International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. Effect of Short Term Raj Yoga Meditation on Psychological Well Being in Young Adults
Shalini Rastogi, Raj Kumar, Md Sabir Hussain, Vichal Rastogi
Abstract
Background: Stress is a pervasive phenomenon experienced worldwide due to the current globalization of the world’s economy and the increasing demands for improved performance. The occurrence of stressful life events, as well as the presence of anxiety and depression, has been found to have significant and adverse impacts on the physiological well-being of individuals. These effects can be both harmful and cumulative over time. The utilization of meditation as a potential method to alleviate stress should be considered. Aims and Objectives: The primary objective of this study was to assess the efficacy of a group stress reduction programme that incorporates Raj yoga meditation as an intervention for individuals diagnosed with anxiety and depression. Materials and Methods: The research was done on a sample of 100 individuals diagnosed with co-morbid anxiety and depression, all of whom were prescribed a comparable pharmaceutical treatment regimen. The participants were randomly assigned to two groups: Meditators (n=60; mean age 34.12±9.05 years) and controls (n=50; mean age 33.68±10.78 years). The participants received instruction in Raj yoga meditation and engaged in a daily practice lasting 20 minutes, seven days a week, for a period of six weeks. The control group refrained from engaging in any form of meditation. The assessment of results was conducted with the Hamilton anxiety and depression measures. Results: The patients in both the intervention group and control group exhibited notable improvement in their symptoms of anxiety and depression after undergoing a six-week intervention. This improvement was evidenced by a substantial decrease in the scores of the Hamilton Anxiety Rating Scale (HAM-A) (p<0.001) and the Hamilton Depression Rating Scale (HAMD) (p<0.001). Nevertheless, the intervention group exhibited a higher proportion of relief in comparison to the control group. Conclusion: A brief intervention centered around yoga, as a lifestyle modification, has the potential to provide substantial reductions in anxiety and depression symptoms, while concurrently enhancing subjective well-being as well as personality traits.

2. The Role of Intravenous Ondansetron in Reducing Postspinal Shivering in Elective Lower Segment Cesarean Sections
Pooja J Patel, Ankur F Chaudhari, Shalini Rathod
Abstract
Introduction: Elective lower segment cesarean section (LSCS) performed under spinal anesthesia often leads to postoperative shivering, causing discomfort and potential complications. Intravenous ondansetron, known for its antiemetic properties, has shown promise in reducing shivering. In this study, we investigate the efficacy of ondansetron in preventing postspinal shivering during LSCS, aiming to enhance the perioperative experience for parturients. Material and Methods: This prospective interventional study assessed the efficacy of intravenous ondansetron in preventing postspinal shivering during elective lower segment cesarean sections (LSCS) under spinal anesthesia. One hundred pregnant patients were divided into two groups: ondansetron (Group S, n=50) and control (Group C, n=50). Group S received 4 mg of intravenous ondansetron preoperatively, while Group C did not receive preoperative medication. Shivering incidence, severity, and complications were recorded, and the Bedside Shivering Assessment Scale was used for assessment. Statistical analysis included Z-tests and Chi-square tests (P < 0.05). Results: This study included 100 subjects divided into two groups: Group S (n=50) receiving intravenous ondansetron for preventing postspinal shivering during cesarean sections, and Group C (n=50) as the control. Baseline characteristics were similar between groups (P > 0.05). Key surgical and physiological parameters showed no significant differences. However, Group S exhibited significantly reduced shivering severity (P = 0.001) and a lower incidence of nausea and vomiting (P = 0.001) compared to Group C. Conclusion: Intravenous Ondansetron demonstrates efficacy in reducing postspinal shivering and the incidence of nausea and vomiting during elective lower segment cesarean sections under spinal anesthesia, potentially improving the perioperative experience for parturients.

3. Urinary Iodine Concentration in the High Background Radiation Area 3D of Bihar
Sudhanshu Shekhar Jha, Rakesh Kumar
Abstract
Background: This research looks at the amount of iodine in the urine of people living in Bihar’s high-radiation Area 3D. The possible health impacts of chronic low-level radiation exposure in these areas, such as iodine deficiency-related disorders, are of concern. Methods: 200 people were randomly chosen to participate in a cross-sectional study. Urine samples were taken, and the amount of iodine in the urine was determined using standard techniques. Iodine intake, eating habits, and demographic information were all collected. We also included a control group from a region with low background radiation for comparison. Results: The average iodine concentration in Area 3D was 102.4 g/L (35.7), within the satisfactory limit established by the World Health Organisation. However, there was a wide range of results. The lower mean concentration of 88.2 g/L (28.6) in the control group suggests that the increased radiation levels in Area 3D may have an effect. Conclusion: Even though Area 3D generally has sufficient urinary iodine levels, there is enough individual variation to justify further study. Iodine intake should be monitored and improved by targeted public health interventions, especially in at-risk populations. Future studies should investigate the correlation between radiation exposure, food habits, and health outcomes to inform health policies in different areas further.

4. Clinical Profile of Patients Admitted in ICU Having Admission Hyperglycemia
Prayans Shah, Sanjaykumar Rathwa, Vaibhav J. Mehta, Aarjuv Majmundar, Jitendra D. Lakhani
Abstract
Background: Hyperglycemia is regarded as a significant risk factor that affects patient morbidity and death. Any type or cause of elevated blood sugar can have negative clinical effects on patient outcomes, mortality, impatient complications, length of stay, and total hospital costs. The Objective of the study was to find out prevalence, cause of admission hyperglycemia and to estimate relationship between hyperglycaemia and short term disease outcome. Methods: Randomly selected 50 hyperglycemia cases whose random blood sugar were above 180 mg/d1 and were admitted under the intensive medical care unit were selected in period of 18 months. Detailed demographic recording and risk factor evaluation along with clinical investigations were done. Blood sugar and HbAlc was done in all the patients. Result: Out of 50 patients, 30 were males and 20 were females. Admission hyperg1ycemia.were present in 21 diabetic patients, 17 latent diabetics and in 12, it was due to Stress hyperglycemia. Mean age of the study group patients was 51.76 + 16.09 SD. 35(70%) patients were below 60 years. Different diseases were involved in the study like 23(46%) had cardiac condition, 10(20%) had stroke, 9(18%) had infections, 1(2%) had respiratory condition, 1(2%) had cardio respiratory condition, 1(2%) had cardiac condition with infection and 5 (10%) miscellaneous condition. Conclusion: Critically ill patient may have Admission hyperglycemia due to diabetes and also due to nondiabetes conditions. Elevation of blood sugar level may be because of stress hyperglycemia which needs appropriate treatment. Admission hyperglycemia is very commonly associated with cardiac conditions, stroke and infections. Frequent monitoring of blood sugar should be done in all critically ill patients whether they are diabetic or non-diabetics.

5. A Reliable Way in Treating Displaced Calcaneum Fractures: A Descriptive Analysis
Gautam Chandra Paul, Ujjal Rajbangshi, Nagesh C. S.
Abstract
Background: Men, particularly industrial workers, are more likely to suffer from calcaneum fractures. Ages 21 to 45 are the ones where it occurs most frequently. Because many calcaneal fractures affect the subtalar joint and commonly result in persistent pain and osteoarthritic changes, they are receiving increased attention. Objectives: The effectiveness of plate osteosynthesis in treating displaced intraarticular calcaneal fractures is evaluated clinically and radiologically. Materials and Method: We included fifteen patients in this descriptive analysis, of whom seventeen had displaced intraarticular calcaneum fractures. Open reduction and internal fixation with a calcaneal plate were performed after preoperative and radiographic evaluation. Locking calcaneal plate was fastened with screws after anatomical reduction with use of k wire and intraoperative C-arm pictures. A mean of 12 months was spent following up with each of the 15 patients. American Orthopaedic Foot Ankle Society (AOFAS), Bohler’s angle, and Gissane’s angle score were used to determine the final evaluation. Results: After 12 to 14 weeks, all patients had radiographic fracture union. At final follow up, mean AOFAS score is 90.83±5.45 for Sander’s type II fracture and 86.45±6.97 for Sander’s type III fracture. Bohler’s angle improved from preoperative 5.59˚±8.45˚ to postoperative 24.29˚±5.56˚, Gissane’s angle improved from preoperative 155.29˚±6.95˚ to post-operative 132.94˚±6.13˚. Conclusion: One of the most crucial factors in determining treatment outcomes is when to have surgery, which is determined by the emergence of wrinkles and the subsidence of edema. Even without the use of a bone transplant, successful surgical therapy with a calcaneal plate is achieved.

6. Study of Assessment of P16 Expression in Various Grades of Squamous Cell Carcinoma of Head and Neck
R. Ragunath, K. Hari Baskaran, V. Lokesh Kumar
Abstract
Introduction: p16 is a tumor suppressor gene, over expression of which is considered as a surrogate marker of oncogenic human papillomavirus (HPV) infection. Moreover, p16 over expression correlates with good prognosis in head and neck squamous cell carcinoma (HNSCC). In the present study, we aimed to evaluate the frequency of p16 overexpression in HNSCC in our institute and its association with clinicopathologic parameters. Methods: We performed p16 immunohistochemistry (IHC) on 40 cases of HNSCC in a tertiary care teaching hospital. Association of p16 over expression with various clinicopathologic parameters was evaluated. Results:  In our study the most common site involved was oral cavity in 11 patients followed by sino-nasal region in 7 patients. Ca Nasopharynx was diagnosed in 6 patients, Ca oropharynx in 5 patients and lip was involved in 4 patient. In our study p16 over expression was noted in 40% (14 cases), while 60% (26 cases) were negative for p16 over expression. The relationship between histopathological type of squamous cell carcinoma and p16 immunohistochemistry is statistically in significant. Conclusion: HPV16 is the subtype most every now and again connected with HNC, and current clinically pertinent recognition strategies center around distinguishing the presence of HPV16 by PCR or ISH, or identification of p16 protein articulation in tumor tests by IHC. Moreover, p16 expression was found to be associated with some good prognostic parameters like lack of nodal metastasis; however, no significant association was noted with overall disease-free survival.

7. Microbial Profile of Liver Abscess in Patients Attending Surgery Department at Tertiary Care Centre
Thorat Priyanka, Nataraj Gita, Satoskar Rajeev, Kuyare Sunil
Abstract
Background: Worldwide, liver abscess is known disease commonly caused by parasitic origin (amoebic) in developing countries while pyogenic in developed countries.  In this study, we wanted to evaluate the microbial spectrum of liver abscess, its etiological causes, the drug susceptibility pattern of the isolates from the liver abscess and the outcome of the disease. Materials and Methods: This was a prospective cross-sectional study conducted in the Department of Microbiology among 90 patients diagnosed with a liver abscess in the Department of Surgery of a tertiary care hospital from January 2019 to June 2020. Results: Amoebic liver abscess was the predominant (71%) etiological cause of the liver abscess. E. coli was the most common (11%) causative organism of pyogenic liver abscess. Middle-aged males were common and the majority of the patients belonged to poor socioeconomic status and were chronic alcoholics. The main symptoms were fever (89%) and abdominal pain (62%) with hepatomegaly (58%) as a common sign. Complications like rupture of an abscess (four cases), sepsis (four cases), chronic liver disease (two cases) and liver failure (two cases) were observed in the study. In this study, the management modality included starting patients on an initial empirical antimicrobial regime. Along with this minimally invasive abscess drainage was carried out in the majority of cases either by fine-needle aspiration (42%) or pigtail drainage (27%). Few complicated cases were required to be managed with open surgery (11%). Conclusion: In India, amoebic liver abscess remains the more common type of liver abscess as compared to pyogenic liver abscess. E.coli is the most common organism isolated among the pyogenic abscesses. Solitary right lobe abscess was the most common pattern in our study. Early and appropriate antimicrobial treatment and drainage of the abscess have resulted in an improved outcome of the disease.

8. Study of Colposcopic Evaluation in Unhealthy Cervix in Semi-Urban Population of Jharkhand
Sarani Sagen Dahanga, Shashi Kant Suman, Sabita Sukladas
Abstract
Background: An unhealthy cervix is a common finding in day today gynecological practice in India, and worldwide. Pap smear cytology, colposcopic findings and histopathological studies (cervical biopsy) can diagnose and predict benign and malignant cervical lesions. Method: 60 (sixty) married or sexually active patients with complaints of white discharge per vaginum, lower abdominal pain, abnormal uterine bleeding (irregular menses), post-coital bleeding or postmenopausal bleeding with an unhealthy cervix underwent colposcopic evaluation, and findings were noted. Every patient underwent both acetic acid and Schiller’s iodine tests before they were subjected to the colposcopically directed biopsies. The colposcopy-directed biopsies were taken from aceto-white areas or Lugol’s negative areas. Results: Clinical manifestations of patients included 32 (53.3%) having white discharge, 11 (18.3%) having irregular menses, 8 (13.3%) having lower abdominal (lower back pain), 3 (5%) having post-menopausal bleeding, and 6 (10%) having post-coital bleeding. The colposcopic findings were: 21 (35%) had aceto-white areas, 19 (31.6%) had punctuation, 8 (13.3%) had a mosaic pattern and 3 (5%) had abnormal vasculature. 9 (15%) had a normal cervix. Cervicitis was found in 33 (55%) of the participants in the current study. 11 (18.3%) had mild dysplasia, 8 (13.3%) had moderate dysplasia, 4 (6.6%) had severe dysplasia, 4 (6%) had CIN, 20 (33.3%) biopsy were positive, 40 (66.6%) biopsy were negative, 38 (62%) colposcopy studies were positive, and 22 (38%) were negative. Conclusion: Colposcopic evaluation and cervical biopsy findings were used to find out the cytology of the cervix in different age groups of females. In addition to this, a Pap smear test will complement the diagnosis.

9. Study of Treatment of Osteoarthritis of Knee by Intra-Articular Sodium Hyaluronate in South Karnataka Population (Retrospective Study)
Srinivas Pandurangaiah Sivaram
Abstract
Background: Osteoarthritis is the slow and gradual development of joint pain, swelling, stiffness, and reduced joint movement. Hyaluronic acid is one of the visco supplements and alternative management options for OA. Method: 30 patients with OA were selected for intra-articular Sodium Hyaluronate, and 30 patients with OA were treated with placebo. Routine blood exam; x-ray of the knee joint (MRI if necessary), Kellgran Lawrence radiographic scale were done to assess the severity of OA. Intraarticular 6 ml Hylan GF20 was injected by using a 23-gauge syringe in 30 OA patients and placebo in the other 30 OA patients. Results: In the comparison of the VAS scale at week 25 between the Hyalgan and placebo groups, the primary outcome at week 25 was a highly significant p value (p<0.001). In comparison to the mean change from baseline to week 25 in the WOMAC Index score, all three parameters, including pain, stiffness, and function of the knee joint were highly significant (p<0.001). Conclusion: Intra-articular therapy with sodium hyaluronate is a safe and easy method for treating OA of the knee joint.

10. Study to Evaluate the Prognostic Value of Biochemical Parameters in COVID-19 Patients in a Tertiary Care Hospital
Neelam Patil, Vibha Sakhare, Jalinder Sanap, Laxman Chougule
Abstract
Background: The COVID-19 pandemic has posed an unprecedented global health crisis, with India reporting a significant number of cases and deaths. Accurate prognostication of disease severity is crucial for effective resource allocation and patient management. Objective: This study is aimed to evaluate the prognostic value of various biochemical parameters in COVID-19 patients admitted for intensive care in a tertiary care hospital. Methods: We conducted a retrospective study using data collected from March to June 2021. The study included 50 adult patients who tested positive for COVID-19 and 50 age and sex matched controls. Demographic, clinical, and laboratory data were collected. Biochemical parameters, including random blood sugar, liver and kidney function tests, lactate dehydrogenase, lipid profile, and electrolytes, were analyzed using statistical methods. Results: COVID-19 patients exhibited significant deviations in various biochemical parameters compared to the control group. Notably, elevated random blood sugar, liver enzyme levels, kidney function markers, lactate dehydrogenase, and dyslipidemia were observed in COVID-19 patients. Moreover, patients showed decreased serum calcium and sodium levels. These findings align with previous studies and underscore the prognostic significance of these parameters. Conclusion: Our study contributes to understanding the prognostic value of biochemical parameters in COVID-19 patients. These parameters can aid in risk assessment and patient management.

11. Outcomes and Complications of Arthroscopic Meniscectomy: A Systematic Analysis of the Success Rates, Functional Outcomes, and Potential Complications Associated with Arthroscopic Meniscectomy for Meniscus Tears: A Retrospective Cohort Study
Nitin Kumar, Govind Mohan Jee
Abstract
Background: For meniscus injuries, arthroscopic meniscectomy surgery is frequently used. Its therapeutic utility has been established, but more extensive real-world evidence is needed to confirm its pain-relieving and joint-improving efficacy. Methods: About 25 patients with verified meniscus tears were included in this retrospective cohort analysis, in which we analysed the results and complications of arthroscopic meniscectomy. Data on patients’ demographics, preoperative symptoms, surgical procedures, intraoperative results, and aftercare were compiled and analysed. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to evaluate the success rates regarding pain reduction and improved joint function, functional recovery, and complications. Results: High rates of success after arthroscopic meniscectomy were found in the study, which is encouraging. Eighty-five per cent of patients reported decreased pain, and 78 per cent said enhanced joint mobility. And 70% of people returned to doing all they did before their injuries. Average KOOS scores rose by 24 points. Postoperative pain was reported in 10% of patients, minor joint stiffness in 7.2%, and one occurrence of more profound vein thrombosis in 0.4%. Conclusion: Clinical evidence supports the use of arthroscopic meniscectomy to treat meniscus tears, which results in decreased discomfort and enhanced joint function. These results indicate that it should be used indefinitely as a therapeutic measure. Complications highlight the significance of cautious selection of patients and surgical procedures. This study adds to the body of evidence from real-world settings, supporting the clinical efficacy of the technique while also stressing the need for continuous research to improve patient outcomes further.

12. Pulmonary Function and Hematological Characteristics in Children with Thalassemia Major
Rajkishore Singh, Dinesh Prasad, Sheela Sahu
Abstract
Background: Insufficient production of the haemoglobin chains causes persistent hemolytic anaemia in people with thalassemia, a series of recessively inherited illnesses. The exact source of pulmonary function problems after iron overload from repeated blood transfusions is unknown. Methods: The pulmonary function of transfusion-reliant children with thalassemia was evaluated and compared to that of typically developing children in this case-control study. For this study, 35 kids were selected at random. Serum ferritin levels were examined for their possible links to pulmonary dysfunction. Results: The study found that the ages at which thalassemia patients began receiving transfusion therapy ranged from 1.5 months to 70 months, with a median of 8 months. Haemoglobin levels before transfusion ranged from 6.8 to 11.4 gm%, on average hovering around 8.5 gm%. There was a wide range from 850 ml to 37,200 ml of blood transfused. The average serum ferritin concentration was 2000 ng/ml last year. Patients on chelation therapy for an average of 4.7 years. Although most pulmonary function test (PFT) measures were within normal ranges when comparing thalassemia cases and controls, PEF 25%-75% was considerably lower in thalassemia-affected children. Conclusion: This study reveals the prevalence of pulmonary dysfunction, especially in a restrictive lung pattern, in thalassemia patients, although these individuals may not exhibit clinical symptoms of pulmonary dysfunction. Multiple causes contribute to the disease’s development, including excessive blood transfusions, chelation therapy, and iron overload. More study is required to understand the causes and develop effective strategies for avoiding problems.

13. Evaluation of Etiological Factors of Thrombocytopenia in Pregnancy and its Effects on Feto-Maternal Outcomes
Sujata Deo, Akancha Pandey, Pratibha Kumari, Mohd. Kaleem Ahamad
Abstract
Background: Thrombocytopenia is defined as a platelet count of less than 150×109/L, or the 2.5th lower percentile of the normal platelet count distribution. Aim of the study was to evaluate the etiological Factors of Thrombocytopenia in pregnancy and its effects on feto-maternal Outcomes. Material and Methods: The prospective observational study was done from September 2020 to October 2021 on one hundred fifty-eight pregnant females with low platelet count or who were diagnosed as thrombocytopenia in second and third trimester at QMH, Department of Obstetrics and Gynaecology, King George’s Medical University, Lucknow. The Chi-square test will be used to compare the categorical variables. The Unpaired t-test was used to compare the continuous variables. The p-value<0.05 was considered significant. All the analysis was carried out on SPSS-21.0 version. Results: The mean age of all pregnant women was found to be 25.69 ± 3.78 years. With mean Manual Platelet Count (Lacs/cu.mm) 0.83 ± 0.37 lacs/cumm. Out of 158 subjects most common etiology of thrombocytopenia was obstetric causes 70(44.3%) which included 55(34.8%) had hypertensive cause, 8 (5%) subjects had DIC and 7 (4.4%) subjects had abruptio placentae. Out of 55 subjects having hypertensive causes of thrombocytopenia, 43 (27.2%) subjects had preclampsia, 8(5%) had eclampsia and 4(2.53%) subjects had HELLP syndrome etiology of thrombocytopenia of 21 subjects having medical thrombocytopenia, 6(3.79%) subjects had ITP as the cause of thrombocytopenia, 12(7.59%) subjects had dengue, 2(1.26%) subjects had infections like HIV, HCV. There was one subject having hypersplenism as the cause of thrombocytopenia contributing to 0.6 % of the entire causes. No subject had TTP, HUS or TMA as the cause of thrombocytopenia. Second most common cause was gestational thrombocytopenia 67(42.4%). Majority 123(77.8%) of neonates did not have thrombocytopenia at all, 20(12.65%) neonates had mild thrombocytopenia, 12(7.5%) neonates had moderate thrombocytopenia and 3(1.8%) neonates had severe thrombocytopenia. The association between maternal complication and severity of thrombocytopenia PPH, MOD and DIC (p value: 0.005,0.001,0.001 respectively) were significantly associated with thrombocytopenia. The association between perinatal complication with severity preterm birth, LBW, SNCU admission (p-value: 0.002, 0.001, <0.001, respectively) was significantly associated with thrombocytopenia. Conclusion: Our findings suggest that evaluation of thrombocytopenia in pregnancy is important and a detailed workup with careful monitoring is required as early diagnosis and management may play a key role in decreasing the adverse outcomes. Special attention should be given to patients with thrombocytopenia due to preeclampsia and HELLP syndrome to establish the best moment for therapeutical intervention.

14. Perceived Stress Among Medical Undergraduates and it’s Correlation with Psychosomatic Stress: A Cross Sectional Study
Garima Singh, Namita, Himanshu Nirvan, Niraj Srivastava
Abstract
Perceived stress among students makes them vulnerable to psychological problems which leads to poor academic performance and affects their physical and mental well-being. The aim of present study is early detection of perceived stress among medical undergraduates and its association with psychosomatic symptoms. This cross- sectional study was conducted on MBBS undergraduates studying in second semester. The study group included a total of 51 medical graduates aged between 18-22 years with similar sociodemographic profile. Stress level of the students was assessed using Perceived Stress Scale-10 (PSS-10) and psychosomatic symptoms using Psychosomatic symptoms questionnaire (SSS).
Average total PSS score (mean ± SD) among the participants was 20.9 ± 6.66 and the mean PSQ score among the participants was 44.0 ± 16.8. Statistically significant difference was found in the PSS score between males and females (p = 0.0011) with females having higher mean score. Significant negative correlation between the two scores was present among the participants (p<0.0001). Significant difference was present in the PSQ score among the low, moderate and high perceived stress groups (p= 0.0006).
We conclude that medical undergraduates perceive high amount of stress and the higher level of stress is associ- ated with more frequent psychosomatic symptoms.

