in Silvassa, UT of Dadra and Nagar Haveli
Patel D D, Babariya M J, Kamath N, Bin Najeeb M A, Patel B C
Introduction: The hospital atmosphere can harbour a large variety of microbial flora which can potentially constitutes an risk of infection in patients, visitors and healthcare workers. Contaminated hands act as vehicle for transmission of microorganisms. Poor hand hygiene practices are a significant cause of rise in healthcare associated infections which increases morbidity, mortality, and healthcare costs among hospitalised patients worldwide. So, hand hygiene of HCWs plays a crucial role in the prevention of healthcare associated infections. Material and Methods: A questionnaire based cross-sectional study, conducted at 600 bedded teaching hospital for eight months. All the data was collected in the principal investigator’s google drive, Kruskal-Wallis non-parametric test applying on correct and not correct answers of the respondents. Result: The study showed 52.1% HCWs had Moderate knowledge, 88% had a good attitude, and 84% had good a practice. There was no significant difference (p>0.05) in the knowledge of HCWs. Hand drying practice (27%) were found poor. CONS (27.5%) were the major bacterial flora found on the hands of HCWs. Alcohol-based hand rub is effective to remove transient flora of hands. Conclusion: The findings of this study shows that most healthcare workers had moderate knowledge, displayed a positive attitude and good hand hygiene practice. Continuous education on hand hygiene and administrative orders can improve the knowledge and attitude towards the hand hygiene.

71. Risk Factors Associated with Recurrence of Febrile Seizures in Western Indian Children
Aswani Nishant, Ameta Gaurav, Gupta Piyush Kumar
Introduction: Febrile seizure is a very important cause of admission of children especially in developing countries with more commonly seen in young age group children. Risk factors for recurrence of febrile seizures and associated infectious diseases may be different in children in this region with histories of febrile seizures. Objective: Present study was aimed to evaluate demographic & clinical profile and to determine the risk factors associated with recurrence of febrile seizures in western Indian children aged 6 months to 5 years. Materials and Methods: It was a hospital based prospective observational study in which 61 children between 6 months to 60 months of age, presented with seizures accompanied by febrile illness diagnosed as febrile seizures as per American Academy of Pediatrics were included. Results: Age more than 1 year at first episode, fever duration <24 hrs and temperature at the time of seizure was <102.2°F were found to be significantly associated with recurrence of seizures. Conclusion: Age less than 1 year at first episode of febrile seizure, fever duration <24 hrs, the temperature at the time of seizure <102.2°F were found to be significantly associated with recurrence of febrile seizure.

72. Correlation of Serum Vitamin D Level with Osteoarticular Infection
Ankesh Jain, R.K. Beniwal, Karan Maggo, Deepanshu Mittal, Syed Sahil Ali
Introduction: Vitamin D regulates innate and adaptive immune function, including activation and differentiation of macrophages, dendritic cells and lymphocytes. The non-skeletal actions of vitamin D are mediated by the gene expression in a number of organs. Aims and Objectives: To study correlation of serum vitamin D level with osteoarticular infection. Materials and Methods: The study included 50 patients presented with osteoarticular infection, aseptic loosening and other bony pathology. Serum 25OHD level and other parameters were measured as per standard protocol. Results: The mean age of participants was 37.94 ± 12.71. The mean S. Vitamin D (ng/mL) was 19.01 ± 8.04. There was no significant difference between the groups in terms of S. Vitamin D (ng/mL) (F = 1.620, p = 0.198). Conclusion: Patients with osteoarticular infection had vitamin D deficiency. However, statistically significant correlation between lower level of serum vitamin D level in comparison to non-infectious disease was not found.

73. Assessment of Nutritional Risk Index and Prevalence of Malnutrition in Elderly Hospitalized Patients at a Tertiary Care Center: A Prospective Study
Divya Malar Krishnasamy, Balaji Karunakaran, Velayutharaj Alwar, Thamarai Rajappa, Nivedha Pandiyan
With the increasing number of elderly populations, majorly in those living in low-income and middle-income countries, the health and quality of life of these people basically depends on the nutritional status. With progression in age, the focus shifts over to safety and security along with social and financial issues, while nutritional needs of them goes unnoticed, which in turn contributes to various problems and accelerates the age-related changes. A cross sectional study was conducted among the elderly patients admitted in a tertiary care hospital, excluding those under intensive, palliative care and nutritional support. Demographic profile, anthropometric indices along with signs and symptoms, lab parameter and diagnosis were documented. GNRI scores were calculated for all the patients and the nutritional risk was evaluated resulting evidence of 93% of the elderly patients admitted being either malnourished or at the risk of malnutrition. The risk of malnutrition was found to be higher in those being financially dependent on other compared to those being independent, and the prevalence was also higher in female patients compared to male. The length of hospital stay was found to be higher in those having low scores of GNRI compared to those having low risk of malnutrition and was found to be statistically significant. The BMI progressively increases with increase in GNRI scores. Thus, adequate knowledge and awareness regarding the prevention and management of the diseases along with ample nutrition, balanced diet and physical activity is required for proper effective functioning of the elderly. These intervention at the early stages helps in better quality of life among elderly patients.

74. Prevalence of HIV Infection among Blood Donors at Blood Centre in Western Rajasthan
Gautam Harsh, N.L. Mahawar, Arun Bharti, Rishi Mathur, Sonam
Background: The HIV/AIDS epidemic is one of the largest public health crises of the 21st century, which has evolved from a mysterious illness to a global pandemic in less than 20 years. The purpose of this study is to estimate the prevalence of HIV infection among voluntary blood donors at the blood Centre. Methods: A Retrospective study was carried out at Blood Centre, Department of Immuno-Haematology and Transfusion Medicine, S.P Medical College, Bikaner, Rajasthan. All Donors were screened from January 2022 to November 2022 and a total of 41167 donations were screened by trained personnel after satisfactory completion of the donor’s questionnaire, their physical examination, and hemoglobin (Hb %) estimation. These donors were Voluntary Donors (VD) and Replacement Donors (RD). All data were collected in an excel data sheet and analyzed using statistical calculations by IBM SPPS statistical software platform 26. The Chi-square test was applied to test the significance. A p-value of <0.05 was considered significant.  Results: Out of the total 41167 donors tested for HIV infection, 21 (0.051%) were found to be HIV seropositive. Conclusion: The prevalence of HIV was 0.051% among blood donors in Rajasthan.  We concluded that increasing trend of voluntary donation with a male predominance. It can also be seen from the above data that there’s a marked fall in the prevalence of HIV infection in the past decade which could be due to the various awareness, educational programs, and campaigns run by The Government of India.

75. Detection of Genetic Mutations in Lung Cancer Patients with the Help of Liquid Biopsy in Madurai, India: A Cross Sectional Study
R. Shivani, K. Rekha, M. Saravanan, R. Rajkumar, S. Anu
Background and Objectives: Current biopsy procedures are invasive and especially in NSCLC, often produce too few cells or tissue sections for extensive analysis, multiple biopsies are not feasible for many patients, such as the elderly and those with comorbidities. Based on the detection of circulating free DNA, liquid biopsy is a minimally invasive procedure for determining the genetic status of cancer. Because blood samples can be easily obtained, the concept of a blood- based biopsy has long held promise as a less invasive complement to traditional biopsy techniques. The present study aimed to detect the incidence of Epidermal growth factor receptor (EGFR), Kirsten rat sarcoma viral oncogene (KRAS) in the newly detected lung cancer patients with the help of Liquid Biopsy. Methods: 20 Patients with Non-Squamous Non-Small Cell Lung Cancer (NSCLC) who were recently diagnosed and were planned for initial therapy underwent blood sampling (10 to 15 ml) and plasma droplet digital Polymerase Chain Reaction(ddPCR) for EGFR & KRAS mutations was done. Results: 40 % of the patients in the study population were positive for EGFR mutation. In 7 out of 10 females with adenocarcinoma histology (70 %), EGFR mutation was found to be positive. KRAS Mutation was not detected in the female cohorts. 3 out of 10 patients (30%) among the female cohorts were negative for KRAS and EGFR mutations. One patient was positive for KRAS and EGFR mutations each among the male patient population. Conclusion: In this study, we found that approximately one third of NSCLC patients harbour an EGFR mutation. Patients who are female, non-smokers, and have adenocarcinoma are more likely to harbour an EGFR mutation, which is consistent with previous studies.  Detection of EGFR mutation from blood sampling can be done rapidly, reliably and conveniently in lung cancer patients whereas obtaining the tissue through invasive procedure is associated with delay in diagnosis and morbidity.

76. Prevalence of Antenatal Depression and its Associated Risk Factors: A Community Based Longitudinal Study in the Rural Area of Amroha District
Neelam, Shweta Yadav, Sachin Singh Yadav
Background: Maternal mental health is the leading ignored problem in the Indian population. Considering the high prevalence of antenatal and postpartum depression, mental health assessment and screening of high-risk cases should be a part of routine antenatal care. Aim: The study aims to estimate the prevalence of Antenatal depression among pregnant women in the rural Amroha district and to assess risk factors associated with it. Method: Three hundred (300) Antenatal women were interviewed using validated Hindi version of Edinburgh Postnatal Depression Scale (EPDS) to measure Antenatal depression. All the registered antenatal women in their first trimester were included in the study and were followed up to delivery of mother. The collected data was entered in Microsoft office excel sheet and this was analysed by using SPSS Version 20.0 software. To test the association chi-square test was used for categorical variables and p<0.05 was considered statistically significant. Results: Prevalence of Antenatal depression was 10.7% Thirty two out of 300 women scored ≥ 10 on the EPDS. Age, Education, order of delivery and pallor were found to have a statistically significant with Antenatal depression. Conclusion: Antenatal depression is prevalent and serious problems with changing courses. Continuous assessment over the course of pregnancy is warranted. The findings in our study implicate policy makers to include maternal mental health screening as a part of maternal and child care programs.

77. Retrospective, Observational Assessment of the Maternal and Fetal Outcomes in Term Pre-Labour Rupture of Membranes
Afreen Nabi, Rekha Kumari, Usha Kumari
Aim: The present study was conducted to analyze the maternal and fetal outcome of term Prelabour rupture of membrane in tertiary care hospital in Bihar region. Methods: This was a retrospective, observational study and it was conducted in the department Obstetrics and Gynaecology at Nalanda Medical College and Hospital, Patna, Bihar, India for 1 year. The case records of 240 women admitted as PROM were collected from the medical record department. Out of which, 200 cases of term PROM was included in this study as per the inclusion criteria and the remaining 40 were excluded as per the exclusion criteria. Results: The age group in this study varies from 18-38 years and the most common age group was 22-25 years (80 cases) 40% followed by 18-21 years 30% and 26-29years 20%. Time of rupture of membrane to the time of delivery varies between 6 hours to more than 24 hours with the maximum of 60% occurred between 12-24 hours followed by 30% occurred later than 24 hours and the least at less than 12 hours (10%). 66% babies had weight >2.5 kgs. Conclusion: PROM is associated with higher rate of induction and LSCS. Timely intervention will reduce the maternal and fetal morbidity and mortality.

78. Plain versus Hyperbaric Solutions of 0.75% Ropivacaine in Spinal Anaesthesia in Elective Lower Abdominal and Lower Limb Surgeries: A Randomized Comparative Clinical Study
Jitendra Prasad Singh, Amit Kumar
Aim: This study was designed to compare the clinical efficacy of plain and hyperbaric solutions of 0.75% ropivacaine in spinal anaesthesia in elective lower abdominal and lower limb surgeries. Methods: The present study was conducted in the Department of Anesthesiology, Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India for one year and Fifty ASA grade I–II patients who were to undergo elective lower abdominal and lower limb surgeries under spinal anaesthesia  gave written informed consent to take part in the study, which was approved by the local research ethics committee. Results: In the study, the mean specific gravity of the freshly prepared hyperbaric ropivacaine 0.75% solution (by the addition of 50 mg/mL dextrose) observed was 1.148 and plain ropivacaine 0.75% was 1.160. The two groups were comparable with regard to age, sex, height, weight, ASA status, and types of surgeries and the mean difference was statistically not significant. Hyperbaric ropivacaine produced a more rapid onset of more extensive, but less variable sensory block, which, nonetheless, ultimately regressed more quickly. The onset of analgesia to pinprick at T10 was more rapid, and the maximum block height (median T4 vs T8) was greater, but less variable. Median time to maximum block height was the same in both groups, but the range was considerably greater with the plain solution. The onset of lower limb motor block was slightly faster in the hyperbaric group, but the maximum degree obtained was the same in both groups. Conclusion: Addition of glucose 50 mg /ml to ropivacaine 5 mg /ml increases the speed of onset, block reliability, duration of useful block for perineal surgery, and speed of recovery. Plain solutions are less reliable for surgery above a dermatomal level of L1.

79. A Prospective Observational Screening Assessment of Carcinoma of Cervix Using Pap Smear
Rekha Kumari, Afreen Nabi, Usha Kumari
Aim: The aim of the present study was to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital in Bihar region and to correlate it with clinical findings. Methods: This prospective study was carried out over 1 year in the Department of Obstetrics and Gynaecology in Nalanda Medical College and Hospital, Patna, Bihar, India. We screened 200 women were included in the study. Results: Maximum number of cases was in the age group 30-39 years constituting 35% of the total cases followed by age group 20-29 years 30%. Minimum percentage (1.5%) of cases were under 60-69 and 70-79 age group. Vaginal discharge was the commonest chief complaint followed by menorrhagia and lower abdominal pain. Maximum number of cases reported as Non- Specific Inflammatory Smears (55%). Among epithelial cell abnormalities incidence of ASCUS, SCC and ASCUS – H was 1%. Conclusion: This study emphasized the importance of Pap smears screening for early detection of premalignant and malignant lesions of cervix. Pap smear testing is an economical, non-invasive and simple OPD procedure to detect potentially precancerous and cancerous lesions of cervix. It should be established as a routine screening procedure to reduce the treatment burden, morbidity and mortality.

80. A Study of Cervical Pap Smears in a Tertiary Care Hospital of Bihar Region
Abhilasha, Manoj Kumar
Aim: The present study is intended to evaluate the pattern of cervical Pap smear cytology at a tertiary hospital and to correlate it with clinical findings. Methods: The prospective study was carried out at Sri Krishna Medical college, Muzaffarpur, Bihar, India during for the period of one year and total 1000 patients were screened. The patients were in the age range of 19-69 years, having complaints like watery vaginal discharge, blood mixed discharge, pain in lower abdomen, bleeding per vaginal, intermenstrual bleeding, post-coital bleeding, something coming out per vagina, foul smelling discharge and itching in private parts. Results: The result showed that maximum number of cases was in the age group 30-39 years constituting 36% of the total cases followed by age group 20-29 yrs. The oldest case was of age 65 years. Minimum percentage (1%) of cases were under 60-69 age group. The result depicted vaginal discharge was the commonest chief complaint followed by lower abdominal pain. Total 46% showed inflammatory lesion, 1% showed atrophy, 0.5% showed ASCUS, 0.5% showed LSIL, 0.5% showed HSIL, 1.5% showed SCC, 10% showed metaplasia,10% showed reactive changes. Conclusion: This study emphasized the importance of Pap smears screening for early detection of premalignant and malignant lesions of cervix.

81. Distribution of Rh, Kell and Duffy Blood Group Antigens and Their Phenotypic Characteristics in Blood Donors of Barpeta District of Assam: A Hospital Based Study from North East India
Dipankar Baruah, Abhijit Bharali, Abhinanda Barua, Gitali Devi
Background: Determination of the blood group antigens and the different phenotypes is limited to the ABO and Rh blood group antigens only as antigens of these system can cause most of the transfusion reactions. This is the first study to evaluate the frequency of Rh, Kell and Duffy antigens and their phenotypes in voluntary blood donors of Barpeta district of Assam, North East India. Materials and Method: A total of 520 samples from voluntary blood donors attending the Blood Centre, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India, were typed for the presence of antigens of Rh, Kell and Duffy blood group system by tube agglutination method. The different phenotypic frequencies were evaluated and results were expressed in percentage. Results: The D antigen frequency was highest with 95.96% followed by e (92.69%), C (87.88%), c (41.35%) and E (21.54%). The most common Rh phenotype is DCCee. Most common antigen in Kell blood group system was k (100%) and its most common phenotype was K-k+ (98.46%). K antigen was positive in 2.69%. In Duffy blood group system, Fya is positive in 80.77% and Fyb is positive in 57.50%. The most common Duffy phenotype is Fy(a+b+) (46%). Conclusion: This study will not only help in having a database of antigens and their phenotypic frequencies but also in providing antigen negative compatible blood units in alloimmunized patients, thalassemia patients requiring repeated blood transfusions, which will be helpful to prevent blood transfusion reaction and thereby ensure safe blood transfusion.

82. Microbial Profile of Bacterial Keratitis in a Tertiary Care Hospital in Southern Odisha
Raghu A.C., Sarita Panda, Deepika Priyadarshini
Background: The emergence of bacterial resistance towards topical antimicrobial agents increases the risk of treatment failure with potentially serious consequences in bacterial keratitis. Aim: To arrive at microbial profile of bacterial keratitis in patients attending ophthalmology  out patient department of a tertiary care hospital in Southern Odisha. Materials and Methods: A Prospective Cross-sectional study was done in a tertiary care center from October 2018- March 2021 in OPD patients. Samples were collected by corneal scrapping and Culture and sensitivity testing done. Results were compiled and analysed. Results: Out of the 64 cases in our study, 62.5% were male, and common age group was 51-60. The most common predisposing risk factor for keratitis was trauma (43.7%). Most of cases of keratitis were farmers (62.5%) by occupation. 71% of samples were culture positive. The most common bacteria isolated in our study was Staphylococcus aureus, and showed 100% sensitivity to vancomycin and linezolid, 75% to gentamicin and 55% to ciprofloxacin. Conclusion: Successful management of microbial keratitis requires correct identification of the etiological pathogen and further the appropriate choice of antibiotics, a concept called antibiotic stewardship.

83. A Comparative Cross Sectional Study of Ophthalmic and Ocular Sequalae Following Orbital Wall Fracture
S. Ravikumar, V. Ravindran, Yavana Rani, P. Saravana Sankar
Background: Orbital wall fractures are commonly seen among adult males and adolescent males, road traffic accidents is important factor in recent admissions. These fractures may be of isolated bone involvement or multiple bone involvement, the fractured orbital walls heals with fibrous union altering the normal anatomy of orbit. This altered anatomy causes various complications to the refractive state as well as adnexa of eye. This study is about the outcome of visual acuity, refractive status, Ocular tear film stability and various parameters of patients of orbital wall fracture who were either managed conservatively or surgically treated. Methods: This study was done among 50 subjects above 18 years, 25 surgically intervened, 25 conservatively managed, they were periodically followed. Each patient underwent best corrected visual acuity, orthoptic evaluation. refraction, fundus, tear film stability tests with appropriate instruments. Results: The study revealed that most of the patients were adult males involved in RTA related orbital wall fractures, 44 % of persons were in 21-40 yrs. age group, esophoria 14% was the deviation of most common occurrence, 62% patients developed astigmatism as most common refractory error, dry eye was seen in 85% of individuals. Conclusion: Orbital wall fractures are more common with increasing road traffic accidents, young adults are most commonly affected, the sequlae being dry eye, orthoptic deficiencies and significant refractory errors.

84. Mental Health Status of Parents of Children Under Five Years of Age during Covid-19 Pandemic in Guwahati City, Assam
Jhankar Hazarika, Pankaj Jyoti Barman, Soumitra Nath
Background: Today the world is facing an unprecedented situation owing to the effects of COVID-19, an infectious disease caused by SAR-COV-2 virus, with clinical spectrum ranging from asymptomatic to mild respiratory symptoms to rapid death. COVID-19 was first reported in a hospital in Wuhan city, China on 29th Dec 2019. Subsequently the disease spread rapidly throughout the country. The first case of COVID-19 outside of China was confirmed in Thailand in January, 2020. The disease has spread far and wide all over the world effecting almost every country in the world making it a global pandemic. As of now more than 200 million people have been effected across 213 countries and territories leading to loss of lives. As there is no treatment for the novel corona virus till date, lockdown, and social distancing and vaccination is the only practical and safe option to slow down the spread of the virus. Since the onset of the pandemic in early 2020, 35% of the population has experienced mental distress. Material and Methods: It is a community based cross-sectional study on parents having children from 0-5 years of age. The study was conducted in different municipal wards of Guwahati city, Assam. 5 municipal wards are selected randomly out of which 260 parents will be selected randomly. Based on the previous study “Impact of COVID-19 Outbreak on mental health and perceived strain among the caregivers tending children with special needs” conducted by Sapna Dhiman and Shilpa Jain, School of Psychotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi India and published in Research in Developmental Disabilities, 6th October 2020. The prevalence of anxiety was found to be 20.5%. Results: Out of the 260 parents that were interviewed, 77 (29.6%) reported having a family member who was diagnosed with COVID-19, while 183 (70.4%) reported not having any family member who was diagnosed with COVID- 19. Among the 87 parents who are govt. sector employees, 79 (90.8%) did not suffer from stress, while 8 (9.2%) suffered from stress. Among the 125 parents who are private sector employees, 93 (74.4%) did not suffer from stress, while 32 (25.6%) suffered from stress. Among the 30 parents who own business, 19 (63.3%) did not suffer from stress, while 11 (36.7%) suffered from stress. Among the 3 parents who reported being involved in agriculture, 2 (66.7%) did not suffer from stress, while 1 (33.3%) suffered from stress. Among the 15 parents who reported being unemployed, 9 (60%) did not suffer from stress, while 6 (40%) suffered from stress.  Conclusion: Thus, through this study, one can conclude that the ongoing pandemic has certainly taken a toll on the mental well-being of parents and as such taking measures to identify and address the issue is the need of the hour. Thus, awareness should be created about identifying signs of various mental health issues so that people can identify and seek necessary medical help at the earliest.

85. Memory Impairment in Patients with Depression with and Without Hypothyroidism: A Comparative Study
Sunil Suthar, Tanuja, Ishwar Dayal Gupta
Introduction: Relationship between hypothyroidism and depression as well as between hypothyroidism and memory impairment is known since long time but remains poorly defined. Hypothyroidism affects both mood and cognition. Thyroid hormones has been found effective as adjunct treatment for depression. Aim & Design: The aim of this study was to compare memory impairment in patients with depression with  and without Hypothyroidism. Materials and Methods: A total of 186 patients with depression were included in this study. HAM-D-17 (Hamilton Depression Rating Scale) was used to assess depressive symptoms and severity. On the basis of  serum TSH level the study group was categorized into two groups- patients with hypothyroid and without hypothyroidism (euthyroid group). Hypothyroid group was further divided into subgroups clinical and subclinical hypothyroidism. PGI memory scale was used to compare memory impairment in groups. Results: Among 30 hypothyroidism cases 9 were male and 21 were female. Depressed female had higher prevalence of hypothyroidism. With respect to severity of baseline overall depression (total score on the Ham-D-17), the two groups did not differ significantly (p = 0.472). Patients with hypothyroidism performed poorly in memory scale in compare to depressed patients without hypothyroidism. Conclusion: Patients with depression and hypothyroidism appear to have significant memory impairment in compare to depressed patients without hypothyroidism. Hence clinical features like memory impairment may help clinician for early diagnosis of hypothyroidism in patients with depression.

86. Determination of Variation in Dimensions of Lumbar Vertebral Pedicles among Indian Adult Population
G. S. Mali Patil, Prakash K.G., Anjali Jain, Kalpana Sharma
Introduction: An operating surgeon can carry out these treatments more accurately and safely if they are aware of slight anatomical heterogeneity. Prior to implant implantation, general orthopedic surgery guidelines encourage templating with precise measurements. It is known that there is a significant discrepancy between both the historically recorded diameter of the outer cortical and the effective cancellous diameter, suggesting that a safe screw selection might not always be possible with the use of traditional methods. It is strongly believed by the surgeon community that appropriate morphometric information on the lumbar pedicles is essential to undertake these treatments in a risk-free setting. Aims and Objectives: To determine and analyze the dimensions of lumbar vertebral pedicles in adult Indian population. Methods: This is a prospective and observational study conducted on 35 specimens of lumbar vertebrae. The study considered 35 dry, fully ossified, healthy lumbar vertebral pairs from the Department of Anatomy were used in the investigation. All vertebrae were divided into typical (L1 to L4) and atypical categories for the study (L5). The specimens were determined for variation in their dimensions and required analysis were carried out for proper analysis. Results: Pedicles in normal vertebrae (L1 to L4) ranged in length and height from 8.86 millimetres to 10 millimetres and 13.12 millimetres to 13.89 millimetres, respectively. The typical vertebra’s pedicle thickness ranged from 7.12 to 11.23 millimetres. PDL, PDH, and PDTh for L5 had mean values of 8.81 mm, 12.78 mm, and 16.11 mm, respectively. Pedicle axial length increased from L1 to L3 and then decreased from L4 to L5, with the mean transverse angle of the right and left side of the pedicle at L5 being larger than L4 (16.97 degrees and 15.82 degrees). The study found that there is shows statistically significant variations in the sizes of the pedicles of each of the five lumbar vertebrae. With the exception of height, a highly significant (P < 0.01) difference was seen for all measures. Conclusion: The study has concluded that there are significant differences in dimension of pedicles of both the typical and atypical variant of lumbar vertebrae.