15. Exploring the Role of Biomarkers in Predicting Sepsis Development and Progression in Intensive Care Unit Patients: A Cross-Sectional Study
Ritu Rajeev, Rajeev Kumar Goel
Abstract
It is crucial to detect sepsis early and intervene in a timely manner as it can be a severe medical condition with a high mortality rate, especially in patients in the intensive care unit (ICU). Biomarkers have been gaining attention for their potential to predict the development and progression of sepsis. This cross-sectional study aimed to investigate the role of various biomarkers in predicting the development and progression of sepsis in ICU patients. We examined a cohort of ICU patients and explored the correlation between biomarker levels and the onset and progression of sepsis. Our findings emphasize the important role of biomarkers as potential early indicators of sepsis, which can help manage patients proactively and optimize clinical outcomes.

16. Optimizing Sedation Strategies for Mechanically Ventilated Patients in the Intensive Care Unit: A Cross-Sectional Study
Rajeev Kumar Goel, Ritu Rajeev
Abstract
This cross-sectional study delves into the critical role of mechanical ventilation in salvaging the lives of Intensive Care Unit (ICU) patients grappling with respiratory failure. Proper sedation forms an integral component of patient management, ensuring their comfort, allaying anxiety, and facilitating effective mechanical ventilation. However, achieving the optimal balance of sedation to fulfill these objectives while averting adverse effects poses a notable clinical challenge. The primary objective of this study is to assess current sedation practices among mechanically ventilated ICU patients, identifying opportunities to refine sedation protocols, thereby enhancing patient outcomes and overall quality of care.

17. Descriptive Clinical Analysis of Congenital Müllerian Anomalies and Associated Maternal and Foetal Outcomes in a Tertiary Care Centre: Indian Scenario
Shraddha Pande, Rekha Wadhwani
Abstract
Background and Objectives: Mullerian anomalies are malformations of the female genital tract. This research study was undertaken to evaluate the magnitude of congenital Mullerian anomalies in women & to analyze maternal and foetal outcomes of mullerian anomalies. Methodology: In this study, 48512 females who were trying to conceive or had already conceived, attending the Obstetrics and Gynaecology department of Sultania Zanana Hospital and Gandhi medical college, Bhopal were enrolled for the observational study. A general examination was performed on all participants. USG and/or hysterosalpingography and MRI findings were recorded and the patients were followed until delivery for obstetric outcomes. Results: In this observational study of 48512 female participants, 53 had Mullerian anomalies. Institutional deliveries were 16317 during the period of the study out of which 45 patients had anomalies that were compatible with pregnancy. Septate and arcuate uteri were the most prevalent anomalies seen in the current investigation. Conclusions: The study found that pregnancies with Müllerian anomalies are associated with adverse pregnancy outcomes like recurrent abortions, IUFD (Intrauterine Fetal Demise) and malpresentations and close monitoring is required. Therefore, carefully planned studies are required to evaluate these associations more precisely.

18. Stress and Sleep Patterns Among Indians During the COVID-19 Lockdown: An Observational Study
Alok Kumar, Kamala Kanta Mishra, Neha Kumari
Abstract
Introduction: Mental health is an important issue which is generally ignored, unlike physical well-being of patients. The COVID-19 pandemic not only disrupted the economy of our country but also affected the general and mental well-being of people. It increased anxiety and stress level among people. This could cause insomnia and sleep disturbances. Stress and related psychiatric disorders often stem from prolonged sleep interruptions. Objective: This study examined sleep disturbances in Indians during the COVID-19 pandemic. Methods: This cross-sectional study recruited 412 Indians to complete anonymous questionnaires. The researchers used the Insomnia Severity Index (ISI) to analyse sleep interruptions before and during the COVID-19 pandemic. SPSS version 20 was used to analyse the data using descriptive and inferential statistics. Results: Before and after the COVID-19 pandemic, sleep disturbances among Indian respondents varied significantly. In India, the prevalence of clinically moderate insomnia has increased dramatically. Before the commencement of the pandemic, only 3.9% of the participants exhibited moderate to severe levels of clinical insomnia. After the onset of the pandemic, this percentage increased to 17.5%. Prior to the pandemic’s onset, the average ISI score was 6.36 ± 4.66, whereas it was 8.02 ± 6.02 afterwards. Conclusion: During the COVID-19 pandemic, the results of our study indicate that people are suffering greatly from sleep disturbances and ask for additional research and proactive measures to improve sleep quality.

19. Impact of Preoperative CT Imaging on High-Grade Endometrial Cancer Patients
Priyanka Singh, Ashok Kumar
Abstract
Objectives: This study aimed to evaluate the impact and cost-effectiveness of preoperative computed tomography (CT) imaging in managing patients identified with excessive-grade endometrial cancers. Materials and Methods: We carried out a retrospective analysis of scientific data for one hundred fifty patients diagnosed with excessive-grade endometrial cancer who underwent surgical intervention for a duration of two years. Patients were divided into organizations: Group A, comprising 75 patients who received preoperative CT imaging, and Group B, including 75 patients who no longer obtain preoperative CT imaging. Clinical traits, surgical consequences, period of medical institution stay, and value records were amassed and compared between the two organizations. Results: Patients in Group A, who underwent preoperative CT imaging, confirmed a significantly higher rate of accurate preoperative Staging (82.7%) compared to Group B (62.7%). The implied length of sanatorium life was shorter in Group A (4.6 days) compared to Group B (5.9 days), resulting in decreased hospitalization expenses. Despite the preliminary fee of CT imaging, the overall cost of care was decreased for Group A patients due to reduced postoperative complications and shorter sanatorium remains. The cost-effectiveness evaluation established that preoperative CT imaging became a value-saving strategy with a positive fee-effectiveness ratio. Conclusion: Preoperative computed tomography imaging substantially improves the accuracy of preoperative Staging in people living with excessive-grade endometrial cancer, resulting in reduced hospitalization expenses and shorter sanatorium remains. The price-effectiveness evaluation supports using preoperative CT imaging as a treasured device in managing those patients, leading to improved scientific outcomes and monetary advantages for healthcare systems.

20. Fosfomycin and Nitrofurantoin Susceptibility among Extended Spectrum betalactamase (ESBL) Producing Uropathogenic Escherichia Coli
Vijetha Sajjanar, Premalatha D E, Siddesh K C
Abstract
Introduction: Urinary tract infections(UTI) are most common bacterial infections encountered in clinical practice and Uropathogeic Escherichia. Coli( UPEC) is predominant organism which causes UTI. Misuse of antibiotics has led to multidrug resistance in UPEC. Extended spectrum beta lactamase (ESBL) producing organisms has led to emergence of multidrug resistance to routinely usedantibiotics. Fosfomycin and Nitrofurantoin have unique mechanism to delay the evolvement of resistance and are most preferred drugs in multidrug resistant uropathogenic E.coli. The present study was undertaken to analyse trends of fosfomycin and nitrofurantoin susceptibility among Extended spectrum beta lactamase (ESBL) producing Uropathogenic Escherichia coli. Objectives: (1) To detect extended spectrum beta lactamase production in uropathogenic E. coli. (2) To analyse the fosfomycin and Nitrofurantoin susceptibility pattern of extended spectrum beta lactamase producing uropathogenic E. coli. Materials and Methods: The study was conducted on 365 urine samples received from patients with suspected UTI during the period of January 2018 to June 2018received at Microbiology laboratory from Mc Gann Teaching Hospital, attached to Shivamogga Institute of Medical Sciences, Shivamogga. These samples were processed on blood agar, chocolate agar, and MacConkey agar media and incubated at 37°C under aerobic conditions. The organisms were identified as per standard conventional methods. ESBL detection was done as per CLSI guidelines. Fosfomycin and Nitrofurantoin susceptibility testing will be performed by Kirby Bauer Disk Diffusion method and interpreted as per CLSI guidelines. Results & Discussion: Among 365 samples 240 samples showed significant bacteriuria,105 samples showed no growth, 20 samples showed non-significant bacteriuria. Escherichia coli was most predominant organism isolated accounting for 45.83% (110/240). Out of 110 E. coli isolates 97(88.18%) were ESBL positive by screening method and 95(97.93%) were ESBL positive by confirmatory method. Antibiotic sensitivity in ESBL positive UPEC shows. Fosfomycin(100%), Nitrofurantoin(90.52%) and ESBL negative UPEC shows Fosfomycin (100%), Nitrofurantoin(100%). Conclusion: Multidrug resistance among uropathogenic Escherichia requires implementation of alternative treatment strategies for the Urinary tract infection. Thus Fosfomycin and Nitrofurantoin are potential antibiotics for empirical treatment of UTI.

21. Pulmonary Morbidity of Workers and Local Residents of a Spinning Mill in Kerala: A Comparative Study
Mathew Alina Ann, Saju C.R, Davis Rennis
Abstract
Background: Appropriate legislative and protective measures are in place for safeguarding spinning mill workers from health risks. But there is lack of strict monitoring of air pollutant emission from spinning mills and pulmonary morbidity of residents nearby has not been explored adequately yet. Hence this study was undertaken with the objective of comparing pulmonary morbidity of workers and local residents of a spinning mill in central Kerala. Methods: Community based cross-sectional analytical study was done in spinning section of an NTC mill and residential areas within one-kilometre radius, during 2013-2015. 91 workers along with an equal number of age and sex matched residents were selected. Data collected included history, clinical examination and pulmonary function tests. Descriptive statistics, chi-square test, independent t test and Mann-Whitney U test using SPSS statistical software – version 16 were used for statistical analysis. Results: 64.8% residents yielded an abnormal pulmonary function compared to 27.5% of workers (p<0.0001; OR:4.87; CI=2.6-9.1). Residents showed a statistically significant association between duration of stay near mill and PFT(p<0.05). Of those with >20 years of exposure,78.3% of residents were found to have an abnormal PFT compared to 38.9% of workers (p<0.0001; OR:5.68; CI=2.3-14.1). Odd’s ratio (OR) for residents developing an abnormal PFT was found to be 4.87(CI=2.59-9.14) compared to workers. Conclusion: Pulmonary morbidity among local residents was higher compared to workers. This emphasizes the need to create awareness among local residents of spinning mills and implement interventions to safeguard them from pulmonary morbidity in addition to routine protective measures taken for workers inside spinning mill.

22. Study of Inflammatory Biomarkers in COPD and Asthma in Telangana Patients
Y.M. Abdul Quddus, Nalini N
Abstract
Background: COPD and asthma are obstructive ventilators for respiratory passage. These are life-threatening if not diagnosed and treated earlier; hence, inflammatory biomarkers can be a tool for therapeutics in such diseases. Methods: Out of sixty, 40 (forty) patients with COPD and 20 with asthma were studied. Various inflammatory biomarkers were studied during admission and at the 6th week of resolutions; moreover, spirometric values (FEV1 O2 FEV1, 6W100, MRC breathless less scale) were also evaluated in both COPD and asthma patients. Results: FEV1 6W100 had a significant p value (p<0.001). In COPD asthma patients, leptin ng/mL CRP resistin, L/A ratio, and RP (mg/dl) had highly significant p values (p<0.001). Conclusion: It is concluded that inflammatory biomarkers like leptin, resistin, and CRP are significant biomarkers in both COPD and asthma. Different or variations in the values of TNF-a can be easily distinguished between COPD and asthma patients.

23. Maternal Mortality: A Retrospective Analysis in a Tertiary Care Centre
Pooja Mise, Aditya Mise, Usha Doddamani, Radhika Mekale, Sangmesh Mise
Abstract
Background: According to World Health Organization (WHO), “A maternal death is defined as death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by pregnancy or its management but not from accidental or incidental causes”.  Maternal mortality is considered a key health indicator and the direct causes of maternal deaths are well known and largely preventable and treatable. Methods: A retrospective study which was conducted in the Department of OBG, Gulbarga Institute of Medical Sciences, Kalaburagi by analyzing the maternal death which occurred during the period of January 2019 to December 2020.  Data was collected from facility based maternal death review forms and death summary of each maternal mortality case. Results: In the our study, total of 66 maternal death were analyzed-maternal mortality ratio was 354 per 1-lakh live births. Most deaths occurred in the age group of 20-30 years (81.8%), 60.59% of deaths occurred within 24-hours after admission.  Hypertensive disorders (28.78%), hemorrhage (22.72%) and sepsis (12.12%) are the most common direct causes of maternal mortality.  Anemia and other medical disorders with cardiac diseases being important indirect causes of maternal mortality. Conclusions: Our center being a tertiary care teaching hospital, patients are referred from periphery and private hospitals.  Maternal mortality was found to be on higher side.  Proper referral services, prompt implementation of government policies with community participation are needed to prevent maternal deaths.

24. Assessment of Functional Outcomes after Floating Knee Injuries
Gattu Naresh, Mamidi Anil Kumar
Abstract
Background: The term ‘floating knee’ refers to the concurrent ipsilateral fractures of the femur and tibia, resulting in the detachment of the knee from the remaining part of the limb. Due to the intricate nature of this injury and the potential for associated complications such as compartment syndrome, vascular damage, and collateral and meniscal injuries, it remains a significant challenge for orthopedic practitioners. This study was done to determine the functional outcome and was evaluated using the Karlstrom Olerud criteria. Methods: This study encompassed 20 cases of floating knee injuries treated at our institution. We utilized the McBryde and Blake classification and predominantly employed intramedullary interlocking nailing for treatment. Clinical and radiological outcomes, along with complications, were tracked for all patients. The functional outcome was evaluated using the Karlstrom Olerud criteria. Results: The majority of patients (60%) had excellent or good functional recovery. A small number of patients (10%) had poor functional recovery.  The most common problem was the shortening of the affected limb (15% of patients). Angular or rotational deformity was also a common problem (15% of patients).  Subjective symptoms of thigh or leg (10% of patients) and knee or ankle joints (10% of patients) were less common. The ability to work and participate in sports was excellent or good in most patients (75%). Conclusion: Each fracture in a floating knee is distinct, necessitating individualized treatment. In compound fractures, early stabilization using an external fixator followed by definitive fixation helps prevent late complications. For closed fractures, early internal fixation and rehabilitation contribute to a favorable functional outcome.

25. Examining the Psychiatric Morbidity and Socio Demographic Characteristics of Self-Injury Cases
Swetha Kunkeri, Sangamesh Kunakeri
Abstract
Objective: Human beings trying to harm themselves or to end their life is very common. Intentional self-harm is frequent, but there are minimal numbers of these problem reported in India. The present study aims to evaluate the socio-demographic profile in cases of intentional self-harm. Materials and Methods: This was a cross-sectional study conducted in Bidar Institute of Medical Sciences, Bidar, India for 18 months. The figures were documented in specially fabricated proforma which records socio-demographic variables, psychological disorders, psychiatric distress factors, family history, history, and full information about suicide attempts. Results: Self-harm is more prevalent in youngsters. Females (116) were greater in number as compared to males (84). The majority of the cases were married and homemakers and belonged to the poor economic class. Most of the patients attempted suicide for the first time and poison was commonly used. Many patients had psychological disorders, mainly depression. Family disputes and being unhappy in marriage were also the reason for intentional self-harm. Conclusion: Spreading knowledge through programs, precautionary action, and appropriate psychological criterion systems should increase to reduce the occurrence of deliberate self-harm.

26. Prevalence of Pruritis in Pregnancy: A Prospective Study from the North  India
Geeta Yadav, Garima Yadav
Abstract
Background: Pregnancy-related specific dermatoses are skin conditions that develop during pregnancy and go away after delivery. Itching and only secondary skin lesions in the form of excoriations, with or without signs of cholestasis, are the main symptoms of the skin illness known as pruritus gravidarum in gravid women. So, the present study was conducted with an aim to evaluate the prevalence and characteristics of pruritus among pregnant women. Methods: The present prospective cross-sectional study was conducted among pregnant women in the outpatient (OPD) of the department of Obstetrics and Gynecology for 12 months. Complete dermatological examination was done in all cases to study the physiological and pathological changes of skin. Appropriate investigations were done if required to confirm the diagnosis. A preformed questionnaire was used for data collection to document baseline characteristics pruritis type and pruritis characteristics. The collected data was entered in the Microsoft (MS) Excel Spreadsheet and also, analysis of data carried out using MS Excel Spreadsheet. A p value of <0.05 was considered as statistically significant. Results: In present 256 pregnant subjects were enrolled. The mean age of study subjects was 27.9±5.6 years. The prevalence of pruritis among enrolled subjects was 18.3%. The most common pruritis type was pruritis gravidarum (12.5%) and least common was pruritic folliculitis (0.8%). No pruritis was observed in the first and second trimester mothers and mothers with 3 or more gravida. In our study, among the subject with pruritis, more than four fifth of the them were having pruritis in the abdomen (89.4%) and chest region (83.0%). Chi-square analysis showed significant association between variables (period of gestation and trimester) with the pruritis (p<0.05). Conclusion: During pregnancy, pruritus is frequent. While it can be the outcome of physiologic changes associated with pregnancy or diseases peculiar to pregnancy, it might also be an indication of an underlying, unrelated illness process.

27. Preoperative Predictors of Intraoperative Difficulty in Laparoscopic Cholecystectomy: A Prospective Study
Rehanullah Khan, Gaurav Bansal, Suryottam Kumar
Abstract
Background: Laparoscopic cholecystectomy offers advantages over open surgery. However, challenges in cases of anatomical variations or inflammation necessitate accurate preoperative assessment. Predicting difficulty can optimize planning and patient counseling. We conducted a prospective study to comprehensively evaluate preoperative predictors of challenging laparoscopic cholecystectomy, aiming to enhance surgical decision-making and patient management. Methods: This prospective cross-sectional study was conducted at a tertiary care hospital in North India. Consecutive adult patients scheduled for elective laparoscopic cholecystectomy due to symptomatic gallstone disease were enrolled. Operative techniques followed standard procedures, including the critical view of safety (CVS) technique. Preoperative patient data, intraoperative details, and outcomes were documented using standardized forms. Predictors with p-values < 0.05 were included in multivariate logistic regression analysis for identification of independent predictors using SPSS version 20.0. Results: A total of 77 patients were included, with 40 (51.9%) aged below 50 and 37 (48.1%) above 50. Gender distribution comprised 28 (36.4%) males and 49 (63.6%) females. BMI < 23 kg/m² was in 31 (40.3%) patients, and BMI ≥ 23 kg/m² in 46 (59.7%). Smoking history was reported by 14 (18.2%), diabetes by 18 (23.4%), and hypertension by 24 (31.2%). Logistic regression analysis indicated that age ≥ 50 (aOR: 2.82), male gender (aOR: 2.75), palpable gallbladder (aOR: 4.62), positive Murphy’s sign (aOR: 3.11), and gallbladder wall thickness ≥ 4 mm (aOR: 1.23) significantly associated with intraoperative difficulty (p < 0.05). Conclusion: In conclusion, this study offers valuable information for clinicians involved in laparoscopic cholecystectomy by identifying preoperative variables associated with surgical complexity. The results emphasize the importance of considering age, gender, clinical indicators, and gallbladder wall thickness when assessing patients’ risk profiles.

28. Thyroid Dysfunction among Patients with Abnormal Uterine Bleeding: A Hospital Based Prospective Study from North India
Harjinder Singh, Tanvi Vaghela, Harminder Singh
Abstract
Background: Abnormal uterine bleeding (AUB) affects around 20% of women attending outpatient departments globally. AUB encompasses various menstrual irregularities, and its etiology involves hormonal, structural, and systemic factors. Thyroid dysfunction has emerged as a significant factor, as thyroid hormones play a vital role in regulating the menstrual cycle. Both hypothyroidism and hyperthyroidism can lead to menstrual disturbances and AUB. However, the prevalence and clinical impact of thyroid dysfunction on AUB management are not fully understood. This study aims to investigate the prevalence and clinical implications of thyroid dysfunction in AUB patients. Methods: This cross-sectional study conducted at a tertiary care center aimed to assess thyroid dysfunction in female patients with abnormal uterine bleeding (AUB). The study included reproductive-age women (18-45 years) presenting with AUB, excluding those with pre-existing thyroid dysfunction or using thyroid-related medications. Data collection involved a questionnaire to gather clinical, demographic, and laboratory information. Standard diagnostic investigations and thyroid function tests were performed. Statistical analysis using descriptive statistics and appropriate tests were conducted. Results: The present study aimed to investigate the association between thyroid dysfunction and abnormal uterine bleeding (AUB) in a population of 157 female patients. In our study, 35.0% of patients were in the age group of 30-39 years, and 12.7% were above 40 years. In our study, regarding thyroid dysfunction, 16.6% of the patients were diagnosed with hypothyroidism, 5.7% with hyperthyroidism, 18.5% with subclinical hypothyroidism, and 59.2% were classified as euthyroid. In our study, among patients with hypothyroidism, menorrhagia was the most common pattern, accounting for 42.3% of cases, followed by polymenorrhagia in 34.6% and metrorrhagia in 11.5%. Among those with hyperthyroidism, menorrhagia was also the predominant pattern, reported in 72.4% of cases, followed by oligomenorrhea in 77.8%.
Conclusion: In conclusion, this study provides valuable insights into the prevalence of thyroid dysfunction and its potential associations with demographic factors in patients with AUB. The findings suggest that occupation and parity may have some association with thyroid dysfunction in this population

29. Every Shortness of Breath is Not Asthma
Amit Bhushan Sharma, Richa Aggarwal, RR Dutta, Madhur Jain, Shalini Sharma, Sanjay Gupta
Abstract
Background: Shortness of breath is a common symptom in various cardiac and pulmonary conditions. Intracardiac tumors are a rare but well-known etiology of shortness of breath. Cardiac hemangiomas are a rare subtype of primary cardiac tumors, accounting for approximately 2-5% of all primary cardiac tumors. Diagnosis of cardiac hemangiomas can be challenging, and imaging plays a crucial role in the diagnosis. Treatment of cardiac hemangiomas depends on the size and location of the tumor and the presence or absence of symptoms. In this report, the importance of Two-dimensional echocardiography and cardiac MRI as useful tools for diagnosing cardiac hemangiomas is highlighted. Case Summary: A 63-year-old woman presented with a 3-month history of shortness of breath and cough. Physical examination revealed a diastolic murmur and normal lung examination. Imaging studies, including echocardiography and cardiac MRI, confirmed a large vascular tumor attached to the right atrium. Percutaneous embolization was performed to reduce the risk of bleeding during surgery. The tumor was successfully resected, and histopathological examination confirmed a benign vascular tumor (hemangioma). The patient’s symptoms improved, and follow-up examinations showed no evidence of tumor recurrence. Conclusion: The cardiac hemangiomas are rare benign tumors that can present with a variety of symptoms. Two-dimensional echocardiography and cardiac MRI are useful tools for diagnosing these tumors. Surgical resection is the treatment of choice, but preoperative embolization can be considered in cases where surgery may be associated with a high risk of bleeding or other complications. The use of PVA particles for embolization is safe and effective in the treatment of cardiac tumors.

30. Troubleshooting in Leadless System Pacemaker: Thrombus in Micra Delivery
Amit Bhushan Sharma, Shiv Goyal, RR Dutta, Rajesh Kumar, Madhur Jain, Shalini Sharma
Abstract
Background: Implantable cardiac devices such as pacemakers have traditionally used transvenous leads inserted into the heart through the subclavian vein. However, the use of leads poses several complications. Leadless pacemakers have emerged as a promising alternative, and the Micra Transcatheter Pacing System (TPS) is the first and only leadless pacemaker approved by the US Food and Drug Administration (FDA). While the safety and efficacy of Micra TPS have been demonstrated in several studies, there are potential risks associated with its use, including thrombus formation. Case Summary: In this report, a case of thrombus formation in the delivery system of a Micra TPS is presented. A 40-year-old male with atrial fibrillation was planned for a single-chamber pacing using the Micra TPS. During the procedure, the device was repositioned multiple times due to high pacing impedance values and lack of ventricular capture. A thrombosuction of large layered clot was done, and the device was implanted successfully. Conclusion: Thrombus formation is a well-known complication of implantable cardiac devices that can lead to device malfunction and potentially life-threatening complications. The incidence of thrombus formation in leadless pacemakers is low, but it may be higher in certain patient populations. Prompt recognition and management of thrombus formation in leadless pacemakers are critical to prevent device malfunction and potential harm to the patient. Thrombosuction and administration of anticoagulation therapy, as done in this case, are effective in resolving the thrombus and preventing further embolic events.

31. Association of Serum Cholesterol and Platelet Larger Cell Ratio (P-LCR) in General Population
Anju Kacker, Imran Hasan, Rohit Mishra
Abstract
Introduction: Hyperlipidemia is a disorder in which lipid and cholesterol levels in the blood are elevated. It is also known as dyslipidemia, which refers to a variety of lipoprotein metabolism abnormalities. Although an elevated amount of low-density lipoprotein (LDL) and cholesterol in the blood is regarded to be a conventional risk factor for atherosclerosis. Platelet-large cell ratio (P-LCR) is defined as the percentage of platelets that exceed the normal value of platelet volume of 12 fL in the total platelet count. Platelet size has been shown to reflect platelet activity. In general population, higher MPV and P-LCR values are observed in CAD patients compared to patients without coronary atherosclerosis. Therefore P-LCR indices, combined with other prognostic parameters, may be an important element of various scoring systems used in long-term prognosis in both stable CAD and ACS. Thus this study to study role of platelet function in hyperlipidemic patients. Methods: A cross sectional study conducted from November 2022 to January 2023. This study was started after taking permission from institutional ethical committee. All the patients with hyperlipidemia who gave consent to be part of the study were included. The study excluded patients who had any cardiovascular illness, bleeding problems, or was using anti-platelets, anti-coagulants, or lipid-lowering medicines. Thrombocytopenia, anemia, cancer, pregnancy, recent blood transfusion history, infections and chemotherapy. Results: The mean age of the study participants was found to be 54.22±14.8 years. 65% of the study participants >50 years, followed by 16% being 41-50 years. Majority of the participants of the study participants male (60%). Association between cholesterol and gender showed that there was no significant association across gender and cholesterol levels with p value= 0.445. It was found that there was no significant association across cholesterol and age group with p value= 0.934. No significant association across was found across cholesterol and P-LCR with p value= 0.824 in our study.

32. PCR-Based Assessment of MRSA: mecA Gene Detection Among Patients and Healthcare Workers
Dheepa N, A.V.Mathivadhana, Sasikala Gunasekaran, Panneerselvam Periasamy
Abstract
Methicillin-Resistant Staphylococcus aureus (MRSA) is a notorious pathogen responsible for a wide range of healthcare-associated and community-acquired infections. Timely detection and management of MRSA colonization among both patients and healthcare workers are essential to prevent its spread and associated adverse outcomes. This research aims to screen for MRSA colonization in both patient populations and healthcare workers while employing Polymerase Chain Reaction (PCR) technique for the identification of the mecA gene, a key genetic determinant of methicillin resistance.
The study will involve a cross-sectional approach, where nasal swabs will be collected from a representative sample of patients admitted to healthcare facilities and healthcare workers across diverse departments. The collected swabs will be subjected to MRSA screening using both traditional culture methods and PCR-based techniques targeting the mecA gene. The results will be analysed to determine the prevalence of MRSA colonization, assess the concordance between the two methods, and investigate potential risk factors associated with colonization.
This research aspires to provide valuable insights into the prevalence of MRSA colonization among patients and healthcare workers, shedding light on the effectiveness of PCR-based mecA gene detection in comparison to conventional culture techniques. The findings could contribute to the development of more efficient and rapid screening protocols, facilitating early intervention and infection control measures. Ultimately, this study seeks to enhance our understanding of MRSA transmission dynamics within healthcare settings and underscore the importance of rigorous screening procedures.

33. A Clinical Study of Lung Cancer in Non Smokers with Special Reference to Histopathology
Farjana Begum, Basanta Hazarika, Aishwarya Nair
Abstract
Introduction: Lung Cancer is the most common cause of cancer related deaths in men and women worldwide, responsible for 1.8 million deaths in 2020. There are two broad categories of lung cancer, Small cell lung cancer (SCLC) and Non-small cell lung cancer(NSCLC) .Adenocarcinoma is the most common of the NSCLC.[1,2] For study purpose, the term Non-smoker is considered same as the term Never smoker, which is defined as a person who smokes less than 100 cigarettes in life time including lifetime non-smokers. Aims and Objectives: To study the clinical and radiological profile of lung cancer in Non-smokers and to study the histopathologic type of lung malignancy occurring in Non smokers. Materials and Methods: A total of 342 cases of Lung Malignancy were studied out of which 279 cases were smokers and were excluded from the study. The rest 63 patients who were non-smokers were included in the study. Proper history, physical examination, relevant investigations, bronchoscopy, biopsy was done to obtain a histopathological examination. Results: Total of 63 cases who fulfilled the inclusion criteria were included in the study, 68.3% were females and 31.7% were male. It was observed that most of the cases in this study were housewives and majority of the patients in our study had exposure to biomass fuel, seen in 54% of cases, followed by exposure to passive smoke, seen in 30.2% cases., Adenocarcinoma (74.6%) cases, Squamous cell carcinoma in 8 (12.7%) cases, Non-small cell Lung carcinoma in 4 (6.3%) cases, Small cell carcinoma in 2 (3.2%) cases, Carcinoid tumour in 1(1.6%) case, Mesothelioma in 1(1.6%) case. Conclusion: Lung cancer in non-smokers is common among middle aged females who were housewives and had exposure to biomass fuel. Lung mas is ,peripheral in location in most cases and ct guided biopsy was the most common modality used for getting diagnosis. Adenocarcinoma was the most common type followed by squamous cell carcinoma.

34. A Prospective Study for Comparison of Anterior Nasal Packing with Rapid Rhino Packs and Merocel Packs after Septoplasty in Terms of Pain, Bleeding and Post-Operative Complications
Manorama Saini, Harender Simar, Dinesh Kumar, Anil Kumar, Mahendra S Naik
Abstract
Introduction: Nasal packs are used to stop bleeding after septoplasty. Wide ranges of packing materials are available, which primarily work by compression of vasculature. Rapid Rhino and Merocel are two types of commonly used nasal tampons. An inflatable cuff and carboxymethyl cellulose packing make up the Rapid Rhino pack when comes in contact with blood; it causes platelets to clump together. It stops active capillary and venous bleeding by compressing arterial bleeding and promoting clotting. Merocel nasal packing is a foam-like substance made of hydroxylated polyvinyl acetate. The pack material has cavities that can absorb liquid. The present study aimed to compare the Rapid Rhino and Merocel packs for nasal packing after septoplasty, in terms of pain, bleeding, patient tolerance (both with the pack in place and during removal), postoperative complications and endoscopic findings. Methodology: 50 patients with deviated nasal septum were randomly selected from patients scheduled for septoplasty. Right nasal cavity was packed with a Rapid Rhino pack and left with a Merocel pack at the conclusion of septoplasty. Follow-up examinations were done for observing pain, bleeding, comfort and to check for synechiae formation. Result: On removal of the pack, 14 (28%) of the patients in the Merocel group and 6 (12%) of the patients in the Rapid Rhino group developed bleeding. There was a statistically significant difference in the occurrence of pain and comfort in the two groups. Conclusions: Based on our findings, Rapid Rhino is better tolerated than Merocel by patients after septoplasty. Rapid Rhino has the advantage of removing the pack sooner and causing less reactionary bleeding.

35. Cemento-ossifying Fibroma
Prasad Bhange, Shubhada Wankhede, Tejas Gavit
Abstract
Cemento-ossifying fibromas are rare fibro-osseous benign neoplasms that affect the jaws. They are included in the group of mesodermal odontogenic tumors and commonly present as a progressively growing lesion that might attain enormous size with resultant deformity, if left untreated. A case of cemento-ossifying fibroma involving the left mandibular region of 10-year-old male patient. The clinical, radiographic, histologic features are presented and the various differential diagnosis are discussed. Cemento-ossifying fibroma (COF) is a distinct form of a benign fibro-osseous tumor, affecting predominantly the craniofacial region. Cemento-ossifying fibroma was initially classified by the World Health Organization (WHO) as a fibro-osseous neoplasm in 1992. However, they do not arise in the long bones, and occur mostly in the tooth- bearing areas of the jaws. Their resemblance to ossifying fibroma and cemento-osseous dysplasias give evidence for an odontogenic origin. They are derived from the mesenchymal blast cells of the periodontal ligament and have a potential to form fibrous tissue, cement and bone or a combination of such elements.

36. Study of Aspiration Sclerotherapy in the Management of Hydrocele in Telangana Population
Chaitanya Kumar Jilla, Bhargavi. P, Yellapu Naga Karthik
Abstract
Background: The surgical method to treat hydrocele is painful and may injure reproductive organs. Prolonged stays at the hospital is an economic burden on patients. Hence, an alternate method of non-surgical treatment at OPD is acceptable to the majority of patients. Method: Out of 60 (sixty) patients with hydrocele, thirty were treated surgically by Jaboulay’s procedure and thirty with injection Sclerotherapy (IS). In Sclerotherapy first 2% lignocaine was injected with a 24-gauge needle and fluid is aspirated using 18-gauge needle under aseptic conditions. At the puncture site, the cannula was left in situ, and a mixture of STD’s and 2% xylocaine of volume equivalent to 10% aspirated fluid were instilled. The aspirated fluid was sent for cytological analysis. Tight scrotal binding was done after the procedure. Patients were followed for 7 days, 1 month, and 6 months. After the procedure, patients with recurrence were treated surgically. Results: There were significant results in the aspired volume, of hospital stay, work resumption (p<0.000). In the comparison of post-aspired and post-surgical 83.3% had pain, 26.6% fever, and 13.3% infection were observed in the surgical group. Mild volume recurrence: 6.6% gross volume recurrence, 3.3% was observed in I.S. group. Cure percentage was 9 (100%) in 0–50 volume, 10 (66.6%) in 50–99 volume, and 5 (83.3%) in >100 ml volume in I.S.group. Conclusion: Hydrocele aspiration and Sclerotherapy were successful in correcting 83.3% of simple, non-septated hydroceles. It avoids hospital expenses, and patients can resume their work on same a day as it was an OPD treatment and recurrence was treated surgically.

37. Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetic for Ultrasound Guided Supraclavicular Brachial Plexus Block: A Prospective, Randomized Controlled Study
Ahmedi Fathima, Naveed Abrar, Waseem Anjum
Abstract
Background: Brachial plexus block is one of the most commonly performed regional anesthesia techniques. Several drugs have been studied as adjuvant to brachial plexus block. Our aim was to study the efficacy of dexmedetomidine as an adjuvant to local anesthetics supraclavicular brachial plexus block done using ultasonography. Methods: 60 adults in the age group of 18-60 years, with American society of anesthesiology class I or II, posted for elective upper limb surgery, were randomized into two groups. Block was performed using ultrasound. Group I patients received a local anesthetic mixture of 0.5% bupivacaine (15ml) + 2% lignocaine with adrenaline (15ml) + normal saline (0.5ml) and Group II Patients received 0.5% bupivacaine (15ml) + 2% lignocaine with adrenaline (15ml) + Dexmedetomidine (50μg). Parameters recorded intraoperatively and postoperatively were pulse rate, mean arterial pressure, sensory block, motor block and sedation. Adverse effects if any were recorded. Results: The mean duration of onset of sensory & motor block was faster in group II in comparison to group I (p<0.001). The duration of sensory & motor blockade was prolonged in group II (p<0.001). Duration of analgesia was higher in group II. Requirement of rescue analgesics were less in group II with better sedation scores. Conclusion: Dexmedetomidine as an adjuvant to local anesthetics for supraclavicular brachial plexus block significantly reduces the onset time of sensory & motor block with prolongation of the duration of anesthesia & provides good post-operative analgesia.

38. A Study of Serum Magnesium Levels in Acute Myocardial Infarction
Arun Thankappan, Kiren Thankappan, Anu Jacob
Abstract
Background: Magnesium has been implicated in the pathogenesis of acute myocardial infarction and its complication like arrhythmia. Magnesium improves vascular tone, peripheral vascular resistance, after load and cardiac output, reduces cardiac arrhythmias and improves lipid metabolism. Magnesium also reduces vulnerability to oxygen derived free radicals, improves endothelial function and inhibits platelet function including platelet aggregation and adhesion. Objective: To know the relationship between the serum magnesium levels and arrhythmias in patients with acute myocardial infarction. Method: By using simple random method, 50 cases of acute myocardial infarction, admitted in Basaveshwar Teaching & General Hospital, attached to M.R.Medical College, Gulbarga over a period of 2 years i.e., between October 2006 to March 2008. Results: There is a significant difference in the magnesium levels in patients with arrhythmias and without arrhythmias. Conclusion: In acute myocardial infarction, patients with low magnesium levels are more prone to get arrhythmias. So magnesium treatment can be considered in patients of acute myocardial infarction with low magnesium levels.

39. Multimodality Evaluation of Breast Lesions
G David Chakravarthi, Riaz Mohammed
Abstract
Aim: To comparison of real time elastography, greyscale sonomammography and CR mammography and their correlation with FNAC/biopsy to differentiate the benign and malignant lesions of the breast. Method: A prospective study conducted in 80 Patients with complaint of pain or lump in the breast or nipple discharge those attending OPD/admitted at the Govt General Hospital for the 2 year duration. A Proforma used to collect the clinical and other relevant from all patients. Evaluation was done by mammography, sonomammography, elastography, MRI and correlated with FNAC/biopsy. Results: Benign diseases (56.25%) were more common than malignant (43.75%), of which fibroadenoma is the most common lesion. Benign lesions are more common in below 50yrs age group. Incidence of malignant lesions is more in above 50yrs age group. Most common location for the lesions is upper outer quadrant (35%). In mammography, 30 lesions are malignant of which only 2 are benign in FNAC, whereas 50 lesions are benign of which only 7 are malignant. Mammography has a sensitivity of 80%, specificity of 95.5%, positive predictive value of 93.3%, and negative predictive value of 86%. Sonomammography has a sensitivity of 74.2%, specificity of 91%, positive predictive value of 86%, and negative predictive value of 82%. Real time Elastography has a sensitivity of 91.4%, specificity of 94.4%, positive predictive value of 94.1%, and negative predictive value of 91.8%. Combined CR mammography and sonomammography has a sensitivity of 82.8%, specificity of 93.3%, positive predictive value of 90.6%, and negative predictive value of 87.5%. Combined sonomammography and Real time Elastography has a sensitivity of 91.4%, specificity of 97.2%, positive predictive value of 96.96%, and negative predictive value of 92.1%. By combining all three modalities CR mammography, Greyscale Sonomammography and real time Elastography only two malignant lesions were misdiagnosed as benign and all benign lesions were correctly identified as benign. Combined Greyscale Sonomammography and real time Elastography do not have the disadvantage of radiation and it is easily available and easy to perform without any compression. Even in dense breasts the lesion can be identified easily. Conclusion: Combination of CR mammography, Sonomammography and Real time Elastography has high diagnostic sensitivity and specificity in the diagnosis of benign and malignant breast masses obviating the use of higher modalities like MRI, CAD and Digital Tomosynthesis which is very useful.

40. Evaluation of Cerebral Venous Thrombosis by CT Venography in Patients Attending to Tertiary Care Institute
Riaz Mohammed, G David Chakravarthi
Abstract
Aims: To study the varied findings of Cerebral venous thrombosis (CVT) on CT-Venography in clinically suspected cases. Method: This clinic-radiological study conducted in 50 patients with signs and symptoms of cerebral venous thrombosis referred for CT-Venography for the duration of 2 years. Results: The mean age was 32.18 ±13.14 years (2- 76 yrs). 66% of patients were in 3rd decade. Large number of patients (35/50) had subacute onset of symptoms i.e. symptom duration (48 hours -30 days). Headache (31/50), seizures (29/50) altered sensorium (7/50) and focal deficits (23/50) Papilledema (54%) were the major clinical features recorded. Cerebral infarction was the most common abnormality noted on CT scan (72%) which was hemorrhagic in 29% of the cases. Deep seated venous infarction (Thalamus and basal ganglionic structure) was seen in 10% of cases. On CT-Venography, Superior sagittal sinus (sss) (the commonest sinus involved) was involved in 39 patients, (isolated sss in 7 patients) total involvement was seen in 11 patients while in other patients anterior, middle and posterior parts involved with various combination of other sinuses. Transverse sinus was the next most common sinus involved 33 patients, (isolated in 4 patients) followed by sigmoid sinus 22 patients superficial venous system was involved in 5 patients (isolated in 2 patients) while deep venous system was involved in 5 patients. Majority (39) of patients had combination of sinuses and veins involvement, 11 patients had only isolated sinus involvement. When we correlated the clinical profile with the topographic Radiological substrate like involvement of superficial/deep venous system or the pattern of infarction, there was no significant correlation to evolve a pattern of diagnostic significance, correlating with involvement of sinus. CSVT is an important and treatable cause of the stroke; it has risk factors like OCP use, alcoholism, procoagulant state are increasingly recognized in addition to the conventional risk factors like postpartum state. Procoagulant state and infections are the most common predisposing factors for cerebral venous thrombosis in this study. Most of the patients who were followed-up had re canalized the occluded veins.  Only one patient expired in acute phase and only one patient presented with recurrent CVT. Conclusion: In patients with unenhanced CT findings suggestive of venous thrombosis, CT venography can be performed without delay to confirm the diagnosis and to start appropriate therapy immediately there by decreasing morbidity and mortality.

41. Study of Post-Operative Changes in Corneal Astigmatism Post Pterygium Excision Using Various Methods
G. Ramya, K.VijayaSekhar
Abstract
Aim of the study is to investigate post-operative changes in corneal astigmatism following pterygium removal using various surgical methods using conjunctival autograft (CLAG), and amniotic membrane graft (AMG). This is randomized, prospective, comparative study conducted at department of ophthalmology for period two years. The study population included 100 patients who had surgery for primary pterygium. Each group is randomly assigned 50 AMG techniques and 50 CLAG techniques. Preoperatively, all patients were evaluated for visual acuity, anterior and posterior segments, autorefraction, and auto keratometry. The patients’ visual acuity, autorefraction, and auto keratometry were assessed on day 5, one month, and three months after surgery, and the results were analysed.
The mean age of the study population was 46.88 ±11.35 years. Majority of the patients including in this study are giving history of chronic exposure to sunlight and dust. Pterygium is predominantly found nasally of about 84% and temporal 16%.  Patients underwent surgery with Grade 1 (0%), 104 in grade 2(74%) and 36 in grade 3 (26%). Pterygiums of grades II, III, and IV were present in 53%, 27%, and 20% of the patients. Eighty percent of patients in the conjunctival autograft group had ‘with the rule astigmatism’ prior to surgery. In the AMG group, 68% of patients had ‘with the rule astigmatism.  After 3 months of surgery, the preoperative corneal astigmatism of 3.52±1.665 D was reduced to 1.174 ±0.26 D (P< 0.0001). The groups CLAG and AMG had preoperative mean corneal astigmatism of 3.63 1.50 D and 3.41 ±1.83 D, respectively, which were reduced to a 3-month postoperative corneal astigmatism of 1.33± 0.30 D (p< 0.0001) and 0.99±0.23 D(p<0.0001), respectively. The preoperative mean astigmatism in eyes with grade II, II, and IV pterygiums was 2.26± 0.14 D, 3.69±0.09 D, and 6.57±0.113 D, respectively. At three months, the postoperative mean astigmatism in eyes with grade II, III, and IV pterygiums was 1.17 ±0.26 D (P< 0.0001), 1.105 ±0.26 D (P< 0.0001), and 1.196± 0.27 D (P< 0.0001). All three grades of pterygium showed a significant reduction in corneal astigmatism three months after surgery. BCVA changes 3 months postoperatively were statistically significant. Primary complication among two groups following pterygium excision with conjunctival limbal autograph and amniotic membrane graft is recurrence in 5 cases. AMG has an 8% recurrence rate, while CLAG has a 2% recurrence rate. These patients are providing a history of UV exposure and dust exposure because of their outside work. These patients are outdoor workers. The most common site of recurrent pterygium is the nasal side, and the average duration of recurrence is 3 months. All cases are managed with CLAG.  In CLAG group 1 recurrence was seen with age of 58 years male. All these patients have history of dust exposure and UV radiation site of recurrent pterygium is nasal side. Mean duration of recurrence is 3 months. All the 3 cases underwent CLAG + topical mitomycin C (MMC). Epithelial inclusion cyst seen in 1 case of AMG which may be due to embedded conjunctiva epithelium and cyst was excised and regrafting done. 2 cases in AMG and 3 cases in CLAG which may be due to faulty technique in excessive scraping on cornea and managed by decreasing steroid dose, increasing lubrication and observation. Graft infection was identified in one case of AMG and is being treated with topical antibiotics and lubricants. Graft retraction seen in 2 cases of CLAG and 1 case of AMG. One case adjusted by sutured with 8.0 vicryl and in other case, replaced with AMG. Surgical excision can significantly reduce pterygium-induced astigmatism. Hence, visual acuity improves as well. Amniotic membrane graft, and conjunctival autograft resulted in significant reductions in corneal astigmatism. Study proves that amniotic membrane graft and conjunctival autograft are superior surgical techniques.

42. Incidence of Intra Uterine Adhesion by Relook Hysteroscopy After Hysteroscopic Removal of Uterine Septum
Priyanka Beniwal, Farendra Bhardwaj, Kalpana Tiwari
Abstract
The purpose of this study is to find the and the morphology of the septum after the hysteroscopic resection of the uterine septum. The study was conducted on the candidates undergoing hysteroscopic septolysis. After 2 months intrauterine adhesion and the residual septum was evaluated in the intra uterine cavity during second look hysteroscopy. Additionally, the relation between the septal morphology and the severity of adhesion and the residual septum was also analysed.  As per the data it was observed that there is no considerable correlation was found between the length and width of septum and the intrauterine adhesion and their severity. However a significant correlation was found between the length of septum and the residual septum but no considerable correlation was found between the width of septum and the residual septum.

43. Assessment of Visual Evoked Potentials in Patients with Chronic Kidney Disease: A Study in an Urban Tertiary Care Centre in Chennai, Tamil Nadu
Dhivya Krishnamoorthy, Mathumithaa Subburayalu, Ramya Selvaraj, Suganya Gunasekaran
Abstract
Chronic kidney disease (CKD) is linked to functional alterations in the central nervous system (CNS), which may not display clinical symptoms in its early stages. Early CNS involvement can be detected through the evaluation of electrocortical activity. Visual evoked potentials (VEP) represent valuable diagnostic tools for early identification of CNS participation in CKD, exhibiting greater sensitivity when compared to electroencephalography. The study encompassed 20 adult patients with chronic kidney disease (CKD) and an equal number of control participants. Comprehensive evaluations of clinical and biochemical parameters were conducted for both patient groups and controls, followed by visual evoked potential (VEP) assessments for all individuals. The Serum urea (66.10±5.22 Vs 27.00±0.776) and Serum creatinine (5.22±1.64 Vs 0.776±0.13) of the study groups were compared with control group with significant P value <0.01. The analysis of VEP revealed extended latencies for all three peaks (N75, P100, and N145) when compared to the control group. Central nervous system (CNS) dysfunction is a prevalent occurrence in individuals with chronic kidney disease (CKD). Utilizing electrophysiological VEP tests can aid in the early detection of these disorders, even during subclinical stages, thereby enabling more effective management.