87. Impact of Sensorineural Hearing Loss Due to Injectable Aminoglycoside Drugs in Patients of Multi-Drug Resistant Tuberculosis
Chavan S S, Mendonca E C, Khond A D, Kale V D, Gund T, Shah K R
Introduction: Multi-drug tuberculosis (MDR-TB) is a serious threat and needs a combination of drugs for its effective treatment. The aminoglycoside group of drugs are widely used for the same. The adverse effect of ototoxicity of these drugs is irreversible and can lead to permanent disability. Aminoglycosides affect the higher frequencies first and it gradually progresses to the lower (speech) frequencies. Regular audiological monitoring can help identify patients developing hearing loss early and can prevent its further progression thus preventing debilitating disability. We discuss this drug induced hearing loss in this study. Material and Methods: In this prospective observational study, sixty patients with MDR-TB who were to be started on aminoglycosides underwent pure tone audiometry testing before starting the drug and every 3 months further on for a total of three follow up visits. The patients were grouped on the drug received (Amikacin, Kanamycin or Capreomycin). The results were tabulated and presented graphically. Results: Of the 60 patients, 16 (26.67%) patients developed sensorineural hearing loss in the higher frequencies. Furthermore, 3 patients among these developed hearing loss in the speech frequencies too. Hearing loss was seen in 26.08%, 30% and 25% in the Amikacin, Kanamycin and Capreomycin groups respectively. None of the patients who developed sensorineural hearing loss showed any improvement of hearing thresholds after stoppage of the drugs indicating permanent damage. Discussion: The current study highlights that hearing loss due to aminoglycosides occurs in the higher frequencies and also the speech frequencies in some patients leading to a permanent disability. Audiological management of these patients should therefore be an essential part of their therapeutic treatment plan, to minimize the disabling effect of hearing loss.

88. Psychiatric Morbidity and Quality of Life in Bronchial Asthma Patients undergoing Treatment in Tertiary Care Hospital
Renganathan, A. Ramesh Babu, H. Ahamadu Nisha, M. Mangayarkarasi
Introduction: Asthma is a chronic inflammatory condition that may cause a disturbance in our routine activities, on sometimes requires a prolonged stay in the hospital. Hence an asthmatic may have episodes of illness throughout their lifetime. This frequent illness has more chance of causing depression and anxiety in them. Like asthma, even a lot of other chronic medical disorders are also related to a lot of psychiatric disorders. Based on this aim of our study is to evaluate the occurrence of anxiety and depression among chronic asthmatics and also in turn how it affects the quality of life. Also, to correlate the control level of asthma with the above factors. Methodology: This study was done as a cross-sectional descriptive study, at the outpatient Department of pulmonology and Psychiatry in Stanley Medical College, for six months. In our study a hundred patients were included. Spirometry, anxiety level and incidence, depression level and incidence, Quality of life were assessed. Hamilton Rating scale for Anxiety (HAM-A) and Beck Depression Inventory (BDI) was used. Results and Conclusion: In our study, thirty-six patients had anxiety and thirty-nine patients had depression. Our study concluded that good asthma control had a lesser incidence of anxiety and depression. Also, patients who had a longer duration of disease had more incidence of psychiatric morbidity than patients with a lesser duration of asthma. In spirometry too there was an inverse correlation with FEV1 /FVC% values. The same relation was seen with quality of life in the above patients. Hence proper control of asthma with earlier treatment will help in reducing psychiatric morbidity. Whereas Good pulmonary function results have a lesser relation with psychiatric morbidity.

89. Randomized Control Study to Compare the Efficacy of Ultrasound-Guided Bilateral Posterior Transversus Abdominis Plane Block (US-BPTAB) versus Ultrasound-Guided Bilateral Rectus Sheath Block (US-BRSB) in Caesarean Section for Post-Operative Analgesia
Alka Shah, Ila B. Patel, Tanvi Patel, Khushali Nayak, Ruhi Bangoria
Background: In this study, the analgesic effectiveness of bilateral ultrasound-guided posterior transversus abdominis plane block (US-BPTAB) and bilateral ultrasound-guided rectus sheath block (US-BRSB) following caesarean delivery was examined. Aims and objective: The purpose of the current study was to assess post-operative pain using the Visual Analogue Scale as a measure of pain intensity (VAS). Duration of analgesia, total requirement of analgesic drug in first 24 hours, time for first rescue analgesia and patient’s satisfaction. Material and Methods: The posterior TAP block or Rectus sheath block was randomly assigned to 30 moms scheduled for caesarean sections under spinal anaesthesia. At the conclusion of surgery, the US-BPTAB group and the US-BRSB group each received a 20 mL injection of 0.25% ropivacaine into the Rectus sheath and posterior transversus abdominis plane under ultrasound guidance. The postoperative pain intensity in the first 24 hours was the main result. The duration of analgesia attained by each block, the total amount of tramadol consumed, and patient satisfaction were secondary outcomes. Results: Postoperatively at all time points, the VAS score in the PTAB group was significantly lower (P 0.0001). When compared to the RS group, the PTAB group’s 24-hour tramadol intake was significantly lower (91.43 vs. 145.71 vs. 61.08 mg, P 0.0001). When comparing the PTAB group to the RS group, the time for the first rescue analgesia was substantially longer (787.14±377.87 minutes vs. 445.71±264.44 minutes, p<0.0001). Conclusion: Posterior TAP block is more effective at relieving pain than the Rectus sheath block, has a longer duration of analgesic action, extends the time before the need for analgesia, is linked to lower tramadol consumption, and can be used in multimodal analgesia and opioid-sparing regimens following caesarean delivery.

90. The Association between Digital Screen Time and Myopia among Children of Age Group 5 Year to 15 Year Presenting at a Tertiary Care Medical Centre
Sweta Singh, Mahrukh, Swati Agrawal
Introduction: The WHO recommends no sedentary screen time (such as watching TV or videos, playing computer games) for children <2 years and limits sedentary screen time to no more than 1 hour (less is better) for children older than 2 years but younger than 5 years. The American Academy of Paediatrics (AAP) has also endorsed similar screen time restrictions. There are no screen-time cut-offs specifically recommended for older children or adolescents by either or any other government/country health guidelines. Aim and Objectives: To estimate the prevalence of myopia in preschool and school going population and its associations with Digital screen time among the study subjects. Material and Methods: This study was conducted as a hospital based cross sectional study to estimate the prevalence of myopia and its correlation with Digital screen time. This study was conducted at field area of tertiary medical center of Delhi-NCR region. The study was carried out from August 2021 to August 2022. Result: The proportion of myopia was more in 5-8 years age group which was 14(50%) of the total number of myopic subjects. When compared with the total population of the age group of 5-8 years, the percentage of the myopic subjects was 9.52 %. When compared within the age group of 9-11 years, the proportion of myopic subjects in total myopic population was 9(32.1%), and when compared with the total respective population of age group of 9-11 years the proportion was 13.6%. When compared within the age group of 12-15 years, the proportion of myopic subjects in total myopic population was 5(17.9%), and when compared with the total respective population of age group of 12-15 years the proportion was 10.64%. Conclusions: In this study we found that there was a strong association between increased digital screen time and myopia. Other factors such as presence of myopia in one or both parents, and increased prevalence in myopia with the increase in age were also observed as considerable factors.

91. Risk Factors, Presentation, and In-Hospital Events of Young ST-Elevation Myocardial Infarction Patients
Himadri Shanker, Sumit Shanker, Hem Shanker Sharma
Introduction: The incidence of coronary artery disease among younger people is rising at an alarming pace throughout the Indian subcontinent. There have only been a few of studies that have focused on young ST-elevation myocardial infarction (STEMI) patients in these areas. We investigate the clinical characteristics and therapy of individuals younger than 40 years old who have STEMI. Methods: Patients with ST-elevation myocardial infarction (STEMI) who were younger than 40 years old and hospitalized in JLNMC, Bhagalpur, Bihar were included in the study. The use of electronic medical records allowed for the collection of data. The ST-elevation myocardial infarction (STEMI) profile, medical history, risk factors, in-hospital events, and therapy all had descriptive statistics derived for them. Results: In patients who had no previous history of either ailment, the hospital made the diagnosis that they had hypertension 19.5% of the time, and reduced high-density lipoprotein 9.5% of the time. Conclusions: Better screening for risk factors is required among young people who use cigarettes. This population has a high prevalence of health problems. In patients younger than 40 years old who have numerous risk factors, acute cardiac events may be avoided with earlier diagnosis of dyslipidemia and hypertension as well as treatment of these conditions.

92. Study of Cases of Multi-Drug Resistant Tuberculosis in Cervical Tuberculous Lymphadenitis
Hiren Doshi, Abhi Modi, Anuj Kansara, Meeta Bathla, Rinkal Diwan, Ritiksha Gajjar
Introduction: Lymph nodes are organs which are present in regions of neck, chest, abdomen, and groin. Neck consists of 300 lymph nodes nearly 2/3rd of overall lymph nodes that are there in body. Lymphadenopathy is course of disease and this course involves lymph nodes that are anomalous in uniformity and dimension. Lymphadenitis relates to lymphadenopathies which are caused because of inflammatory pathology. Among the different infective and inflammatory conditions of cervical lymphadenopathy, the commonest cause is tuberculous lymphadenitis. It is a commonest form of extra-pulmonary tuberculosis since tuberculosis is chief health-related problem because of social and economic issues. Tuberculosis is a disease of great antiquity and has even been found in Egyptian mummies. Multidrug-resistant tuberculosis (MDR-TB) is tuberculosis due to organisms which show resistance to both isoniazid and rifampicin, with or without resistance to other anti-TB drugs. Objective: To determine incidence of Drug resistant Tuberculosis in cervical tuberculous lymphadenitis and to determine response of treatment of Drug resistant Tuberculosis. Materials and Methods: It is an observational, prospective hospital based study in 52 patients carried out at Sheth L.G Hospital in Ahmadabad in 2 years span. Proper history and clinical evaluation were done. According to the new NTEP guidelines, the pus of each of these patients included in the study were sent for CBNAAT in falcon tube. The expert MTB/RIF technique was performed in the machine kept at Microbiology Department of Narendra Modi Medical College. Results regarding sensitivity of bacilli against rifampicin are produced using this technique within 2 hours. Results thus obtained, were analysed. Results: There were 52 cases of cervical tuberculous lymphadenopathy in which 14 cases were of drug-resistant tuberculosis. In the present study of gene Xpert, Rifampicin sensitive Tuberculosis which includes Drug sensitive tuberculosis was detected in 73.15% while Rifampicin resistance in 26.9%. Out of 14 cases of drug resistant tuberculosis, 85.71% cases showed treatment success, 7.14% cases were defaulters, 7.14% were lost to follow up. Conclusion: The emergence of MDR-TB has been attributed to factors such as nonadherence to treatment, inappropriate treatment regimens, drug malabsorption, poor drug quality, lack of health education, delay in initiation of treatment, resistance to additional drugs and a poor health infrastructure for effective delivery of treatment.

93. A Patient Centric Alternative Approach to Treating Large Diastemas: A Case Report
Ridyumna Garain, Krishnakumar GR, Bharathi M, Jibin Karim, Priyansha Singh, Prakruthi S N
The current case report discusses the morphofunctional rehabilitation of a large midline diastema and labially inclined teeth with the help of virtual smile designing and lithium disilicate restorations.
Key Messages: It is important to be aware of the etiology and the various treatment options available for the closure of diastemas. As a clinician, it is important to understand the unique challenges each case presents. It is the ability to translate acquired knowledge to suit the current situation that enables a clinician to provide the best possible treatment to their patients.

94. A Study to Evaluating the Burden of Anaemia and its Association with Socioeconomic Status and Dietary Habits among School Children (5-16 Year) in Rural Area of Northern India
Rahul Chaturvedi, Rajesh Bansal, Esha Singhal, Prashant Bhardwaj
Background: Anaemia is the most common hematological disease of the pediatric age group. Highest prevalence of anaemia is seen in developing countries. Anaemia is widely prevalent in India and affects both sexes and all age groups. Anaemia has significant negative impact on the health of school children including poor scholastic performance and cognitive impairment. The main aim of this study is to estimating the burden of anemia among school going children (5-16 year) in rural area, of northern India and their association with socioeconomic and dietary habits. Materials and methods: This cross sectional study would be conducted in government and private rural school of Bareilly district from February 2021 to August 2022. All children would have venous blood samples taken while adhering to stringent aseptic procedures in an EDTA anticoagulant for a haematological study. Sahli’s approach would be used to estimate haemoglobin. Results: A total of 386 cases in age group of 5-16 years were studied. 56.73% were males and 43.27% were females. Prevalence of anaemia was more in male comparison to female. The overall prevalence of anaemia was found to be 38.7%. Conclusion: Childhood anaemia still continues to be a significant public health problem in school children between 5-16 years. Compared to earlier studies, our study found that there is significant prevalence of anemia among school going children.

95. Real World Experience of Unprotected Left Main Coronary Artery Angioplasty: A Single Centre Experience from Western Rajasthan
Rohit Mathur, Pawan Sarda, Anil Baroopal, Abhishek Sakwaria, Pankaj Kumar
Background: For several decades Coronary artery bypass grafting (CABG) was accepted as the first line management option for unprotected left main coronary artery (ULMCA) disease while techniques for the percutaneous management of coronary atherosclerosis were in the early stages of development. Objectives: To assess the demographic, angiographic and procedural characteristics in patients subjected to angioplasty of unprotected left main coronary stenosis, and to compare the characteristics in patients suffering with major adverse clinical event (MACE) with non-MACE patients. Materials & Methods: Total 50 patients were selected based on inclusion and exclusion criteria. After surgical intervention, patients were followed up during stay in hospital; and after getting discharge at time intervals of 1st, 6th months, and 1 year. After 1 year of treatment, coronary angiogram was done for all patients. The data was collected and subjected to statistical analysis using SPSS version 20.0. Results: All characteristics were observed and compared for both MACE and Non-MACE group patients. Statistically significant relation was found for all parameters in operative, angiographic and procedural characteristics except presentation and Left ventricular ejection fraction. (p<0.05). Conclusion:In MACE group, incidence of co-morbidities, high Syntax score, and left ventricular dysfunction with EF≤45%, were common. The study advocated ULMCA PCI technique for cases having low Syntax score, without co-morbidities and LV dysfunction.

96. To Study the Safety and Efficacy of Fentanyl TTS Patch in the Management of Multiple Rib Fracture: A Comparative Study
Minakshi Gadahire, Vishwadeep Bhalerao, Vishal Kale
Multiple fracture of ribs in blunt chest trauma, causes significant amount of pain, which can lead to hypoventilation, collection of secretions in the lungs, atelectesis and pneumonia. Adequate analgesia will decrease these complications. We studied the safety and effectiveness of Fentanyl Transdermal Therapeutic System (TTS) versus transdermal Diclofenac patch for analgesia in patients with multiple fracture of ribs. Aim: To study the safety and efficacy of Transdermal fentanyl patch versus transdermal Diclofenac patch in case of multiple fracture ribs due to blunt chest trauma. Methodology: It is a Prospective, Analytical, Hospital based study, in a Tertiary care Hospital in a Metropolitan City for a period of 18 months. Total 70 patients who had multiple rib fracture were studied. The study participants who fulfilled the inclusion criteria were enrolled in either group using method of random sampling. Group A was transdermal Fentanyl patch and Group B was transdermal Diclofenac patch group. Dosage of Fentanyl TTS- 50μg, Diclofenac patch was 200mg. Each patch was given for a period of 72 hours. Patch was applied on the clean, intact skin over the chest wall. Clinical history, general, and Clinical examination findings were noted. Intensity of pain was noted using pain scale-1 to 10, ABG, respiratory rate for respiratory Depression and follow up secondary clinical examination were conducted on day 1, 2, 3, 4 and day 5. Patient’s demographic details, examination findings, investigations findings like, CBC, Oxygen saturation, Chest X-ray and CT-scan of Chest were noted. Complications like, pneumothorax, hemothorax, pneumonia, requirement of ventilatory support were noted. All the findings were recorded in the standard, semi-structured, pre-validated case record proforma. Results: We observed greater reduction and stabilization of the pulse rates in Fentanyl group (f-value: 246.81), as compared to Diclofenac group (f-value: 27.28). There was increase in Oxygen saturation in Fentanyl group (f-value: 28.1), as compared to Diclofenac group (f-value: 16.51). There was significant increase in Oxygen saturation in Fentanyl group (f-value: 28.1), as compared to Diclofenac group (f-value: 16.51). Conclusion: Transdermal Fentanyl Patch is effective, non-invasive and safe, as an analgesic in treatment of Multiple rib fractures.

97. Evaluation of Antimicrobial Potential of Crude Plant Extracts of Begonia Semperflorens, Morus Alba, and Myrisitica Fragrans against Mentioned Bacterial and Fungal Species
Khurana R
In the present study crude extracts of leaves of two plants, Begonia semperflorens, Morus alba and seeds Myristica fragrans in distilled water, ethanol and methanol, respectively were subjected to preliminary phytochemical and antimicrobial studies on certain microorganisms. The phytochemical analysis done using the chemical methods showed the presence of various phytochemicals in all the plants. The results of antimicrobial studies showed that only ethanolic and methanolic extracts of Morus alba have good antimicrobial activity against the test organisms: Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, Aspergillus niger, A. flavus. No extract had any activity against E. coli, Candida albicans and Cryptococcus neoformans. Complete inhibition of sporulation was seen in A. fumigatus by methanolic extract of Myristica fragrans and ethanolic extract of Morus alba. This study supports the use of plants in traditional medicine and the potential of using them as food supplements. This opens future prospects of these plant constituents to be used as potential drugs for the treatment of infectious diseases, especially those caused by antibiotic resistant organisms.

98. Effect on Blood Parameters after Chelation Therapy in Thalassemia major patients
Sourabh Agrawal, Anil Prasad
Background: It is estimated that 3% of the world population and 3-17% of the Indian population are beta (β)-thalassemia gene carriers. Β-thalassemia is a disease resulting from a decrease in β-globin chain production and a subsequent imbalance in α/β-globin chain ratio. Excess α chain gets precipitated within RBC, resulting in hemolysis and ineffective erythropoiesis, require RBC transfusions in every two to three weeks, which means 52 units of blood in a year. These lifelong blood transfusions can lead to iron overload, which ultimately damages tissues in the liver, heart, endocrine organs, and joints. Aim: This study aims to study effect on blood parameters after chelation therapy in thalassemic major patients. Methodology: In our study Hydroxyurea (HU) was administered orally to Beta-thalassemia major patients in doses of 8-15mg/kg/day. They were followed up for a period of 6 months. Before starting hydroxyurea, all patients underwent routine biochemical laboratory tests. 23/60(38.34%) thalassemia major cases were non-responder. There was no change in mean Hb, mean Hb-F, mean serum ferritin level and mean blood transfusion requirement in these cases after HU therapy. In 12 cases HU was used in 12-15mg/kg of dose, these all patients developed response to HU. Out of 42 patients where a dose of 8-11mg/kg was used only 19 patients showed response to HU (12-15mg kg). Conclusion: This study shows that HU can be a used in TM to decrease the need of blood transfusion, Because of oral use, inexpensive cost, minimal side effect and positive clinical and hematological response, we strongly recommend the use of HU with blood transfusion in patients of TM.

99. An Ethnobotanical Survey of COVID-19 Therapeutic Plants
Adouani B, Kuyu Gwangasa N.I, Zakariya I., Derraji S
After the emergence of COVID-19, the global usage of herbal medicine has expanded considerably. Exploring the scientific and clinical potential of medicinal plants, the World Health Organization (WHO) promotes projects to create COVID-19 medicines via traditional medicine. The purpose of our research was to compile a list of plants used in the outpatient treatment of COVID-19 by herbalists, including the plants, the sections utilized, and the method of preparation and administration. an ethnobotanical survey was done in order to determine the plants prescribed by herbalists to their COVID-19 patients/clients. In our investigation, we discovered 14 plant species, with Eucalyptus globulus, Lavandula angustifolia, Artemisia herbacea alba, Syzygium aromaticum, and Thymus vulgaris being the most often suggested.

100. Activation for Self-Management in Patients with Diabetes, Chronic Obstructive Pulmonary Disease, Chronic Heart Failure, and Chronic Renal Disease: A Cross-Sectional Survey Study Patients with Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF), and Chronic Renal Disease (CRD)
Sumit Shanker, Himadri Shanker, Hem Shanker Sharma
It has been shown that a sizeable fraction of patients suffering from chronic diseases do not react favorably to self-management treatments. This finding shows that one size does not fit all, which calls for interventions that are more specifically customized. We want to have a better grasp of the traits that are connected with patient activation for self-management, and we want to determine whether or not these features are disease-transcending. This will allow us to design more tailored strategies. Patients with type-2 Diabetes Mellitus (DM-II), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF), and Chronic Renal Disease were included in a survey study that was carried out in primary and secondary care settings (CRD). We examined the relationships between self-management activation (as measured by the 13-item Patient Activation Measure; PAM-13) and a broad variety of sociodemographic, clinical, and psychosocial factors by using multiple linear regression analysis. In addition, we investigated if the relationships found between the determinants and the PAM were influenced by illness by trying to see whether the disease acted as an effect modifier. Through the use of logistic regression analysis, we were also able to determine the factors that are related with a low level of activation for self-management. We enrolled 1160 patients,425 of these 1160 individuals were diagnosed with DM-II, 290 were diagnosed with COPD, 225 were diagnosed with CHF, and 220 were diagnosed with CRD. The results of a multiple linear regression analysis revealed 9 explanatory determinants of activation for self-management. These determinants are as follows: age, body mass index (BMI), educational level, financial distress, physical health status, depression, illness perception, social support, and underlying disease. Together, these factors explain 16.3% of the variance. Every relationship was a disease-transcending one, with the only exception of social support. The purpose of this research was to investigate the elements that are connected with different activation levels for self-management. These findings represent the first step in assisting doctors and researchers in the process of identifying subpopulations of patients suffering from chronic diseases who are less likely to participate in self-management. There is a need for an increase in the number of scientific efforts made to explain the majority of the components that contribute to the intricate nature of patient activation for self-management.

101. A Comparative Study of Dexmedetomidine versus Midazolam with Fentanyl for Monitored Anaesthesia Care in Tympanoplasty under Local Anaesthesia
Sumaiya Tahseen, Prabhakar S, Subi Krishnan, Arun Sampath
Background and Aims: Monitored anaesthesia care is a process in which several medicines are used to administer local anaesthesia and sedation. This comparative study was done to determine the safety and efficacy of Dexmedetomidine and midazolam with fentanyl for tympanoplasty under MAC. Methods: Sixty patients between the ages of 18 and 60 years who were scheduled for tympanoplasty under MAC were randomly divided into two groups. Group D (n = 30) patients were administered intravenous (IV) dexmedetomidine 1 mcg/kg as a bolus followed by 0.2 ml/kg/h normal saline infusion. Patients in Group MF (n =30) received intravenous administration of midazolam 0.05 mg/kg + fentanyl 1.5 mcg/kg as a bolus, followed by 0.2 ml/kg/h normal saline infusion. Intraoperatively, the heart rate (HR), mean arterial pressure (MAP), amount of sedation, and degree of analgesia were evaluated. Postoperatively, Pulse Rate (PR) and Mean Arterial Pressure (MAP) were evaluated. The data were analyzed using an unpaired t-test. Result: Dexmedetomidine produced significant decrease in heart rate and mean arterial pressure, improved sedation and analgesia during surgery, and a reduced need for rescue sedative and analgesic dosages. Conclusion: Dexmedetomidine is superior to midazolam and fentanyl for sedation and analgesia during tympanoplasty surgery under supervised anaesthetic care because it results in a better hemodynamic profile, sedation, and analgesia.

102. A Prospective Observational Study of Histopathological Changes in Gallbladder Mucosa Associated with Cholelithiasis
Kritika Gyanchandani
Introduction: Gallstones are responsible to produce varies histopathological changes in the gall bladder. Our aim of this study was to correlate various gallstone characteristics with the type of mucosal response in gall bladder. Materials and Methods: The observational study was conducted on 72 cholecystectomy specimens with complete gallstones. The stones were assessed for various parameter. For microscopy, sections were obtained from the fundus, body and neck of the gallbladder. Additional sections were taken from abnormal looking areas. Results: Morphological types of gallstones among the 72 cases found were as follows: 64% had mixed stones, 20% combined, 9% pigment stones, and 7% cholesterol stones. Number of stones varied from a single calculus in 30%. Majority (52 specimens) of HPE shows chronic cholecystitis. Pigment stones appears to correlate with severity of inflammation (6/16 in Grade I inflammation, 18/22 in Grade III inflammation). Conclusion: We conclude that pigment gallstones are association with severe inflammation and higher degree of fibrosis. Gall stone also leads to the gallbladder mucosa changes from cholecystitis, hyperplasia, and metaplasia to carcinoma.