44. A Morphometric Study of Superior Articular Facet of Atlas Vertebra and its Significance
Fatima Begum, Sadakat Ali, Harish Chaturvedi
Abstract
Introduction: The anatomy of atlas vertebra shows extensive variability in form and size, and also undergoes many structural modifications it is located at point close to the vital centres of the medulla oblongata which can get compressed by a dislocation of the atlantoaxial joint or instability of the atlantoaxial joint. Atlas vertebra helps in complex biomechanical movements of the skull along with weight transmission of skull to spine. Recent developments in fixation technologies and minimally invasive surgical approaches have encouraged acquisition of knowledge of various dimensions of atlas vertebrae which is very important for the development of instrumentation related to atlas vertebrae. Material & Methods: In this study, total 120 dry, adult human atlas vertebrae of unknown age and sex were examined for shape, size and number of superior articular facets on each side, in various medical colleges of North India. All dimensions were measured in bilateral manner using Digital Vernier Calliper. Results: Different shapes of superior articular facets observed were oval‑shaped, kidney‑shaped, rectangular, comma‑shaped, 8‑shaped, irregular and two or three separate facets. Length and width of the facet were similar on two sides. Conclusion: The observations of present study helps in improving understanding of bony dimensions of superior articular facet of atlas vertebra which could facilitate diagnosis and preoperative planning of craniovertebral joint dysfunction.

45. A Prospective Study on B Scan Findings in Advanced Cataract Cases During COVID-19 Pandemic: A Hospital Based in North Karnatak Region
Amogh Harsoor, Afreen, Nausheen Niyaz, Sana Nizami, Navaneeta Reddy
Abstract
Purpose: To determine posterior segment pathologies using B scan in advanced cataracts of patients with limited access to healthcare during the COVID-19 lockdown. Type of Study: Hospital based descriptive cross-sectional study over 1-2 years  duration. Material and Method: This study is done at the Dept. of Ophthalmology in KBN University from Dec 2021 to Aug 2023.50 eyes of patients with advanced cataracts visiting OPD with complaints of progressive diminution of vision when lockdown was relaxed. After taking detailed history, inclusion and exclusion criteria, patients were included in the study. All patients underwent comprehensive ocular evaluation. B-Scan USG (12 MHz) was performed and data was assessed regarding posterior segment pathologies found. Results: Incidence of posterior segment pathology was 16% with male preponderance. Out of 50 patients,12 patients recovered from COVID-19 infection- out of which 1 had Diabetes Mellitus and on B scan no posterior segment pathology was found and 38 patients were tested negative for COVID-19. Diabetes was most common systemic disease (32%). 10% of patients had intra ocular pressure over 21 mmof Hg. Retinal detachment was seen in 1 patient and vitreous hemorrhage with retinal detachment was seen in 1 patient of blunt trauma. CT scan orbit in showed no IOFB. Retinal detachment, PVD and Asteroid hyalosis were most common accounting for 4% followed by Posterior staphyloma (2%) and Vitreous hemorrhage (2%). Conclusion: B-scan is extremely efficient and necessary tool in diagnosing various ocular abnormalities and influences surgical planning and postoperative visual outcome. Lockdowns imposed in India due to COVID-19 further increased the incidence of advanced cataracts highlighting importance of performing B scan in such eyes. Knowledge about posterior segment pathologies invisible on fundoscopy is of immense help to surgeons in planning, executing and explaining prognosis to patients.

46. Intravenous Ketamine with Local Anaesthesia as an Alternative to General Anaesthesia for Orchidopexy in Children
Syed Moinuddin Omar, Syed Ameenuddin Ali
Abstract
Introduction: Undescended Testis is the most common birth defect of male genitalia. Two factors are very important in determining the type of anaesthesia in children, one is clinical presentation: palpable or impalpable and the second is unilateral or bilateral presentation. Material Method: This is a review of 243 Cases of Undescended Testis operated in our Institute over a period of 10 years. For cases of palpable testis with unilateral and occasionally bilateral presentation we used anaesthetic technique of Ketamine plus local infiltration. Results: Most Pediatric Surgeons prefer General Anaesthesia for children for doing Orchidopexy, but in selected cases like Unilateral, Palpable Undescended Testis Sedation by Intravenous Ketamine along with Local Anaesthesia can be safely used for Orchidopexy in children. With the use of Ketamine patients can be kept on spontaneous ventilation with oxygen by facemask, thereby avoiding the need for intubation and muscle relaxants that is required with use of General Anaesthesia.

47. Maternal and Neonatal Outcome after the Use of Low-Dose Sublingual 25 µg Misoprostol for Labor Induction in Women with Term Pregnancy
Preetha Solomon, Vijaya Lakshmi Nambula, Deepana S. N.
Abstract
Background: Labor induction is a common obstetric intervention employed to manage pregnancies at or beyond term. Misoprostol, a prostaglandin analog, has been widely used for this purpose. This study aims to investigate the maternal and neonatal outcomes following the administration of a low-dose sublingual 25 µg misoprostol regimen for labor induction in women with term pregnancies. Materials and Methods: A prospective observational study was conducted over a one-year duration, from October 2022 to September 2023, at Karpagam Medical College Hospital in Othakkalmandapam, Coimbatore, Tamil Nadu. Eligible participants included women with term pregnancies (≥37 weeks) who required labor induction for medical or obstetric indications. Sublingual misoprostol, at a dose of 25 µg, was administered, and maternal and neonatal outcomes were assessed. Data on maternal age, gestational age, parity, indications for induction, labor duration, mode of delivery, neonatal birth weight, Apgar scores, and maternal and neonatal complications were collected and analyzed. Results: A total of 250 women with term pregnancies were included in the study. The average maternal age was 28.5 years, and the mean gestational age at induction was 39 weeks. The most common indications for labor induction were post-term pregnancy (45%) and maternal medical conditions (30%). The majority of women (72%) achieved successful vaginal deliveries, with an average duration of labor of 8 hours. Neonatal birth weight averaged 3.2 kg, and Apgar scores at 1 and 5 minutes were 8.5 and 9.3, respectively. Maternal complications were observed in 10% of cases, including uterine hyperstimulation and postpartum hemorrhage, while neonatal complications occurred in 8% of cases, predominantly related to transient tachypnea. Conclusion: Low-dose sublingual 25 µg misoprostol for labor induction in women with term pregnancies appears to be a safe and effective method, associated with favorable maternal and neonatal outcomes. This regimen can be considered as an option for labor induction in this population.

48. A Cross-Sectional Survey of Clozapine Prescribing Trends Among Psychiatrists in India
Vijay Niranjan, Priyash Jain, Shivani Dua, Kashyap Shah
Abstract
Background: Clozapine has been found to be an effective atypical antipsychotic since the time of discovery. Clozapine was also approved by FDA for reducing the risk of suicide in schizophrenic or schizoaffective patients judged to be at chronic risk for suicidal behavior in December 2002. There is a scarcity of data from the Indian subcontinent on the preference of clozapine in the medico-surgical setting. Aims and Objective: To study the clozapine prescribing trends in various psychiatric disorders among psychiatrists in India. Methods: A survey using structured questionnaire form was done with 125 psychiatrists which included various aspects like area of practice, starting dose of clozapine, maximum dose of clozapine tried, most common side effects encountered during practice, preference of using clozapine in various disorders, monitoring side effects, most common augmentation agents, etc. Results: Majority psychiatrists have had good experience using clozapine. However, side effects and need for repeated blood investigations turned out to be a barrier for its use. Conclusion: Need to influence policy to ensure wider availability of blood investigations to ensure increased usage of clozapine while keeping it in safety checks.

49. High Prevalence of Prediabetes and Associated Risk Factors in Urban Areas: A Cross Sectional Study
Ravi Prakash, Aparna Singh
Abstract
Background: Prediabetes, the intermediate stage between normal glucose homeostasis and type 2 diabetes poses a substantial public health challenge due to its potential progression to full-blown diabetes. The prevalence of prediabetes has been on the rise globally, with urbanization often implicated in driving this trend. Urban areas bring about lifestyle changes, including altered dietary habits and reduced physical activity, which can significantly contribute to the development of prediabetes. Materials and Methods: In this cross-sectional study conducted in Bihta (urban area) Patna District, we aimed to shed light on the prevalence of prediabetes and the factors associated with it in an urban population. A representative sample of 2,000 adults aged 18 to 65 was meticulously selected to ensure diversity. Health screenings were conducted; encompassing fasting blood glucose measurements and structured interviews to collect crucial demographic and lifestyle information. Prediabetes was defined following the American Diabetes Association (ADA) criteria, with fasting plasma glucose (FPG) levels ranging from 100-125 mg/dL or glycosylated hemoglobin (HbA1c) levels between 5.7% and 6.4%. Furthermore, we assessed various risk factors, including age, family history of diabetes, physical activity levels, dietary patterns, and waist circumference, assigning arbitrary values to denote potential risk factors. Results: Our findings unveiled a disconcerting reality – prediabetes had affected approximately 32% of the urban population. When examining risk factors, age emerged as a significant determinant, with 50% of individuals aged 45 or older exhibiting prediabetic conditions. Family history of diabetes, sedentary lifestyles, unhealthy dietary choices, and increased waist circumference were also substantial contributors, with arbitrary values assigned to illustrate their prevalence. Conclusion: The high prevalence of prediabetes in urban areas, as evidenced by our study, underscores the urgent need for targeted public health interventions. These interventions should focus on lifestyle modifications, promoting healthier dietary choices, encouraging physical activity, and addressing the unique challenges presented by urban environments. By addressing prediabetes in its early stages, we can potentially curb the escalating burden of type 2 diabetes and its associated complications, ultimately enhancing the overall health and well-being of urban populations.

50. Comparative Analysis of Nonalcoholic Fatty Liver Disease Diagnosed by Ultrasonography with Lipid Profile and Body Mass Index in Young Adults
Diksha Kalariya, Sunil Akhani
Abstract
Background and Aim: Obese people have a higher BMI and a lipid profile that is abnormal. The liver biopsy is the gold standard for detecting nonalcoholic fatty liver disease, however the noninvasive ultrasonography method is a safe, straightforward, noninvasive, affordable, and reproducible tool for liver research. The current study sought to investigate the ultrasonography grading of liver seatosis and BMI in a young adult population. Material and Methods: The current cross-sectional investigation was carried out in 80 people over the course of a year at the Department of Radiology, Tertiary Care Teaching Institute of India. On a conventional clinical weighing equipment, height was estimated in centimetres and weight was measured in kilogrammes. BMI was computed by dividing weight in kilogrammes by height in metres squared. They are categorised based on BMI, and a liver ultrasound and lipid profile were performed on each participant. Results: The majority of high BMI subjects had Grade 2 steatosis, followed by Grade 1. Around 54% of people with BMIs greater than 25 belong to Grade 2 and Grade 3, while 18% of people with BMIs less than 25 belong to Grade 2 and Grade 3. Serum triglycerides, cholesterol, VLDL, and LDL are significantly higher in the BMI greater than 25 group compared to the BMI less than 25, however serum HDL is significantly lower in the higher BMI group. Conclusion: People with a high BMI had more steatosis. Simple semi-quantitative Ultrasound Grading of Liver Steatosis will aid in the earlier diagnosis of metabolic syndrome, and early therapies will lower cardiovascular risk and improve these patients’ prognosis.

51. Gynaecological Cancers: an Analysis of Prevalence, Demography and Effect of Multi-Modality Cancer Treatment in a Tertiary Care Hospital
D. Niharika, Surekha Mallipeddi, B. Sweta
Abstract
Background: Gynecological malignancies account for the most common cancers among all cancers occurring in India. Dearth in the cancer awareness, non-availability of regular rural cancer screening programmes, pathological variations, in India has led the patients to report at advanced stages of disease which in turn led to unpredictable treatment out comes. The present study attempts to analyze the various Gynecological malignancies encountered in a tertiary care Hospital attached with a full-fledged Cancer Hospital in Kurnool district of Andhra Pradesh. Aims of the Study: To analyse the prevalence, demography and effect of multi-modality cancer treatment in a Tertiary care Hospital. To find the types of gynaecological malignancies occurring in the district of Kurnool, reporting stages, and final outcome of treatment. Materials: 127 patients with gynecological malignant diseases were included in the study. 31.49% with Carcinoma cervix, 24.40% patients with ovarian cancer, 22.83% patients, with endometrial carcinoma, 12.59% patients, with Gestational Trophoblastic carcinoma were included. The study was conducted between June 2021 and May 2023 All the included patients were examined thoroughly after history taking (age, parity, past menstrual history, past obstetrical history, and any family history). Demographic data of the patients like, educational status, economic status, rural or urban status were collected. Results: There were 33/127 (25.98%) women in the age group of 45 to 54 years, 27/127 (21.25%) women in the age group of 55 to 64 years and 24/127 (18.89%) women in the age group of 35 to 44 Years. There were 58/127 (45.66%) patients with Squamous cell carcinoma, 44/127 (34.64%) patients showed Adenocarcinoma, Villoglandular carcinoma in 17/127 (13.38%) patients and small cell Neuro-endocrine carcinoma in 08/127 (06.29%) patients had Adeno-squamous type of malignancies. Conclusions: Malignancies affecting the female genital tract are the leading causes of morbidity and mortality all over the world. Hence it was necessary to bring awareness among the medical fraternity as well as the general populations. Lack of awareness was found to be the main cause for reporting of patients at a very late stage of the malignancy.

52. Impact of Digital Media Exposure and Severity of Attention Deficit Hyperactivity Disorder on Caregiver Burden
Rayilla Shravya Sree, Mukkala Prajwala, Prasanna Kumar N, Sandhya K, Fidal Hastro P
Abstract
Background: Exposure to various screens, including mobiles, has increased significantly in the recent Covid times, and this exposure is seen in children of the preschool age group than the recommended guidelines, which may be associated with inattention and aggressive behaviours. Children with attention deficit hyperactivity disorder (ADHD) had more chances for increased screen time than normal children. The current study aims to assess screen time’s impact and its association with caregiver burden in children with attention deficit hyperactivity disorder. Methodology: This cross-sectional study includes 60 children in the age group of 2-6 years diagnosed with ADHD attending child guidance clinic, Government Hospital for mental care. Sociodemographic details were obtained from their caregiver. Digital Screen Exposure Questionnaire (DSEQ) assessed child screen time exposure. The severity of ADHD was assessed by using the ADHD-RS IV scale. The Burden Assessment scale evaluated caregiver burden in their caregivers. Results: 60 children with ages 2-6 years diagnosed with ADHD were included in our study. Most Children with ADHD had severity scoresabove the 93rd percentile. 60% of children with ADHD had a frequency of watching smartphones more than 5 times a week. The average time spent watching television daily was about 1 and a half hours and 2.3 hours on smartphones. The mean Burden Assessment Scale (BAS) score was 74.58, and 58.3% of caregivers had moderate caregiver burden, 37.7% had severe caregiver burden, and 10% had minimal caregiver burden. Conclusion: The results show significantly high screen time exposure in children with ADHD. Among digital media, most children were exposed to smartphones, followed by television. There is a considerably higher caregiver burden in parents of children with ADHD, with a positive correlation between the severity of ADHD and caregiver burden.

53. Study of Fever in Neonates: A Cross-Sectional Study
Riya Patel, Ashwin Dangi, Himanshu Joshi, Parth Patel
Abstract
Background and Aim: Due to immature thermoregulation system in newborn and lack of heat producing mechanism like shivering, newborn are more prone to hypothermia. The aim of the present study was to evaluate complete clinical profile in arriving at various etiologies of fever in neonates. Material and Methods: The present study is observational cross sectional study which was carried out at Nootan General Hospital with aim to identify the cause of fever in early neonatal days and to study clinical and socioeconomical profile of the newborn having dehydration fever. Sample size include 30 admitted newborn presented to our newborn care unit with fever between March 2023 to August 2023. Detailed clinical history, antenatal history, birth history and feeding history was taken to find out contributing factors to fever.  Full physical examination of newborn was done. More than 6% weight loss from birth weight per day was considered significant Status of hydration was noted and RFT with electrolytes were sent for dehydration. Results: Out of 30 newborns presented with fever, 6 newborn had positive CRP hence considered septic in this study. Rest 24 newborns were studied for the factors contributing to their fever and their clinical presentation. Out of 24 newborn, 75% (18) have primi mother, 66.66% (16) had inadequate feeding, 79.16%(19) of them were belongs to lower socioeconomical status and 29.16%(7) have uneducated mother. Out of 24 newborn with fever, 70.83% (17) newborn had significant weight loss, 62.50% (15) had decreased urine output and 37.50% (9) newborn had altered RFT in term of raised creatinine and 42%(10) had raised serum sodium level. Conclusion: As dehydration is a very common and serious complication during the post-natal period especially between 3rd to 5th days of life. As it’s a preventable, it is very crucial to educate mother about feeding techniques, good latching and to do regular new born assessment in initial few days of life of newborns.

54. Study of Testosterone Levels in Type-II Diabetes Mellitus Male Patients in Telangana Population
Mohammed Asif Muzaffer Iqubal , Mohammed Mudassir Ali, Md Muneer Ahmed, Juwairia Mohammed Fariduddin
Abstract
Background: Type-II DM affects millions of people in India and globally, but the association between serum testosterone levels (STL) and type-II DM is still unclear, but it impairs reproductive health and quality of life. Method: 95 (ninety-five) type II DM patients of different age groups were studied and compared with 90 normal (controlled) groups. The blood investigation included FBS, PP Blood sugar, Blood urea, serum creatinine, HBA1C, lipid profile, urine albumin, creatinine ratio, serum testosterone were estimated by chemiluminesience immune assay and HbA1c by HPLC. Results: The BMI, age, HBA1C, and serum testosterone level were compared with the control group, and the p value was highly insignificant (p<0.001). Conclusion: The present pragmatic study has confirmed that type II DM patients have significantly lower testosterone and higher sugar level was proved.

55. Intravenous Ketamine with Local Anaesthesia as an Alternative to General Anaesthesia for Orchidopexy in Children
Syed Moinuddin Omar, Syed Ameenuddin Ali
Abstract
Introduction: Undescended Testis is the most common birth defect of male genitalia. Two factors are very important in determining the type of anaesthesia in children, one is clinical presentation: palpable or impalpable and the second is unilateral or bilateral presentation. Material Method: This is a review of 243 Cases of Undescended Testis operated in our Institute over a period of 10 years. For cases of palpable testis with unilateral and occasionally bilateral presentation we used anaesthetic technique of Ketamine plus local infiltration. Results: Most Pediatric Surgeons prefer General Anaesthesia for children for doing Orchidopexy, but in selected cases like Unilateral, Palpable Undescended Testis Sedation by Intravenous Ketamine along with Local Anaesthesia can be safely used for Orchidopexy in children. With the use of Ketamine patients can be kept on spontaneous ventilation with oxygen by facemask, thereby avoiding the need for intubation and muscle relaxants that is required with use of General Anaesthesia.

56. Potential Role of Magnesium and Uric Acid in Metabolic Syndrome
Yogita Joshi, Jaya Jain, Ashutosh Jain, Krishna Murari Lodha
Abstract
Introduction: Metabolic syndrome is a well-recognized risk factor for cardiovascular diseases. It is associated with various disorders such as overweight and obesity, insulin resistance, type 2 diabetes mellitus and hypertension. Magnesium is an essential nutrient for maintaining vital physiological functions. Hypomagnesaemia may be implicated in the pathogenesis of various metabolic disorders such as overweight and obesity, insulin resistance, type 2 diabetes mellitus and hypertension. Hyperuricemia reflects defect in insulin action on the renal tubular reabsorption of uric acid in the renal system and may contribute to hypertension through its effect on the endothelium in the blood vessels. Objectives: To evaluate the role of serum Magnesium and Uric acid level in patients with metabolic syndrome. Methodology: We conducted an analytical case-control study on Metabolic Syndrome patients (N=90) and age matched healthy controls (N=90). Serum magnesium and Uric acid level were measured by colorimetric and Uricase-PAP method respectively. Results: We found that serum Magnesium levels were significantly decreased (0.8 ± 0.4 Mg/dl) in patients having metabolic syndrome as compared to healthy controls 2.0 ± 0.2 Mg/dl), whereas there were elevated levels of serum uric acid (10.5± 2.5 Mg/dl) in metabolic syndrome patients as compared to healthy controls (6.5 ±2.5 Mg/dl). Conclusions: Low serum magnesium levels have been associated with risk factors of metabolic syndrome, such as hyperglycemia, hypertension, hypertriglyceridemia and insulin resistance. Increased serum uric acid  levels are commonly seen in patients with metabolic syndrome and are widely accepted as risk factors for hypertension and cardiovascular diseases.

57. Groin Hernias Presenting as Acute Emergencies
M. Saikrishna, M. Sony Jhansi Priya, K. Lokesh
Abstract
Introduction: The most frequent kind of hernias occurs mainly in the groin region. Delaying in surgical intervention may lead to irreducibility, obstruction and strangulation. A strangulated Hernia’s mortality rate is directly correlated with the age of the victim and the duration of the strangulation. Aim of the study was to closely examine the clinical manifestation of the groin hernias that have developed complications and potential strategy for handling the case successfully with the background objective of preventing the recurrence. Methodology: This was a prospective study done in Tertiary Care Centre Nandyal from October 2020 to October 2022, with a sample size of 50. Conclusion: Incidence of groin hernias presenting as acute emergencies was highest among 50 and 60 decades. In males complicated inguinal hernia is more common than females, in females femoral hernia is more common than males. Most of the complicated groin hernias occur on right side when compared to left side. Majority of groin hernias present as acute emergencies within one year duration of hernia. Most common symptom was pain with groin swelling followed by vomiting. Small bowel is the most common content of sac followed by omentum. Most common site of obstruction was found to be deep ring. In our study most common procedure done was only hernioraphy followed by resection and anastomosis. Majority of the patients recovered with no complications. Most common complication encountered in our study was wound infection.

58. A Study on Seroprevalence of Dengue Virus in a Tertiary Care Hospital in North Karnataka
Md Hamed Altaf Mali, Mirza Hammad Ali Baig, Syeda Heena Kauser
Abstract
Introduction: Dengue fever is an acute viral disease caused by Dengue virus of the Flaviviridae family and is transmitted by the bite of an infected female mosquito Aedes aegypti. The Dengue virus causes significant morbidity and mortality in many parts of the world, including India. Though, the cases of dengue fever are mild and self-resolving, there can be fatal complications like Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). The aim of this study is to calculate the seroprevalence of Dengue fever referred to tertiary care hospital in North Karnataka. Materials and Methods: This is a prospective type of cross-sectional study conducted in Department of Medicine for a period of two years from June 2021 to May 2023 at ESIC Medical College And Hospital, Kalaburagi, North Karnataka, India. The serum samples were collected from suspected dengue fever cases and tested by Immunoglobulin M (IgM) capture Enzyme Linked Immunosorbent Assay (ELISA) to detect IgM antibody against dengue virus and NS1 for dengue NS1 (Non-Structural Protein-1) antigen using Standard ELISA kits. The statistical analysis was done with SPSS 26.0 version. Results: A total of 5940 serum samples were screened over a period of two years for Dengue IgM and IgG. Most affected age group was  between 10-20 years and male to female ratio was 1.2:1. A total of 1040 (17.50%) cases were positive for dengue infection. Among which 812(80.3%) cases were positive for anti-dengue IgM antibodies, 96 (9.23%)cases  were positive for NS1 antigen and 132 (12.70%)cases were positive for both, respectively. Conclusion: Regular epidemiological studies are necessary to monitor the dengue situation in high risk areas. Seroprevalence of dengue infection being critical signifies the importance of detection of both IgM antibodies and NS1 antigen for diagnosis of dengue infection to prevent fatal complications like Dengue Haemorrhagic Fever and Dengue Shock Syndrome . The study identifies younger population being at higher risk and most cases were reported during the during monsoon period, which warrants coordinated action toward vector control measures.

59. Maternal Complications and Foetal Outcome in Eclampsia
Asharani Kanaki, Soumya R Patil, Anita Goura, Anuja Sagamkunti
Abstract
Objective: To evaluate maternal complications and fetal outcome in eclampsia and to formulate strategies to improve the maternal and perinatal outcome. Methods and Material: It is a prospective study done between November 2013 to May 2015, in which 100 patients with eclampsia antenatal or within 10 days after delivery were included, Patients with seizures due to epilepsy or other cerebral conditions were excluded. This study was conducted in Basaveshwar Teaching & General Hospital and Sangameshwar Hospital, Kalaburagi both attached to M.R. Medical College, Kalaburagi. A thorough general physical examination, systemic and obstetric examinations were done.  Immediate decision regarding mode of delivery was taken. Maternal complications and foetal outcome were noted. Patient followed through from admission till discharge. Results: Out of 100 patients of eclampsia, 77 cases were antepartum, most of patients were nulliparous, with age between 20-30 years, unbooked, belonging to rural population. maternal complications were cerebral oedema 6%, CVT 3%, pulmonary oedema 2%, deranged LFT 3%, grade 1 nephropathy 3%, grade 1 hypertensive retinopathy 12%, massive ascites 3%, abruptio placentae 1%, PPH 3% and PRES 4%.maternal mortality is 2% and perinatal mortality is 22.22%. Conclusion: This study is done in an area which is considered underdeveloped & backward in the state, therefore early diagnosis of hypertension and its prompt management will prevent eclampsia and thereby preventing complications of eclampsia, hence by increasing awareness, regular antenatal check-ups, improving medical and transport facilities, the incidence and associated morbidity & mortality can be further reduced.

60. Obstetric and Perinatal Outcomes in Term Singleton Malpresentations: A Prospective Analysis
Pramoda Kumar Sahoo, Manas Ranjan Behera, Deepa Sethy, K B subudhi
Abstract
Background: Malpresentations in obstetrics refer to any fetal presentation other than vertex, including breech, shoulder, face, brow, and compound. The management of malpresentation remains controversial, and there is a need to evaluate obstetric outcomes in term singleton malpresentation to optimize perinatal outcomes while preserving the art of conducting vaginal breech deliveries. Methods: The study was a prospective observational study conducted in the Department of Obstetrics & Gynaecology at MKCG Medical College & Hospital, Berhampur, from October 2015 to September 2017. The study included 276 term singleton malpresentations out of 17,997 deliveries during the two-year study period, with an incidence of 1.6%. Data on obstetric outcomes, including perinatal mortality, stillbirth, neonatal death, and APGAR scores, were collected and analysed. The study compared outcomes between vaginal deliveries and cesarean section deliveries, focusing on the risks of low APGAR scores and soft tissue damage in different malpresentations. Results: The study analyzed 276 term singleton malpresentations, with breech presentations being the most common (81.1%). Most cases were delivered via cesarean section (69.6%), with emergency cesarean sections accounting for 43.2%. In vaginal deliveries, breech presentations were the most common (91.6%). The perinatal mortality rate was 11.9%, with stillbirth and neonatal death accounting for 9.4% and 2.6%, respectively. Vaginal deliveries had a higher risk of low APGAR scores, with compelling indications being the largest factor contributing to perinatal mortality. Conclusion: The present study revealed that most malpresentation cases are cesarean, with breech presentations being the most common. Vaginal deliveries in term breech malpresentations have a higher risk of low APGAR scores, with brow and shoulder presentations having the highest rates.

61. Severity of Retinopathy in PIH Patients Attending the Tertiary Care Center of South Gujarat: A Cross-Sectional Study
Chaudhari Akshay Kumar Mukesh Bhai, Chaudhari Pratixaben Zinabhai, Raj Ratna Nithaal
Abstract
Introduction: Pregnancy induced hypertension (PIH) is a major public health concern as it raises foetal and maternal mortality and morbidity. Hypertension in pregnancy causes vascular alterations in retinal vessels. So, retinal examination in pregnant females reflects information regarding foetal well-being and placental circulation status. Material and Method: The study was based on cross-sectional study design. 88 pregnant females attending a tertiary care center of South Gujarat, India from October 2020 to August 2021 were taken as participants. Visual acuity was assessed by Snellen’s chart and severity of retinopathy was graded based on Keith wagener and barker classification. For all statistical tests, p-value <0.05 was considered statistically significant. Result: The association of retinopathy with age, vision, gravida status, proteinuria and severity of disease was non-significant. Retinopathy was maximally seen in 20-25 years age group, primigravida, eclampsia patients and patients with proteinuria++. Grade II retinopathy was the most common retinopathy found. The association of severity of retinopathy with visual acuity was significant however it was non-significant with age, gravida status, proteinuria and severity of disease. Conclusion: Routine ophthalmoscopy must be done in PIH females specifically to know retinal vasculature condition and placental vasculature in general. This will prevent maternal and foetal morbidity and mortality by their timely diagnosis and management of complications.

62. Child Bearing Practices Among Ante Natal Women in Tertiary Care Hospital
Lynette M Fernandes, Aseefa Ghouse, Rupa Padwalkar, Ankita Naik
Abstract
Background: Motherhood is an important event in the life of a woman, and it is significantly dependent on cultural, traditional and social practices. It is also important to note that while good healthcare has a considerable contribution, safe motherhood and childbearing practices are also equally essential to build a healthy society. While there is no shortage on the data available for the medical aspect of maternal healthcare, the social and cultural part of it still needs more study and analysis. To understand the pschye and beliefs of women and what they undergo in their households on a day to basis, could probably be a stepping stone to exploring this rather obscure part of maternal well-being. This study is undertaken to know about these practices. Methods: This was an observational descriptive hospital-based study. A pre-structured questionnaire was given to study participants, after taking due informed consent. The data was then tabulated and analysed using SPSS software. Results: Majority of the participants preferred the two child norm (47%). Preference for male child was seen among 60% of participants.95% of participants fed colostrum to new-born. A significant proportion of the study population opted for hospital delivery (94%). Sleeping in practices were seen only among 35% of participants. Only 60% of study participants believed in providing equal educational opportunities for males and females. Conclusion: Child bearing practices are controlled considerably by traditional beliefs and culture, social norms. Pregnant women tend to follow these traditional practices and sometimes do not adhere to advice given by health professionals. Hence it is of utmost importance to include these practices in patient care, while discouraging unhealthy practices with sensitivity towards their emotions.  The physician sees or encounters the pregnant woman only during her antenatal period, during routine check-ups and for a short duration postnatally. The family and their accompanying traditions, beliefs and customs, however, are part of the woman throughout. Hence Tobring a change for the positive, it is important to create awareness within the cultural frame work.

63. Study to Compare the Effect of Bolus versus Intravenous Infusion of Dexmedetomidine on Intraoperative Haemodynamics in ENT Surgeries Under General Anaesthesia
Surabhi Varshney, Shubham Dadoo, Shubhranshu Shekhar
Abstract
Background: Modern anaesthesia demands optimal intraoperative conditions for surgical success and patient safety. Dexmedetomidine, a selective α2-adrenergic agonist, offers potential due to its sedative, analgesic, and sympatholytic properties. Administered via bolus injection or infusion, its impact on intraoperative haemodynamics in otolaryngological surgeries is a relevant exploration. Comparing these methods’ effects can refine anaesthetic practices and enhance outcomes in ENT surgeries. Methods: A prospective, randomized controlled trial included patients aged 18-60 undergoing elective ENT surgeries under general anesthesia. Randomized into bolus or infusion groups, blinding was ensured. Anaesthesia protocol included induction with propofol and sevoflurane maintenance. Hemodynamic parameters were recorded pre-, intra-, and post-surgery. Bolus group received Dexmedetomidine (loading dose: 1 μg/kg), infusion group received Dexmedetomidine (0.2 μg/kg/h) starting 20 minutes before induction. Statistical analysis included T test and Chi-square test, with p-value < 0.05 indicating significance. Results: A total of 70 patients were analysed (Group I: 33 and Group B: 37) in the present study. Baseline characteristics such as age, gender, body mass index (BMI), ASA grade was comparable between the two groups. In terms of systolic blood pressure (SBP) and mean arterial blood pressure (MABP), the patterns were similarly dynamic over time intervals, highlighting significant differences between the two groups at distinct points. Recovery time showed similar values in both groups, with 10.23 ± 3.54 minutes in Group B and 9.67 ± 2.94 minutes in Group I (p = 0.477). Occurrence of adverse events differed between the two groups, with bradycardia showing a statistically significant higher incidence in Group I (21.2%) as compared to (2.7%). Conclusion: This study highlights dexmedetomidine’s benefits for surgical conditions, haemodynamic stability, and bleeding reduction. Its use as premedication induces hypotension and enhances field visibility. Dexmedetomidine’s consistent efficacy and safety, along with versatile applications, make it valuable in modern anaesthesia.

64. Admission Test: Cardiotocograph as a Marker of Fetal Outcome: A Case Series Study
Anita Goura, Anuja Sagamkunti, Asharani Kanaki, Soumya R Patil
Abstract
Background and Objectives: To study the cardiotocography at admission. To assess the fetal outcome of in relation to cardiotocograph. Materials and Method: Pregnant woman with term gestation, singleton pregnancy, vertex presentation with no associated high risk factors, in active labour were included. Admission cardiotocography was done and checked weather it was assuring or non-assuring, and perinatal outcome was tested with APGAR scoring at 1 and 5 minute. This study was conducted at H.S. Kumareshwara Hospital and research centre over a period of 18 months from January 2014 to May 2015, 185 patients were included. Results: The reassuring CTG had no significance for perinatal outcome, whereas the non-reassuring CTG had significance at APGAR score of 5 minutes. The sensitivity at 1 minute APGAR score was 65.89% and specificity was 30.36%, the sensitivity and specificity at 5 minute APGAR was 70.32% and 50% respectively. We found the T value of 1.280, and P value of 0.934 at APGAR score at 1 minute which doesn’t seem to be significant. The T value at APGAR score at 5 minute was 2.923 and P value of 0.004 which has high significance. Conclusion: CTG can be a reliable testing to prevent birth asphyxia in low resource setting, and to take decision about surgical intervention. Hence with a high significance we can use CTG to predict the fetal outcome.

65. Study of Mode of Delivery in Women with Previous One Lower Segment Cesarean Section
Soumya R Patil, Asharani Kanaki, Anuja Sagamkunti, Anita Goura
Abstract
A recent analysis of the caesarean birth epidemic concluded that the practice of elective repeat caesarean section for patients with a previous caesarean delivery has been the major contributor to the escalation of the total caesarean section rate. The dictum “once a caesarean, always a caesarean”, originally enunciated by Cragin in the New York Medical Journal in 1916 is no longer valid today. The statement was issued when the classical operation was generally the rule and the utilization of antibiotics and blood transfusions unknown. The Consensus Development Conference on Caesarean Child Birth in 1980 was convened at the National Institutes of Health and concluded that vaginal birth after a previous low transverse caesarean delivery was a safe and acceptable option.

66. A Comparative Study of Desflurane and Sevoflurane for Hemodynamic Ability and Postoperative Outcome under General Anesthesia
Priyanka Kanni, Prema Bangonda, Yuvaraj Shashidhar, Akshay Margutti
Abstract
General anaesthesia can be defined as reversible depression of central nervous system resulting in loss of consciousness and absence of response to external stimuli. General anaesthesia is usually defined as triad of amnesia, analgesia and muscle relaxation. Inhalational anaesthetics are the drugs which are most commonly used for the maintenance of general anaesthesia. Adding only a small amount of volatile anaesthetic to the inspired mixture of gases results in a state of unconsciousness and amnesia. Materials and Methods: This study done at Dept of Anaesthesiology, ESIC Medical College and Hospital Kalaburagi, the study was conducted in 40 patients. All were ASA I and II patients undergoing elective surgical procedures under general anesthesia lasting for less than 2 hours but more than 1 hour duration. After getting consent, the anesthetic technique was performed. Results: Majority of the study participants belonged to the age group 31-40 years in both the groups and in total. The age did not differ significantly in both groups hence both the groups are comparable in terms of age. Conclusion: The aim of this study is to prospectively compare the hemodynamic, emergence and recovery characteristics of sevoflurane with that of desflurane in general anesthesia.

67. Evaluation of Effects of Various Co-Morbidities on Abdominal Wound Dehiscence after Midline Laparotomy
Anjana Ekka
Abstract
Background: Abdominal wound dehiscence (AWD) is a terminology which is commonly used to explain separation of different layers of an abdominal wound before complete healing has taken place. Other terms used interchangeably are acute laparotomy wound failure and burst abdomen. Wound dehiscence usually occurs when a wound fails to achieve required strength to withstand stresses placed upon it. Postoperative wound healing plays a significant role in facilitating a patient’s recovery and rehabilitation. Surgical wound dehiscence (SWD) impacts on mortality and morbidity rates and significantly contributes to prolonged hospital stays and associated psychosocial stressors on individuals and their families. Materials and Methods: This is a prospective study conducted in the Tertiary care teaching Hospital. Patients who had undergone abdominal surgery (laparotomy) who developed acute fascial wound dehiscence (AFWD) and who had to return to the operating theatre for closure of the fascial dehiscence under general anaesthesia. The medical records were reviewed and the diagnosis of fascial dehiscence was confirmed for all included patients. Each single case was matched to two cases of patients who were admitted in the same year for surgery and who underwent similar surgical intervention, were of the same gender, and were within 5 years of the index patients’ age. Patients who developed incisional hernia on follow-up were excluded due to the aetiological overlap between fascial dehiscence and incisional hernia. Result: Out of these 90 cases 43 patients were female (47.8%) and 47 patients were male (52.2%). The cases were distributed in two groups randomly depending on the technique of midline closure. Out of the total 90 patients, 20 (22.2%) had band obstruction, 15 (16.7%) had sigmoid volvulus 13 (14.4%) had gastric carcinoma, 10 (11.1%) had sigmoid cancer, 1 (1.1%) had mid gut volvulus, 13 (14.4%) had obstructed hernia, 8 (8.9%) had carcinoma of ascending colon, 10 (11.1%) had pyloric stenosis. The other co morbidities which contributed to wound dehiscence were DM, HTN, Pulmonary Disease, Malnutrition and  Anaemia. Out of everything DM had a Significant amount of contribution. Conclusion: We therefore hope that the results of this study will lead to better, evidence-based treatment options for abdominal wound dehiscence and, eventually, a lower incidence of this severe complication.

68. To Study the Correlation of Surgical, Radiological and Histopathological Findings of Adnexal Masses
Urmila Tripathi, Vaishali Singh, Neelam Raghuwanshi, Priyanka Paliwal
Abstract
Background & Methods: The aim of the study is to study the correlation of surgical, radiological and histopathological findings of adnexal masses. Adenxal mass is a very common clinical presentation in gynaecological practice. Adnexal masses can be ovarian masses and cyst, however, paratubal cyst, hydrosalpinx and other non-ovarian masses are also included. Complete general physical examination, per abdomen and bimanual examination (where permissible) were done to make provisional diagnosis. For further evaluation, USG either TAS or TVS was done with color doppler and CECT for suspicious cases of malignancy was done. Standard laboratory tests consisting of complete hemogram, fasting and postprandial blood sugar, CA125 and other tumor makers, liver and renal function test were done prior to surgery. Results: Maximum 45% cases out of 100 found to be ovarian cyst. 12% cases were diagnosed dermoid cyst during surgery while 6 cases of ovarian cyst and 1 chocolate cyst also confirmed as dermoid cyst on histopathology. 1 broad ligament fibroid were diagnosed as paraovarian mass in radiological imaging found broad ligament fibroid during laparotomy also confirmed same on histopathology. On histopathology (gold standard), 14 cases were confirmed malignant. But on radiology only 11 cases of advance stage showed features of malignancy. During laparotomy, 16 cases were found malignant in which 14 were confirmed on HPE but and 2 cases (1 granulosa cell tumor and 1 tubercular TOA) found benign on HPE. Conclusion: Inaccurate size determinations can lead to the impression of false–negative imaging reports, for example when a 3 cm mass found surgically was missed in USG reporting. CECT helps in diagnosing metastatic sites, bulk of disease and provide help in making decision that what should be extent of cytoreduction. Correlation of the lesion location and appearance at imaging with the surgical findings will aid in the detection of potential pathology reporting errors. In conclusion, imaging, surgical, and histopathological correlation is important in assessing the diagnostic accuracy of imaging of adnexal masses.

69. To Study the Ultrasonographic Color Doppler and CECT Findings of Various Adnexal Masses
Urmila Tripathi, Vaishali Singh, Neelam Raghuwanshi, Niharika Pandey
Abstract
Background & Methods: The aim of the study is to study the ultrasonographic color doppler and CECT findings of various adnexal masses. Detailed history about presenting complaints and menstrual history was taken. Complete general physical examination, per abdomen and bimanual examination (where permissible) were done to make provisional diagnosis. For further evaluation, USG either TAS or TVS was done with color doppler and CECT for suspicious cases of malignancy was done. Standard laboratory tests consisting of complete hemogram, fasting and postprandial blood sugar, CA125 and other tumor makers, liver and renal function test were done prior to surgery. Results: Out of 100 cases, on USG 59% cases of adnexal masses were heteroechoic and 4% anechoic, 29% cases of adnexal masses were devoid of septations/nodules/locules. 14% cases were having moderate color uptake on color doppler, which is an indicator of malignancy and were subjected to CECT also shows a very fast contrast enhancement. Only 8% cases shows loss of fat plain in pelvic CECT and found indicating metastasis and malignancy which was found same in histopathological examination. Conclusion: Adnexal masses are more commonly encountered in young patients are of benign nature whereas patients with malignant histopathology are mainly older and more often postmenopausal. Many tumor markers in reference to ovarian masses are used in practice to support pre-operative diagnosis. Echogenicity, vascularity, internal structure in USG color doppler and contrast enhancement in CECT helps in metastatic sites, bulk of disease and provide help in making decision that what should be the extent of cytoreduction. Correlation of the lesion location and appearance at imaging with surgical finding is important in assessing the diagnostic accuracy of imaging of adnexal mass.

70. Incidence of Acute Kidney Injury in Patients with Acute Myocardial Infarction
Amit Malakar, Shiv Charan Jelia, Saurabh Soni, Banwari Lal, Rima Biswas, Sakshi Apurva
Abstract
Background: The purpose of this study is to evaluate the incidence of  Acute Kidney Injury, as defined by the KDIGO, in the acute phase of a myocardial infarction, thereby making vigorous efforts to preserve renal function as we attempt to salvage and protect cardiac muscle. Methods: Cohort study was conducted on patients admitted with Acute Myocardial Infarction in Government Medical College and Associate group of Hospital, KOTA (Rajasthan). Results: The incidence of Acute Kidney Injury in hospitalized patients presenting with Acute myocardial Infarction is 29%. Development of AKI is associated with poor outcome in terms of in hospital mortality of acute MI patients, with p= 0.001. Conclusion: Acute Kidney injury is an important and common complication occurring in acute MI patients. All the more, there is an increase need for more prospective studies to document the incidence of acute renal insufficiency occurring during critical illness such as MI, and the associated comorbidities so that the treatment modalities can be altered accordingly so as to prevent further damage to the kidneys during the acute phase of illness, and by educating the patient to be on long term follow up to identify early before these acutely injured pair of kidneys fail irreversibly so that necessary measures can be initiated to ensure better quality of life in such patients.

71. Study of Thyroid Profile and Lipid Profile in Chronic Kidney Disease Patients
Saurabh Soni, Shiv Charan Jelia, Amit Malakar, Banwari Lal, Sakshi Apurva, D P Soni
Abstract
Background: The progression of chronic kidney disease (CKD) is linked to a multitude of comorbidities, such as thyroid dysfunction, dyslipidemia, and cardiovascular disease. Objective were to determine the thyroid and serum lipid profile of CKD patients and to establish correlation between severity of renal disease with these 2 metabolic parameters. Methods: This was a prospective study conducted among the 100 CKD patients over 3 year admitted in the Department of general medicine, Government medical college and associated hospital Kota. Results: There were 66 (66%) male patients and 34 (34%) female patients among the 100 patients. There were no patients in grade 1, whereas there were 2, 20, 66, and 12 patients in grades 2-5 CKD, respectively. In each grade of CKD, the mean age, eGFR, urea, creatinine, thyroid profile, and lipid profile were computed individually. The levels of urea, creatinine, and eGFR differed significantly across CKD grades 2-5. The thyroid profile differed significantly across CKD grades 2-5 with p=0.001, 0.006, 0.001 for serum T3, serum T4, serum TSH. The lipid profile differed significantly across CKD grades 2-5, with p=0.001, 0.171, 0.001, 0.199, 0.423 for total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) levels, respectively. Conclusions: The number of patients increases with decreasing T3 and T4 and increasing thyroid stimulating hormone (TSH) proportionate to the severity of the renal failure. In addition, hypothyroidism is becoming more common in people with chronic renal disease. Serum triglycerides, LDL, and VLDL levels rise statistically significantly in CKD grades 3-5 patients.

72. A Clinical Study of Management of Wounds using Vaccum-Assisted Dressings
Mohammed Faizul Viqhas K, Nivedita, Mohammad Noor Alam
Abstract
One of the most common causes for admission in surgical ward is non healing ulcer. In which diabetes is the most common etiology. In most of the cases, hospital stay of many weeks is required for management of the above. In many cases they ultimately go for amputation. Acute and chronic wounds affect at least 1% of the population. Regardless of etiology, wounds are difficult to treat if coexisting factors (eg. infection or diabetes mellitus) prevent regular wound healing.

73. A Comparative Study of Colostrum Dressing Versus Conventional Dressing in Deep Wounds
Nivedita, Mohammed Faizul Viqhas K, H M Abhijith, Vithal Prasad
Abstract
Deep wounds are commonly encountered in general surgical practice and managing them is a great challenge to a general surgeon. Clinically we can classify deep wounds broadly into diabetic and non-diabetic ulcers. The later includes varicose ulcers, traumatic ulcers, arterial ulcers and Pressure sores. Materials and Method: A total of 100 patients admitted in Department of General Surgery, Navodaya Medical College Hospital and Research Centre. Results: The age wise distribution of patients in this study is as shown above. In our study the ulcer most commonly occurred in age group between 46 to 50 years. Below 30yrs, 5%. Conclusion: Management of chronic wounds and ulcers is always a challenging issue due to delayed healing, causing morbidity and disability in the patient, is a burden on our health resources.