103. Role of Immunohistochemistry and Its Correlation with Histopathological Diagnosis of Lymphomas
Narmatha M., Maheswari J., Premalatha A.
Introduction: Currently, the diagnosis of lymphomas relies on immunophenotyping in addition to morphological features and relevant clinical data. According to WHO classification, lymphomas are categorized into Hodgkin’s and Non-Hodgkin’s lymphomas, further subclassified as T cell, B cell and NK cell types based on the cell lineage, stage of maturation and function. Appropriate selection of panel of antibody markers according to histopathological diagnosis is essential for definite and accurate diagnosis. Aims and Objectives: (1) To analyze the incidence and spectrum of morphological features of lymphomas. (2) Role of immunohistochemistry in subtyping of nodal and extranodal lymphomas and its correlation with histopathological diagnosis. Materials and Methods: This retrospective study includes 30 cases received in the Department of Pathology, KAP Viswanatham Govt Medical College, Trichy from January 2019 to December 2021. The distribution of cases were determined according to age, sex and site. Formalin–fixed, paraffin-embedded tissue sections were stained with Hematoxylin and eosin stain., Histopathological diagnosis based on revised 2016 WHO classification and final diagnosis using panel of IHC markers was done. Results: Among 30 cases, 18 cases(60%) were females and 12 cases (40%) were males. Female to male ratio 3:2. The predominant age group being 50-60 years followed by 40-50 years. Non-Hodgkin’s lymphoma (80%) were found to be more common than Hodgkin’s lymphoma(20%). In NHL, B-cell lymphomas accounted for 80% and T-cell lymphomas 20% among which most common subtype is Diffuse large B cell type (37.5%), followed by Follicular lymphoma (25%), Peripheral T cell lymphoma (16%), Marginal zone lymphoma (0.5%), Lymphoblastic lymphoma (0.5%) and NK/T cell lymphoma (0.5%). Conclusions: NHL is more common than HL. To avoid pitfalls in the diagnosis of lymphoma , clinical details, definite pathological criteria for each lymphoma and its correlation with immunophenotyping, molecular genetic testing, and cytogenetical analysis are essential.

104.A Clinical Study of Corneal Complications of Cataract Surgery at BMIMS, Pawapuri, Nalanda, Bihar
Farmood Alam, Amit Rajan, Arun Kumar Sinha
Background: In this study, we examine the prevalence of ocular problems following manual small incision cataract surgery and extra capsular cataract extraction (ECCE) (SICS). We research the many preoperative, intraoperative, and postoperative prophylactic procedures that can be used to prevent these problems as well as the various etiological factors that contribute to them. Methods: From October 2021 to November 2022, 100 patients underwent cataract surgery at the Department of Ophthalmology, BMIMS, Pawapuri, Nalanda, Bihar. Two groups of patients were randomly assigned. The 50 patients in Group A underwent ECCE with PCIOLs, whereas the 50 patients in Group B underwent minor incision cataract surgery with PCIOLs. Results: Five post-operative cases (10%) in ECCE and four instances (8%) in SICS experienced corneal edoema on the first post-operative day. In 4 cases of ECCE (8%) and 3 cases of SICS (6%), striate keratitis manifested. In contrast to 52% of instances in SICS, nearly 62% of patients who underwent ECCE accepted cylinders between 0.25-0.75 D. Conclusions: We draw the conclusion from this study that different advancements in cataract surgery have decreased the incidence of corneal complications, assisted in early visual rehabilitation, and minimised post-operative astigmatism by careful selection of incision type and placement for MSICS.

105.A Clinical Profile of Fungal Corneal Ulcer at BMIMS, Pawapuri, Nalanda, Bihar
Farmood Alam, Arun Kumar Sinha, Amit Rajan
Background: A corneal irritation brought on by fungi is called a fungal keratitis. This infection can cause significant visual damage or perhaps blindness and is challenging to treat. Although it is found throughout, the tropics and subtropics are where it is most prevalent. In tropical developing nations, corneal ulcers rank second after cataracts as the leading cause of avoidable blindness. Methods: From March 2020 to February 2022, a retrospective study involving 50 instances of fungal corneal ulcers was conducted at BMIMS, Pawapuri, Nalanda, Bihar, by the department of ophthalmology in cooperation with the department of microbiology. Results: The age group of 41 to 60 years saw the highest prevalence of ulcers, and the majority of those affected were men. Trauma was the most prevalent predisposing factor. Slough was the most frequent clinical characteristic, followed by satellite lesions, hypopyon, perforation, decreased intraocular tension, and vascularization. Conclusion: Fungal keratitis is typically difficult to diagnose. Unquestionably, the ophthalmologist’s clinical suspicion is a crucial factor in determining the diagnosis of a fungal infection of the cornea. For the laboratory diagnosis of fungal keratitis, a wide range of conventional and molecular methods are currently available. To prevent blindness, early diagnosis and effective treatment are crucial.

106.An Epidemiological Study on Gynaecological Malignancies among the Patients Attending the Out-Patient Department of Obstetrics and Gynaecology, JNKTMCH, Madhepura, Bihar
Manoj Kumar, Poonam Kumari, Kamalini Kumar, Chanchal, Kashif Shahnawaaz
Background: In this study, we examine the prevalence of ocular problems following manual small incision cataract surgery and extra capsular cataract extraction (ECCE) (SICS). We research the many preoperative, intraoperative, and postoperative prophylactic procedures that can be used to prevent these problems as well as the various etiological factors that contribute to them. Methods: From October 2021 to November 2022, 100 patients underwent cataract surgery at the Department of Ophthalmology, BMIMS, Pawapuri, Nalanda, Bihar. Two groups of patients were randomly assigned. The 50 patients in Group A underwent ECCE with PCIOLs, whereas the 50 patients in Group B underwent minor incision cataract surgery with PCIOLs. Results: Five post-operative cases (10%) in ECCE and four instances (8%) in SICS experienced corneal edoema on the first post-operative day. In 4 cases of ECCE (8%) and 3 cases of SICS (6%), striate keratitis manifested. In contrast to 52% of instances in SICS, nearly 62% of patients who underwent ECCE accepted cylinders between 0.25-0.75 D. Conclusions: We draw the conclusion from this study that different advancements in cataract surgery have decreased the incidence of corneal complications, assisted in early visual rehabilitation, and minimised post-operative astigmatism by careful selection of incision type and placement for MSICS.

107.Identification of A Better Strategy to Control Anemia in Adolescent Girls in Singheshwar, Madhepura, Bihar
Manoj Kumar, Poonam Kumari, Kamalini Kumar, Chanchal, Kashif Shahnawaaz
Background: Intense physical, psychological, and cognitive development occurs during adolescence. The fact that teenagers gain up to 50% of their adult weight, more than 20% of their adult height, and 50% of their adult skeletal mass at this time explains the increased dietary needs at this point. Due to increasing demands for blood volume expansion brought on by teenage growth spurts and the start of menstruation, adolescent girls have higher than average iron needs. The prevalence of iron deficiency anaemia among women, particularly teenage girls, is highest in India. Anemia affects 60–70% of adolescent girls in India. Objectives: To gather baseline information on haemoglobin (Hb) levels of adolescent girls attending anganwadi centres (11–18 years old) in Singheshwar, Madhepura, Bihar from August 2020 to December 2021; to compare the effectiveness of once-weekly and once-daily iron-folate tablet administration with regard to impact on the Hb levels; and to determine the impact of additional ascorbic acid supplementation on the effectiveness of iron-folate administration. Methods: The baseline assessment for this prospective randomised research includes assessments of Hb levels, weight, and height. After three months and six months of supplementation, the Hb levels of the enrolled subjects were assessed once more. Results: 61.9% of the participants had anaemia. Hb levels responded better to daily iron/folic acid intake than they did to once-weekly supplementation. The increase in individuals’ haemoglobin levels brought on by the addition of vitamin C to iron and folate treatment was greater than that brought on by iron and folate administration alone. Conclusions: A public health approach that entails once-weekly distribution of iron/folate supplements through welfare centres and schools is preferable and can be suggested as an effective technique for battling anaemia in adolescent girls from underprivileged populations in developing nations like India.

108.A Study of Incidence and Clinical Profile of Cardiac Arrhythmias in Patients Presenting with Acute STEMI Admitted in Medicine Department, KMCH, Katihar, Bihar
Md. Aftab Alam, Major Durga Shankar
Background: Tachycardias and other abnormally fast or slow heartbeats are examples of cardiac arrhythmias, which are disruptions in the heart’s rhythm (bradycardias). Patients who notice these irregularities most frequently have palpitations, which some describe as feeling like “my heart is rolling around in my chest” or being aware of how quickly or slowly their hearts are pounding. Other signs and symptoms include fatigue, breathlessness, lightheadedness, dizziness, syncope, and, on rare occasions, chest pain. When the rate is higher, ventricular function is worse, or the arrhythmia is linked to anomalies in autonomic tone, the symptoms frequently become more severe. This study’s goal was to determine the prevalence and clinical characteristics of cardiac arrhythmia in acute STEMI. Methods: There were 100 acute MI patients in total who were investigated. Acute myocardial infarction symptoms, new ischemic ECG alterations, the development of pathological Q waves, imaging evidence of new loss of viable myocardium, or new regional wall motion abnormality in a pattern compatible with an ischaemic origin were used to make the diagnosis of MI. Arrhythmia in all patients was recorded using a Holter monitoring and multipara monitor for the first 48 hours. Result: Out of 100 patients, 86 had some sort of arrhythmia. Out of 30 females and 70 males, 27 (90%) and 59 (84.2%), respectively, experienced arrhythmia. Conclusion: The most common arrhythmia overall was VPC (80.23%), followed by AIVR and CHB (11.63% each), and VT (9.30%). As compared to Antero-lateral and Infero-lateral STEMI (<75%), the majority of patients with anterior, inferior, and infero-posterior wall STEMI have arrhythmia (>85%).

109.Study of Linezolid and Vancomycin Susceptibility in Methicillin Resistant Staphylococcus aureus Isolates from Clinical Specimens in a Tertiary Care Hospital
Sukhada Buwa, Rashmi Bawane, Hemangi Ingale, Shubhra Sengupta, Sunita Bhandari
Objectives: (1) To estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections. (2) To study the susceptibility pattern of MRSA to linezolid (LZD) and Vancomycin. Materials and Methods: A cross-sectional observational study was carried out for a period of one and half years. 370 S. aureus isolates from different clinical specimens were studied for their antimicrobial susceptibility pattern to cefoxitin (as a surrogate marker for Methicillin resistance), linezolid and vancomycin as per CLSI guidelines. Results: Out of 370 isolates of Staphylococcus aureus, 165 were MRSA (44.5%). None of the MRSA isolate were resistant to vancomycin and linezolid. Conclusion: Strict infection control practices should be implemented to prevent the spread of the MRSA in healthcare settings. Also, regular screening of these isolates for development of resistance to Linezolid and Vancomycin is essential to prevent treatment failure.

110.To Study the Amount of Deformity Correction Attained after Pre and Post Operative Total Knee Replacement
Aravind U R, K Kumaran Chettiar, Jacob Mathew
Total knee arthroplasty, another name for total knee replacement, is a surgical treatment used to replace the weight-bearing surfaces of the knee joint in an effort to reduce pain and impairment. It is performed for arthritic knees, which can be brought on by a variety of secondary factors in addition to basic osteoarthritis. Surgery may be riskier and more difficult for individuals who have significant deformities brought on by advanced rheumatoid arthritis, trauma, or osteoarthritis. In order to treat osteoarthritis in the knee, total knee replacement is increasingly performed on senior patients. But if not planned appropriately, a lot of procedures might fail early. The mechanical and anatomical angles of the tibia and femur must be calculated for planning purposes. In this study, calculations of such angles are made. In this study, calculations of these angles are made, and the results are compared to normal values gleaned from several earlier investigations. This shows that the mechanical alignment of the knee may not always need to be corrected in order to rectify the anatomical alignment of the distal femur and proximal tibia. As a result, the mechanical alignment of the anatomically aligned knee is not necessary, and further testing is required to determine the ideal alignment for total knee replacement patients. This necessitates long-term follow-up research.

111.A Retroprospective Clinicopathological Study of Associated Lesions in Benign Prostatic Hyperplasia and Prostatic Adenocarcinoma in Surgical Biopsy Specimens
Kritika Gyanchandani
Introduction: Benign prostatic hyperplasia and Carcinoma of the prostate are increasingly frequent with advancing age. The aim of the present study is to study the spectrum of prostatic lesions among the biopsies received in our hospital. Materials and Methods: This retrospective study was conducted on 104 specimens which received in Department of Pathology, Shri Shankaracharya institute of medical sciences (SSIMS). The biopsy material included transuretheral resection of prostate specimens, needle biopsies, both trucut and core needle biopsies. Results: Out of 104 cases analyzed, 90 were TUPR specimens, 12 were trucut needle biopsies and 02 were open prostatectomy specimens. Majority of the specimen (92) showed BPH, 86 from TURP, 04 from trucut biopsy and 02 from open prostatectomy specimen. Conclusion: The present study showed that the most frequently encountered prostatic lesion was BPH, commonly seen in the age group of 61 to 70 years. The prostatic Carcinoma was common among males of more than 60 years. Histopathological examination is the best diagnostic tool for prostatic Carcinoma.

112.Clinical Presentation and Management of Primary Hyperparathyroidism: A Single Centre Experience
Rajeshkumar Mahey, Asma Khalife, Jenny Thomas, Praveen Kumar, Abhi H Kothari, Tejas P Narkhede
Background: Primary Hyperparathyroidism (PHPT) is the 3rd most common endocrine disorder. The clinical presentation of primary hyperparathyroidism has undergone a paradigm shift with asymptomatic PHPT being the predominant form in the western world. In developing countries like India PHPT still presents as a severe symptomatic disorder typically described by Fuller Albrights as “Stones, Bones, Groans, & Moans”. Aim: The study aims to present the clinical profile and management outcome of PHPT at our centre in western India. Method: In this retrospective study, we analyzed the clinical presentation, biochemical profile, radiological features, management and its outcome in 30 histopathologically proven patients of PHPT over a period of 3 years (2018-2021) at a tertiary care Centre in western India. Results: The disease was seen predominantly in the age group of 50-60 years. The median age of presentation was 50.5 years. There was female preponderance with the female to male ratio being 3:1.The majority of patients this study were overtly symptomatic (94%) and only 6% of cases presented as asymptomatic PHPT. In symptomatic group 50% of patients had skeletal manifestations, around 43% of patients had renal calculi and 40% had GI symptoms like gastric or duodenal ulcer & acute pancreatitis. The mean preoperative calcium and iPTH levels were 11.2mg/dl & 304.4pg/ml respectively. The diseased parathyroid was localized radiologically in all cases. For preoperative localization The sestamibi scan had the highest sensitivity (88.8 %) whereas USG had the greatest positive predictive value (94.7%).Most of the patients (70%) in this study had single gland adenoma & were subjected to focused parathyroidectomy . At the end of 6 months, only 2 patients (6.6%) had a persistent disease and were subsequently managed by bilateral neck exploration. Conclusion: The majority of patients of PHPT at our institute had a classical symptomatic presentation with skeletal and renal manifestations. The surgical cure rate was 90% with Focused parathyroidectomy being the main surgical approach.

113.Exteriorization and Intraperitoneal Closure of Uterus in Caesarean Delivery: A Comparative Study
Manjula A. Patil, Vindhyashree S.
Background: Caesarean delivery is the most common intraperitoneal surgical procedure in obstetrics. Many surgical techniques for caesarean delivery have been described, and the debate about the ideal caesarean technique to minimize morbidity is going on still. Aim: To assess the intraoperative and postoperative advantages and disadvantages following exteriorization of uterus at caesarean section with intraperitoneal repair of uterus. Methods: It is a RCT conducted at Adichunchanagiri Institute of Medical Sciences, B G Nagar, Mandya. Minimum of 100 cases, 50 each were randomly allocated into exteriorised  and insitu groups. All patients who were undergoing emergency and elective caesarean delivery under spinal anaesthesia were randomly allocated into Exteriorization and intraperitoneal group. In exteriorization group, uterus is exteriorized after delivery of foetus and placenta for repair, whereas in intraperitoneal group in situ repair was done. A pfannenstiel incision was taken for all the cases. Placenta was removed either by controlled traction after spontaneous separation or manually. Uterus was exteriorized after delivery of placenta and may be repaired by single or double layer. Visceral and parietal peritoneum are not closed. Results: There is significant difference in the operating time in the exteriorization group and in the in situ group. But no significant difference between 2 groups regarding nausea, vomiting intra operatively, in return of bowel function, number of analgesic doses, incidence of cystitis, endometritis and wound infection. Period of hospitalization were also same in both groups. Conclusions: Exteriorization of uterus at caesarean delivery has the advantages less perioperative haemoglobin reduction, good exposure, good access to incision angle, specially during difficult extraction. Easy identification of uterine anomaly, adnexal mass if present and exposure of posterior aspect of lower segment.

114.Diabetes Mellitus in Pregnancy: A Tertiary Care Hospital Experience
Mahendra Kumar, Priyanka Meena, Santosh Meena, Anushikha, Mohd Shakeel
Background: In this study, we examine the prevalence of ocular problems following manual small incision cataract surgery and extra capsular cataract extraction (ECCE) (SICS). We research the many preoperative, intraoperative, and postoperative prophylactic procedures that can be used to prevent these problems as well as the various etiological factors that contribute to them. Methods: From October 2021 to November 2022, 100 patients underwent cataract surgery at the Department of Ophthalmology, BMIMS, Pawapuri, Nalanda, Bihar. Two groups of patients were randomly assigned. The 50 patients in Group A underwent ECCE with PCIOLs, whereas the 50 patients in Group B underwent minor incision cataract surgery with PCIOLs. Results: Five post-operative cases (10%) in ECCE and four instances (8%) in SICS experienced corneal edoema on the first post-operative day. In 4 cases of ECCE (8%) and 3 cases of SICS (6%), striate keratitis manifested. In contrast to 52% of instances in SICS, nearly 62% of patients who underwent ECCE accepted cylinders between 0.25-0.75 D. Conclusions: We draw the conclusion from this study that different advancements in cataract surgery have decreased the incidence of corneal complications, assisted in early visual rehabilitation, and minimised post-operative astigmatism by careful selection of incision type and placement for MSICS.

115.A Prospective Randomized Assessment of the Effectiveness of Magnesium Sulphate and Lignocaine for Attenuation of Haemodynamic Responses during Laryngoscopy and Intubation
Amish Kumar, Rishi Kant, Rajesh Verma
Aim: To compare the effectiveness of magnesium sulphate and lignocaine for attenuation of haemodynamic responses during laryngoscopy and intubation. Methodology: It is Prospective Randomized study was done in Department of Anesthesia and critical care, Patna Medical College and Hospital, Patna, Bihar for 12 months. 100 Patients scheduled for various elective surgical procedures under general anaesthesia, belonging to ASA class I and II were included in the study which were divided into two groups with 50 cases in each group. In group A, patients received 1.5mg/kg of preservative free 2% lignocaine intravenously 90 seconds before laryngoscopy. IN group B, patients received 30 mg/kg of magnesium 90 seconds prior to laryngoscopy. The following cardiovascular parameters were recorded in all patients: Heart rate [HR] in beats per minute, systolic blood pressure [SBP] in mm of Hg, diastolic blood pressure [DBP] in mm of Hg, mean blood pressure [MBP] in mm of Hg. All the parameters were monitored in the following time interval of Base line (before giving study drug), Post induction (Pre-laryngoscopy), and 1,3,5 and 10 min after laryngoscopy and intubation. Results: The age range was 20-60 years in both the groups. There was no statistically significant difference between the groups with regard to age and so they are comparable. (p=0.62). In group A, 76% of the patients were male and 24% were females. In group B, 68% of the patients were males and 32% were females. Intergroup comparison between the two groups showed that the SBP at 1, 5 and 10 minute after laryngoscopy in magnesium group were statistically significantly lower compared to lignocaine group (P<0.05). At 3 minute SBP was lower in magnesium group but not statistically significant when compared with lignocaine group. In Magnesium group the post induction DBP values was significantly lower compared to its baseline. At 1 minute there was slight increase in mean DBP which returned near baseline value by 3 minutes. At 5 min and 10 minutes values were significantly lower when compared to its baseline. Whereas in Lignocaine group statistically significant increase in DBP compared to baseline was seen only at 1 minute after laryngoscopy. MBP at 1 minute after laryngoscopy in magnesium group was statistically significantly lower compared to lignocaine group. At 3, 5 and 10 minutes MBP was lower in magnesium group but not statistically significant when compared with lignocaine group. Conclusion: The current study revealed that magnesium sulphate provide fairly good and sustained control over haemodynamic responses to the stress of laryngoscopy and intubation and is significantly better than lignocaine, so we conclude that magnesium sulphate is more efficient as compared to lignocaine for attenuation of stress responses of laryngoscopy and intubation.

116.A Randomized Controlled Comparative Assessment of the of Incidence and Severity of Nasal Complications While using Nasal Prongs and Nasal Mask as CPAP Interface in Preterm Neonates
Mohammed Shamim, Tanmoy Patra, Nupur Kumari
Aim: This study was conducted to compare the outcome of nasal prong and nasal mask interfaces in preterm infants on CPAP support due to respiratory distress. Methods: A randomized controlled trial was performed at Department of Pediatrics, Nalanda Medical College and hospital Patna, Bihar, India for the period of six months. Results: A total of 148 preterm infants were assessed for eligibility to the study of which 28 newborns were excluded from the study as they did not meet the inclusion criteria. A total of 120 babies were enrolled in the study, of which 12 babies were ventilated due to CPAP failure and 8 babies left against medical advice before the study could be completed and hence were excluded. Finally, 100 participants completed the study. 50 participants were enrolled in Group A (nasal prongs) and 50 in Group B (nasal masks). The mean duration of CPAP administration in Group A (nasal prongs) was 4.536 ± 0.86 days and in Group B (nasal masks) was 5.205 ± 0.614 days (P = 0.0778). Babies in Group A had an average hospital stay of 21.36 ± 5.14 days, and babies in Group B had hospital stay of 24.58 ± 7.31 days (P = 0.7900). CPAP failure was seen in 10 (20%) babies in Group A and 11 (22%) babies in Group B (P = 0.7395). Conclusion: Based on our study, we concluded that the use of binasal prongs and nasal masks as interface during CPAP therapy makes no difference in overall outcome of nasal trauma in the patient. Both were found equally effective and comparable to each other.

117.A Prospective Observational Assessment of Atypical Presentation of Acute Myocardial Infarction
Abhay Kumar Sinha, Rakesh Kumar, Ashok Kumar, Devendra Kumar Sinha
Aim: In this study atypical presentations of AMI and in-hospital mortality and outcome were evaluated. Methods: The present study was conducted at Department of  Geriatric  Patna medical college and Hospital, Patna, Bihar, India for the period of 9 months. We studied 100 patients of AMI admitted in the CCU who fulfilled the inclusion criteria. Results: Of all the 100 patients diagnosed as having MI, 20 (20%) patients presented with atypical presentation to the hospital. The maximum incidence of AMI with atypical presentations was in the age group of 61-65 years followed by the age group 66-70 years. Presentation of dyspnoea (35%) was the most among the atypical symptom followed by vomiting 25%, excessive sweating 25% and the least incident with vertigo 5%. Among the other presentations syncope 16%, epigastric pain 10% and Palpitation 10%. Conclusion: The patients without chest pain represent a substantial segment of the MI population. Older patients presented with more atypical symptoms with breathlessness being the commonest atypical symptoms. Mortality was high among the patients who presented with atypical symptoms, increasing age, and who presented lately.

118.Chronic Pancreatitis: Clinical Profile and Management
Himanshu Kumar,  Kumar Ratnesh, Arun Kumar Singh, Anamica Arya
Aim: The aim of the present study was to evaluate clinical profile and management of chronic pancreatitis with respect to demography, clinical findings, lab parameters, imaging investigations and management modalities in tertiary care hospital in Bihar region. Methods: The present study was conducted in the Department of General Surgery, Jawahar Lal Nehru medical College and Hospital, Bhagalpur, Bihar, India to study clinical profile and management of chronic pancreatitis and the study was conducted for the period of six months. 100 patients were included in the study. Results: It was observed that majority of patients were in age group 51-60 years (45%) followed by 41-50 years (25%) The mean age of the patients was 56.54±12.68 years. There were 75 males as compared to 25 females in the present study. The study revealed that majority of patients had etiology of alcoholism (45%) followed by idiopathic (30%), gall stones (20%) and post-operative (5%). It was observed that majority of patients presented with pain in abdomen (40%) followed by nausea/vomiting (25%), Steatorrhea (15%), weight loss (10%), constipation (6%) and diarrhea (4%). Conclusion: Primarily, chronic pancreatitis is not a surgical disease, Surgery is indicated only when medical treatment fails and/or complication arises. There is no single ideal operation for chronic pancreatitis. Selection of an appropriate method of management for a particular patient is more important.