74. Morphological Variations of the Lung Fissures and Lobes
A. Senthamizchelvan, P. Mangaiyarkkarasi, E. Manikandan
Abstract
Introduction: Awareness of anatomical variation in lung is essential for doing segmental lobar resections of lungs. This study aims to find variation in morphology of lung fissures and lobes in Indian population to provide data for radiologists and surgeons for correct diagnosis and plan of surgery. Methods: Morphological variations of fissures and lobes of the lungs were studied in 24 right and 26 left isolated lungs from dissection hall from a tertiary care teaching hospital. Results: Horizontal fissure was absent in 12.5 % and incomplete horizontal fissure in 12.05%. In right lungs oblique fissure incomplete in 11.5%.various parameters were measured by inch tape in cms. In right lung specimens heights were 14-16 cms in 41.6% and 17-21 cms in 58.4%.The breadth at the level of hilum 9-12cms in 70.84% and 13-14cms in 29.16%.The width of the right lungs at the apex level 3-4cms in 58.4% and 5-6 cms in 41.6% and width at the level of base is 10-13 cms in 75% and 14-15cms in 25%.The length of oblique fissure is 12-15 cms in 63.6% and 16-18 cms in 36.4%, the length of horizontal fissure were 4-6 cms in 33.3%, 7-9 cms in 29.2%,10-12cms in 25% and absent fissures in 12.5% specimens. The height of left lung specimens was about 14-16 cms in 38.4% and 17-21 cms in 61.6%. Breadth at the level of hilum was 8-11 cms in 46.2% and 12-14 cms in 53.8% specimens. The width of left lung at the level of base were about10-12 cms in 61.6% and 13-15 cm in 38.4%.The length of oblique fissure of left lungs were about 12-14 cms in 23%, 15-17cms in 30.7%, 18-22cms in 38% and incomplete (4 cms) in 7.7%. One left lung show 2 fissures about 4%. Conclusions: The nature of fissure is of great importance in planning operative strategy of thoracoscopic pulmonary resection. An incomplete fissure may contribute to postoperative air leakage. Incomplete fissure mimic usual patterns of collapse seen in patients with bronchial lesions and may also give rise to appearance of pleural effusions. Also they alter the spread of disease within lung. Hence awareness regarding anatomical variations is essential for performing lobectomies and segmental resection and interpreting radiological images.

75. Effects of Early N-Acetyl Cysteine in the Management of Rodenticide Consumption: A Prospective Study
Namburu Sindhura, Koniki Priyanka, P Tabitha R J Chandrika, Siva Sankar Annangi, Srinivasula Sri Ranga Pravallika
Abstract
Background: A poison is a substance that is capable of causing illness or harm to a living organism on contact or upon introduction to the body. Rat poisons (Ratol) paste contains yellow phosphorus also called as Rodenticides. There is no antidote for rodenticide poison, and consumption is often fatal. The Role of N acetyl cysteine (NAC) in acetaminophen induced ALF is well established. Aim and Objectives: To find out the outcome of patients treated with NAC in rodenticide poisoning admitted in rural tertiary care hospital. Material and Method: This was the Hospital based prospective observational study, conducted on patients with consumption of Rodenticide poisoning, during period from May 2021 to December 2022 (18 months), at one of Tertiary care hospital – Guntur Medical College, Guntur. In the study we have included 100 patients, selected by using simple random sampling method admitted for rodenticide poisoning in the hospital after following inclusion and exclusion criteria. Results: Mean age of the study population was found to be 37.6 ± 12.45 years and maximum patients were lying in the age group of 31-40 years. 83% of cases were found to be Suicidal followed by accidental. mean duration of Hospitalization was found to be 6.42 ± 4.12 days. There was statistical significant difference between proportion of survival and non-survival due to treatment of NAC (P-value=0.0007). Conclusion: Early use of NAC which is inexpensive and relatively safe among rodenticide poisoning, patients shows significant impact on the recovery of the patients. Mortality rate was found low among the patients treated before 12 hours with NAC.

76. Comparison of Isobaric Levobupivacaine and Isobaric Ropivacaine for Spinal Anaesthesia in Patients Undergoing Elective Lower Abdominal and Lower Limb Orthopedic Surgeries: A Randomized Study
Saravanakumar Sundaresan, Harish Rajendran, Bhavani Vaidiyanathan
Abstract
Introduction: Levobupivacaine and Ropivacaine are two relatively new amide local anesthetic agents that have been produced in order to address the issues of bupivacaine toxicity. Aim and Objectives: To compare block characteristics of levobupivacaine with ropivacaine in providing anaesthesia for lower abdominal and lower limb procedures. Methodology: The study was conducted involving 200 patients belonging to ASA grade I and II coming for lower abdominal and lower limb surgeries. They were divided into 2 groups of 100 each. Group L received 0.5 % isobaric levobupivacaine 15 mg and R group received 0.75% isobaric ropivacaine 22.5 mg. Following administration of spinal anesthesia, block characteristics such as onset and duration of sensory blockade, maximum sensory level achieved, time needed for 2-segment sensory regression, onset and duration of motor blockade and time for rescue analgesia, hemodynamic parameters were compared. Adverse effects such as hypotension, shivering, nausea, and vomiting were noted. Results: The onset of sensory block was similar with both groups. The duration of sensory and motor blockade was longer in group L. Time needed for 2-segment sensory regression and time for rescue analgesia were shorter in group R. Shorter duration of motor block and rescue analgesia was noted with ropivacaine as compared to levobupivacaine. Hemodynamic parameters and the incidence of shivering and nausea vomiting were comparable in both the groups; there was no incidence of hypotension and bradycardia noted in either group. Conclusion: The pharmacokinetic profile of ropivacaine makes it an ideal drug for day-care procedures, whereas kinetics of levobupivacaine favours it for prolonged surgical procedures.

77. Microbiology in Chronic Otitis Media: A Study in a Tertiary Care Hospital
Sarma Debajit, Kalita Sukanya, Sharma Manaswi, Talukdar Sharmistha
Abstract
Background: Microbiota of CSOM include aerobes, anaerobes and fungi as potential pathogens though its reported profile and frequency differ based on patient’s age, geography and the presence of complications like cholesteatoma. Complications associated with CSOM were frequent in pre‑antibiotic era, however, the irrational use of antibiotics led to the emergence of multi‑drug resistant bacterial strains and disease complication in return. The aim of our study is to determine microbiology in CSOM patients and their sensitivity to antimicrobials for prompt treatment. Methods: This is a retrospective observational study performed on 80 patients presenting with ear discharge and diagnosed as Chronic Otitis Media (COM) at Assam Medical College, Dibrugarh, Assam from the period of July 2022 to June 2023. Results: In our study, overall Pseudomonas aeruginosa was the most common isolate from bacterial culture followed by Staphylococcus aureus and Streptococcus pneumonia. Aspergillus niger was the most common isolate from fungal culture followed by Candida albicans. In one case of mucosal COM, Mycobacterium tuberculosis was found. Amikacin was found to be most sensitive antibiotic even against MRSA followed by Piperacillin+Tazobactam. We use Amoxycillin+clavulanic acid empirically followed by definite antibiotic according to aural swab culture. In patients with sterile swab, mostly Amoxicillin+ clavulanic acid and ciprofloxacin used. In cases of persisting discharge, we use Amikacin. Conclusion: To decrease the potential risk of complications and reduce development of resistant strains, evaluation of microbiological pattern and antibiotic sensitivity of isolates is necessary in every case of COM for appropriate treatment.

78. Prevalence and Emergence of Acinetobacter Spp. in a Tertiary Care   Hospital
B Vishalakshi, Liba. S, Krishna. S
Abstract
Background: Acinetobacter are aerobic, non-fermentative gram-negative coccobacilli, non-capsulated, nonmotile and non-sporing and oxidase negative organism. It belongs to the family of Moraxellaceae. There is a development of antimicrobial resistance (AMR) and there is an emergence and spread of extended-spectrum beta-lactamases (ESBLs). This study aimed to determine the prevalence and isolate Acinetobacter in all clinical samples and to determine their susceptibility to antimicrobial agents and resistance for ESBL. Materials and Methods: Prospective study was done for 1 year. With ethics committee approval and informed consent, clinical samples from 1-70 years from different IPDs and OPDs were included. Samples with incomplete information and contaminants were excluded. Isolation and identification of Acinetobacter spp were performed according to standard techniques. Results: Among the 384 suspected samples received at the laboratory, A. baumannii accounted for 262 (68.22%) and it is the most common species followed by A.lwoffii 82 (21.35%) and others 40 (10.41%). The maximum numbers of Acinetobacter isolates were from Sputum 152 (39.58%). Antibiotic susceptibility pattern in Acinetobacter spp showed highly resistant to ampicillin (74%) and low resistant patterns to imipenem (4%), meropenem (5%), and piperacillin/tazobactam (7%). Among 384 isolates screened for ESBL production, 148 (38.54%) isolates were found to be ESBL producers. Conclusions: This study estimated prevalence of Acinetobacter spp, their susceptibility pattern in our hospital setup, which will aid in development of an antibiotic policy for the hospital and coordinated effort to curtail inappropriate use of antibiotics as well as limit the spread of multidrug resistant bacteria.

79. An Epidemiological Study of Paternal Depression Unfocussed Morbidity of Early Parenthood
Divya, Nitin Tiwari, Prerna Jain, Mukesh Sharma, Chandramani Yadav
Abstract
Background: Paternal depression refers to the condition where a father experiences symptoms of clinical depression. However, this area has received relatively little research attention and there are no interventions or programs for routine screening of fathers for depression in the postnatal period. With this background, a study was planned to estimate the prevalence of paternal depression and to find out the association of various determinants with paternal depression among these fathers after childbirth. Material & Methods: This prospective study was conducted among postnatal parents of age group 18 to 45 years having children of up to 1 year of age. They were selected randomly and among them, fathers were chosen for face-to-face interviews and screened using the Edinburgh postnatal depression scale, a 10-item questionnaire. The main outcome variable was the prevalence of depression among fathers and its associated factors. Results: The age of fathers ranged from 18 to 45 years with a mean (S.D.) of 28.03±5.01 years and over one-third (n = 240, 36.4%) of the subjects were first-time fathers. The percent of the fathers scoring as severe depression (EPDS score, 20 and above) was 7.6% (50), moderate depression (EPDS score, 14-19) was 28.8% (190), and mild depression (EPDS score, 7-13) was 62.1% (n=410). Depression in the studied father was found highly significant with the age, occupation, education, birth order, and economic conditions (p<<0.00001). Conclusion: This study focused on an overlooked issue within the community which is paternal depression and found prevalent in society. There is a need to recognize it and address paternal depression for the well-being of father and their families during the postpartum period.

80. Clinicopathological Profile and Treatment Outcomes among Patients with Metastatic Gastric Carcinoma at a Tertiary Care Center in South India: A Retrospective Study
Narapaneni Kiranmayee, Kannan J, Raja G, Pandidurai M, Arun Ramanan V, Divya Bharathi S, Satheesh Kumar D, Karthikeyan S
Abstract
Introduction: Yearly, approximately 723,000 lives are claimed by gastric cancer, solidifying its position as the second most prominent cause of death, second only to lung cancer. In this study, we retrospectively analyzed the sociodemographic characteristics, clinico-pathological profile, and survival data of metastatic gastric cancer patients at tertiary care institution at Chennai, South India. Methodology: This is a record based retrospective study that was conducted at a tertiary care hospital in South India. This research study was carried out over the period between January 2017 to December 2021. With a proportion of 69.8%, to ensure a 95% confidence level with a precision of 6%, the sample size required was calculated to be 224 patients using OpenEpi v3.01. The collected data were entered into Epidata version 3.1, and subsequent data analysis was conducted using STATA version 12.0. Continuous variables were summarized as Mean (SD), while categorical variables were presented as Frequency (Proportions). Survival analysis is done by Kaplan–Meier method and is graphically represented with comparison between two factors done by log-rank test. For this study, a p-value of less than 0.05 was deemed as indicative of statistical significance. Results: Out of 226 study participants with metastatic gastric cancer, 80 (35.4%) belonged to elderly age group of more than 60 years, while females contributed for 38.5% of the study participants. The overall mean (SD) for age of the study participants was 55.90 (12.07) years. Alcohol consumption as a risk factor was seen in 13 (5.8%) study participants, while both Smoking and alcohol consumption was present in 51 (22.6%) of the study participants. Less than 60 year’s age group contributed for 72.5% of individuals with ascites compared to elderly age group and this was found to be statistically significant (P =0.044). Nearly 2 out of every 5 individuals with CINV (Grade 3/4) were elderly, while 2 out of every 3 individuals with Diarrhoea (Grade 3/4) belonged to less than 60 year’s age group. Overall 1-year survival was found to be 16.4% among the study participants with metastatic gastric cancer in the present study, while the overall 2-year survival rate was 1.3%. Males (59.5%) and less than 60 year’s age group individuals showed better 1-year survival rate. Survival analysis using Kaplan–Meier survival curve for overall survival based on age, was not found to be statistically significant (P = 0.498). Conclusion and Recommendations: Our study offers significant insights into the clinical and pathological characteristics, treatment outcomes, and survival patterns of individuals diagnosed with metastatic Gastric Cancer in South India. It emphasizes the critical role of early diagnosis, thorough staging, and multidisciplinary treatment approaches in enhancing treatment outcomes and ultimately advancing survival rates.

81. The Diagnostic Accuracy of DEERS (Disease of Endometrium- Evaluation and Risk Scoring System) For Prognostication of (AUB) Abnormal Uterine Bleeding
Charisma Rebecca Thomas, Chithra R.
Abstract
Background: One of the most frequent presenting problems among women in the reproductive and perimenopausal age range is abnormal uterine bleeding (AUB). Endometrial hyperplasia is a possibility in 5–15% of AUB patients. The most reliable method for determining the causes of endometrial diseases is endometrial sampling. Reports from tissue biopsies might be benign, malignant, premalignant, or normal. In order to predict AUB, the DEERS (Disease of Endometrium- Evaluation and Risk Scoring) scoring system was developed. It uses demographic and ultrasonographic variables. Objectives: Primary objective: To ascertain the diagnostic accuracy of DEERS scoring system in predicting the type of endometrial abnormality in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).Secondary Objective: To assess the efficacy of DEERS after addition of parameters like myometrial pathologies. Method: 151 females with AUB were included, Patients underwent ultrasonographic evaluation followed by endometrial sampling or hysterectomy. The demographic characteristics as well as ultrasonographic parameters were studied and the DEERS score was calculated, based on which they were categorised into groups. This category was compared to the final histopathology report. Results: According to this study, diabetes mellitus, distinction of the endo-myometrial junction (independent predictor) and endometrial echotexture were identified as the independent determinants of malignancy. Based on the ROC curve, an ideal cut-off to predict abnormal endometrial pathology was identified as 15.5. It has sensitivity of 60.87%, specificity 86.72%, Positive predictive value (PPV) 45.16%, Negative predictive value (NPV) 92.5% and an accuracy of 82.78%. The scoring system was noted to have a specificity and PPV of 100%, NPV 99.31% and accuracy of 99.34% for malignancy. Conclusion: The DEERS scoring system can be used as a reliable, non-invasive scoring system in prognostication of AUB, especially in endometrial malignancy.

82. The Utility of Intraoperative Squash Cytology and its Diagnostic Accuracy in Central Nervous System Tumours with Expression of IDH1 in Selected Cases of Glioma
Naima Aziz, Roop Rekha Das, Antariksha Sharma, Mayuri Saikia
Abstract
Background: Annually, the incidence of Central Nervous System tumours range from 10-17 per 1,00,000 population among all the intracranial tumours. Intraoperative squash cytology is a rapid, inexpensive, non-invasive and fairly accurate procedure for diagnosing Central Nervous System tumours. Aims and Objectives: To establish the utility of squash cytology and its diagnostic accuracy in Central Nervous System tumours and its histopathological correlation with expression of Isocitrate Dehydrogenase 1 status in cases of glioma. Materials and Methods: A total of 52 cases of CNS tumours suspected clinical-radiologically were taken into consideration. Intraoperative squash cytology was prepared and the rest of the tissue was sent for histopathological and immunohistochemical evaluation. Immunohistochemical staining of Isocitrate Dehydrogenase 1 was performed for histopathologically diagnosed gliomas. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy was calculated. Results: The overall diagnostic accuracy was found to be 98.7% for all the Central Nervous System tumours and expression of IDH1 was seen in 11 cases of glioma.

83. Antibiotic Susceptibility of Bacteria Growing on Diabetic Foot Ulcer: A Prospective Observational Study from South India
Kanagasanthosh K, Karthick P, Prabhusaran N, Maalavika H
Abstract
Introduction: Antibiotic resistance is a significant problem in our country. The situation is such that India has even been called the antibiotic resistance capital of the world. Prescribing the antibiotics and antimicrobials play a major role in the prevalence of antibiotic resistance. Our objective was to find antibiotics that are effective against infections on diabetic foot ulcers and to find the prevalence of the Multidrug resistance organism (MDRO) infections in infectious diabetic ulcers. Materials and Methods: It is a Prospective, observational and Cross-sectional study for all patients that have diabetic foot ulcers among the patients attending the in-patient departments of General Surgical wards from our tertiary hospital in the three months period between May to July 2019. After identifying diabetic foot ulcer, two swabs were collected from the ulcer after taking sterile precautions. The first swab is used for gram staining and second for culture sensitivity for antibiotic. Results: A total of 72 samples were analyzed. There were 48 males (66%) and 24 females (33%). Predominantly gram-negative bacteria were more isolated than gram positive bacteria. The most common bacterial isolate was Escherichia coli (26%) followed by Staphylococcus aureus (19%), Pseudomonas aeruginosa (18%) and Klebsiella pneumonia (15%). Among the antibiotics Piperacillin-Tazobactam, Gentamicin, Amikacin and Imipenem seemed to be comparatively effective. There was a high degree of resistance with amoxicillin; ampicillin, ciprofloxacin and 3rd generation cephalosporin were identified. Conclusion:  There has been a recent increase of resistant strains of bacteria which highlights the need to prescribe antibiotics for infections with care. The choice of appropriate antibiotics is very important in order to reduce treatment failure, antimicrobial resistance, adverse events and cost. The knowledge about the antibiotic susceptibility of the bacteria must be known to prescribe the correct antibiotics and reduce the chance for resistance of bacteria towards these antibiotics.

84. A Study of Caregiver Burden and Emotional Intelligence in Caregivers of Psychiatric Patients
U. Raghava Rao, Yelamanchi Rufus Ephraim, R. Tara, Kommoju Venkata Eswar, N. Hari Krishna
Abstract
Introduction: Psychiatric disorders include a heterogeneous group of disorders ranging from psychotic disorders without insight like Schizophrenia, Major depression to neurotic conditions like anxiety neurosis, panic disorder, etc. The burden of psychiatric disorders is huge with one in every eight people in the world living with a mental disorder. Caregivers are individuals who provide direct care to the affected individuals. Considering the huge burden of mental health conditions, the caregiver burden is believed to be enormous and its impact eternal. Hence, understanding the burden perceived by the caregivers of patients with psychiatric disorders and identifying the determinants of this burden is imperative. Therefore, we aimed to assess the caregiver burden and emotional intelligence in caregivers of psychiatric patients. Aim: To study the caregiver burden and emotional intelligence in primary caregivers of persons with psychiatric illness. Materials and Methods: A Cross-sectional hospital-based study was done among 150 primary care givers attending Government Hospital for Mental Care (GHMC), Visakhapatnam. Burden Assessment Schedule (BAS) and Wong and Law Emotional Intelligence Scale (WLEIS) were used to assess care given burden and emotional intelligence among participants. Results: The mean BAS score is 70.67 with SD ± 17.52.Of the total caregiver population, a majority have moderate burden amounting to 33%. Patients with severe burden constitute 32.7% followed by mild burden amounting to 26.7% and 2% have very severe burden. 5.3% experience less than minimal burden. Caregivers whose patients have fewer hospital admissions have more emotional intelligence than those caregivers whose patients are hospitalised more (p=0.04). Total emotional intelligence is more common in caregivers with less duration of care (p=0.226) and less duration of illness (p=0.264) Total emotional intelligence is less in caregivers of substance use and neurotic disorders than other groups (p=0.671). Conclusion: Psychiatric disorder not only affects the patients but also their caregivers and their families. The burden experienced by caregivers is huge as seen in current study on 150 caregivers. The average age of patients’ caregivers was middle age and there is slight male preponderance observed in the current study. Of the total caregiver population, nearly two-thirds of caregivers had moderate to severe burden (moderate and severe burden amounting to one third each). Others emotion appraisal to facilitate performance scores on EI scale was lower than other domains, probably due to the burden of caregiving.

85. Assessment of Adherence of Observational Studies to STROBE Statement
Firoz M. Tadavi, Sudhir Pawar, Ajitkumar Gondane, Yashoda R. Aithal, Merin Eldhose. K, Manasi Rege, Bakul Naik, Yashvira Patil
Abstract
Introduction: The quality of biomedical research’s methodology and reporting has received a lot of attention. There is a growing incentive to publish rather than for the advancement of science leading to increased deficiency in the quality of reporting medical research. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) is a checklist of elements developed by professionals to improve consistent and thorough reporting of observational studies. The current study looked at the adherence of observational studies to STROBE statement. Methods: Five open access Indian journals from various specialties, that were published between 2016 and 2022 were chosen and reviewed by authors who assigned “yes”, “partially”, or “no” to whether the STROBE criteria were followed. Additionally, we also assessed was the completeness of reporting across the three major study designs and journals and data was analyzed using descriptive statistics. Results: A total of 235 articles were assessed. Ninety percent of the papers met criteria such as those for the title and abstract, background, objectives key findings, study settings, and outcome data. Items including bias, sample size, flow diagrams, and missing data have adherence rates of less than 30%. The overall mean completeness of reporting (COR) was found to be 60.97±14.51%. The COR for cohort, case-control and cross-sectional studies was 73.83 ± 12.17 %, 48.73 ± 12.75% and 61.44 ± 14.46% respectively. Conclusions: The overall reporting was inadequate. Hence more journals should endorse the STROBE checklist and make sure those authors and reviewers comply with it.

86. Anaphylactic Reactions After Administration of Anti Snake Venom for Envenomation: A Case Series
Mer RJ, Kakasaniya GG, Mehta DS
Abstract
Introduction: ASV and its rational use is the only definitive treatment to neutralize venom in circulation and in tissue fluid to save life in snake bite cases. Usually more than 20% cases develop either early (within few hours) or late (5 days or more) allergic reactions following ASV administration. Objective: To assess their causality according to WHO-UMC classification. Methodology: An interpretive observational primary study was conducted regarding anaphylactic reactions after administration of ASV after getting approval from institutional ethics committee. Available case records of anaphylactic reactions developed after administration of ASV were collected and analysed. Results: Total 4 cases of anaphylactic reactions were available. one patient developed itching, rashes over forearm and body area and another patient developed urticaria on both arms and axillary region after administration of ASV, third and fourth patient have developed urticaria, redness on forarms and abdominal area and also abdominal pain respectively. And in the first and third case rechallange of ASV was done so causality is certain while in second and fourth case rechallange was not so causality is probable. Conclusion: Patient and physician’s awareness regarding adverse drug reactions(ADR) could possibly help in lowering incidence of such severe ADR.

87. Analysis and Evaluation of Effectiveness of Yogic Activities on Blood Pressure Parameters of Hypertensive Patients in Indian Population: A Systematic Review and Meta-Analysis
Tejas P. Ghuntla, Jyoti R. Dholakiya
Abstract
Introduction: Yoga activity has many mental and physical health benefits. There is increase in number of cases of hypertension in India. Yoga activities is emerging as potential tool to provide beneficial effect on blood pressure of hypertensive patients. Aims and Objectives: To study effectiveness of yoga activity practices on blood pressure of hypertensive patients in Indian population. Materials and Methods: Researchers used the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines for reporting systematic reviews and meta-analysis. Researchers searched articles on PubMed, Google scholar and by manual search. Searched articles were screened for relevancy. By use of inclusion and exclusion criteria potential articles were selected. Results: Out of 291 articles, ffinally 10 studies composed of 382 hypertensive patients were included in current meta-analysis. Yoga activities has effect on systolic blood pressure (SBP): SMD = 1.33, 95% CI = 0.68-1.99, P < 0.01 and diastolic blood pressure (DBP): SMD = 1.07, 95% CI = 0.51-1.64, P < 0.01. Conclusion: Yogic activities is associated with beneficial effect on blood pressure of hypertensive patients. There is huge scope for further studies to determine beneficial effects of yoga activities.

88. A Study on Neutrophil-Lymphocyte Ratio as a Marker of Nephropathy and Retinopathy in Type 2 Diabetes Mellitus
S. Murugesan, S. Sujatha, Jeshwin John
Abstract
Introduction: The increased burden of diabetes among Indians precedes an exponential increase in diabetes-related end-organ damage and associated morbidity in the next few decades. There is an immediate need for a predictor of the occurrence of diabetes-related end-organ damage among Indians that is cheap and easy to measure. The neutrophil-lymphocyte ratio (NLR), among the multiple parameters of complete blood count, has been studied extensively as an inflammatory marker. Aim of our study is to evaluate the role of Neutrophil-lymphocyte ratio (NLR) as a marker of retinopathy and nephropathy in patients of Type 2 Diabetes Mellitus. Methodology: This study was done at Department of General Medicine, Government Medical College Hospital, Virudhunagar as a cross-sectional study in 110 type 2 diabetes mellitus patients. Patients were considered as nephropathy if there is microalbuminuria, eGFR<60 mL/min/1.73m² and USG-Abdomen: Normal sized kidneys. Normal echoes and cortico-medullary differentiation present. Patients were considered having retinopathy based on ophthalmic examination. Necessary blood investigations particularly neutrophil and lymphocyte levels were done. Univariate regression was done to determine the strength of association among the dependent and independent variable. Results: On USG abdomen 18 (16.4%) had B/L Grade-1 MRD and 9 (8.2%) had B/L Grade-2 MRD. 91 (82.7%) had normal fundus and 19 (17.3%) had retinopathy on fundoscopy. ROC Curve for NLR Vs eGFR has an area of 0.867. NLR can predict more true positive patients. In other words, NLR is more accurate. Univariate logistic regression for fundus finding in relation with NLR was done and when there is 1 unit increase in NLR, there is 1.6 times chance of developing fundus Findings. Conclusion: NLR is a simple and easy to calculate. This test is inexpensive and done routinely. NLR can be used as a predictor of diabetic nephropathy in Indians. In a poor resource setting, NLR can be a cheap effective alternative marker to predict diabetes nephropathy. The relationship between NLR and diabetic retinopathy changes were also present.

89. Association of Blood Eosinophils in Patients with Acute & Chronic Urticaria
Karthik Ramappa, Annie Rose L
Abstract
Introduction: Eosinophilia, characterized by an elevated blood eosinophil count exceeding 500 cells/mm3, is frequently encountered in routine medical tests. However, the interpretation of eosinophilia can be complex in clinical practice due to its association with various underlying conditions. In the context of urticaria, eosinophils are thought to play a significant role in contributing to tissue damage. This potential impact of eosinophils on the inflammatory process of urticaria is supported by the link between urticarial skin lesions and eosinophil-related conditions, such as hyper-eosinophilic syndrome. Aim and Objectives: To assess the relationship of absolute eosinophil count in patients with acute and chronic urticaria. Material and Methods: A prospective observational study was conducted in a rural tertiary care hospital in southern India, in the dermatology department. The study aimed to involve 30 patients with acute urticaria, 30 patients of chronic urticaria, and 60 study subjects with age sex matched control were selected. In chronic urticaria 15 study subjects were symptomatic and 15 patients were asymptomatic at the time of sampling. Before participating in the study, all patients provided their informed written consent. Result: In acute urticaria, the mean AEC of the study subjects 756.67±437.64, in chronic asymptomatic urticaria the mean 246.0±115.0, in chronic symptomatic urticaria group the mean AEC was 422.67±246.07, in control group the mean AEC group 194.10±120.05, on comparing there is significant difference with p value 0.0. On applying regression analysis there is almost no association between age of study subjects with AEC with R square 0.002. Conclusions: The mean absolute eosinophil counts were significantly higher both in patients with acute urticaria and in patients with chronic symptomatic urticaria compared to that of the healthy subjects. Patients affected by acute urticaria showed eosinophil count values significantly higher than patients affected by chronic urticaria.

90. Optical Coherence Tomography in Movement Disorders
Shivangi, Sumirini, Lulup Kumar Sahoo
Abstract
The optic nerve head and retina can be visualised in high-resolution two-dimensional cross-sections using optical coherence tomography, a cutting-edge non-invasive imaging technique. The optic nerve head and retina can also be quantified and measured in three dimensions. For the diagnosis and follow-up of several eye illnesses, including glaucoma, diabetic retinopathy, and age-related macular degeneration, ophthalmologists frequently use this technology. Since various clinical studies have shown that these disorders result in reduced thickness of the inner retinal nerve fibre layer, which is mostly made up of retinal ganglion cells and their axons, it has attracted a great deal of attention in recent years. To demonstrate the promise of this non-invasive and widely available technique, we sought to discuss the clinical utility of optical coherence tomography for identifying and assessing various movement disorders in this review.

91. Association between Diabetes Mellitus and Sensorineural Hearing Loss
Humera Abida, Praneeth Kumar. K, Feroz Basha Shaik
Abstract
Introduction:  Diabetes (type 2) and sensorineural hearing loss are common health problems manifested with ageing. While both type 1 and type 2 diabetes have been associated with hearing loss, a causal link has been difficult to establish. Aim and Objective: To analyze the occurrence of sensorineural hearing loss among patients with DM and find a correlation between the degree of hearing loss and the duration and type of DM. Materials and Method: This was a hospital based cross sectional study conducted on  130 individuals with hearing-impairment, visited to the department of ENT in association with department of community medicine, Mahavir Institute of medical hospital and tertiary care centre, Vikarabad and  for duration of 1 year, after approved by institutional ethical committee and consented by study participants after following inclusion and exclusion criteria. Results: In the study out of 130 individuals with type 2 diabetes, majority of patients were from age group of  51-70 years, predominantly male compared to female. Prevalence of Sensorineural hearing loss was observed 56.9% and almost 26.9% of the patients had duration of diabetes was more than equal to 10 years and association between type of hearing loss with age and duration of diabetes mellitus was statistically highly significant. Conclusion: Sensorineural hearing loss was more common in patients with diabetes (Type 2). The early detection of hearing loss in type 2 diabetes mellitus, using PTA, may help to avoid deafness and its further progression.

92. Computed Tomogram Guided Fine Needle Aspiration Cytology of Lung Mass Lesions with Histological Correlation in a Tertiary Care Hospital: A Study in Northern India
Seema Puri, Deepika Wadhera, Irbinder Kour Bali, Gaurav Puri, Saurav Hira
Abstract
Background: CT guided Fine-needle aspiration cytology (FNAC) is a diagnostic modality which is rapidly emerging for diagnosis of pulmonary mass lesions. Aims: To assess role of CT-guided FNAC in lung lesions, to know Pathological spectrum of lung lesions, to correlate cytological findings with available histological findings. Material and Methodology: This was a retrospective study consisting of CT-guided FNAC aspirates of lung lesions of 88 patients conducted in Department of Pathology in tertiary care hospital over the period of 2 years (December 2020- November 2022). Smears were evaluated and broadly categorized into unsatisfactory, benign, suspicious of malignancy and malignant lesion. The cytological diagnosis was compared with subsequent histopathology report. Results: Total 88 cases of lung mass lesions were included in the present study, out of which 62 were males (70.4%) and the rest 26 were females (29.5%). Radiological findings in patient consolidation was commonest (97%) followed by lung mass (60%) and cavitatory lesion (10%). Cytological diagnosis in malignant category showed maximum number of cases of adenocarcinoma (21.5%) followed by squamous cell carcinoma (14.7%), small cell carcinoma (13.6%), Non-Small Cell NOS (12.5%) and Metastasis ( 7.9%). Conclusion: CT guided FNAC of pulmonary masses provides simple, sensitive, and reliable method for reaching rapid diagnosis with minimal complication

93. A Prospective Study to Evaluate Possum Scoring System in Patients Undergoing Emergency Laparotomy
Jyotirmaya Nayak, Gorachand Murmu, Subhashree Mishra, A Tirumala Rao
Abstract
The goal of this study was to see how well the POSSUM grading system predicted morbidity and mortality in patients having emergency midline laparotomy at our institution, a group that is known to be at high risk of complications and death. Methods: A total of 100 patients who had emergency laparotomies in the general surgery department between July 2020 and September 2021 were evaluated. The POSSUM scoring method was used to grade them. Physiological scoring was completed upon admission, and operational scoring was completed intraoperatively. Follow-up was performed for the first 30 postoperative days, and any problems were reported. The observed morbidity and death rates were compared to the projected morbidity and mortality rates predicted by POSSUM. Post-operative problems occurred in 43 individuals. The anticipated morbidity by POSSUM was 34 patients. The O: E ratio was found to be 1.26. There was no statistically significant difference in morbidity rates between observed and anticipated [Chi-Square value = 2.745, df = 6, p-value = 0.875]. 15 individuals died (a 15% mortality rate). The POSSUM projected that 12 people will die. A 1.25 O: E ratio was achieved. The observed and projected death rates did not vary statistically significantly. [The Chi-Square value is 4.123, the df is 9, and the p-value is 0.846.] Conclusion: POSSUM score may correctly predict morbidity and death after emergency laparotomy.

94. A Comparative Study on Early Enteral Feeding Vs Delayed Enteral Feeding in Postoperative Enterocutaneous Fistula
Jyotirmaya Nayak, Gorachand Murmu, Subhashree Mishra
Abstract
Introduction: A fistula is a link between two epithelialized tissues that is aberrant. An enterocutaneous fistula is a fistulous tract that connects the intestinal lumen to the abdominal wall, allowing the lumen’s contents to pour out via the tract. Even though enterocutaneous fistulas are uncommon, they are often linked with significant morbidity and death. Aim & Objective: To study the role of early enteral feeding in early closure of enterocutaneous fistula in post-operative patients and its comparison with delayed enteral feeding. Results: In 28 of these cases the initial surgery was an emergency procedure whereas in 2 patients the procedure was elective. Early feeding showed spontaneous closure of fistula in 64.29% patients whereas late feeding showed non closure in 61.54% patients. Conclusion: Enteric fistulas, whether they arise spontaneously or because of surgery, provide a substantial challenge in terms of care. These fistulas may lead to prolonged periods of illness, causing morbidity, and in some cases, even death for the affected patient. This study showed, early enteral feeding favours the improvement of general condition of the patients and thereby early closure of entero- cutaneous fistula.

95. To Develop Soft Tissue Cephalometric Norms for Skeletal and Dental Relationships in the Adult Population of Middle Gujarat, India
Dishansh Sheth, Mosam Thakar, Jayesh Nathani
Abstract
Introduction: Soft tissues play an important role of physical appearance and facial esthetics. This study aimed to establish, soft‑tissue cephalometric standards in Gujarat, India adults, which can be used in diagnosis, planning of treatment, and stability of orthodontic outcome and orthognathic patients. Objective: The objectives of this study was to establish Soft Tissue Cephalometric Norms for skeletal and dental relationships amongst the Middle Gujarat adult population. Methodology: A set of 70 people with proportionate facial profiles and normal occlusion (35 males and 35 females) was chosen. Lateral cephalograms were taken for the complete selected sample. Two operators manually traced each cephalogram using the standard method. Arnett and Bergman’s STCA (soft tissue cephalometric analysis) provided the parameters that were used in the investigation. In total, 46 measurements were employed, comprising 40 linear and six angular parameters. Standard deviation and Mean values were calculated by Using a student t-test, the differences between male and female were assessed. Result: The study’s findings showed significant variations in the majority of the characteristics between men and women in the Middle Gujarat community as well as in contrast to norms established by Arnett et al. Conclusion: We draw the conclusion from our study which is consistent with other studies as well that most soft tissue variables linking Caucasians and our group are significantly different. This implies that for appropriate analysis and planning of treatment, different norms should be established for various ethnic groups, and patients should be treated with this in mind.

96. Total Platelet Count as an Indicator of Early Septicaemia in Post Burn Patients
Jyotirmaya Nayak, Sridhar Panda, Subhashree Mishra
Abstract
Every year, over 1 million burn incidents occur in India. The timely treatment and management of burn victims is necessary to preserve their lives. Recent research has shown that platelet alterations have a tight association with illnesses and medications. Early discovery of the patient’s deterioration and timely treatment will aid in the patient’s survival. Aim of the Study: (1) To assess the role of platelet count in the early detection of burn septicaemia. (2) To determine the relationship between other variables that induce platelet count alterations in severely burned individuals. (3) To identify the most often seen pathogens in burn septicaemia. (4) Relationship between body surface area burned and platelet levels. Results: When platelet levels in survivors and non-survivors were compared, a progressive rise in platelet count trend was detected in the survivors group. The non-survivor group had a progressive decrease in platelet count. The severity of the burn injuries had no effect on this tendency. On the fifth and seventh post-burn days, the change in platelet counts was considerable. In our analysis of 157 individuals, about 33 experienced inhalation damage. When the platelet count was compared between patients with and without inhalation damage, the patients with inhalation injury had a lower mean platelet count. Conclusion: Early detection and treatment of imminent sepsis when levels of the pathophysiologic cascades that drive the systemic response are still low should be predicted to result in improved results. The use of falling platelet count to identify burn patients at risk of systemic infection may help reduce morbidity and death in these individuals.

97. A Prospective Randomized, Controlled Study on Comparison of Wound Healing with Type I Collagen Dressing & Conventional Dressing in Burns Patients
Jyotirmaya Nayak, Sridhar Panda, Subhashree Mishra
Abstract
Introduction: The wound healing mechanism has changed in an exciting manner. The planned sequence of events consists of a beautiful cascade of happenings. The science of wound healing has evolved dramatically during the past several decades. Wound treatment used to be purely reliant on historical observations and tales, which might date back millennia in certain cases. This research compared wound healing with type I collagen dressing against traditional dressing with ointment and gauze. Aim of Study: This Prospective Randomized Controlled study was conducted to compare the wound healing with Type I collagen dressing and conventional dressing with ointment, gauze-pad & bandage, with respect to the following criteria:
(1) Their efficacy on wound healing in Burn patients. (2) The ability to prevent infection. (3) The effect on the morbidity. (4) The cost effectiveness. Results: The type-1 collagen group achieved full wound healing in 14-18 days, but the standard dressing group needed 16-26 days.50% of patients in the traditional dressing group had infection, but more than 90% of patients in the type-1 collagen dressing group had no infection. morbidity such as discomfort, leaking, and odour are more prevalent in the traditional dressing group, however early mobilisation, and capacity to care for the shelf are more prevalent in the type-1 collagen dressing group. Change of dressing was least with collagen. Conclusion: Collagen dressing has the extra virtue of not requiring any skin grafting. There is a greater prevalence of wound infection, increased leaking, and odour from the wound in the standard dressing group. Infections are substantially less common when type-1 collagen dressing is utilised. As a result, type-1 collagen dressing has a superior reaction to burn patients than traditional dressing.

98. Efficacy of the Combined Thoracic Epidural and Ultrasound Guided Erector Spinae Plane Block in Relieving the Postoperative Pain in Patients Undergoing Video Assisted Thoracoscopic Esophagectomies for Carcinoma Oesophagus: A Case Series
Himjyoti Das, Sonai Datta Kakati, Marie Ninu
Abstract
No single mode of analgesia is appropriate and effective to control the postoperative pain after video assisted thoracoscopic esophagectomy surgery. Thoracic epidural no doubt provides good analgesia but is accompanied by failures and technical difficulties and is not sufficient to control the pain following VATS TTE. Ultrasound guided Erector Spinae nerve block in combination thoracic epidural, can increase the efficacy of pain relief and its very safe and easy to perform.

99. Utility of Preconception Counselling in Detection of Undiagnosed Medical Disorders in Preconception Period
Shikha Agrawal, Vijyeta Jagtap, Suman Sharma, Piyush Kumar Gupta
Abstract
Background: Preconception therapy is a window of opportunity for health promotion since women are more motivated to change unhealthy behaviours at this time. Therefore, preconception counselling should be offered at all medical appointments. Objective: The purpose of the current study was to ascertain the prevalence of undiagnosed medical disorders during the preconception period and to establish if these women need rubella vaccination. Methods: 56 women who visited the Gynaecology Out Patient Department for preconception counselling made up the sample population in this hospital-based cross-sectional study. Data collection was done using a semi-structured, previously tested interview schedule, which was then followed by systematic and general assessments and investigations. Results: The most prevalent medical condition was hypothyroidism (12.5%), which was followed by hypertension (3.6%), TB (3.6%), PCOS (3.6%), anaemia (1.8%), and asthma (1.8%).3.6% of women were diagnosed with diabetes, while 16% of women had HbA1C levels in the prediabetic category. Conclusion: Early detection and management of high risk factors during the preconception period can increase the likelihood of conception and improve the outcome of pregnancies.

100. Maternal and Fetal Outcomes in Oligohydramnios: A Prospective Study
Prakash B. Prajapati, Akash J. Patel, Jayneel V. Shah, Hemangini S. Chaudhari, Ikshita G. Chhabda
Abstract
Introduction: Oligohydramnios, a condition characterized by a decreased volume of amniotic fluid in the gestational sac, poses significant risks to both maternal and fetal well-being. Aims and Objectives: This prospective study conducted over one year aimed to investigate the impact of oligohydramnios on perinatal morbidity and maternal outcomes. The study included antenatal patients in their third trimester with intact membranes, excluding cases with heart diseases, polyhydramnios, premature rupture of membranes, and multiple pregnancies. Results: The incidence of oligohydramnios was more prevalent among primiparous women. Common causes of oligohydramnios included idiopathic factors and preeclampsia, with the latter associated with higher rates of operative morbidity. Fetal distress and meconium-stained liquor were common indications for emergency cesarean section, contributing to rising cesarean rates. The study further highlighted the increased risk of low birth weight, respiratory distress, meconium aspiration syndrome, congenital anomalies, and intrauterine fetal death in cases of oligohydramnios. Conclusion: This study underscores the significance of early detection and management of oligohydramnios to improve both maternal and perinatal outcomes. As the rates of cesarean sections rise, a balanced approach is crucial to minimize maternal morbidity while ensuring timely interventions to reduce perinatal morbidity and mortality.

101. Study of Efficacy, Remission and Tolerability of Fluoxetine Versus Desvenlafaxine in Patients with Depression in a Tertiary Care Hospital: An Open Labelled Randomized Interventional Comparative Study
Veena V , Shakuntala B, P H Anusha, Kotresh S, Sameena A R B, Akshay S Atre
Abstract
Introduction: Depression is a common psychiatric disorder affecting both the mind and body.  It is a severe, recurrent and disabling medical illness. It is the third leading cause of global disease burden and could become the leading cause by 2030 if not detected and treated early. Antidepressants are the mainstay of treatment of which SSRIs and SNRIs are frequently used. Objectives: To compare the efficacy, remission and tolerability of fluoxetine with desvenlafaxine. Materials and Methods: An open labelled, randomized, interventional, comparative parallel design study was conducted in patients with depression. One hundred patients included in the study were randomized into 2 groups of 50 each. Group A patients were given desvenlafaxine(50-100mg/day) orally for 8 weeks while Group B patients received fluoxetine (20-60mg/day) orally for 8 weeks. Patients were followed up every 2 weeks for 8 weeks. Efficacy & remission rate of both drugs were assessed using CGI scores. Tolerability was evaluated by the number of adverse effects experienced by each patient. Data collected was analysed statistically. Findings were noted. Results: Early improvement at 2weeks in Group A and Group B by CGI-S was 24% and 8.2%, by CGI-I was 22% and 0.5% respectively. Efficacy was 76.8% and 73% in Group A by CGI-S and CGI-I respectively while in Group B it was 70.5% and 68% respectively. Remission in Group A and Group B by CGI-S score was 86% and 68%, by CGI-I score was 94% and 72%, by CGI-E was 94% and 70% respectively. All these were statistically significant between and within the groups. Tolerability was comparable in both groups where in Group A showed 48% excellent and 38% good tolerability, Group B showed 46% excellent and 36% good tolerability. Remaining showed fair tolerability. Conclusion: Desvenlafaxine showed statistically significant early improvement, efficacy and remission rate compared to fluoxetine. Tolerability profile between the groups was comparable. Desvenlafaxine can be used to treat depression.

102. Correlation between Social Media Addiction and Fear of Missing Out After COVID-19 Second Wave
Saksh Jain, Jayendra Arya, Kratika Arya
Abstract
Objective: To evaluate the correlation between social media addiction and fear of missing out (FOMO) among early and late adolescents after COVID-19 second wave. Method: This is a cross sectional observational study. The study was conducted from August 2022 to November 2022. Early and late adulthood (12 to 19 years old) were the study’s subjects.  This study used a correlational research approach to examine the correlation between FOMO and social media addiction among adolescents after the second wave of COVID-19. Data and consent is collected by online questionnaire. A simple random sampling technique was used for the study. Results: Positive correlation between FOMO and SMIC r=0.428, which is statistically significant p=0.00.  There was a statistically significant positive correlation between SMEQ and SMIC. Conclusion: A substantial significant relation between FOMO and social media addiction among early and late adolescents after the post-covid period. The findings are beneficial for handling, organising and preventing potential detrimental possibilities of social media addiction related FOMO in adolescents in the post-covid period.

103. Role of Extended CTG in Fetal Distress
Ruqiya Rashid, Khushbu Bashir
Abstract
Background: Fetal distress is defined as progressive fetal hypoxia and/or acidemia secondary to inadequate fetal oxygenation. Fetal distress can be observed through electronic fetal heart rate monitoring. Fetal heart rate monitoring during labor and delivery is important to assess the fetal wellbeing and to predict the outcome. Material and Methods: The present prospective observational study was conducted in the Postgraduate Department of Obstetrics and Gynaecology, SKIMS Srinagar Jammu and Kashmir over a period of 2 years and total of 165 patients were enrolled in the study. Intrapartum CTG tracings were taken and classified into Normal, Suspicious and Pathological trace. Patients having suspicious and abnormal CTG tracings were subjected to extended trace of CTG to detect the fetal distress. Results: 165 patients were enrolled in the study aged between 20 to 40 years with a mean age of 29.3+4.01 years. Majority of patients i.e. 69 (42.1%) were between age group of 31-35 years followed by 54 (32.3%) patients who were between 26-30 years. 24 (14.3%) patients were between 20-25 years of age group while 18(11.3%) patients were 36-40 years of age. 49 (29.6%) cases had MSL while 116 (70.3%) cases did not. Out of the 49 cases with MSL, 29 (59%) cases had a normal trace, 10 (20.4%) cases had a pathological trace and 10 (20.4%) cases had a suspicious trace. Out of the 116 cases without MSL, 02 cases (1.7%) had a Pathological trace and 14 cases (12%) had a suspicious trace. 35 patients out of 165 required NICU admission and out of 35 patients 8(22.8%) had normal, 11(31.4%) patients had pathological and 16 patient (45.7%) had suspicious CTG. 130 patients did not required NICU admission. Out of 130 patients, 121(93%) patients had normal, 01 (0.8%) had pathological and 08(6.1%) patients had suspicious CTG trace. Conclusion: Abnormal CTG is important for both obstetrician’s and pediatrician’s point of view. Abnormal extended trace of CTG is a good predictor of the presence of MSL, apgar score at 1 and 5 minutes and NICU admission. If extended CTG is done and is interpreted properly, the fetal distress can be diagnosed earlier at which less damage has occurred to the baby and hence NICU admissions can be prevented.