119.A Hospital Based Prospective Outcome Assessment of Minimally Invasive Spine Decompression in Lumbar Spinal Stenosis and Intervertebral Disc Prolapse
Abhas Kumar, Kumar Gaurav, Rajeev Anand, N.P. Sinha
Aim: The purpose of the present study was to assess the outcome in terms of improvement in neurology, extent of pain relief in the postoperative period and complications in patients undergoing minimally invasive spine decompression by tubular retractors. Methods: We conducted a prospective interventional study in the Department of Orthopaedics, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India for the period of 6 months. 20 patients were included in the study. Patients with low back ache and leg pain between 18-60 age who were diagnosed with lumbar canal stenosis and intervertebral disc prolapse who failed to respond to trial of conservative management for 6 weeks were included. Results: 4 patients belonged to 21-40 years of the age group and 16 patients belonged to 41-60 years of the age group. Patient’s age ranges from 24 years to 60 years. 12 patients (460%) were male and 8 patients (40%) were female. Out of 20 patients, 13 (65%) patients had intervertebral disc prolapse and 7 patients (35%) had lumbar spinal stenosis L4L5 (55%) was the most commonly involved level, 11 patients had L4L5 level, 4 patients had L3L4 (20%) and 4 patients had L5S1 (20%). Only one patient (5%) had L2L3 involvement who had sacralised L5. Conclusion: Minimally invasive spine decompression using tubular retractors is an excellent surgical option for patients suffering from lumbar spinal stenosis and intervertebral disc prolapse due to its minimally invasive nature, high success rate, and long-term outcomes.

120.A Cross Sectional Study to Assess the Non-Adherence to Inhalational Medication in Bronchial Asthma Patient as Well as to See the Factors Responsible for Non-Adherence
Abhay Kumar Sinha, Devendra Kumar Sinha, Ashok Kumar, Rakesh Kumar
Aim: The objective of the present study was to assess the non-adherence to inhalational medication in bronchial asthma patient as well as to see the factors responsible for non-adherence. Methods: The present study was conducted at Department of Geriatric Patna medical college and Hospital, Patna, Bihar, India for one year and 200 patients were included in the study who met inclusion criteria. Results: A total of 200 asthmatic patients who meets the inclusion criteria were included in the study. Among the total of study participants, higher proportions of patients were female (58%). Most of the participants (45%) were in between 18 and 30 age group. Large number of the respondents, 120 (60%) were unable to read and write. A total of 19% patients had previous history of adverse drug reaction (ADR) to inhalational anti asthmatic medications. The mean (±standard deviation) duration of years living with the disease was 6.09 ± 3.13 ranging from 2 to 19 years. Respondents who were not taking inhaler education were found to be 20%, whereas 7% were smokers. Among the total participants, poly pharmacy was present in 30% of them. Regarding to co-morbidity, 40% of the participants has had at least one more disease in addition to asthma. Conclusion: The rate of non-adherence is very high amongst the participants. Therefore promoting optimal medication adherences through education, proper counseling is essential to optimize the benefits of treatment.

121.A Cross-Sectional Study to Elucidate the Indications for HFNC Therapy in Children of All Ages and Diagnoses, and to Evaluate the Efficacy and Risk Factors for Failure of HFNC Therapy
Tanmoy Patra, Mohammed Shamim, Naz Yasmeen
Aim: The aims of this study were to elucidate the indications for HFNC therapy in children of all ages and diagnoses, and to evaluate the efficacy and risk factors for failure of HFNC therapy. Methods: A cross-sectional study was undertaken at Department of Pediatrics, Nalanda Medical College and hospital Patna, Bihar, India and consecutive patients with respiratory distress necessitating admission to PICU, in the age group of 1 month to 16 years of age were included. Results: A total of 200 children were commenced on HFNC therapy. HFNC failure occurred in 20 children at a median (IQR) time of 2 (1.75-24) hours. In univariate regression analysis, respiratory clinical score [Hazard ratio (95% CI) 4.9 (2.1-11.2), P=0.001]; SF ratio [HR (95% CI) 0.94 (0.97-0.99), P=0.012]; and COMFORT score, [HR (95% CI)1.99 (1.4-2.8), P=0.001] on admission were associated with HFNC failure. In multivariable regression analysis, none of these parameters were associated with increased risk of HFNC failure, respiratory clinical score [HR (95% CI) 2.26 (0.84-7.7), P=0.09], SF ratio, [HR (95% CI) 0.99 (0.97- 1.00), P=0.29] and COMFORT score [HR (95% CI) 1.39 (0.88-2.21), P=0.15]. Conclusion: HFNC is an effective and safe primary mode of respiratory support in children with respiratory distress due to various causes. Children who succeed on HFNC show favourable response within first few hours and response is sustained over the next few days.

122.Randomized Controlled Prospective Postoperative Assessment of Analgesic Efficacy of the Pulmonary Recruitment Manoeuvre Compared to Intraperitoneal Hydrocortisone in Laparoscopic Gynaecological Surgeries
Amish Kumar, Rishi Kant, Rajesh Verma
Aim: To investigate the hypothesis that PRM is superior to intraperitoneal hydrocortisone for postoperative pain reduction in patients who have undergone laparoscopic gynaecological surgery. Methodology: A prospective, randomized, controlled study was conducted in Department of Anesthesia and critical care, Patna Medical college and hospital, Patna, Bihar, India for one year. Female patients of American Society of Anesthesiologists (ASA) physical status I and II, aged between 20 and 45 years, scheduled for diagnostic laparoscopic gynaecological surgeries done as a part of infertility management were enrolled to participate in this study. The day before surgery, all patients had pre-anesthesia check-up with routine and subjective investigation as per requirement. The visual analogue score (VAS) was explained to the patients (where 0 = no pain and 10 = worst imaginable pain). A written valid informed consent was obtained from the patients. By the end of the operation, using a computer-generated randomization schedule, patients were randomly assigned into three equal groups i.e. Hydrocortisone group, pulmonary recruitment group, and control group. Vital measurements, (blood pressure and heart rate) were also recorded hourly for the first 24 h. The primary outcome was the first 24 h total analgesic consumption. Results: There was no statistically significant difference between the three groups in demographic details. In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions. There was a statistically significant difference between both the hydrocortisone and the pulmonary recruitment groups in comparison with the control group as regards 24 h postoperative total analgesic consumption. Also, the first request for analgesia was less in both the hydrocortisone and the pulmonary recruitment groups as compared to the control group with a significant. Conclusion: Our study demonstrates that performing a pulmonary recruitment maneuver at the completion of laparoscopic surgery significantly reduces pain after gynecologic laparoscopy. Both intraperitoneal hydrocortisone installation and the pulmonary recruitment maneuver could effectively reduce pain but intraperitoneal hydrocortisone might give a longer pain-free time following gynaecological laparoscopies.

123.A Randomized Comparative Assessment of Intubating Conditions and Hemodynamic Effects after Administration of Rocuronium and Succinylcholine for Endotracheal Intubation in Adult Patients for Elective Surgeries
Rishi Kant, Rajesh Kumar Choudhary, Vijayendra prasad
Aim: To compare rocuronium 0.9mg/kg and succinylcholine 2 mg/kg for tracheal intubation at 60 seconds after the administration of muscle relaxants in patients undergoing elective surgeries. Methodology: A randomized controlled study conducted on Department of Anesthesia, Bhagwan Mahavir institute of Medical Sciences, Pawapuri, Nalanda, Bihar, India for one year. 50 adult patients American society of anesthesiologist grade I and II patients. All patients underwent pre-anesthetic evaluation and relevant investigations one day prior to surgery. All patients underwent pre-anesthetic evaluation prior to surgery and written informed consent was obtained. Oral Pantoprazole 40 mg, Alprazolam 0.25mg were given. Patients were randomly assigned to 2 equal groups R and S (n=25) according to computer generated list. Group S received Succinylcholine 2 mg/kg intravenous. Group R received Rocuronium 0.9 mg/kg intravenous. The pulse rate and blood pressure were recorded before and after induction, after injection of muscle relaxant and at 1-, 2-, 3- and 5-min following intubation. Results: In the present study, based on intubating conditions in Rocuronium group, 16% showed score 7, 44% scored 8 and 40% scored 9. Whereas in Succinylcholine group, score 7 was noted in 16%, score 8 in 52% and score 9 in 32%. There was no statistically significant association observed with relation to intubating conditions between the study groups. A higher SBP was recorded in Succinylcholine group compared to Rocuronium group at Post induction, Post muscle relaxant use, 1 Min, 2 Min, and 5 min. At Post induction, Post muscle relaxant use, 1 min this difference was observed to be statistically significant. A higher DBP was recorded in Succinylcholine group compared to Rocuronium group at Post induction, Post muscle relaxant use, at post muscle relaxant use, this difference was observed to be statistically significant. Conclusion: There was no significant change in hemodynamic variables after the administration of Succinylcholine and Rocuronium. There were significant changes in the heart rate and mean arterial pressure with the use of Rocuronium following one minute after the intubation which became preinduction value after 5 minutes. Hence, rocuronium bromide (0.8 mg/kg) can be used as an alternative to Succinylcholine (1.5 mg/kg) in selected situations.

124.COVID-19 Vaccination Status and Attitude Towards COVID-19 Pandemic among Medical Students: An Online Cross-Sectional Survey
Ramesh Agrawal, Chakresh Jain, Pankaj Kumar Jain, Pratik Akhani
Aims: Medical students belong to frontline health care providers of future. Risk of COVID 19 exposure is more among medical students, and COVID 19 vaccination plays very crucial role for controlling COVID 19 pandemic. Hence, this study was planned with the objective to evaluate attitude of medical students towards COVID 19 pandemic and their vaccination status. Materials and Methods: We conducted an online web-based survey among medical students of Madhya Pradesh, India. Online Google form-based Questionnaire was sent through WhatsApp groups, and responses were collected and analysed. Voluntary consent was obtained through from all the participants. Findings: A total of 516 medical students from different medical colleges of Madhya Pradesh voluntary participated in this study. Out of that majority of the participants were in 18-20 years’ age groups, unmarried and belonged to rural areas. Most of them were worried about their MBBS studies due to COVID 19 pandemic. 71% of the medical students received two doses of the COVID 19 vaccination till 15the August, 2021. Conclusion: Medical students of Madhya Pradesh are worried about their MBBS course completion, examination and education shift towards online due to COVID 19 pandemic. There is a need of psychological counselling and awareness program regarding vaccination among medical students.

125.Prevelance of Central Nervous System Cryptococcosis in Human Immunodeficiency Virus Reactive Hospitalised Patients
Ashatha P, D. Sarada
Cryptococcosis is a systemic mycosis caused by two environmental species, Cryptococcus neoformans and Cryptococcus gattii. Cryptococcus neoformans is distributed worldwide and is primarily an opportunistic fungal pathogen, most commonly associated with HIV infection, meningoencephalitis being the most common presentation. Early diagnosis is essential to prevent the complications of Cryptococcosis as it is associated with high mortality and morbidity. Materials & Methods: We did a comparative study on detection of Cryptococcal infection by conventional method and latex agglutination. A total of 71 CSF samples from HIV seropositive cases, with clinical suspicion of Cryptococcal meningitis, were processed by conventional methods – Gram staining, India ink preparation, culture on Sabouraud’s Dextrose agar. Antigen detection was done on all CSF samples using latex agglutination test. Conclusion: The prevalence of Cryptococcal infection was found to be 7.04%. Latex agglutination was more sensitive (100%) than conventional methods (80%).

126.An Evaluation of CT Chest Features and its Association with Severity of Illness in H1N1 Influenza-Infected Patients
P. P. Balamurugan, S. Kanaga Durga, D. Jayaraja
Aim: To analyze in detail the CT chest features in H1N1 influenza-infected patients and their frequency of CT changes and lobar distribution. Also, to relate the radiological findings with the extent of hospital admission and ICU requirement. Materials and Methods: The study participants included patients hospitalized at Coimbatore Medical College Hospital with signs of flu, laboratory proven test for the Influenza viral infection, and undertaken CT chest. A total of 200 patients were involved in the study among which 62 patients undertook chest CT. Study participants were separated into two groups based on the duration of hospital stay with a cut-off of seven days. The CT images were examined and the radiological configuration was evaluated. The findings were designated as follows – Peripheral/ Central/Focal/ Multifocal /Diffuse. Results: CT chest findings were present in all patients with more than 7 days duration of admission and 40 percent in patients with less than 7 days hospital stay. In our study multifocal, peripherally distributed ground glass opacities were the most frequent radiological feature noted followed by the opacity due to consolidation. In our study, pleural effusion was present in 14 patients, among which 12 patients needed more than 7 days of hospital stay. Conclusion: Major discoveries in our study were ground glass opacities and consolidation. Outcomes of our study also recommend that in CT chest features will help in triage of patients and to foreseet he severity of the infection and further consequences.

127.A Clinical Comparison Between 0.5% Ropivacaine and 0.5% Ropivacaine with Magnesium Sulphate in USG Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries
Anita J Patel, Hanna Musa, Manthan Parmar, Nisarg Patel, Dixitkumar Modh, Khushboo Hadiya
Introduction: Ropivacaine is one of the recently synthesized long-acting local anaesthetic which belongs to the amide group. Magnesium Sulphate can be a good adjuvant to Ropivacaine in supraclavicular brachial plexus block. Its role in peripheral nerve blocks has only minimal literature and available literature has shown mixed results. Materials & Methods: This single blind randomized controlled study was conducted on patients undergoing elective upper limb surgeries at tertiary care hospital. Patients were randomized by using random number tables into two study groups with equal patients in both of the study. Group RN: received 30ml 0.5% Ropivacaine plus 1.5ml of normal saline, and Group RM: received 30ml 0.5% Ropivacaine plus 150 mg Magnesium Sulphate. This study was primarily compare the efficacy of supraclavicular block in both the groups in terms of the Duration of sensory block and Motor block, quality of analgesia, complications, and total duration of analgesia. Result: Patients receiving Ropivacaine & Magnesium Sulphate (446.6 ± 8.06 min) had longer duration of Sensory block than patients receiving Ropivacaine alone (289.43 ± 2.14 min). Patients receiving Ropivacaine & Magnesium Sulphate (368.4 ± 5.59 min) had significantly longer duration of Motor block than patients receiving Ropivacaine alone (242.3 ± 5.09 min). Requirement of first Rescue Analgesia was delayed in group RM (467.7±11.79 min) as compare to group RN (373.5 ± 3.4 min). Conclusion: Addition of 150 mg Magnesium sulphate to Ropivacaine 0.5% solution in ultrasound guided supraclavicular brachial plexus block for upper limb surgeries speeds up the onset of both sensory and motor blockade. It also lengthens the duration of sensory and motor blockade and reduces the requirement of rescue analgesic in postoperative period.

128.Comparison of Safety and Efficacy of Metformin and Vildagliptin versus Metformin and Glimepiride in Patients of Type – 2 Diabetes Mellitus (T2DM)
Derangula Sambasivaraju, K R Suresha, Byna Jayachandra Babu, S. Srimanth Madanna, Ravi H. Kudthni
Introduction: The common medication used to treat diabetes is metformin. Add-on therapy is advised if metformin is unable to effectively manage blood glucose levels. Dipeptidyl peptidase-4 (DPP-4) inhibitors and an incretin-based therapy have emerged as significant supplementary medications in Type – 2 Diabetes Mellitus (T2DM), replacing the usual and gold standard of adding a sulfonylurea to metformin to achieve tight glycaemic control. In order to assess and evaluate the efficacy and safety of vildagliptin-metformin versus glimepiride-metformin in patients with T2DM who were not satisfactorily managed with metformin alone, the current study was designed. Materials and Methods: A total of 30 patients were assigned to each of the glimepiride-metformin and vildagliptin-metformin groups. The study lasted for three months. At 0 week, 6 weeks, and 12 weeks, fasting plasma glucose, postprandial plasma glucose, adverse events were reported. Glycosylated haemoglobin levels were measured at 0 and 12 weeks. Result: When vildagliptin-metformin was compared to glimepiride-metformin, there was a substantial reduction in mean FBS, PPBS levels, and HbA1c% from baseline. The glimepiride metformin group was associated with considerably higher hypoglycemia, gastrointestinal problems, and weight gain than the vildagliptin-metformin group. Conclusion: The vildagliptin-metformin combination produced equivalent glucose control to the glimepiride-metformin combination. It also resulted in a lower risk of hypoglycemia, gastrointestinal symptoms, and weight gain, as well as an improved adverse event profile.

129.Correlation between Transcutaneous and Serum Bilirubin in Preterm Neonates Before, During and Post Phototherapy: A Prospective Observational Study
Rakesh Bairwa, Nishant Aswani, Prabhudev Basavaraj Hasbi, Jitendra Kumar Jain, Gopi Kishan Sharma, Amrit Lal Bairwa
Introduction: Hyperbilirubinemia is the single most common abnormal physical finding in majority of preterm neonates. Phototherapy plays a significant role in the treatment and prevention of hyperbilirubinemia in neonates. Transcutaneous measurement of bilirubin concentration is considered to be ideal for screening of neonatal jaundice as they are immediate and can indicate the need for total serum bilirubin testing. Reduction in number of invasive blood tests is associated with reduction in pain and discomfort for newborns and in parental distress and reduction in health costs. Aims and Objective: To study correlation between Transcutaneous Bilirubin (TcB] with Total Serum Bilirubin (TSB] in preterm neonates before, during and post phototherapy. Methods: This is a prospective observational study conducted in department of Pediatrics, J. K. Lon Mother and Child Hospital, attached to Government Medical College, Kota. 190 preterm neonates (28 to 37 weeks] requiring phototherapy for the first time were enrolled in this study. TcB and TSB was assessed pre-, during and 24 hours post-phototherapy over mid sternum. The area of 2.5cm diameter on mid sternum where TcB was assessed was patched with photo-opaque material before starting of phototherapy. The decision to initiate and stop phototherapy was as per the NICE guideline recommendations. Results: It was found that TSB and TcB has good correlation before phototherapy (r=0.97]. The total serum bilirubin decreases significantly after phototherapy. Conclusion: Transcutaneous bilirubin correlates significantly with total serum bilirubin at the patched sternal site before phototherapy in preterm neonates.

130.A Comparative Study of Ilioinguinal/ Iliohypogastric Nerve Block with Spinal Anaesthesia for Inguinal Hernia Repair
Arun Sampath, Jagan Govindasamy, B Ravindran, Prabhakar S.
Introduction: Typically, inguinal hernia repair is performed under spinal anaesthesia. Local anaesthetic, on the other hand, gives stable hemodynamics and decreased postoperative discomfort. We examined the efficacy, feasibility, and safety of ilioinguinal/iliohypogastric nerve block with spinal anaesthesia for inguinal hernia repair. Material and Methods: Sixty adult male patients were randomised into two groups of 30 individuals each for elective inguinal hernia repair. Group A was given an ilioinguinal/iliohypogastric nerve block, while Group B was given spinal anaesthesia. Both groups were compared in terms of total time to complete anaesthetic operations, time of onset, hemodynamic changes, and complications. For continuous variables and categorical variables, the unpaired t-test and Chi-square were used. P <0.05 was taken as significant. Results: Duration to perform ilioinguinal/iliohypogastric nerve block was significantly longer than that of spinal block. The duration of postoperative analgesia was longer in Group A than Group B. Mean blood pressure showed statistically significant reduction in Group B patients. Complications like Nausea, Vomiting, Headache, Hypotension & urinary retention were seen in Group B patients. Conclusion: For elective unilateral inguinal hernia repair, ilioinguinal/iliohypogastric nerve block can be a safe alternative to spinal anaesthesia.

131.Comparison of Dexmedetomidine Combined with Propofol versus Fentanyl Combined with Propofol for I-GEL Insertion in Elective Surgeries Performed under General Anaesthesia: A Double Blinded Randomised Study
Aditya Kumar Kejriwal, Ajay Kumar, Hari Damodar Singh, Satyeshwar Jha, Sushil Kumar
Background: Before inserting the I-GEL, the appropriate level of anaesthesia is necessary to prevent laryngospasm, choking, or limb movements. We compared the circumstances surrounding I-GEL implantation to propofol induction after dexmedetomidine or fentanyl pretreatment. Methods: Eighty patients with ASA I/II underwent general anaesthesia and were randomly assigned to Groups D (n = 40) and F (n = 40). After receiving 1 µg/kg of dexmedetomidine over the period of ten minutes, Group D received 5 ml of 0.9% normal saline (NS) over the course of two minutes. 10 ml of 0.9%NS were given to Group F over a period of ten minutes, followed by two minutes’ worth of 1 µg/kg fentanyl. Two mg/kg of propofol was given after the research drug. I-GEL was inserted 90 seconds after propofol. The Modified Scheme of Lund and Stovener was used to evaluate the overall insertion circumstances. Heart rate (HR) and mean arterial pressure (MAP) measurements were made at baseline, following propofol induction with the study medication, and 1, 3, 5, and 10 minutes after IGEL insertion. Apnea times and respiratory rate were noted. Results: Both groups insertion conditions were comparable. There were more patients in Group F who had a moderately relaxed jaw, coughed, and moved body. Group F (18/40) had a considerably higher incidence of apnoea than did group D (3/40) (P<0.0001). Group F had a significantly longer mean apnoea duration than group D (217.17±16.48 sec; 284.5±11.19 sec). In comparison to the baseline, group F MAP decreased by a higher proportion (10.3%) than group D’s (5.6%) after propofol. Although the response to I-GEL insertion was identical at 1, 3, 5, and 10 minutes after insertion, group F’s post-induction MAP was significantly lower than group D’s (P = 0.002) (group F). After propofol and I-GEL insertion, the HR was significantly lower with dexmedetomidine (P = 0.003 and P <0.001, respectively). Conclusion: When combined with propofol, dexmedetomidine and fentanyl offer similar I-GEL insertion circumstances.

132.Corrected QT Dispersion within the First 72 Hours of Acute ST Elevation Myocardial Infarction in JLNMCH, Bhagalpur, Bihar
Ajitesh Kumar, Abilesh Kumar
Background: Greater ventricular repolarization heterogeneity after acute myocardial infarction has been linked to increased QT dispersion, which is associated with a poor prognosis in a variety of patients. This study’s goal is to determine how QTc dispersion affects patients with acute ST elevation myocardial infarction (STEMI) both at the time of admission and after 72 hours. Method: In a cross-sectional study, 60 patients with acute STEMI who were admitted to the department of medicine at the JLNMCH in Bhagalpur, Bihar, between November 2021 and October 2022 were included. All patients had their corrected QT (QTc) dispersion measured, which is the difference between the maximum and minimum QTc intervals for a given heart rate. Results: In this study, 60 patients with acute STEMI were included, and 41 (68.3%) of those patients were male. Male patients were significantly younger than female patients in terms of mean age, which was 54.66±12.13 years for men and 62.84±13.00 years for women. When patients arrived with anterior and inferior acute myocardial infarction rather than lateral and posterior acute myocardial infarction, there were significant reductions in QTc dispersion at admission versus QTc dispersion at 72 hours. In addition, 8 (13.3%) individuals had malignant ventricular arrhythmias (VT and VF). In comparison to the non-arrhythmia group (59.18±26.98 msec), the QTc dispersion at admission was greater in the group with ventricular tachyarrhythmias (97.07±27.27 msec). With a significant difference between QTc dispersion at admission and QTc dispersion at 72 hours in this group, QTc dispersion was higher in the heart failure group, with a P value <0.001 for this difference. Conclusion: When patients with acute STEMI are admitted, QTc dispersion is higher. Patients with acute STEMI of the front wall have increased QTc dispersion. In individuals with acute STEMI, increased QTc dispersion can predict the onset of ventricular tachyarrhythmias and heart failure.

133.Study of Blood Glucose Level in Newborns at SKMCH, Muzaffarpur, Bihar
Jayprakash Kushwaha, Gopal Shankar Sahni
Background: The three main energy substrates used by foetuses throughout development are lactate, amino acids, and glucose. One of the typical metabolic risks in the practise of newborn care is hypoglycemia. Based on AARR from 2000–2012, the anticipated newborn death rate for 2020 is 22 per 1000 live births. Some cases of unexplained newborn death may be related to neonatal hypoglycemia, which can develop as a result of prenatal starvation, birth asphyxia, postpartum hypothermia, or infection. The development of the nervous system and blood glucose levels are related. Methods: In our study, 125 babies had their blood glucose levels measured using the glucose oxidase method both at birth and 72 hours afterwards. From December 2021 to November 2022, a cross-sectional study was carried out at pediatrics department of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. Results: Preterm neonates had lower blood sugar levels at delivery than term neonates (63.71±15.62 and 69.38±16.53 mg/dl, respectively), although these differences were not statistically significant. However, results at 72 hours (52.61±10.50 and 67.10±10.11 mg/dl) were determined to be statistically significant. Hypoglycemia was 15.2% common. Conclusion: The study demonstrated that hypoglycemia is a prevalent issue in preterm neonates, and that by adopting straightforward, low-cost treatments, the prevalence may be decreased, which may have a significant influence on early neonates mortality and neurological sequelae of perinatal origin.

134.Study the Role of Iron Deficiency Anaemia in Febrile Seizures at SKMCH, Muzaffarpur, Bihar
Jayprakash Kushwaha, Gopal Shankar Sahni
Background: According to the World Health Organization, between 500 million and 2 billion individuals worldwide are iron deficient. Iron deficiency is the most common haematological condition in children between the ages of 6 months and 5 years. This age range typically corresponds to the period of time when febrile seizures are most common. This study sought to ascertain the impact of iron deficient anaemia on febrile seizures. Methods: In Department of Pediatrics at Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, carried out this cross-sectional observational study. 85 children between the ages of 6 months and 5 years who presented with simple and complex febrile seizures to the hospital emergency and pediatrics ward were included during the 12-month study period from November 2021 to October 2022. Results: The median age in this study for the onset of febrile seizures is 21 months. The frequency of febrile seizures and the severity of anaemia are unrelated. Iron deficiency is indicated by low HB, low MCH, low MCV, high RDW, low serum iron, high TIBC, and low serum iron to TIBC ratio, among other parameters. Conclusion: The current hospital-based observational analysis led us to the conclusion that children who experienced febrile seizures were more likely to develop iron deficiency anaemia. The results suggest that infants experiencing febrile seizures should undergo screening for iron deficiency anaemia (IDA). All of the tests used to evaluate iron deficiency anaemia (Sr Iron, TIBC) produced significantly lower results. This demonstrates that febrile seizures are more common in kids with low iron levels.

135.Study on Prescribing Pattern and Rational Use of Antidiabetic Drugs in Patients with Type 2 Diabetes Mellitus in Tertiary Care Hospital
Sanjeev Kumar, Vinay Kumar Sinha, Jeetendra Kumar
Background: In developing nations, diabetes mellitus (DM) is a significant public health issue. It is crucial to improve diabetics’ rational drug use and provide useful information for the medical staff through drug use studies of antidiabetic medicines. The study’s goal was to look into how people with type 2 diabetes used their medications. Methods: From June 2022 to November 2022, a prospective, cross-sectional study was conducted at Department of Pharmacology, JLNMCH, Bhagalpur, Bihar. Patients selected from outpatient department of medicine, JLNMCH, Bhagalpur, Bihar. Included were patients with type-2 diabetes who had been on medication for at least a month. A pre-made proforma was used to record the sociodemographic and clinical information about the patients. Using Excel 2007 and SPSS version 20, data was analysed. Results: A total of 114 patients were included, and their ages and diabetes durations, respectively, were 56.8±10.5 and 8.3± 9.4 years (mean, SD). The ratio of men to women was 0.72:1. The mean blood glucose levels at fasting and after meals were 147.5±73.1 and 215.6±97.3 mg/dl, respectively. Weakness or weariness was the most prevalent symptom (77.2%). Co-morbid hypertension (70.2%) was the most prevalent condition. 7.8±2.5 medicines on average were prescribed. 89.5% of patients received more than five medications in total. Biguanides, which were used the most frequently (87.7%), were followed by sulphonylureas (68.4%). Conclusion: Biguanide, or metformin, was the most often used anti-diabetic medication for type-2 diabetes (87.7%). This study found that the prescribing pattern for anti-diabetics was logical and mostly in line with NICE (National Institute for Health and Clinical Excellence) recommendations.

136.Efficacy and Safety of Topical Calcitriol and Topical Calcipotriol in Stable Chronic Plaque Type Psoriasis: A Comparative Study
Vinay Kumar Sinha, Tauseef Haider, Jeetendra Kumar
Background: There are not many research that contrast topical calcitriol and calcipotriol, two vitamin D derivatives that are believed to be useful in treating psoriasis. The objective of the current study was to compare and evaluate the efficacy and safety of calcitriol and calcipotriol in individuals with chronic plaque-type psoriasis that is persistent. Methods: A total of 50 patients with chronic stable plaque-type psoriasis were randomly split into two groups of 25 each. One group received calcitriol 3 mg/g ointment for 12 weeks, whereas the other received calcipotriol 50 mg/g ointment. Clinical and subject evaluations of overall improvement were included in efficacy assessments (on a 4-point scale from 0: no change to 3: clear or almost clear). Effectiveness was also influenced by the “dermatological sum score” (DSS) from each trial visit. The safety evaluations included subject assessments of cutaneous discomfort and clinical exams of cutaneous safety (on a 5-point scale from 0: none to 4: extremely severe). Results: Both calcitriol and calcipotriol were significantly effective (p<0.001) in reducing DSS, although there was no statistically significant difference between the two groups. While the mean score for the subject was 1.92 for calcitriol and 1.84 for calcipotriol, the mean score of total improvement as determined clinically was 2.20 for calcitriol and 2.16 for calcipotriol, respectively (p > 0.05). The discrepancies between the two groups did not differ statistically from one another. The mean worst score for cutaneous safety was higher in the calcipotriol group as compared to the calcitriol group (0.28 vs 0.04 and 0.36 vs 0.04 by clinically and by the subject, respectively). Only when the participant evaluated the safety profile was a statistically significant improvement (p<0.05) shown for calcitriol. Compared to calcitriol, which had only 4% documented treatment-related adverse events, calcipotriol had 24%. Conclusions: Both topical calcitriol and calcipotriol were equally effective in treating chronic plaque psoriasis, but calcitriol had a higher safety profile due to their greater local tolerability and lower incidence of treatment-related side effects.

137.Efficacy of Latanoprost (0.005%) and Dorzolamide (2%), in Primary Open-Angle Glaucoma (POAG) Patients, as Monotherapy: A Comparative Study
Tauseef Haider, Sanjeev Kumar, Jeetendra Kumar
Background: In India as well as the rest of the globe, glaucoma is the second most frequent cause of blindness, and its incidence is rising. The most significant factor and a direct cause of the development of primary open-angle glaucoma is increased intraocular pressure (IOP) (POAG). In order to compare the effectiveness of latanoprost and dorzolamide for lowering IOP in POAG as monotherapy, the current study was conducted. The following are the objectives: To compare the effectiveness of topical latanoprost (0.005%) and topical dorzolamide (2%), both used as monotherapies for POAG, and to assess the negative effects of each drug. Methods: Eighty patients; 40 males and 40 females with a POAG diagnosis were randomly chosen for the current prospective, open-label trial and split into two groups. One group received topical latanoprost eye drops (0.005%) once day, while the other received dorzolamide eye drops (2%), three times daily. Three follow-up visits were made with each participant at two, four, and eight weeks. IOP was measured using a Perkins Handheld Tonometer before to beginning the baseline phase of treatment. IOP was once more recorded at every subsequent visit in order to track the impact of medications. All patients provided their freely given informed permission. Results: The mean IOP reduction for latanoprost group was 9.5 ± 3.56 and dorzolamide group was 7.89 ± 3.56. Both medications were successful in lowering IOP. Latanoprost and dorzolamide reduced IOP in different ways, and this difference was statistically significant (P = 0.02). Both medications were well tolerated over the course of the research, with latanoprost group (n = 9) experiencing more adverse effects than dorzolamide group (n = 7). Conclusion: The results of this study show that topical eye drops containing latanoprost (0.005%) and dorzolamide (2%) both significantly lower IOP in POAG. In terms of lowering IOP, latanoprost is more effective than dorzolamide.

138.A Study on Determinants of Indian Diabetic Risk Score among Adult Population
Manish Jain, Mayank Jain, Kapil Garg, Vinod Kumar
Background:  Diabetes mellitus, long considered a disease of minor significance to world health, is now taking its place as one of the main threats to human health in the 21st century. The past two decades have seen an explosive increase in the number of people diagnosed with Diabetes worldwide. Objective: to determine the association of IDRS status with socio-demographic factors and personal habits among adult population. Materials and Method: Study was carried out among urban adult men and women aged 18 years and above. Study proforma included information on socio-demographic characteristics like gender, marital status, education, occupation, family income, type of family and family size, habits like diet, addiction of tobacco, alcohol or other substance etc. Chi-square test was used to test the association between categorical variables. P value < 0.05 was considered statistical significant. Results: Proportion of participants found with high risk status was higher in female gender, Hindu religion, marital status widowed, illiterate and socio economic status class III and IV. Theses associations were found statistically significant. No significant association was seen between IDRS status and type of family, tobacco, alcohol consumption and smoking habits of the study participants. Mean BMI of participants increased from low risk group to high risk group. Conclusions: The present study showed significant association between IDRS and socio demographic variables like gender, religion, marital status, education, occupation, socio economic status class.

139.Comparison of Efficacy of 2% Lignocaine to 4% Articaine in Mandibular Third Molar Impaction
Singh DP, Kumar M, Sharma A, Naiem A
Introduction: The discovery of anaesthesia has been a great boom to the field of dentistry and surgery in general. Local anaesthesia is an important part of the daily routine for dentist. Local anaesthesia as a therapeutic modality defined as a transient regional loss of sensation to a painful or a potentially painful stimulus, resulting from a reversible interruption of peripheral conduction along a specific neural pathway to its central integration and perception in brain. Aim and Objective: To evaluate the efficacy of articaine in third molar impactions and VAS scores preoperative, intra-operative and post operative for pain and swelling. Material and Methods: A prospective study was conducted 123 patients who had undergone surgical removal of impacted Mandibular third molar between one year time period. Results: We randomized 123 patients and treated 71 with articaine and 72 with lignocaine. 35 male and 36 female patients with mean age group of 30.18 years in articaine group and 35 male and 37 female patients with mean age group of 27.72 years in lignocaine group were included in the study. VAS evaluation for efficacy analysis. No statistically difference was found in preoperative and post-operative pain parameters. But intraoperative pain parameters were 3.17 and 2.51 for lignocaine and articaine respectively, which were statistically significant. Conclusion: The efficacy of 4 % articaine is slightly better to 2% lignocaine. 4% articaine has longer duration of action than Lignocaine. The efficacy of 4% articaine based on VAS scores for pain, the intraoperative pain parametres are much less for articaine when compared to Lignocaine. No significant difference in preoperative, intraoperative and postoperative vital parametres.

140.A Study on Musculoskeletal Manifestation of Type 2 Diabetes Mellitus and its Association with Markers of Disease Progression
Medha Gupta, Kishore Moolrajani, Dharam Prakash Bansal, Puneet Rijhwani, Ram Kishan Jat, Namrata Pareek
Background: Diabetes is one of the top 10 causes of death globally. Diabetes mellitus accounts for a number of vascular complications, which impairs patients’ survival. Musculoskeletal complications are also found, and, although less valued than the vascular ones, they significantly compromise the patients’ quality of life. This study tries to find out the musculoskeletal manifestation of type 2 Diabetes Mellitus and its association with markers of disease progression. Methods: A Hospital based Observational study was conducted in in the Department of Medicine Mahatma Gandhi Medical College Hospital, Jaipur from the period of  March 2021 to September 2022 among 100 patients of type 2 diabetes mellitus, with Fasting Blood sugar levels ≥126 mg/dl and Glycated HBA1C levels ≥ 6.5 were selected and associated musculoskeletal disorders were noted. Results: Majority of study subject i.e., 24% had Cheiroarthropathy. Among 29 patients with HbA1c level <7%, 31% had deformity; among 49 patients with HbA1c level 7-10%, 91.8% had deformity while among 22 patients with HbA1c level>10%, 81.8% had deformity (p<0.0001). In 1st tertile of CRP out of 33 patients 17 patients developed Musculoskeletal deformity, in tertile 2 out of 34 patients 25 patients developed muscular deformity while in tertile 3 out of 33 patients 30 patients developed muscular deformity.(p<0.0001). Conclusion: As CRP is an established marker of inflammation and also cardiovascular disease marker, and HbA1c a marker of disease progression it is important to estimate the CRP and HbA1c levels and this study found musculoskeletal disorder significantly associated with increased HbA1c and CRP level in the patient of Type 2DM.

141.Monkey Pox: A Review on Existing Scenario
Anil A, Saravanan A, Kumar T, Dutta G, Vinoth R, Singh S, Varthya SB
Monkeypox is an uncommon zoonotic viral infection with symptoms similar to smallpox but with less severe clinical presentation. The term ‘Monkeypox’ was coined in 1958 following it’s discovery from the colonies of laboratory monkeys. It is endemic in some African countries. Following the outbreak in 2022. WHO declared monkeypox as a global public health emergency on 23rd July 2022. 12 cases have been recorded in India till 24th September 2022. Despite the incidence of cases, outbreak preparedness by the WHO and national governments have contributed greatly to reduce the infectivity of this disease. Literatures from online databases such as PubMed, CENTRAL, ScienceDirect, Google Scholar and International Guidelines were searched for the articles. A total of 33 articles and websites were utilized to concise the quality information about this emerging disease.

142.Evaluation of Acute Kidney Injury Brought on by Warfarin Anticoagulation and Haematuria
Dharmendra Prasad, Vijay Shankar, Rishi Kishore
Introduction: According to reports, glomerular haemorrhage can cause warfarin-related nephropathy to develop at an INR of 2.0. Prospective studies evaluating the impact of supratherapeutic warfarin anticoagulation on haematuria and acute renal damage are lacking (AKI). Due to their older age, higher rates of kidney disease, and other concomitant conditions, older people may be more vulnerable. The purpose of this study was to ascertain the prevalence and type of haematuria and AKI in older individuals on warfarin, as well as any correlations with elevated INR values. Method: This study involved 100 patients who were acutely hospitalised at a tertiary hospital and were using the anticoagulant warfarin. RIFLE criteria were used to evaluate AKI. Urinalysis was carried out to determine the amount of haematuria, describe the erythrocyte shape, and gauge the albumin-creatinine ratio. Following up on positive cases for 3-5 weeks to ascertain resolution. Result: In 53% of patients, an INR 2.0 was discovered. The risk of excessive anticoagulation increased with pre-admission antibiotic treatment. AKI, haematuria, and both had isolated incidences of 18.6, 13.2, and 11%, respectively. An INR of 3.0, non-urinary infection, catheterization, and albuminuria were all risk factors for haematuria. The majority of AKI patients were moderate, and there was no conclusive link between admission INR and AKI. An increased risk of persistent renal impairment at follow-up was strongly related with admission with heart failure. Conclusion: A higher incidence of haematuria, but not AKI, was linked to supratherapeutic warfarin anticoagulation. The majority of haematuria instances were temporary.

143.Clinical Profile of Patients of Alcoholic Neuropathy at Tertiary Care Hospital, Gujarat, India
Niyati Gosai, Dinkar Goswami, Shashi Mundra, Arun Makwana, Gaurav Desai
Background: Alcohol is one of the most commonly used substances in the world. After ingestion, alcohol distributes throughout body tissues and rapidly crosses the blood-brain barrier. According to DSM-IV, studies involving clinical and electrodiagnostic criteria prove that neuropathy is present in 25-66% of chronic alcoholics. Alcohol consumption results in multiple end-organ damages. Objectives: To study the clinical profile of alcoholic neuropathy patients. Materials and Methods: This cross-sectional study was carried out among 40 clinically diagnosed with alcoholic neuropathy patients admitted at the department of general medicine in tertiary care hospital, Gujarat during March 2020 to May 2022. Inclusion criteria was patient fulfilling the criteria of alcohol-dependent syndrome with or without symptoms of neuropathy, Age above18 years, patients are willing to participate in the study. Results: Mean age of study participants was 47.1 years. Mean duration of alcohol consumption was 18.8 years. Almost 38% study participants had family history of habit of alcohol consumption. Most common sensory symptoms was Pins & needles sensation of feet and most common autonomic symptoms was Erectile dysfunction. Type of neuropathy like Sensory Neuropathy, Sensory + Autonomic Neuropathy, Sensorimotor Neuropathy, Sensorimotor + Autonomic Neuropathy had noted in 55%, 20%,17.5%, 7.5% study participants respectively. Conclusion: Incidence of alcoholic neuropathy is increased with age. Almost 38% had history of habit of alcohol consumption in family. Most common sensory symptoms noted among study participants was Pins & needles sensation of feet and most common autonomic symptoms noted among study participants was erectile dysfunction. Most common type of neuropathy was noted among study participants was sensory neuropathy.

144.Phenotypic Detection of Extended- Spectrum Beta- Lactamases in Enterobacteriaceae from Clinical Samples at a Tertiary Care Hospital
Ashita Singh, S. Kiranmai, Rajive Kumar Sureka, K. Jaya Krishna Singh
Introduction:  Due to rise in ESBL strains, there is a need to detect this phenotypically. Hence, present study was undertaken to detect ESBL producers by Double disc synergy test (DSST), Combination disk method (CDM), Epsilometer test (E– test). Methods: It was a prospective study conducted in the department of Microbiology, MediCiti Institute of Medical Sciences. Study protocol was approved by the Institutional Ethics Committee. Enterobacteriaceae isolates obtained according to the standard guidelines were included in this research. Isolates which were resistant to third generation Cephalosporins and Aztreonam were considered for ESBL detection. To consider resistance, zone diameter ≤22mm was considered for Ceftazidime, ≤27mm for Cefotaxime, ≤25mm for Ceftriaxone and ≤27mm for Aztreonam. Double disk diffusion synergy test (DDST), combination disk method (CDM) and E-test were used for ESBL. Commercially available ESBL E-test strip was used. Chi square test was used to find the statistical analysis; P<0.005 was to be statistically significant. Results: Total 100 enterobacteriaceae strains were included, Escherichia coli was the leading (38%). Total 44% isolates were resistant to 3rd generation cephalosporins. Klebsiella species was the leading (22; 70.96%) ESBL producer. All ESBL isolates were susceptible to Piperacillin/ tazobactam and Imipenem. Among 44 isolates, all were detected as positive by E-test, 38 were positive by DDST and 43 by CDM. Six isolates which were negative by DDST, were positive by E-test and CDM. One isolate which was negative by CDM was positive by E-test and DDST. DDST was 86.3% sensitive and CDM was 97.7%. Conclusion: Considering the challenging nature of the isolates and resource-limited settings, the phenotypic methods showed high sensitivity and specificity for ESBL detection. However, large sample size is recommended.

145.A Study to Assess the Effects of Ephedrine Pre-Treatment on Intubating Conditions Along with Propofol and Rocuronium
Karuna Sree Vanam, Chembeti Gopalakrishnaiah, Kakileti Vani Subrahmaney Swari, Shaik Jareena Begum, T Jaya Chandra
Introduction: Ephedrine reduces the hypotension following propofol administration. The present study was done to compare the influence of pre treatment with a low dose of intravenous ephedrine on the intubating conditions and its effects on haemodynamics during rapid tracheal intubation using propofol, rocuronium bromide. Methods: It was conducted Rangaraya Medical College. Adults on elective surgery require general anaesthesia were includede. Pregnant women, known hypersensitivity to the study drugs, anticipated difficult airway, Mallampati grade III, IV were excluded. Premedicated at bed time of the previous night of surgery, nil orally 10 pm onwards. Randomly divided into group Ephedrine Rocuronium (ER) received ephedrine 70 µg/kg diluted to 5 ml with normal saline and normal saline rocuronium (NR) group received 5 ml normal saline at the time of preoxygenation. One minute later, induced with intravenous Propofol 2.5 mg/kg with preservative free lidocaine 2%, 1ml for every 10 ml of propofol, injected over 30 seconds. One minute later, intravenous rocuronium was given and mask oxygenation was continued, laryngoscopye was performed 60 sec later.  Heart rate (HR), blood pressuere (BP) were recorded. Care was taken to avoid any stimulus during the study period. P < 0.05 was considered to be statically signifcant. Results: Total 120 members were included, 60 each group. Intubating conditions were statically significant. Statistically there was no significant  difference for mean duration of laryngoscopy, base line HR. The baseline systolic, diagnostic BP and mean arterial pressure were comparable. Conclusion: Ephedrine prior to induction with propofol improves intubating conditions compared to propofol alone.

146.Role of Antenatal Ultrasound in Prediction of Preterm Birth by Using Fetal Adrenal Gland Biometry
Alka Agrawal, Saurabh Atram, Samidha Jain
Background: Preterm birth is a major cause of perinatal morbidity and mortality worldwide. Timely identification of women at risk of preterm birth is crucial for appropriate management. Fetal adrenal glands play significant role in initiation of labor and can be assessed using ultrasonography for predicting onset of labor. Method: Prospective study done on 260 pregnant women of >28 weeks of gestation. 10 women were lost to follow up, so final analysis included 250 women. Ultrasonographic measurements of width (FAZW), length (FAZL), and depth (FAZD) of “fetal zone” of the fetal adrenal gland and the width (FAGW), length (FAGL) and depth (FAGD) of the total gland were taken. Ratios of each measurement (FAZW/FAGW, FAZL/FAGL and FAZD/FAGD) and corrected fetal adrenal gland volume (cFAGV) were calculated. Patients were followed up till delivery, whether term or preterm and outcomes correlated with fetal adrenal gland parameters. Result: The cFAGV, depth ratio and width ratio were significantly higher in women who delivered preterm. FAZD/FAGD had the best efficacy (sensitivity 100%, specificity 80.2%) and AUC of 0.95 with cutoff of 0.5 followed by FAZW/FAGW (sensitivity 94.1%, specificity 84.9%) with cutoff of 0.53. cFAGV with cutoff of 370mm3/kg body weight also had the same sensitivity as the width ratio but less specificity (79.2%). No significant difference was seen in FAZL/FAGL(P> 0.05). Conclusion: The ultrasonographic measurements of fetal adrenal gland parameters show high accuracy in prediction of preterm birth and can be used for screening women at risk of preterm delivery.

147.Functional and Radiographic Evaluation of Locking Plate Treatment for Distal Femoral Fracture
Prakash Kumar, Fagu Ram Majhi
Introduction: Researchers have reported positive outcomes when treating distal femur fractures with distal femur nails, dynamic condylar screws, and even the addition of a medial plate to a distal femur locking plate. In this study, we investigate the potential of a distal femur locking device to prevent extraarticular, partial, or intraarticular distal femur fractures. Numerous organisations from throughout the world have published encouraging findings. to investigate the functional and radiological results of open reduction and internal fixation with a distal femur locking plate for distal femoral fractures in skeletally mature patients. Method: This was a prospective study carried out at Government Medical College Bettiah, Bihar from January 2020 to March 2021 with a one-year follow-up. There were 24 post-traumatic distal femur fractures in skeletally mature patients. Patients with open Gustilo-Anderson grade 3B and 3C distal femur fractures and pathological distal femur fractures were not included in the study. Patients with any fracture in the ipsilateral limb other than the distal femur were disqualified from the research. Follow-up was done at two months, five months, and one year, and evaluation was done using the Neer grading system. Using the SPSS version, the statistical data analysis was completed. A p-value of less than 0.04 was deemed significant. Result: All patients experienced union after adhering to the principles of fracture reduction, with a mean time to radiological union of 18 weeks. The median range of motion (ROM) was 108 degrees, with excellent to satisfactory Neer scores for 19 patients. There were 8 cases in our study who needed additional procedures. All eight of these cases, along with case number two, required the initial insertion of antibiotic cement beads. During the course of our study, 2 patients experienced problems in the form of infection (1 case) and mal-union (1 case), however both patients recovered well. Conclusion: The distal femur locking plate, which is the primary implant of choice for distal femur fractures of all types, can produce positive results on its own. Best results are anticipated if fracture fixation is carried out in accordance with all fundamental fracture fixing principles and makes use of the mechanical qualities of a locking plate.

148.Evaluation of Acute Kidney Injury Brought on by Warfarin Anticoagulation and Haematuria
Dharmendra Prasad, Vijay Shankar, Rishi Kishore
Introduction: According to reports, glomerular haemorrhage can cause warfarin-related nephropathy to develop at an INR of 2.0. Prospective studies evaluating the impact of supratherapeutic warfarin anticoagulation on haematuria and acute renal damage are lacking (AKI). Due to their older age, higher rates of kidney disease, and other concomitant conditions, older people may be more vulnerable. The purpose of this study was to ascertain the prevalence and type of haematuria and AKI in older individuals on warfarin, as well as any correlations with elevated INR values. Method: This study involved 100 patients who were acutely hospitalised at a tertiary hospital and were using the anticoagulant warfarin. RIFLE criteria were used to evaluate AKI. Urinalysis was carried out to determine the amount of haematuria, describe the erythrocyte shape, and gauge the albumin-creatinine ratio. Following up on positive cases for 3-5 weeks to ascertain resolution. Result: In 53% of patients, an INR 2.0 was discovered. The risk of excessive anticoagulation increased with pre-admission antibiotic treatment. AKI, haematuria, and both had isolated incidences of 18.6, 13.2, and 11%, respectively. An INR of 3.0, non-urinary infection, catheterization, and albuminuria were all risk factors for haematuria. The majority of AKI patients were moderate, and there was no conclusive link between admission INR and AKI. An increased risk of persistent renal impairment at follow-up was strongly related with admission with heart failure. Conclusion: A higher incidence of haematuria, but not AKI, was linked to supratherapeutic warfarin anticoagulation. The majority of haematuria instances were temporary.

149.Correlation of Serum hs-CRP with Biochemical and Clinical Parameters in Preeclamptic Pregnant Females: A Case-Control Study
Seema Mehta, Megha Sharma, Lata Mehta, Suresh Kumar Gautam
Background: Preeclampsia is a serious complication & presents as an important cause of fetomaternal morbidity and mortality. Assessment of the circulatory inflammatory markers in the second half of pregnancy can help in the detection of females at high risk. Aims & Objectives: The present case-control study is designed to assess the levels of hs-CRP & correlate it with biochemical & clinical parameters in preeclamptic pregnant females. Materials & Methods: This case-control study recruited 20 preeclamptic and 20 healthy pregnant females who came to the Department of Obstetrics & Gynaecology of our tertiary care hospital. Pregnant females with pre-gestational hypertension, diabetes mellitus and other chronic disorders were excluded. According to the guidelines of the American College of Obstetric and Gynecology, patients were classified as preeclamptic and severe preeclamptic. Group A consisted of a preeclamptic pregnant female (n=20) and Group B consisted of a healthy pregnant female (n=20). The parameters noted were demographic, body mass index, and total protein excretion in 24 h. Venous blood samples were collected, at least 6 hours before delivery. Biochemical tests were conducted to assess the hs-CRP, Blood Urea Nitrogen (BUN), Creatinine, Aspartate transaminase, Alanine transaminase, and Lactate dehydrogenase levels. Results: Demographic parameters and BMI were comparable in both groups (p > 0.05). Mean SBP&DBP was statistically significantly higher in Group A as compared to Group B  ( p < 0.05). In group A, 9% of cases were mild, 62% were severe, 11% had eclampsia and 18% had HELLP syndrome. Hemoglobin levels, serum hs-CRP, BUN, creatinine, AST, ALT, LDH and urinary protein excretion were statistically significantly higher in  Group A as compared to Group B  (p < 0.05). A strong positive correlation was noted between serum hs-CRP levels and diastolic blood pressure and urinary protein excretion. Serum calcium levels and weight and length of the newborns were statistically significantly lower in Group A (p< 0.05). A negative correlation was noted between serum hs-CRP and the weight & length of the newborns in both groups. Conclusion: There was significant increase in serum hs-CRP level in preeclamptic pregnant females as compare to healthy pregnant females. Therefore serum hs-CRP estimation may serve as a useful, inexpensive & potential tool to assess the preeclamptic status and maternal and neonatal outcomes.

150.Altered Mental Status Patients Associated Evaluations in the Medicine Department
Gajender Kumar Kumawat, P.S. Pipliwal, Rajendra Kumar Kasana, Rohit Ishran
Background: Altered mental status (AMS) comprises a group of clinical symptoms rather than a specific diagnosis, and includes cognitive disorders, attention disorders, arousal disorders and decreased level of consciousness. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for general medicine physicians. Material & Methods: Within the Department of General Medicine, SMS Medical College and the attached group of hospitals, Jaipur, our research team explored patterns in 150 AMS patients from June 2020 to May 2021 to conduct observational cross-sectional analytical study for their clinical presentation{according to Age [55.17±18.41], Gender [64% male and 36 % female], Laboratory parameters [RBS (106.7 mg/dl), Na+(136.7 mMol/L), K+(3.86 mMol/L), Cl(98.14 mMol/L), UREA(46.93 mg/dl) and CREATININE(1.15 mg/dl)], Clinical Parameter [S.NH3(25.5 Umol/L), TLC(11.89 1000/cumm), S.PCT(1.66 ng/ml), PCO2(51.32 mmHg) and PO2(74.26 mmHg)], Blood pressure (141.1/86.13 mmHg), Comorbidity [Hypertension (47.33%), ALD CLD PTHN (9.33%), T2DM (22.6%), COPD (16%), No comorbidity (14%) and other] and Personal History [44.66 % smoker and 13.33% alcoholic]}, neuroimaging (MRI Brain finding, CVA-ICH and CVA Infract). Results: At SMS Medical College, from assessed etiological diagnosis data of this study, we saw that 52.6% cases of neurological, 17.3% cases of CO2 Narcosis, 10% cases of Hepatic Encephalopathy, 5.3% cases of Metabolic (Hypoglycemia), 4.66% cases of Metabolic (Hyponatremia), 4.00% cases of Septic Encephalopathy, 4.00% cases of Unknown Poisoning and2.00% cases of Uremic Encephalopathy. Conclusion: This study will demonstrate and provide early recognition, more clinical and etiological information on AMS, particularly in India.

151.Effects of Low Dose Dexmedetomidine Infusion on Haemodynamic Stress Response in Patients undergoing Laparoscopic Surgery
Palak Modi, Khushali Nayak, Mittal Patel, Archana Vaghela
Background and Aim: Dexmedetomidine attenuates stress response by blocking efferent sympathetic pathway, reduce peripheral sympathetic discharge, provide sedation, and support rapid recovery of patient. The purpose of our study was to evaluate the effects of low dose Dexmedetomidine infusion on haemodynamic stress response to critical incidences in patients undergoing laparoscopic surgery. Material and Methods: Present Observational study was conducted for period of sixteen months after approval from institutional ethical committee. A total of 64 patients were included in the study and divided into two groups. Group A: Inj. Dexmedetomidine 0.4 mcg /kg/hr in 50ml normal saline i.v infusion 15 min before induction of anaesthesia. Group B: Inj. Normal saline 0.9% 50 ml i.v infusion 15 min before induction of anaesthesia. Level of sedation in post-operative period was assessed by Ramsay Sedation Assessment Scale and Post-operative pain assessment was done by Visual analog scale (VAS). Results: After 1 min after laryngoscopy and intubation, the mean pulse rate increased above the pre infusion level in group A. Though this increase was less compared to increase in group B (P< 0.001). While comparing mean heart rate post-operatively between the two groups; initially after 1 min of post-operative period, Heart rate was lesser in group A 84.62±73.39 per min compared to Group B 102.09±6.56 per min (P<0.001). After events like endotracheal intubation and extubation, the mean SBP was still lower side in group A whereas increased in group B (P<0.001). Throughout intra-operatively, mean DBP was noted significantly lower in group A compared to group B despite of events like endotracheal intubation, pneumoperitoneum, and extubation (P<0.001). Postoperatively, from 1 min to 120 min both group were showing highly significant difference (p value<0.001) regarding VAS score. So the total duration of analgesia was longer in group A as compared to group B. Conclusion: Low dose Dexmedetomidine infusion surely attenuates sympathoadrenal response and provides better haemodynamic stability in critical incidences like laryngoscopy, endotracheal intubation and pneumoperitoneum in patients undergoing laparoscopic surgeries as compared to group NS(normal saline).

152.Effect of Tranexamic Acid on Expansion of Haematoma and Functional Recovery in Acute Intracerebral Haemorrhage
Shree Dash, Sumirini P, Srikanta Sahoo, Kanishka Uthansingh, Surjyaprakash S. Choudhury
Aim: This study evaluated the efficacy of tranexamic acid in reducing thrombus expansion while controlling prolonged bleeding. In addition, it was attempted to analyze whether the shortens hospital stay and/or overall disease outcome. Materials and Methods: In a randomized, placebo-controlled, parallel-group study conducted for approximately 1 year, 60 adults with acute intracerebral hemorrhage who reached hospital within 8 hours of onset of stroke symptoms (or the last time they were well) were registered. Results: The greater the hematoma burden, the higher the mRS value. In both scenarios, there is no significant difference between mRS values for cases and controls, with p-values for mRS at 1 and 3 months of 0.82 and 0.839, respectively. Conclusion: There was no significant difference in mRS after 1 month between the two groups. The difference in mRS after 3 months was also not significant. There was no significant difference in ICH volume change between the two groups.

153.Self-Prepared Hypertonic Saline Nasal Irrigation as an Effective Adjuctive Treatment in Allergic Rhinitis along with Intranasal Steroids and Oral Antihistaminics: A Randomized Controlled Trial
Bage S, Verma B, Chavan S S, Singh P
Background: Allergic rhinitis is a global health problem, and the symptoms deeply affect a patient’s quality of life (QoL). The current treatment protocols consist of antihistamines and nasal steroids as mainstay. In any setting, AR usually requires chronic treatment, which raises safety concerns about long term drug usage and also its economic burden. Nasal irrigation with saline appears to be useful adjunctive tool improving nasal symptoms and QoL, and also decreasing drug consumption in a cost-efficient manner. Methods: A hospital based, open label, randomized controlled trial was conducted with 100 patients to assess the adjuvant effect of nasal irrigation in cases of allergic rhinitis undergoing regular treatment with oral anti-histaminic and intranasal steroids. 100 patients of AR were randomized into two groups – one receiving oral antihistaminic and intranasal steroid and the other group additionally also received nasal irrigation with self-prepared hypertonic saline for a period of 3 weeks with follow up at 6 weeks. Both the groups were compared on the basis of total symptom score and Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ). Results: The study group was superior to the control group in terms of total symptom score and QoL (both P<0.001). Conclusion: Hypertonic Saline nasal irrigation when combined with Intranasal corticosteroids and oral antihistaminic demonstrates superior efficacy in managing symptoms and improving QoL. It also decreases drug dependence and is safe, easy to prepare and cost effective. Hence it is a worthy adjunctive tool to be considered in AR.

154.Efficacy and Safety of Acamprosate as Add on to Tinnitus Retraining Therapy in Patients of Subjective Tinnitus
Sharmendra Singh, Jasleen Kaur, Dinesh K. Badyal, Ashish Varghese
Background and Aim: Tinnitus retraining therapy (TRT) is main treatment strategy in subjective tinnitus. Certain pharmacological agents also have role in treatment of tinnitus. This study designed to evaluate efficacy and safety of acamprosate as add on to TRT in subjective tinnitus of sensorineural origin. Material and Methods: Study conducted in 60 patients visiting department of otolaryngology of CMC Ludhiana. Patients were divided in two groups (30 in each group). Group A(Control) patients received TRT treatment. Group B (Study) patients received TRT and tab acamprosate 333 mg TDS orally for 6 weeks. Patients assessed at baseline, 2, 4 and 6 weeks for tinnitus severity on VAS and THI scale. ADRs monitored at follow up visits. Results analyzed statistically by student t and ANOVA test. Results: Baseline VAS score for Group A was 51.70+1.36 and Group B was 55.00+1.57(p=0.115). After 6-week treatment the VAS score were 32.00+1.48 and 16.67+1.10 respectively (p<0.001) for the two groups which were statistically significant. Baseline THI score for Group A was 23.93+2.31 and Group B was 24.40+2.83 (p=0.899). After 6 weeks treatment THI score were 14.40+1.86 and 7.27+1.05 respectively (p=0.002) for the two groups which were statistically significant. In group B 10% patients reported mild diarrhea, 6.70% nausea, 6.70% mild abdominal pain and 3.30% reported mild pruritus. Conclusion: Acamprosate as add-on to TRT is more efficacious as compared to TRT alone in subjective tinnitus of sensorineural origin and has reported fewer adverse drug reactions for treatment of subjective tinnitus.

155.To Obtain Standard Anthropometric Measurements of the Faces of Young Adults Aged 18-26 Years and to Correlate with Their Personality Traits
Prabhakar, Vinodh Gurram, Eshwari R, Rajveer Singh Chourasia
Background & Method: This study aims to obtain standard anthropometric measurements of the face of young adults aged 18-26 years and to correlate them with their personality traits. The measuring procedure was explained to each participant clearly to eliminate the participant’s anxiety. The participants were asked to sit in a chair in a relaxed state with the head in a resting position. The resting position is determined by the individual’s feeling about the average balance of the head. When taking measurements of the eyes and mouth, it was resting closed when it was measured. Result: Among the study participants, the majority of them were aged 19 years. The meane is 20.04 years. Among the study participants, the majority were Females. Conclusion: The present study was done on 105 individuals aged 18-26 to evaluate the anthropometric measurement of the face and to correlate with his/her personality traits. The anthropometric parameters viz., Craniofacial height, Face Height, Intercanthal width, Total lip height, Lower vermilion height, Chin heightist, and Mouth width are highly sexually dimorphic. There is no correlation between personality traits Neuroticism and Extroversion/Introversion with face morphology.

156.Prevalence & Profile of Anemia in Children of Age 6-59 Months: A Hospital-Based Cross-Sectional Study
Sunil Kumar, Sangeeta Choudhary, Vidhi Arora, Manita Bambha, Sonam Sharma, Sumit Sharma
Introduction: Anaemia is a global public health concern that affects people in both high and low-socio-economic nations and is an issue for teenage girls, females of childbearing age (especially when the patient is pregnant), and young children. It hurts the overall health status of women & increases the risk of adverse maternal & neonatal outcomes. Globally, around two billion people are affected by anaemia.  The study concluded that in these Indian infants, haemoglobin level was significantly related to iron status; however, maternal haemoglobin level, household affluence, and food shortages were also significant determinants. Aims: To find out the prevalence of anaemia and analyze the associated socio-economic factors of pediatric anaemia. Objectives: To estimate the prevalence of anaemia and evaluate the types and risk factors associated with anaemia. Methods: This is a prospective cross-sectional observational study conducted on 323 pediatric patients of age from 6 months to 5 years who visited the pediatric ward. The patients were determined for anaemia (as per WHO criteria), Protein Energy Malnutrition (PEM) by assessing Z-score, and socio-economic status as per the Kuppuswamy index. Statistical analysis (Chi-square) was carried out and prevalence and its associated socioeconomic factors were determined. Results: The study found the degree of anaemia and mean level of haemoglobin in each age range and found that there is a significant number of patients with anemia (78.6%). Those patients who did not have anemia are either taking iron supplementation bi-weekly or irregularly (p<0.05). The study also found that joint families and children whose mothers are working have a high prevalence of anemia. Also, it was found that 37.4% of the patients had severe underweight, 46.1% had severe wasting and 34.6% of patients had severe stunting. Conclusion: The study has concluded that anaemia is higher in children who do not receive the required nutritional care and those who are from lower and upper-lower socio-economic classes.

157.A Comparative Study of LMA Supreme with I-Gel in Spontaneously Breathing Anaesthetised Adult Patients Undergoing Elective Short Surgical Procedures
Aravind Myageri, Kavyashree N.G., Prathibha K.T., Deepak T.G.
Background: In this study, we wanted to evaluate the performance of two supraglottic airway devices i-gel and LMA supreme in spontaneously breathing patients undergoing elective short surgical procedures under general anaesthesia. Methods: This was a hospital based randomized prospective study conducted among 60 patients who underwent short surgical procedures under general anaesthesia, belonging to ASA class I and II in Chigateri General Hospital, Women and Children Hospital and Bapuji Hospital, attached to J.J.M Medical College, Davangere from December 2012 to July 2014, after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: The first-time insertion rate was similar in both the groups (30 with LMA supreme compared to 29 with i-gel LMA). The insertion of i-gel was easy in 16 patients and moderately difficult in 14 patients. The insertion of LMA supreme was easy in 24 patients, moderately difficult in 5 patients and difficult in 1 patient. There were no significant haemodynamic changes between i-gel and LMA supreme with respect to heart rate, blood pressure and arterial saturation (SpO2). Complications were not significantly different between the two groups.  Conclusion: We conclude that both devices are suitable for routine use during maintenance of anaesthesia in spontaneously breathing patients under general anaesthesia with normal airways. Both LMA supreme and i-gel appear to be effective in establishing a clinically patent airway and have high success rates of insertion, without haemodynamic changes and low morbidity. LMA supreme was slightly easier to insert than the i-gel. Supraglottic devices which can avert the complications of endotracheal intubation are feasible emerging alternative options.

158.A Clinical Study of Retinal Manifestations of Pregnancy Induced Hypertension among Patients Admitted in a Tertiary Care Hospital
Shyam Savith Varanasi, Erra Ramadevi, Bharat Kumar Jain, Vepa Meenakshi
Background: Vascular endothelial dysfunction and its effects (generalised vasospasm and capillary leak) appear to be linked to the pathological alterations of this disease. Vasospastic symptoms can be reversed, and after delivery, the retinal vessels quickly return to normal health. The aim of this study is to find retinal changes corresponding with pregnancy induced hypertension. Early identification of PIH can prevent foetal and maternal problems. Methods: The present obesevational cross-sectional study was conducted on 100 patient in the Department of Ophthalmology and Obstetrics & Gynaecology, Rangaraya Medical College, GGH, Kakinada from December 2019 to November 2021. Results: Out of 100 patients, 53 had gestational hypertension, 2 had mild preeclampsia, 14 had severe preeclampsia and 12 had eclampsia. And 63 patients had no retinal changes, 37 patients had retinal changes, 2 patients had macular edema and in 1 patient serous retinal detachment was seen. Conclusion: The retinal vascular changes correlate with severity of hypertension. Fundus examination in patients with PIH is an important clinical evaluation to predict adverse fetal outcome. When Ophthalmoscopic examination is done carefully every day, it has proven to be of unquestionable value in the reduction of maternal mortality and foetal mortality.

159.Radiological Study of Appearance and Fusion of Ossification Centers of Elbow Joint
Santhosh Joy, C.S. Sreedevi, Manju P.A.
Background: Appearance and fusion of ossification centers like any other biological phenomenon are subject to variation from place to place and race to race. No authentic study on ossification centers has been done in southern Kerala in the last 25 years. In this study, we wanted to determine radiologically the age of appearance and fusion of ossification centers of elbow joint. Materials and Methods: This was a hospital based descriptive study conducted among 139 patients(72 males and 67 females) aged between 5 and 19 years who presented with radiographs of elbow joint in anteroposterior and lateral views in each case to the Department of Orthopaedics, Government Medical College, Trivandrum, over a period of 12 months from May 2011 to April 2012 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants and the legal guardians. Results: Mean age of appearance of ossification center for trochlea was 11.021 years with standard deviation of 0.3219. Sex difference in the appearance of ossification center for trochlea was not statistically significant. Mean age of appearance of ossification center for lateral epicondyle was 12.717 years with standard deviation of 0.5191. Sex difference with respect to appearance of ossification center for lateral epicondyle was not statistically significant. Mean age of formation of conjoint epiphysis was 13.556 years with standard deviation of 0.2396. Sex difference with respect to appearance of ossification center for conjoint epiphysis was not statistically significant. Mean age of complete fusion of conjoint epiphysis was 13.948 years with standard deviation of 0.3534. Sex difference in the fusion of conjoint epiphysis was not statistically significant. Mean age of complete fusion of medial epicondyle was 14.961 years with standard deviation of 0.8291. Sex difference in the fusion of medial epicondyle was not statistically significant. Mean age of complete fusion of Head of radius was 13.948 years with standard deviation of 0.3534. Conclusion: Age of appearance of ossification center for capitulum could not be scrutinized as it fell below the lower age limit of sample size. All subjects from 5 to 6 age group onwards showed presence of capitulum. As per the present study, appearance and fusion of ossifications centers are taking place slightly earlier than the existing standards except for appearance of ossification center for medial epicondyle. The enhancement of bone maturity may be due to better nutritional and health standards and changing life styles. Moreover, no subject selected for the study was ill nourished. Sex difference in the appearance and fusion of ossification centers was seen to be statistically insignificant. The age of appearance and fusion of the ossification centers of the elbow joint had shown differences from the conventional values followed for medico legal purpose.

160.Assessment of Gamma Glutamyl Transferase as a Diagnostic Marker of Metabolic Syndrome
Malasana Maitrey Jayantilal, Chandrashekhar S. Baid, Bindu Rani, Surendra Kumar Kanwat, Shraddha Merja

The purpose of this study was to identify the value of gamma glutamyl transferase (GGT) in instances of metabolic syndrome (MetS), the value of GGT in an age- and sex-matched control group, and the association of GGT as a marker in the diagnosis of metabolic syndrome. Method: Total number of 176 cases of metabolic syndrome, 78 cases (44% of all cases) was male and 98 cases (56% of cases) were female included from outpatients or inpatients in our tertiary care hospital. From January 2021 until June 2022, the study period lasted 18 months. It was possible to estimate GGT and other biochemical parameters. In line with this, descriptive and analytical statistical tests were run. Result: In this study, 25% of patients with metabolic syndrome fell within the upper limit of normal GGT levels, compared to 75% of instances with higher GGT levels. GGT was found to have a sensitivity and specificity of 67% and 100% in men and 94% and 98% in women, respectively, for the diagnosis of patients with metabolic syndrome. Conclusion: Therefore, the study found that individuals with metabolic syndrome had higher GGT levels. The test’s sensitivity for detecting metabolic syndrome was higher in females, but there was no gender difference in its specificity. So, it is possible to suggest GGT as a marker in the algorithm used to assess metabolic syndrome.

161. A Hospital Based Analytical Comparative Assessment of Serum Levels of Zinc, Copper and Magnesium in Type 2 Diabetes Mellitus
Shailesh Kumar Pankaj, Sujit Kumar, Rashmi Singh, C P Jaiswal
Aim:  The aim of the study was to estimate and compare serum zinc, copper and magnesium in Type 2 DM patients with nondiabetic controls and to correlate the serum zinc, copper and magnesium with HbA1c levels in Type 2 DM. Material & Methods: This study was a cross-sectional study conducted in Department of Pathology, NMCH, Patna, Bihar, India . The sample collection and analysis was carried out between 12 months. Ethical clearance for the study was obtained from the Institutional Ethics Committee (IEC). Written informed consent was obtained from all Participants. Results: In controls, deficiency of zinc was not observed. However, 04 subjects had decreased serum levels of both copper and magnesium. Individual serum copper and serum magnesium deficiency were noted in 10 subjects each. Comparison of means between Type 2 DM patients and healthy controls using Independent t-test demonstrated that serum zinc was significantly decreased in Type 2 DM. Pearson’s correlation analysis showed that the association between zinc, copper and magnesium with HbA1c was random. Although, the correlation is not statistically significant. Conclusion: Zinc deficiency noticed in Type 2 DM patients may be due to increased excretion in urine. Zinc oral preparations are cheap and easily available. Considering these, it can be further explored if micronutrient supplementation would help to improve the glycaemic variability in Type 2 DM.

162. A Study on Evaluation of Stress and Anxiety in the First Year Undergraduate Medical Student
Sujit Kumar, Rashmi Singh, Shailesh Kumar Pankaj, Rita Kumari
Aim: The study was carried out to assess the level of stress and anxiety experienced by the 1st year undergraduate medical students and to find out the sources of stress in these students and also to assess their stress coping mechanism. Methods: The present study was conducted at Department of Physiology, NMCH, Patna, Bihar, India for the period of one year.  Informed consent was obtained from the participants. Results: A total of 100 students participated in the study. Out of these participants, there were 60 males and 40 females. The students responded to all items in the scale which was 100%. Among various grades of anxiety, and stress, the majority of students were found to be in the mild to moderate level. Very few students were in severe to extremely severe levels of anxiety, and stress. The anxiety score is extremely high in 40% of the participants with no significant difference in male and female participants before the first internal examination. Conclusion: The present study showed that the stress among the 1st year undergraduate medical students was highly prevalent. There was no significant difference in male and female participants in the anxiety score.

163. A Prospective Randomized Comparative Assessment of Intravenous Magnesium Sulphate and Lignocaine in Attenuation of Pressor Response to Laryngoscopy and Endotracheal Intubation
Amit Kumar, Anil kumar Singh, Arjun Prasad, Veena Horo
Aim: The aim of the present study was to compare the efficacy of intravenous Magnesium sulphate with intravenous Lignocaine hydrochloride in attenuation of cardiovascular responses to laryngoscopy and intubation. Methods: It was Prospective Randomized Double-Blind Study on 100 patients done at Department of Anesthesiology at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India. The patients were randomly allocated into two groups, 50 patients in each group. Patients belonging to Group A received 1.5mg/kg of lignocaine intravenously 90 seconds prior to laryngoscopy and intubation. In Group B patients received intravenous magnesium sulphate 30mg/kg ,90 seconds prior to laryngoscopy and intubation. Results: The result showed the age distribution in Lignocaine (Group A) and Magnesium (Group B) groups. The age range is 20-60 years in both the groups. There was no statistically significant difference between the groups with regard to age and so they are comparable. (p=0.60). Samples are gender matched with P=0.55. In group A 74% of the patients are male and 26% are females. In group B 70% of the patients are males and 30% are females. Both the Groups are comparable with respect to gender. Intergroup comparison between the two groups showed that the SBP at 1, 5 and 10 minute after laryngoscopy in magnesium group were statistically significantly lower compared to lignocaine group (P<0.05). At 3 minute SBP was lower in magnesium group but not statistically significant when compared with lignocaine group. In Magnesium group the post induction DBP values was significantly lower compared to its baseline with P value of 0.02. At 1 minute there was slight increase in mean DBP with P=0.03 which returned near baseline value by 3minute. At 5 min and 10 minutes values were significantly lower (P=0.02 and P=0.001 respectively) when compared to its baseline but this decrease was not clinically significant. Conclusion: Intravenous magnesium sulphate 30mg/kg 90 seconds prior to laryngoscopy and intubation is superior to lignocaine 1.5mg/kg prior to laryngoscopy and intubation.

164. An Observational Study to Find Out Whether Risk Factors for Preterm FGR Are Different from the Preterm Non FGR
Bheemsen Kumar, Sanju Kumari, Gopal Shanker Sahni
Aim: The aim of the study was to find out whether risk factors for preterm FGR are different from the preterm non FGR. Methods: The present study was conducted in the department of pediatrics SKMCH Muzaffarpur, Bihar, India for 12 months. A total of 500 mothers who gave birth to singleton preterm infant attending OPD of Department of  obstetrics and gynecology at NMCH  bihar patna were recruited in our study. Results: Most of the subjects in the study group and control group were in the age group 26-30 years. The mean age of subjects was identical in both the groups. Most of the subjects in both the groups belonged to upper lower socioeconomic status by modified Kuppuswamy scale. In both the groups most of the subjects had a height of 145-155 cm. In terms of BMI, the two groups were statistically significantly different (p<0.001). In our study, 28% of subjects in the study group and 25% of subjects in the control group had a stressful event during pregnancy which was statistically not significant. Conclusion: Interventions to promote early attendance to ANC services, reducing poverty, educating to avoid smoking and manual labour may significantly decrease the burden of FGR and preterm birth.

165. A Hospital-Based Assessment of Iron Deficiency Anemia as a Risk Factor for First Febrile Seizures: Case Control Study
Mohammad Asghar Ali, Anjum Equebal, N. P. Gupta
Aim: To determine the association between Iron Deficiency Anemia (IDA) and the first episode of febrile seizures (FFS). Methodology: This research would be a Prospective case-control study for both children with the first episode of febrile seizures and febrile illness in the Department of Pediatrics, DMCH, Darbhanga, Bihar for 10 months (November 2021 to August 2022). This study includes two groups. Cases includes 50 consecutive children admitted in pediatrics ward fulfilling the following criteria. Control Group features 50 infants from 6 months to 5 years who have the febrile illness without convulsions. After obtaining informed consent from the parents of children to be enrolled for the study relevant history, examination and laboratory investigations were collected in a predesigned proforma. Investigation like hemoglobin, blood indices (MCV, MCH), and serum iron and serum ferritin are done for detection of iron deficiency anaemia and their relationship with the first episode of febrile seizure was observed. Results: In our study comprising 50 cases and 50 controls, 54% of cases were diagnosed as IDA with FS, 20% of controls were diagnosed as IDA. This suggests IDA as a risk factor for febrile seizures with a significant P value of <0.001. The average Hb value in cases was 9.02±1.56 and control values were 9.92±1.29, a mean MCV value of 66.94±15.21, control value of 84.42±14.22, and a mean MCH value of 31.14±13.98 in cases and control values of 37.04±9.62. The mean Serum Ferritin level was 46.21±65.78 in our sample of 50 cases, whereas the mean Serum Ferritin level was 55.21±24.42 in controls. The average serum iron level in our sample was 77.02±45.12, and the average serum iron level in our controls was 97.42±38.78. The mean level of TIBC for this analysis in cases was 435.16±123.85 and the mean level of TIBC in controls was 349.46±101.02. Throughout this analysis, the average level of Serum Transferrin in this sample was 245.62±62.24, and the mean amount in the controls was 292.24±50.12. Conclusion: Iron deficiency anaemia is a significant risk factor in lowering the seizure threshold for FS children between the age group of 6 months to 5 years. IDA was more frequent in children with Febrile Seizures than children with febrile illness alone. The findings indicate that IDA may be a risk factor for FFS. IDA monitoring should be done in children with FFS.

166. To Determine the Effect of a Combination of Nutritional Education and Nutritional Supplementation on Changes in the Nutritional Status of Newly Wed to Prevent Stunting in Newborns
Rashmi Singh, Sujit Kumar, Shailesh Kumar Pankaj, Rashmi Singh
Aim: The purpose of this study was to determine the effect of a combination of nutritional education and nutritional supplementation on changes in the nutritional status of the newly wed female to prevent stunting in newborns. Methods: The present study was conducted at PMCH, Patna, Bihar, India for one year and the number of subjects from the three intervention groups was 120 people. The intervention group is group 1: nutrition education intervention (stunting material) + multi micronutrient, group 2: nutrition education (stunting material) IFA (iron folic acid) and group 3: nutrition education (reproductive health material) + IFA. Results: The average age in group 1,2 and 3 was 24.19±2.60, 24.33±2.74 and 23, 48±2.53. The average BMI value of the three groups on the subject, before the interventions were 21.64±3.16 kg/m2. The mean BMI after intervention was 22.08±3.12 kg/m2 with a difference change of 0.45±0.36 kg/m2. There was a difference in the mean BMI before and after the intervention in all groups (p<0.05), meaning that there was a significant difference in the mean before and after the intervention. The statistical test showed that there was a significant difference in the mean BMI between the three groups (p<0.05). The provision of education and nutritional supplementation from marriage to delivery, based on the distribution of outcome variables, showed that of 120 newborns, 14 babies had a body length of <48 cm, namely stunting. And 15 had low birth weight (<2,500 grams). For the variable head circumference, 13 infants had abnormal head circumferences, i.e. <32 cm for male infants and <31 cm for female infants. Conclusion: The intervention can change the parameters of the nutritional status of the subject and there is a relationship between weight gain during pregnancy and infant anthropometry.

167. A Correlational Study on FNAC and Histopathology for the Diagnosis of Breast Lump
Bhavya Singh, Amit Ranjan, Deepak Kumar
Objectives: This present study was to correlate the diagnostic accuracy of FNAC and histopathology for the diagnosis of breast lump. Methods: A total of 50 patients with palpable breast lumps attending OPD of surgery department were enrolled in this study. FNAC was performed using 23 gauge needle after history and clinical examination of the patient. Aspirated material was expressed to glass slide and slide was immersed in fixator of 95% methyl alcohol. Slides were stained with Hematoxylin-Eosin and Leishman`s stain. According to findings, FNAC study was categorized into benign and malignant lesions. Results: Majorities of patients 29(58%) were in age group of 31-40 years. Out of 50 cases of breast lump, benign lesion was seen in 35(70%) cases and malignant lesion was seen in 15(30%) cases. Conclusions: FNAC is a reliable, safe, inexpensive, little discomfort, fast and time saving diagnostic method for the assessment of breast lumps with high degree of accuracy as compared to histopathological diagnosis. It should be used as preliminary investigation for the diagnosis of breast lump in outdoor patient department.

168. A Retrospective Study on Clinical Outcomes in Patients with SVN and NSVN
Sanjay Kumar
Introduction: One of the most prevalent illnesses of the neurological system is peripheral neuropathy. However, since more than 50% of them are classified as “idiopathic,” there are fewer therapy choices. We attempted to assess the phenotypic, laboratory, and prognostic features of patients with biopsy-proven vasculitic neuropathy in this study. Aim: To describe the clinical and analytical results of patients with vasculitic neuropathy confirmed by biopsy. Patients and Methods: Review of the biopsy results revealed either definite or probable vasculitic neuropathy. Results: There were 67 individuals in the cohort. There were 46 people with non-systemic vasculitic neuropathy and 21 people with non-systemic vasculitis (SVS) (NSVN). In 37 patients with definite vasculitis and 30 with possible vasculitis, the nerve biopsy revealed vasculitis. Paraesthesia and weakness were the primary symptoms at the time of beginning (68.7% and 28.4%, respectively). In 70.1% of individuals, diffuse polyneuropathy developed. For the vast majority of patients (80.59%), the course was chronic. 32.84% of patients had mononeuritis multiplex, and 67.16% had polyneuropathy, according to electrophysiology. 16.42% of the population had pure sensory neuropathy. The majority (71.05%) of the individuals who had completed bilateral nerve conduction testing had an asymmetric neuropathy. 80.59% of patients (mean 71.57 ± 30.81 mm/1 hr [in SVS] and 35.24 ± 21.62 mm/1 hr in NSVN]) had an increased erythrocyte sedimentation rate (ESR). Steroids, additional immunomodulators, and symptomatic drugs were all used in the treatment. 10.98 ± 9.58 months on average were spent following up. In 73.46% of patients, the outcome was favourable (43.8% with SVS and 87.88% with NSVN), with the NSVN group performing much better. Conclusion: Peripheral neuropathy may have a curable underlying cause called vasculitis. The diagnosis and classification of patients into non-systemic and systemic vasculitic neuropathies may be aided by the clinical characteristics, electrophysiological, laboratory data, and nerve biopsy. Compared to patients with systemic vasculitis, NSVN patients had a better long-term prognosis.

169. Incidence of Vaginal Candidiasis in Leucorrhoea in Women Attending in OPD of Gynecology and Obstetrics Department Mehsana
Nitesh Patel, Nehal Patel, Sangeeta Vasava
Background: Candida is the most common agent causing leucorrhoea affecting the women of all strata. It is becoming difficult to completely eradicate the infection mainly due to recurrence caused by non-albican species of Candida. Most of the non-albican species of Candida are resistant to commonly used antifungal agent – azole. Therefore, studying the Incidence of Candida species in vaginal secretion is of great significance. Objective: To study the incidence of Candidiasis in patients of leucorrhoea and identification of different species of candida found in leucorrhoea and to study the effect of pregnancy and age on infection rate in women Attending in OPD of Gynecology and Obstetrics, Department, Civil Hospital, Mahesana, Gujarat, India. Materials and Methods: The study was conducted on 300 patients with specific complaints of leucorrhea. Discharge was examined by direct wet preparation by KOH mount, Gram staining, and Culture on Sabouraud’s dextrose agar. Species differentiation was done by Germ tube formation, Sugar assimilation and Sugar Fermentation test. Results: In 19% of the women the leucorrhea was due to Candida infection with highest incidence in women of age (21-30 years). Incidence of candidiasis was higher in Pregnant (22.5%) compared to non-pregnant (16.6%). Candida albicans was the most common strain identified and Candida krusei was the least common one. Conclusion: Highest incidence found between 21-30 years age group, in pregnant women, in women from lower socio-economic class. Among candida species C. albicans was commonest followed by C. glabrata, C. tropicalis, C. krusei.

170. Study of Chikungunya and Dengue in Tertiary Care Hospital Jamnagar
Nitesh K. Patel, Nehal S. Patel, Sangeeta Vasava
Dengue and Chikungunya are infectious diseases that often result in hospitalizations and are associated with high public health costs. Due to the similarity of symptoms between dengue and chikungunya, improved diagnostic tests are desperately needed. Thus ELISA plays a key role to differentiate between the two. The Aim/Scope of the study was to detect the seropositivity of Dengue and Chikungunya based on ELISA & study the trends in relation to season, region, gender and admission pattern. Study population included Serum Samples received from clinically suspected patients of Dengue and Chikungunya. Study period taken up was from June 2015 to May 2016. For Dengue, NS1 ELISA was done in fever less than 5 days while IgM ELISA was done in fever more than 5 days & IgM ELISA for suspected Chikungunya patients. Also, 42 samples tested for both Dengue and Chikungunya. Chikungunya showed a month wise steady increasing trend from August to December followed by downfall. Males showed more seropositivity for Dengue while Females, for Chikungunya. Jamnagar city showed more cases of Dengue while periphery of Jamnagar showed more cases of Chikungunya. Suspicious In patient cases showed more seropositivity for Dengue, thus suggesting Dengue being a more severe form and more life threatening. 42 samples that were sent for both Dengue and Chikungunya tests, showed that 12 samples were Positive for Chikungunya & one patient showed co-infection. Thus, apart from getting to know the seasonal, regional, gender and admission related differences between the two diseases our study also lead to the conclusion that cases suspected for Dengue should be tested for Chikungunya as well and vice versa, for limiting the chances of misdiagnosis/ under diagnosis and knowing actual rate of Incidence.

171. Comparative Analysis of 3 Community-Based Models Developed for Screening Diabetic Retinopathy
Sachin Gathe
Introduction: Numerous eye conditions, such as cataracts, glaucoma, ocular surface issues, recurrent styes, diabetic retinopathy, non-arteritic anterior ischemic optic neuropathy, and diabetic retinopathy can develop as a result of uncontrolled diabetes. The most frequent and serious eye complication is diabetic retinopathy, which can damage the retina in a way that could jeopardize vision and possibly result in blindness. Retinal examination may involve fundus examination or retinal photography (ophthalmoscopy). In comparison to direct and indirect ophthalmoscopy, mydriatic and non-mydriatic color retinal photography has demonstrated higher sensitivity in the detection of diabetic retinopathy. Aims and Objective: To assess the effectiveness of 3 different community-based models in terms of effectiveness of detection and cost in a screening programme of diabetic retinopathy. Methods: The study used 3 different models for studying their effectiveness in terms of detection of Diabetes Mellitus (DM) and Diabetic Retinopathy (DR). This study was conducted on 80 patients of suspected diabetes who visited to the screening camp and gave consent for the study. A screening program was conducted, which is divided into 3 models. All 80 patients underwent in 3 different models to evaluate the effectiveness of each model. A thorough patient history including demographic information, diabetes history, and treatment information was included in the ophthalmological evaluation, which also included vision tests, measuring intraocular pressure, and performing a dilated fundus examination. Results: The study found that the highest percentage of DR was detected in Model 3 followed by Model 2 and Model 1. This rate of detection of DR was found to be significant(p<0.05). The rate of detection of DM was also highest in Model 3 but it was not significantly different as compared to Model 2 and Model 1. The most practical model for identifying newly diagnosed diabetes was model 1. Model 2 had the highest overall pickup rate for DR patients despite being more financially difficult. Less new DR patients were picked up by Model 3. Conclusion: The study concludes that the screening of diabetic retinopathy in camps, is difficult as compared to diabetes alone due to poor cost effectiveness. However, institutional screening is cost-effective with higher detection rate of diabetic retinopathy.

172. Determination of Opportunistic Screening of Type-2 Diabetes at the District Level in India
Sachin Gathe
Introduction: The following analysis has discussed the metabolic disorder known as diabetes mellitus is caused by an issue with insulin action, insulin secretion, or both. Chronic hyperglycemia is a defining characteristic, and microvascular and macrovascular complications impose a substantial burden on health. In addition, Diabetes complications may not appear or develop more slowly if the issue is detected and treated early. Despite the fact that type 2 diabetes may initially present with few symptoms, the disease’s long-term effects can produce a wide range of complications, which can lead to debilitating complications. Aims and Objectives: To determine the proportion of patients who are at risk of having diabetes mellitus using the Indian Diabetes Risk Score (IDRS) and also to determine the various factors associated with risk of having diabetes mellitus in the future. Methods: A study was carried out on 80 patients who visited our hospital’s outpatient department. This study selected those patients who were aged 30. The researchers conducted personal interviews using a predesigned questionnaire to collect data. The researchers provided comprehensive details of the study to the participants. The patient’s consent has been obtained. The hospital’s ethics committee has approved the methodology of the study. Results: High IDRS was determined using binary logistic regression with “IDRS” as the dependent variable. Hypertensives were 2.43 (95% CI = 1.132-4.980, P = 0.025) times more likely to have high IDRS. For study participants with a BMI of 25 kg/m2, the odds of having high IDRS were 3.24 times (95% CI = 1.475-6.721, P = 0.004) higher and 3.35 times (95% CI = (0.126-0.859), P = 0.006) lower than for those with a BMI of 18.5 kg/m2. Conclusion: The current study concluded that females had higher IDRS scores than males. It highlights the importance of doing opportunistic diabetes screening among patients residing in rural communities.

173. A Hospital-Based Study to Assess the Association between Blood PLT and RBC Related Indices and Disease Activity in Patients with Rheumatoid Arthritis
Rajeev Kumar, S.K. Astik, Subham Bhaskar, Narendra Kumar, Ajay Kumar Sinha
Aim: This study aimed to evaluate the association of blood PLT and RBC related parameters with the disease activity in rheumatoid arthritis (RA) patients. Methods: This study included 200 RA patients who were admitted to the Department of General medicine at Nalanda Medical College and Hospital, Patna, Bihar, India for the period of one year. Results: There were no differences in age and gender distribution, body mass index (BMI) and WBC between the two groups. Besides, CRP, ESR, RF and anti-CCP in RA patients were significantly higher than those in the control group (P < 0.001). Age, gender, BMI, disease duration, anti-CCP and WBC were similar between the two groups. The active RA patients had higher levels of ESR, CRP and RF compared with inactive RA groups (P < 0.001 or P < 0.01). The greater levels of Ig G, Ig A and Ig M were also observed in active RA groups as compared to those in inactive RA groups (P < 0.05). Patients with active RA showed higher levels of PLT counts but lower levels of RBC counts, HCT, RPR and HPR than those with inactive group. No significant differences in PDW and RDW were observed between the active RA and inactive RA. Conclusion: Blood PLT and RBC related indices were significantly associated with RA disease activity. These indices may be used to distinguish active RA from inactive RA.

174. A Prospective Functional Outcome Assessment of Intra Articular Calcaneum Fracture Managed Surgically with Plate Fixation
Sanjeev Kumar Shukla, Bimlesh Kumar Bimal, Rajeev Kumar, Vidya Sagar, Raman Kumar, Vibhu Upadhyay
Aim: The aim of the present study was to evaluate the functional and radiological outcome of intra-articular calcaneal fractures managed surgically with a plate in terms of bohler’s and gissane’s angle, rate of radiological union and AOFAS score. Methods: The Prospective study was done at tertiary health care centre of north india and ethical clearance was taken for 2 years and a total of 30 patients with intra-articular calcaneal fractures meeting the inclusion and exclusion criteria were chosen for the study. Results: In our study, patients between the ages group 18 yr and 60yr with a mean age of 33.36yr were included. The majority of the patients in the study were males, with 90% of the study population. In this study, 60% of the patients had right side involvement and 40% of the patients had left side involvement. The most common mode of injury in the study group was falling from height followed by RTA. The most common fracture type in our study was Sander’s type II, followed by type IV. Type III was the least common. In all the patients included in the study, surgery was delayed until the appearance of wrinkles on the skin to avoid the complication of wound dehiscence and for appropriate wound closure. The number of days from the injury to surgery varied from 4 to 14 days with an average of 7.8 days. The average time period for the radiological union was 13.64 weeks in the study population. Conclusion: We concluded that with proper pre-operative planning, the timing of surgery, intra- operative expertise of the surgeon, and post-operative care, surgical management of intra-articular fracture using a locking plate, gives a better outcome and minimal complications.

175. Role of Magnetic Resonance Imaging in Evaluation and Staging of Breast Cancer: A Prospective Study
Nirmalya Swain, Inuganti Gopal, Nirod Kumar Sahoo, Sumita Tripathy, Mukti Prasad Mishra
Background: Currently breast cancer is staged with ultrasound (USG) and computed tomography (CT). However, Magnetic resonance imaging (MRI) is giving superior results in the detection of axillary metastasis and in local staging of breast cancer. Optimal (local) staging of breast cancer could become crucial in selecting patients for neoadjuvant chemotherapy. In this study, we find out the diagnostic performance of MRI in staging of breast cancer and compare with histopathological study and thus find the accuracy of MRI in staging preoperatively. Aim and Objective: (1) To determine the accuracy of MRI in diagnosis and staging of Breast Cancer and evaluation of axilla. (2) To assess the adequacy of MRI in detecting multi-focality of Breast Cancer. Patients and Methods: It is a prospective study taking 60 number of breast cancer patients who were admitted to the MKCG Medical and Hospital during the period from August 2020 to July 2022. All the patients underwent MRI scan (1.5 Tesla:T1,T2 and diffusion weighted imaging) of the breast and axilla. 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 surgical cases selected. The results were recorded on various parameters like size, shape, calcification, margins of tumour and axillary lymph node involvement. Results: The overall accuracy of TNM-staging  using MRI when all cases were combined was 95% in our study with 96.3% sensitivity, 83.33% specificity, 98.11% positive predictive value and 71.43% negative predictive value. Conclusion: Breast MRI plays an important role in breast cancer screening and diagnosis, based on the current indications, as per the ACR practice parameters. The best non-invasive tool for assessing accurate tumour size is breast MRI. Tumour size can be underestimated by mammography and ultrasound, but the size of the tumour at histology is not significantly different from that on MRI. In breast MRI, both breasts are imaged at the same time, which helps to evaluate contralateral disease. It also assesses for multifocal or multicentric disease, which does alter surgical management. Breast MRI allows for the evaluation of levels 1, 2, and 3 axillary and internal mammary lymph nodes, which not only affects staging and treatment planning but is also the most important deterministic factor for the prognosis of breast cancer. Finally, it is imperative to look for and report extra-mammary findings in the lungs, bones, and visualized liver, especially if they are concerning for distant metastasis.

176. Conventional, NIV and High Flow Nasal Oxygen Therapy in Post-Extubation Hypoxia among Adults Undergoing Abdominal Surgery: An Observational Study in a Tertiary Care Hospital
Chayan Bhowmik, Vaskar Majumdar, Ranjit Reang
Background: Hypoxia is defined as inadequate tissue oxygenation due to either inadequate blood flow or low arterial oxygen content. Hypoxia is one of the most feared critical events during anesthesia and the recovery period. Hypoxia or even hypoxaemia can occur anytime during anesthesia with astonishing suddenness. Severe hypoxaemia can result in death of a patient or leave them with devastating neurological handicaps. Early diagnosis of hypoxia would lead to early correction of this unwanted event, otherwise which might cause postoperative complications or even death. Aim: To compare the efficacy of conventional, non-invasive ventilation and high flow nasal oxygen therapy in the management of post extubation hypoxia among patients undergoing abdominal surgeries. Methods: It was observational cross-sectional study conducted from June 2021 to November 2022 in Anesthesia Intensive Care Unit (AICU), Department of Anesthesiology, Agartala Government Medical College, Agartala, West Tripura. Based on census sampling technique, a sample of 90 patients was selected for the study, out of which 30 patients were grouped in each group A (applied conventional face mask), B (applied NIV/Bi-PAP) and C (applied HFNOC). Results: It was observed that HFNOC applied to those patients where respiratory rate is slightly high than other two groups and correction of tachypnea is much faster in NIV and HFNOC group than conventional facemask. PaO2 (ABG after 120 Minutes) was significantly higher in group C than B and A respectively. PCO2 (ABG after 120 Minutes) was significantly less in in group C than B and A respectively. P/F ratio (ABG after 120 Minutes) was significantly higher in group C than B and A respectively. The mean Patient comfort was significantly higher in Group-C and A compared to Group-B. Dyspnoea VAS was significantly less in in group C than A and B respectively. Conclusion: The present study concluded that HFNOC and NIV is more effective than conventional oxygen therapy in improving oxygenation in patients with post extubation hypoxia.

177. A Prospective Observational Assessment of the Prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) Viral Seropositive among the Patients Posted for Cataract Surgery at a Tertiary Care Hospital
Amit Rajan, Farmood Alam, Arun Kumar Sinha
Background: Treatment of cataract is the most popular surgery around the world. However, there is a safety issue regarding such surgical interventions in areas of high endemicity for HIV infections, viral hepatitis B (HBV) and C (HCV). In India, most of the patients undergoing cataract surgery were not routinely tested for viral seropositivity. Occult carriers of viral infections were prone to infecting others and were deprived of proper treatment. Aim: The present study was done to find out the prevalence of human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) viral seropositive among the patients posted for cataract surgery at a tertiary care center in Bihar India. Methodology: A cross-sectional hospital-based study was done among 800 cataract patients in the Department of Ophthalmology, B.M.I.M.S., Pawapuri, Nalanda, Bihar, India over of 1 year (November 2021 to October 2022). All the patients planned for elective cataract surgery were tested for HBsAg, HCV, and HIV. Result: Out of the total 800 cataract patients who were operated, 720 were adults, 480 were male, 60% were educated up to high school, 70% were employed, 60% were hindu by religion, 70% were staying in rural area and 60%were belonging to lower socio-economic status category. Among the 720 adult patients, the prevalence of HIV, HBV and HCV was found to be 0.69% (50), 2.08% (150) and 0.14% (10) respectively. There was a significant association with the mean age in the patients with HIV (P < 0.001) and HBsAg seropositive (P < 0.001). There was a significant association between HIV and male gender (P = 0.028). There was no association between gender and HBsAg and HCV positivity. Conclusion: Viral seropositivity was significant among the patients posted for cataract surgery. The eye care providers could refer these patients for counseling and further management for the patient’s and their caretaker’s benefit.

178. A Questionnaire-Based Survey Study to Assess the Burden of Care in Nasoalveolar Molding Treatment in Cleft Patients
Puja Priyadarshini
Aim: The study examined the success of presurgical nasoalveolar molding (NAM) therapy in cleft patients from a caregiver’s perspective and revealed factors that can cause inconvenience. Methods: A survey-based study was performed using a 32-item questionnaire following NAM therapy study was conducted at Nalanda Medical College and Hospital, Patna, Bihar, India. 600 patients were treated with CLP. We identified 50 patients of them who initiated NAM therapy. All families received the questionnaire, and 20 of them completed it. Results: The mean age was 5 ± 3.7 weeks (range: 2–14 weeks) when the NAM therapy started. 60 percent patients were male, while 40% were female. Patients lived an average of 60 km from the cleft center (60%), with more than 60 minutes of traveling time (60%). The unilateral cleft and lip palate was present in 60%, while the bilateral was 40%. It was observed that the alveolar defect affected mainly the first born (45%). However, there were no correlations between the distribution of the dentofacial deficiency and its occurrence among the siblings ( p  = 0.3737). Conclusion: The present study highlighted the value of caregivers’ role in NAM therapy. The burden of care is acceptable caregivers have high compliance, and are determined to help the effectiveness of therapy.

179. A Retrospective Observational Assessment of the Clinicopathological & Demographic Profile of Patients with Meningioma from Rural Setup
Shambhwi Sharma
Aim: The aim of this study was to determine clinic-demographic profile of Meningioma among population in a rural setup of Bihar region. Methods: This study was retrospective observational study at AIIMS, Patna, Bihar, India for the period of 2 years. Out of 200 cases of CNS tumors operated, meningioma consists of 50 cases (25%). Results: The average age of presentation was 44.1 years. Most common affected age group was 30-50 years comprising 26 cases (52%). Out of 50 cases 42 (84%) were intracranial menigioma and 8 (16%) were spinal meningioma. The most common clinical symptoms for intracranial cases were headache followed by seizures and vomiting. Among intracranial meningioma, the most common location was convexity meningioma (40%) followed by parasagittal (12%). Meningothelial meningioma 20 (40%) was the commonest subtype followed by transitional 12 (24%), psammomatous, 5 (10%), fibroblastic 2 (4%), metaplastic 1 (2%) and others. Grade II meningiomas included atypical 2 (4%), clear cell 1 (2%) whereas grade III included all the cases of papillary 1(2 %) and anaplastic 2 (4%) meningiomas. Conclusion: The descriptive epidemiology of meningioma in our rural setup roughly correlates with the epidemiology elsewhere in India apart from the male to female ratio; which could be due to lack of seeking medical care among females in our society.

180. A Hospital-Based Evaluation of the Risk Factors and Vital Role of Mothers in Prevention of Nutritional Anemia in the Early Childhood
Nivedita, Sudarshan, Animesh Kumar
Aim: This study aimed to analyze the risk factors and vital role of mothers in prevention of nutritional anemia in the early childhood. Methods: This study was carried out at department of Pediatrics, JLNMCH, Bhagalpur, Bihar, India for the period of one year. Children aged 6 months–2 years admitted at the hospital during the study period were included. Any child with chronic disorders such as hemoglobinopathies, hemolytic anemia, and treated for anemia and those on any immuno suppressants such as steroids and biologics were excluded as an indirect measure to eliminate anemia of chronic disease. Results: Of the 500 children, 270 (54%) were anemic. Moderate anemia was found in 120 (24%) and only 10 (2%) had severe anemia. Mean age of anemic children was 13.23±5.15 months. Mean maternal age was 26.49±3.46 years, ranging between 19 and 36 years. Majority (78%) of the mothers were aware that neural development of child could be affected by anemia. Despite WHO’s efforts to enforce exclusive breastfeeding until 6 months of age, 18% of mothers preferred to initiate complementary feeds at 4 months of age. Maternal knowledge regarding cow’s milk was poor as 84% had a faulty belief that it increases iron absorption, whereas 16% were unaware of the relationship between cow’s milk and anemia. Around 80% and 70% mothers recognized green leaves and jaggery to be enriched with iron. On an attempt to establish a correlation between maternal education status and anemic children, we found that mothers with better literacy rates had significant awareness regarding anemia and nutrition. Conclusion: Recognizing the causative factors plays an essential role in preventing iron deficiency anemia (IDA). Exclusive breastfeeding must be promoted, along with avoiding excessive cow’s milk intake. Intervening at the right period with age-appropriate foods becomes a necessity. Maternal illiteracy has a positive correlation with anemia in infants. Improving maternal awareness by the physicians will pave the road toward a nation free from anemia.

181. Assessment of Patients with Intracerebral Hemorrhage during the Pandemic COVID-19 Learning from Experience
Hemant Kumar
Aim: We assessed the patients with intracerebral hemorrhage during the pandemic Covid 19. Methods: The study protocol was approved by the Hospital COVID- 19 Paras HMRI Hospital, Patna, Bihar, India.  All research was performed in accordance with guidelines and regulations, and the respective authors declare a statement confirming that informed consent was obtained from all of the participants’ parents and/or their legal guardians. Overall, a total of 50 patients from the PANDEMIC registry fulfilled the inclusion criteria. Results: The demographic and clinical characteristics of patients from the PANDEMIC registry, as well as the results for all individual-level patient data (total n = 100, with n = 50 from the PANDEMIC registry. Conclusion: ICH in COVID-19 patients is rare, but it has a very poor prognosis. Different subtypes of ICH seen in COVID-19, support the assumption of heterogeneous and multifaceted pathomechanisms contributing to ICH in COVID-19. Further clinical and pathophysiological investigations are warranted to resolve the conflict between thromboembolic and hemorrhagic complications in the future.

182. A Hospital-Based Assessment of the Prevalence of Pulmonary Hypertension in Patients with Chronic Kidney Disease
Shashank Shekhar, Preeti Sinha
Aim: The aim of this study was to analyze the prevalence of PH in patients with CKD, its severity in different stages of CKD and risk factors for it. Methods: The present study was conducted at Department of Nephrology, Indira Gandhi institute of medical Sciences (IGIMS), Patna, Bihar, India for 18 months and 100 patients were included in the study. Selected patients were informed about objectives of the study, and informed consent was taken from the patient or their guardian. Information was collected using a preformed proforma from each patient. Results: The mean age of the study population was 44.53 ± 14.63 years. There were 70 males and 30 females in the present study. There were 90 patients in stage 5 CKD disease followed by 7 patients in stage 4 and 3 patients in stage 3. Heart failure with reduced EF (HFrEF) was present in 26 (26%) of 100 patients. Among the patients with LV systolic dysfunction, majority had mild dysfunction. The prevalence of heart failure with preserved EF (HFpEF,) was 85 (85%) of 100 patients at first ECHO, increased further at follow‑up ECHO. Among patients with CKD stage 3 and 4, majority had mild PH, but in stage 5, it was predominantly moderate PH (25 of 92 [27.17%]) patients. This indicates that PH increased in severity with progression of CKD, although this was not statistically significant, since there were few patients in stage 3 and stage 4. Conclusion: PH is a common complication in CKD patients with prevalence of 43.5%–50%. Left-sided heart failure, anemia, fluid retention, and increased calcium phosphate product are the risk factors for developing PH.

183. A Hospital Based Observational Assessment of Quality of Acute Ischemic Stroke Care
Hemant Kumar
Aim: This study was undertaken to examine the quality of acute ischemic stroke care. Methods: The present study was conducted at Paras HMRI Hospital, Patna, Bihar, India and 100 patients were admitted at the hospital with acute ischemic stroke (AIS) as the confirmed diagnosis duly documented in the patients’ medical records for the period of one year. Results: The social demographics of the patients showed a mean (±SD) age of 65 ± 12 years. More than half of these patients were females (approximately 60%). It is observed that 65% of the patients had National Health Insurance Scheme (NHIS) coverage, whilst 35% exclusively paid out of pocket for their medical services. A review of the patients’ clinical characteristics for vascular risk factors for stroke indicated that hypertension was the highest (88%), followed by diabetes mellitus (38%), previous stroke (12%), dyslipidemia (7%), previous TIA (5%), atrial fibrillation/flutter (3%), and smoking (2%) being the least. Conclusion: There were several gaps in the quality of acute ischemic stroke care provided to patients. With the exception of discharging patients on statin medications, there was poor adherence to all other stroke performance indicators.

184.A Hospital Based Assessment of the Incidence and Histomorphological Spectrum of Testicular Lesions Including Non-Neoplastic as Well as Neoplastic Lesions
Shambhwi Sharma
Aim: The aim of the present study was to study the incidence and histomorphological spectrum of testicular lesions including non-neoplastic as well as neoplastic lesions. Methods: The present study is an observational study, carried out in  Department of  Pathology,AIIMS, Patna, Bihar, India, over duration of two years. A total of 50 radical orchidectomy and testicular biopsies were studied for gross and microscopic findings. Clinical details like age, laterality, family history, history of risk factors, and serum markers of the patients were recorded from the patient record section of the hospital and by talking to the patients directly wherever possible. Results: The present study comprised of total 50 cases. 44 orchidectomy specimens and 6 testicular biopsies were studied. Out of these, 40 cases were non neoplastic and 10 were neoplastic. The youngest patient was a 6-month-old male child while the oldest was 78 years old. Maximum number of patients presented in the 2nd & 4th decade of life. Among neoplastic lesions, the youngest patient was 9 years old and oldest was 75 years old. The mean age for non-neoplastic lesions was 33.32 years and for neoplastic lesions was 33.40 years. Clinically, most of the patients presented with scrotal swelling (54%), empty scrotum (40%) pain (36%), fever (12%) and tenderness (8%). Right testis was involved more commonly (31/50;62%) than left testis (19/50;38%). Bilateral testicular involvement was not seen in any of the cases. Conclusion: Germ cell tumors accounted for highest percentage of cases with a commonest subtype of seminoma followed by mixed germ cell tumors. Histopathologic examination can help in accurately diagnosing and determining the prognosis of these rare tumor and tumor like lesions of testis.

185.To Study the Incidence and Adverse Events Associated with Maternal Near Miss Cases in Tertiary Care Hospital
Nina Mishra, Yudhisthir Badka, Anu Priya, Pratik Das
Introduction: Maternal health is an integral part of country’s health care system and the 5th Millennium development goal. It reflects status of obstetrics health and helps in reviewing achievements of facility /country. Near Miss case is an ill woman who would have died but for the good care received or sheer good luck. Maternal mortality is described as “just the tip of the iceberg”, implying that there is a base maternal morbidity which remains largely undescribed. Maternal near miss case /Severe Acute Maternal Morbidity (SAMM) are defined by a WHO working group in 2009 as “a woman who nearly dies but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. Aims and Objectives: (a) To Study the Incidence and adverse events associated with Maternal Near Miss cases (b) To Study the Sociodemographic variables among Maternal Near Miss cases (c) To Study the Post-natal Obstetrical complications in the Maternal Near Miss cases (d) To Evaluate the level of care at maternal lifesaving emergency services by analysing Maternal Near Miss cases. Materials and Methods: This study was conducted in the department of Obstetrics and Gynecology, MKCG Medical College, Berhampur, Odisha, India for a period of 2 years from September 2019 to august 2021. At the end of the study collected data were tabulated and analysed. Results: During the study period, there were 18, 000 deliveries, 15, 000 live births. Among 250 women suspected of near miss, 200 were confirmed based on WHO management criteria.  A total no. of maternal deaths was 100 resulted in a total maternal near miss ratio 13.3 per 1000 live births, incidence was 1.3%. Hypertensive disorders accounted for the most common event (n=100, 50%) followed by haemorrhage (n=66, 28%), sepsis (n=28, 14%) and dystocia (n=12, 6%).The mean age of admission was 25. Majority (77.7%) of women were rural based, 22.2% were urban. Around 180 cases were referred from peripheral hospital and 52 were booked cases. Around 77.5% belonged to BPL category. Only 15% had 3 or more ANC while 85% had less than 3 ANC.  Among 200, 58 % were multigravida and 42% were primigravida. Among these, 39.5% at preterm gestation and 60.5% at term, 92% cases delivered in hospital and 8% at home, by LSCS in 34.2% and 66.8% by vaginal delivery. Outcome assessment showed 63.5% of livebirth and 36% were IUDs. After delivery, 39.5% in shock, 19.5% in PPH, 16% in sepsis/MODS, 3.5% in pulmonary oedema, 5% in HELLP / DIC. Conclusion: The maternal health policy needs to be concerned not only with averting the loss of life, but also with preventing or ameliorating maternal near miss events (hypertensive disorders, sepsis, haemorrhage, and dystocia) at all care levels including primary level. Delayed diagnosis, inappropriate transfer, and inadequate utilization of resources might have been the cause for maternal morbidities and mortalities in our study which needs to be addressed. Along with increased awareness of one’s own health, health education may go a long way in improving the quality of obstetric care.

186.Treatment Outcome and Drug Resistant Profile of Isoniazid Monoresistant Pulmonary Tuberculosis Patients in a Tertiary Care Centre: A Prospective Study
Anand Raja, P. Dhamodharan, N. Muthulakshmi, R. Hariprasad
Background: Tuberculosis (TB), a communicable disease is a major cause of ill health and one of the leading causes of death worldwide. Global TB report 2022 says an estimated 10.6 million people were infected with TB worldwide in 2021, an increase of 4.5% from 10.1 million in 2020.Isoniazid mono-resistance forms a major part of Drug Resistant Tuberculosis. Resistance to it increases the likelihood of negative treatment outcomes, treatment relapse and death. As per National Drug Resistance Survey 2014-2016, Isoniazid resistance is 11.06% and 25.09% and Isoniazid mono-resistance was 3.85% and 7.61% among new and previously treated patients, respectively. Transmission of Isoniazid resistant isolates is possible with mutations, especially katG315T. Hence this study focuses on INH resistance pulmonary Tuberculosis patients, the clinical parameters, genotype profile and their association with the outcome of the disease. Materials and Methods: A Cohort Study conducted with microbiologically confirmed Isoniazid Mono-resistant Pulmonary Tuberculosis patients diagnosed by First Line Probe Assay registered at a tertiary care hospital over a period of one year were included in the study. Drug sensitive Pulmonary Tuberculosis, Multi drug resistant Tuberculosis, Poly drug resistant pulmonary Tuberculosis, and Extra-pulmonary Tuberculosis were excluded. All 83 microbiologically confirmed Isoniazid Mono-resistant Pulmonary tuberculosis patients were included in the study. Data was collected with structured questionnaire following informed consent of the participants. Patients were evaluated with Chest X-ray, physical examination, sputum smear, liquid culture & DST, Line Probe Assay and treated as per Guidelines. Data was entered in Microsoft excel and analysis was done in SPSS Software version 21. Results: Majority of patients belonged to the age group 40-60 (38%). Out of the total 79 patients, 75% were males. About 54% of patients, gained more than 10% of their body weight on completion of treatment. Among patients who gained more than 10% body weight, 53% of patients showed positive outcomes of the treatment. 60.8% patients showed Kat G mutations; 30.2% patients showed Inh A mutations and 5.1% patients showed both. The association between the genetic mutations and outcome of the treatment was not statistically significant. Among all the study participants, 88.6% showed positive outcomes. Conclusion: Maximum number of patients was in 40 – 60 age group (46%). INH mono-resistant TB was more common in males than females. Diabetic patients were more common than hypertensive patients. Positive outcome with Inh A mutation was more common. Negative outcomes were more common when the pre-treatment weight was less than <10%. Poor weight gain was associated with poor outcomes.

187. An Observational Assessment of Physical Activity and Dietary Habits among Adolescents
Binish Inam
Aim: The current study aimed to focus specifically on objectively assessed physical activity & and dietary habits among adolescents of Bihar. Methods: The present study was conducted at Anugrah Narayan Magadh medical College and Hospital, Gaya, Bihar, India and cross-sectional data were collected. Data were obtained from adolescents (12–16 years) recruited from three secondary schools in Bihar. Staff at participating schools selected a subset of their classes for participation. All students from nominated classes (n = 242) were eligible and received written information on the project. Consent was sought from parents prior to the study and adolescent participants provided assent before completing written surveys during class. Results: In total, 221 pupils provided consent and completed the questionnaire (90% response rate). Of these, 123 (54%) provided usable accelerometer data. Comparison of these 123 adolescents with those who did not provide usable accelerometer data (n = 102) showed no significant differences in age, SES, ethnicity or fruit and vegetable consumption. A significantly (p < 0.01) higher proportion of those with usable accelerometer data were girls, compared to boys (53% compared to 37%), and ate breakfast on more days per week (4.7 days compared to 3.5 days). The final sample composition was 123 adolescents, with 61 boys, 62 girls, 68 younger adolescents and 55 older adolescents. The mean age of younger adolescents was 14.3 years and of older adolescents was 14.6 years. Conclusion: Many adolescents fail to meet multiple diet and physical activity recommendations, highlighting that physical activity and dietary behaviours do not occur in isolation. Future research should investigate how best to achieve multiple health behaviour change in adolescent boys and girls.

188. Hospital Based Prospective Observational Assessment of Complications of Functional Endoscopic Surgery (FESS) at Darbhanga Medical College
Raj Kumar Pathak, Nishant Kumar
Aim: The aim of the present study was to assess complications of functional endoscopic surgery (FESS) at a tertiary hospital. Methods: The Present study was single-center, prospective, observational study, conducted in Department of ENT, Darbhanga Medical College and Hospital Laheriasarai, Darbhanga, Bihar, India. From June 2019 to May 2020. Study was approved by institutional ethical committee. During study period 100 patients satisfying study criteria were considered for present study. Results: Majority of patients were from 19-30 years age group (45 %) followed by 31-40 years age group (30 %). Male patients (65 %) were more as compared to female (35 %). In patients undergoing FESS, multiple surgeries were performed simultaneously such as uncinectomy (100 %), middle meatal antrostomy (100 %), anterior ethmoidectomy (100 %), posterior ethmoidectomy (75 %), sphenoidectomy (30 %), frontal recess surgery (25 %) and reduction of the middle turbinate (1 %). In present study we noted only 1 major complication as CSF leak (1 %) which was effectively managed by endoscopy. Few minor complications as synechiae requiring treatment (4 %), periorbital emphysema (2%), epistaxis requiring packing (2%), periorbital ecchymosis (1%) and sinus infection (1%), all were managed conservatively and successfully. Conclusion: FESS is one of the most commonly performed operations in otorhinolaryngology and is generally a safe procedure, with a low rate of complications but as with any surgical intervention, it carries risks and major complications may occur.

189. Study on Prevalence of Communicable Diseases Covered under Integrated Disease Surveillance Project (IDSP) among Inpatients in A Pediatric and Adolescent Ward of A Tertiary Care Hospital
C Karthik, Poornima. ARC, Niranj Rathan, D. Jaiganesh
Background: Communicable diseases are illness due to a specific infectious agent or its toxic products capable of being directly or indirectly transmitted from man to man, animal to animal, or from the environment to man or animal. Surveillance is considered to be the backbone for disease prevention and control. It includes data collection, compilation, analysis, interpretation and distribution for action. IDSP is a decentralized state based surveillance programme, wherein weekly disease surveillance data on epidemic prone disease are being collected from several reporting units. This study was conducted to know the clinico-epidemiology and prevalence of the communicable diseases covered under IDSP. Objectives: To estimate the clinico-epidemiology and prevalence of the communicable diseases covered under IDSP among the pediatric inpatients of Vani Vilas Hospital (VVH), Bangalore Medical College and Research Institute (BMCRI), Bangalore, Karnataka. Methodology: This is a record based institution study. Data collection will be started after obtaining clearance from the college Ethics committee. Data from all the records satisfying the inclusion criteria will be collected on a weekly basis (Monday to Sunday) and analyzed for their completeness and thoroughness in recording and notification. Data will be analyzed using SPSS software and will be presented in the form of tables and figures. Results: A total of 2716 patients were admitted over a period of 12 months from January 2016 to December 2016. Of these, 963 (35.45%) cases were due to the communicable diseases covered under IDSP. The commonly reported diseases are Pneumonia 293 (30.4%), Dengue 220 (22.9%) and Acute Diarrheal Disease 144 (15.8%). Data was analyzed by using Statistical Package for Social Sciences (SPSS) software version 20.0.

190. Clinico-Epidemiological Study of Communicable Diseases Covered under Integrated Disease Surveillance Project among Inpatients in a Pediatric and Adolescent Ward in a Tertiary Care Hospital
C Karthik, Poornima. ARC, Niranj Rathan, D. Jaiganesh
Background: Surveillance is the continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill health. IDSP is a decentralized state based surveillance programme, wherein weekly disease surveillance data on epidemic prone disease are being collected from several reporting units. The objective of the study is to determine the clinico-epidemiology of the communicable diseases covered under IDSP. Materials and Methods: Data collection will be started after obtaining clearance from the college Ethics committee. This is a record based study. Data from all the records satisfying the inclusion criteria will be collected on a weekly basis (Monday to Sunday) and analyzed for their completeness and thoroughness in recording and notification. Data will be analyzed using SPSS software and will be presented in the form of tables and figures. Results: A total of 2716 patients were admitted over a period of 12 months from January 2016 to December 2016. Of these, 963 (35.45%) cases were due to the communicable disease covered under IDSP which comprised of 535 (55.6%) males and 428 (44.4%) females. Data was analyzed by using Statistical Package for Social Sciences (SPSS) software version 20.0. Conclusion: Cases entered in the IDSP P forms should be given codes on the respective case sheets to avoid reentry of data. Definitions delineating upper respiratory tract infections from lower respiratory tract infections should be explained. This helps in avoiding misclassifications and re- reporting of cases.

191. Pruritus Ani: Associated Surgical Conditions, a Retrospective Analytic Study
Navneet Parashar, Atul Sharma, Ramesh Kushwah, Anil Kumar Dadhich4, Santosh Sharma
Background: Pruritus ani is an unpleasant cutaneous sensation, and its symptoms are characterized by varying degrees of itching around the anal orifice. It is a common proctologic problem and many physicians believe that it amounts due to hemorrhoidal disease. This study addresses the etiology and underlying disease. Methods: This was a retrospective study of 100 patients of all age and sex who presented to skin and surgery OPD of NMCH Kota were included in the study. Results: Perianal fecal contamination was found in 43% of the study population while perianal infection (Bacterial and fungal) in 15% patients. Contact dermatitis and neoplasia were found in 3% of patients. Hemorrhoids were found most prevalent while fistula and fissure were less commonly found in our study. Amongst post-surgical patients post fistulectomy suffered maximum (65%) with pruritic ani followed by hemorhoidectomy(27%). Conclusion: The majority of pruritis ani patients can still be managed with great success with the elimination of irritants and scratching, general control measures and active treatment measures.

192. Role of Fixation of Fibula Fractures in Proximal and Distal One-Third to Prevent Hind Foot Valgus Deformity following Interlocking Nailing of Tibial Diaphyseal Fractures
Sunil Kumar Kar
Aim and Background: Intramedullary interlocking nailing is the gold standard treatment for tibial shaft fractures, which continues to be the most common type of fractures in the current era. In the event of interlocking tibial fractures, the proximal and middle third fractures are typically treated conservatively. The current study examines the possibility of ankle deformity and the radiological outcomes in the lower extremities if intramedullary interlocking nailing is used to treat tibial shaft fractures with concurrent fractures of the fibula (apart from at the distal one-third level) without surgical fixation of the concomitant fractures of the fibula. Materials Method: The current study included forty patients with concomitant fibular fractures and mid-shaft tibia fractures, excluding those at the distal one-third level. The study was conducted from Nov 2017 to May 2019 at IMS and SUM Hospital, Bhubaneswar. The anatomic reduction was used to fix all tibia shaft fractures using interlocking nails. Conservative treatment was used for the proximal and middle third fibula fractures. In forty fractures, 100% of them had anatomic union. Goniometer-based clinical evaluation was carried out in accordance with Astrom and Arvidson methodology. A long axial view was taken to perform a radiological evaluation. Results:  Compared to the normal limb, the radiographic examination of the long axial view revealed an increase in the hindfoot angle, with a mean value of 16 degrees (9-20 degrees). In 28 patients (70%) fractures the mean value of fibular shortening was found to be 13 mm (range, 5-19 mm). Conclusion: To prevent the development of hindfoot valgus deformity due to fibular shortening, fibula should be fixed in such patients, which can help to achieve better functional outcomes. Moreover, it can be believed that the fractures of the fibula in the middle or proximal one-third level should be anatomically fixed in conjunction with the intramedullary fixation of the tibial shaft fractures.

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