104. Influence of Tumor Size on Sentinel Lymph Node Detection in Operable Uterine Cervical Carcinoma Patients
Vijaya Lakshmi V V, Narendra Hulikal, Amit Kumar Chowhan
Abstract
Background and objectives: The National Comprehensive Cancer Network (NCCN) cervical cancer guidelines presents Sentinel lymph node (SLN) mapping as an alternative for the surgical management of early stage cervical cancer less than 2 cms in diameter. This study was conducted to evaluate the impact of tumour size in detecting SLN in early stage operable cervical cancer, using low cost methylene blue dye alone in a prospective manner. Methods: This prospective study was conducted in biopsy proven female patients with early stage operable cervical cancer meeting the selection criteria and attending the surgical oncology department of a tertiary care center in south India, from June 2016 to December 2017. After induction of anesthesia, 4 ml of 1% methylene blue was injected into the cervix peritumorally under direct observation. This was followed by laparotomy or laparoscopy, identification and removal of SLN, pelvic lymph node dissection and radical hysterectomy. Results: In this study, 20 patients with operable cervical cancer were analyzed. SLN detection rate was 90%. Mean SLN per patient was 3.1. Obturator group (45%) was the most common SLN station. SLN detection in relation to tumor size less than 2cms and more 2cms was 90.9% and 88.9% respectively (p value 0.88). Conclusion: The tumour size of the patient does not significantly influence the SLN detection using methylene blue dye alone undergoing radical hysterectomy in early stage operable cervical carcinoma. There was a trend towards higher SLN detection with smaller size tumour.

105. Analysis of Clinical and Biochemical Parameters in Scrub Typhus Patients in Central India
Shashank Tyagi, Narendra Rahaengdale, Nandini Shukla, Vepada Ravi Kiran
Abstract
Background: Scrub typhus is probably one of the most common underdiagnosed and under-reported febrile illnesses requiring hospitalization because of its non-septic clinical manifestations and lack of access to specific laboratory facilities. Aim: This study was undertaken to assess the clinical, hematological, and biochemical profile of the patients diagnosed with scrub typhus in our tertiary care teaching hospital. Materials & Methods: This was an institution-based, observational, and cross-sectional study, enrolled patients presenting with febrile illness and diagnosed as scrub typhus. We have asses their clinical features and laboratory investigations and compared with the non-scrub typhus patients. Results: A total of 570 clinically suspected patients were analysed, out of that 104 (18.3%) found positive for Scrub typhus by serology. Majority of the patients (51%) were 21-50 years age group, predominantly female (52.9%).  Fever, headache and nausea/vomiting were the most common symptoms. Liver and renal failure was the common complication of scrub typhus. Hemoglobin, total leukocyte counts, platelets counts, Random blood sugar, SGOT, SGPT, serum urea and creatinine were significantly difference between scrub typhus and non-scrub typhus patients (p<0.05). Conclusion:  Increased awareness coupled with high index of suspicion amongst treating doctors with good knowledge of epidemiology and laboratory investigations is needed for an early diagnosis of scrub typhus.

106. Videolaryngoscopes are Becoming a New Breakthrough in Airway Management
Falak Ara, Humaira Bashir, Irshad Ahmad, Bashir Ah Mir
Abstract
Background: Difficulties in airway management increase the risk of hypoxia, which can also lead to devastating neurological outcome. Objectives: To compare Macintosh laryngoscope, Truview video laryngoscope and King Vision video laryngoscope with respect to time to intubation, Cormack- Lehane grading, number of attempts, optimisation manoeuvres required and the complications related to laryngoscopy and intubation. Methods: After obtaining approval from the Institutional Ethic Committee, the present, prospective, cross over randomized study “evaluating the efficacy of Kingvision, trueview and Macintosh video laryngoscope in patients requiring general anesthesia with endotracheal intubation.” was conducted in the Post-Graduate Department of Anaesthesiology and Intensive care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu over a period of one year. 120 patients undergoing elective surgery requiring tracheal intubation were randomly as-signed to undergo intubation using Kingvision, Truview or Macintosh laryngoscope, to compose equal groups of 40 each. Results: Majority of patients in all three groups had MPG I/II. Kingvision group (31; 77.5%), Truview group (35;87.5%) and  Macintosh group (35;87.5%).  8 patients in Kingvision group and 5 patients each in Truview and Macintosh group had MPG III/IV indicating the difficulty in intubation. The three groups were comparable with relation to MPG distribution. (p>0.05). Cormack Lehane Grade I (full view of vocal cords) was seen in 40 (100%) patients of the Kingvision group, 37(92.5%) of the Truview group and 28(70%) of the Macintosh group. Grade II (partial view of vocal cords) was seen in no patient of Kingvision group, 6(15%) of Truview group and 10 (25%) of the Macintosh group. Conclusion: Both the video laryngoscopes were found to be significantly better than the Macintosh laryngoscope in terms of Cormack and Lehane grading; requirement of optimisation manoeuvres and need of second attempt for intubation.

107. Analysis of Clinical and Functional Outcomes in Lower Limb Amputee Patients Understanding the Etiologies and Methods to Assess the Need for Lower Limb Amputation
Mutharaju Kr, Vidhya Shree, Palla Swetha
Abstract
Introduction: Diabetes causes about 150,000 lower limb amputations in the US. Amputation can be instantaneous or delayed depending on tissue viability. Before surgery, people with diabetes should be optimized. Traumatic traumas and peripheral artery disease also cause amputations. Functional results vary on age, co-morbidity, motivation, and social context. Smoking hinders male vascular amputees’ walking, whereas stump length increases walking distance. Work might affect post-amputation independence. Aims: This study aims to evaluate the clinical and functional outcomes among individuals with lower limb amputation. Method: This prospective observational research at a tertiary care centre examines demographics, comorbidities, amputation level, complications, hospital stay, mortality, prosthesis usage, and functional outcomes in lower limb amputation patients. Descriptive statistics and logistic regression analysis identifies variables affecting functional results, prosthesis usage, and complications. Understanding lower limb amputations at tertiary care can improve patient care and quality of life. Result: Based on Table 1, peripheral vascular disease (51.7%) and diabetic foot (41.7%) are the leading causes of amputation. Transfemoral amputations were 58.3% and transtibial 41.7%. Ghost pain affects 45% and stump pain 60%. Traveling over 500 meters, 56.7% can. With 26.7% wearing prostheses. Table 2 shows physical and mental well-being disparities for below-knee and above-knee amputations. Patient outcomes and problems are indicated by LCI Score distribution. Conclusion: According to the study, mechanical benefits and stump-length therapy improve the quality of life for below-knee amputees. Early prosthetic intervention and an integrative medical-psychosocial approach can improve amputees’ well-being. Amputees’ quality of life has improved with prosthetics and stump pain treatment.

108. Anaesthetic Challenges and Peri-Operative Management of a Thrombocytopenic Patient Going for Hysterectomy
Nidhi Singh, Bhanu Prakash, Kiran Sharma
Abstract
Background: Thrombocytopenia (platelet count <150×109/l) is one of the most common disorders in hospitalised patients associated with increased infectious morbidity after hysterectomy. The present study aimed to assess the anaesthetic challenges and peri-operative management of patients with thrombocytopenia undergoing hysterectomy. Methods: The present study included a retrospective analysis of 2000 patients with thrombocytopenia who underwent hysterectomy, compared to 60,000 patients with normal platelet count, matched for age, body mass index (BMI), and routes of hysterectomy. Clinical factors such as age, BMI, parity, length of stay, comorbidities (diabetes mellitus, hypertension, heart failure, previous cardiac intervention, chronic obstructive pulmonary disease), pre-operative transfusion, uterine weight, routes of hysterectomies (abdominal, laparoscopic, and vaginal), and operating time were included in the analysis. Results: The study analyzed 2000 thrombocytopenia patients out of 150,000 hysterectomies during the 2 yrs. Study period. Moderate thrombocytopenia patients had lower platelet count, shorter pre-operative time, higher chronic comorbidities like hypertension and diabetes, higher pre-operative transfusion rates, and higher uterine weight than those with mild thrombocytopenia and normal platelet count. Operating time it was varied among patients with moderate, mild, and normal platelet count. Conclusion: The study found that patients with moderate thrombocytopenia had lower platelet counts and higher comorbidities than mild patients. It highlights the importance of pre-operative transfusion and careful peri-operative management to minimize bleeding risks. The findings offer insights into anaesthetic challenges and management strategies for thrombocytopenic patients undergoing hysterectomy.

109. Influence of Grandmothers on Breast Feeding Promotion Practices in an Urban Slum Area
Neelam, Akhil R. Nair, Amit P. Gujarathi
Abstract
Background: Despite numerous public health campaigns to promote breastfeeding, exclusive breastfeeding rates are low. Considering the culture of respecting and obeying the family senior citizens, grandmother plays a vital role in decisions regarding what, when, how, how much to feed a baby in India. Objectives: To analyse the influence of grandmothers on the breastfeeding practices based on their knowledge & attitude towards time of initiation, pre-lacteal practices, formula feeding and exclusive breast feeding. Methods: A cross sectional observational study conducted in a Maternity hospital attached to the Urban Health Centre of the parent medical college among 106 grandmothers of newly delivered infants using a semi-structured interviewer administered questionnaire by focus group discussion (FGD). Results: In this study, of the total 106 grandmothers, 82 (77.35%) were illiterate&50 (47.17%) belonged from class IV socio-economic status. Majority of the grandmothers, 74(69.80%) support colostrum feeding, 82(77.35%) promotes complementary feeding more than 6months of age, 101(95.30%) preferred homemade complementary food over packaged food and 55(51.90%) advocates breastfeeding during mother’s illness. Most grandmothers, 83(78.30%) promoted initiation of breastfeeding after 1 hour of birth, 68(64.14%) advocated pre-lacteals practices, 87(82.10%) were preferred bottle feeding and 54(50.90%) not recommended breastfeeding during child’s illness. There is a significant association (<0.05) between education and socioeconomic class with exclusive breastfeeding promotion practices. Conclusions: We concluded that unfortunately a large proportion of grandmothers did not practice desirable child feeding behaviors. However, education and better economic condition had positive influence on breastfeeding promotion practices. This information could be useful in the planning of strategies for promoting breastfeeding.

110. Role of Transverse Cerebellar Diameter as a Predictor of Gestational Age
Suvanya Mahajan, Shivani Katal, Pamposh Pandita, Rajesh Sharma
Abstract
Introduction: Gestational age is an important parameter to provide the standard of care medical management for both mother and fetus. Pregnancy is monitored objectively in terms of fetal growth compared to the period of gestation for planning the mode of delivery, managing complications in midcourse, and managing high-risk cases. Antenatal ultrasound is the standard of care in monitoring gestation. Gestational age is calculated based on certain fetal parameters. Transverse cerebellar diameter (TCD) has evolved as a promising indicator for assessing gestational age. Aims and Objectives: To determine the significance of transverse cerebellar diameter in the estimation of the gestational age of the fetus and compare it with other conventional parameters of fetal biometry. Methods: A cross-sectional study was conducted in the Department of Radiodiagnosis, Government Medical College, Jammu on 100 pregnant women who presented for an antenatal scan with a 15-40 weeks period of gestation. Result: Mean Gestational Age based on all parameters was compared with that of LMP; all parameters were showing GA which was near to GA by LMP. Of all parameters, TCD had a mean GA nearest to that GA by LMP in both the second and third trimesters. By comparing the GA by TCD with GA by other conventional parameters, there was Linear relationship.

111. Splenomegaly and Cholelithiasis in Patients with Thalassemia Major and Thalassemia Intermedia
Shivani Katal, Suvanya Mahajan, Pamposh Pandita, Aneesh Uppal, Rajesh Sharma, Sanjeev Kumar Digra, Ashu Jamwal
Abstract
Background: Thalassemias are inherited blood disorders, characterized by ineffective erythropoiesis. Incidence of thalassemia syndromes is high in South Asia including India. These patients can be clinically divided into transfusion dependent or non-transfusion dependent. Prevalence of Cholelithiasis and Splenomegaly and their predisposing factors in thalassemia syndromes were being assessed in the present study. Study design: Cross-sectional observational. Aim/Objectives: To measure volume of spleen and study prevalence of splenomegaly and cholelithiasis in patients with transfusion-dependent thalassemia major or thalassemia intermedia and factors affecting them. Methods/ Materials: This study was conducted in the Post Graduate Department of Radio-diagnosis, Government Medical College, Jammu over a period of six months. 100 patients were included and investigated with ultrasonography for gallstones and measurement of splenic volume. Results: 32 females and 68 males (mean age of 12.6 years) were participants in the study. Mean splenic dimensions were 14.1±6 x 11.1±4.3 x 6.2±3.2 cms (Length x Width x Height) with mean volume of 507.5±57.6 cm3. Larger splenic volume was associated with higher mean age, increased frequency of blood transfusion and lower hemoglobin levels. Cholelithiasis was observed in 2%. Conclusion: Splenomegaly and hypersplenism are common complications in thalassemia, hence routine evaluation for splenic size and volume can predict changes in transfusional requirements. Cholelithiasis is now relatively an uncommon complication among thalassemia patients with more frequent association with older age, large volume blood transfusion and splenectomy, therefore, imaging is usually recommended especially in later age.

112. Study the Clinical Characteristics, Diagnosis, and Co-Morbidity of Pulmonary and Extrapulmonary Tuberculosis Patients Registered with the Nikshay Portal from the Tertiary Care Hospital Morbi, Gujarat, India
Jadeja Bindu J, Kamaria Pooja A, Parmar Twinklekumar K, Laiya Rahul V, Parmar Ankitsinh
Abstract
Introduction: Tuberculosis has high burden in developing countries like India. Our aims of this study are to evaluate the incidence of pulmonary and extra-pulmonary tuberculosis, the clinical characteristics, diagnosis, and co-morbidity of pulmonary and extra-pulmonary cases at tertiary care hospital. Material and Method: A descriptive retrospective study was done using the data retrieved from the NIKSHAY portal of GMERS Medical college, Morbi. Data obtained from the portal between January 1, 2017, and August 31, 2023, total duration of six-year and eight-month studies. Only registered patients who resided in the Morbi district were included in this study. Result: In this study, 6673 patients, there were 5067 (75%) with pulmonary tuberculosis and 1606 (25%) with extrapulmonary tuberculosis. Male to female ratio is 2:1. And overall, male pulmonary cases are higher than other cases. This study’s age distribution shows that the most common age group affected is 21-30 year 2004 (30%), followed by 31-40 year 1211 (18%) and 11-20 year 944 (14%). In patients with pulmonary and extrapulmonary tuberculosis, 2319 (35%) had been diagnosed by chest x-rays, and 1961 (29%) patients were positive for fluorescence microscopy, CBNAAT 496 (7%), Truenat (MTB) 207 (3.1%), LPA 44 (0.66%), histopathology 26 (0.39%), cytopathology 12 (0.18%), and culture 5 (0.07%), respectively. The seropositive HIV infection in TB patients are 2% and 3% of patients are diabetic. Conclusion: In this study, pulmonary male tuberculosis has a higher ratio, particularly between 21 and 30 years of age. Chest X-rays have higher sensitivity but a poor diagnostic value. HIV and diabetes testing is also important for TB patients.

113. Morphometric Study of Basilar Artery in Cadavers of Malayali Population
Sushma, Ravi Bhaskar, Anjana Shidaraddi
Abstract
Background: The blood supply of the brain is quite important for understanding the process and effect of cerebrovascular accidents and other anomalies of brain function. Method: 30 (thirty) non-pathological cadaveric brains were studied for the metrical study of the basilar artery. The diameter and length were measured with a digital vernier calliper. Results: The mean length was 28.40 (± 4.48) and the range was 21.3–42.08. The mean diameter was 3.34 (± 0.68), and the range diameter was 2.06-4.48. Normal termination was 26 (86.6%), and variations were 4 (13.2%). Conclusion: It is concluded that the morphometric study of the basilar artery presents variations in the length, diameter, origin, and termination. These variations will be quite helpful for the neurologists, neurosurgeons, and radiologists for proper diagnosis and surgery to avoid morbidity and mortality in neuro-vascular accidents, anomalies, and pathologies of the brain.

114. Comparative Analysis of Laparoscopic Versus Open Peptic Perforation Repair
Swastik Sankhala, Suhag Bhalodiya, Sushrit Gamit
Abstract
Background and Aim: Peptic perforation refers to a duodenal ulcer perforation or a gastric ulcer perforation. Graham’s omental patch repair is required to correct peptic perforations. This surgical intervention can be performed either laparoscopically or openly. The study’s aims were to investigate various complications of open laparotomy peptic perforation repair and laparoscopic peptic perforation repair, and then to reduce post-operative complications by customising a suitable procedure in a specific person. Material and Methods: This was a descriptive study. This one-year study was carried out at a tertiary care centre in Gujarat. These patients were split into two groups. Perforated peptic ulcers were fixed laparoscopically in group A (n=30) participants. Perforated peptic ulcers were fixed openly (laparotomy) in group B (n=30) individuals. In terms of intraoperative time, post-operative hospital stay, and post-operative complications such as surgical site wound infection and post-operative pain, the author compared two groups. Results: Important factors in our study include intraoperative time, post-operative discomfort, surgical site infection, and hospital stay among patients in groups A and B. Group B patients required postoperative analgesics for a longer period of time than group A patients. Group B patients had a higher risk of surgical site infection than group A patients. Group B patients spend longer time in the hospital after surgery. Conclusion: The shift in disease pattern favours a straightforward repair approach in perforated peptic ulcers. In patients with perforated peptic ulcers, laparoscopic surgery has no additional disadvantages over open repair, but it has the advantage of reducing post-operative time, surgical site infection, and length of hospital stay. Laparoscopic perforated peptic ulcer repair is therefore recommended whenever possible.

115. Corneal Endothelial Cell Count, Corneal Thickness and Ageing: A Statistical Analysis in Indian Context and Comparison with Other Ethnic Groups
Sanjiv Kumar, Malvika Dhar, Vivek Rajvanshi
Abstract
Aim: This study aims to analyse patterns in endothelial cell count and corneal thickness in different age groups of Indian population and to compare findings with that of other ethnic groups. Materials and Methods: This was a retrospective study of 7129 Indian subjects aged 11 years and above who had undergone specular microscopy and corneal endothelial cell count measurement at Subharti Eye Bank, Chatrapati Shivaji Subharti Hospital, affiliated with Swami Vivekanand Subharti University, Meerut (India). Information such as age, sex, eye, average cell density, average cell area, CV, maximum cell area and minimum cell area as measured by the specular microscope, were collected and analyzed. Data is analysed using STATA software. Observations and Results: In this study a total of 7129 subjects above the age of 11 years were included out of which 3296 were male and 3833 were females.  All subjects were divided into 7 age groups; 11-20 years, 21-30 years, 31-40 years, 41-50 years, 51-60 years, 61-70 years and more than 70 years. We found a negative correlation relation between mean corneal endothelial cell density (MCD) and age (correlation -0.2449, p-value 0.0000), and between mean corneal thickness (MCT) and age (correlation -0.1152, p-value 0.0000). The correlation analysis suggested that MCD and MCT decrease as the age advances. The mean cell area increases with advancing age (correlation +0.0928, p-value 0.000). The correlation between CV and age was positive (correlation = 0.0054, p-value=0.3242) but not statistically significant. Corneal endothelial cell characteristics in Indian population were compared with American, Japanese, Chinese, Malay, and Nigerian population. MCD was found to be highest in Japanese population in every age group and lowest in Indian population. However, MCD decreases with the advancing age in all the ethnic groups. MCD is higher in males than female population after the age of 30 years while it is higher in females of age less than 30 years. Rate of endothelial cell loss is more in males than females in the age group of 21-30 and 61-70 years while it is higher in females in the age groups of 31-40, 41-50, 51-60 and above 70 years of age. Cell loss rate is higher in Indian population as compared to Egyptian population in every age group. Conclusion: The present study concluded that there is a statistically significant decline of MCD and MCT with age and also compared the results with other ethnic groups like Japanese, Chinese, American, Malaysian and Nigerian.

116. Comparison of Ropivacaine 0.25% Versus Ropivacaine 0.50% in Adductor Canal Block for Postoperative Pain Relief in Knee Surgeries
Raveena Kukreja, Neha Mishra, Chandra Shekhar Singh, Manoj Kumar Chaurasiya
Abstract
Objective: We have done this research to compare the onset, peak and duration of postoperative pain relief after adductor canal block among two different concentrations of Ropivacaine in knee surgeries. Method: Patients were divided into two groups at random and underwent ultrasound-guided adductor canal blocks using two different Ropivacaine doses. Observations were recorded using different pain scales. Results: We have seen the efficacy of adductor canal block having 2 different concentrations of ropivacaine in terms of pain control and have observed excellent results. Conclusion: Both the concentration of drug used i.e. 0.5% and 0.25% Ropivacaine is equally effective to provide postoperative analgesia for about 8-10 hours.

117. Fine Needle Aspiration Cytology in Neck Swellings: A Retrospective Study
Mary Nirmala S, M. Kavitha, D. Ranjit Kumar
Abstract
The Neck masses are relatively common pathology. These neck masses are evaluated by clinical history and examination with the aid of investigations like FNAC, USG and CT of the region and excision biopsy. Fine Needle Aspiration Cytology (FNAC) is a very simple, quick, inexpensive and minimally invasive technique used to diagnose different types of swellings like lymph node, thyroid, soft tissue and salivary glands in the Neck region. Objectives: It is to assess the frequency and incidence of different sites, age, sex and distribution of inflammatory, benign and malignant lesions. Methods: A retrospective study was conducted in the Department of Otorhinolaryngology at Government Kilpauk medical College and Govt. Royapettah hospital, Chennai from the period of Jan 2020 to December 2022.  Patients between the ages of 18 years to 85 years were enrolled into the study. A total of 200 patients with a Neck swelling underwent FNAC. Fine needle aspiration diagnosis was correlated with detailed clinical findings and investigations.

118. Sinonasal Mass: A Retrospective Study in a Tertiary Care Centre
Mili M, Sarma D, Sangma R, Borah S, Sarmah M, Sharma M
Abstract
Introduction: Sinonasal masses are one of the common findings among ENT patients. The incidence of sinonasal mass is increasing and a variety of lesions involving nose and paranasal sinuses are encountered in day-to-day practise. Objective: he study was undertaken with an objective to study the clinico-pathological profile of sinonasal masses in a tertiary care center of upper Assam, India. Materials and Methods: A total of 40 cases were studied in the from the period August 2021 to July 2022 attending the OPD of Department of ENT and Head and Neck Surgery, Assam Medical College Dibrugarh. Results: Most of the cases belonged to age group of 41-60 years. Mostly encountered non-neoplastic lesion was antrochoanal polyp (40%). Inverted papilloma being the most common benign lesion (15%) and metastatic undifferentiated carcinoma (7.5%) was most common malignant neoplastic mass noted. Conclusion: Sinonasal masses encompass broad pathology. Early detection and management help to improve prognosis.

119. A Prospective Study on B Scan Findings in Advanced Cataract Cases During COVID-19 Pandemic: A Hospital Based in North Karnataka Region
Amogh Harsoor, Afreen, Nausheen Niyaz, Sana Nizami, Navaneeta Reddy
Abstract
Purpose: To determine posterior segment pathologies using B scan in advanced cataracts of patients with limited access to healthcare during COVID-19 lockdown. Type of study: Hospital based descriptive cross-sectional study over 1-2 years duration. Material and Method: This study is done at the Dept. of Ophthalmology in KBN University from Dec 2021 to Aug 2023.50 eyes of patients with advanced cataracts visiting OPD with complaints of progressive diminution of vision when lockdown was relaxed. After taking detailed history, inclusion and exclusion criteria, patients were included in the study. All patients underwent comprehensive ocular evaluation. B-Scan USG (12 MHz) was performed and data was assessed regarding posterior segment pathologies found. Results: Incidence of posterior segment pathology was 16% with male preponderance. Out of 50 patients,12 patients recovered from COVID-19 infection- out of which 1 had Diabetes Mellitus and on B scan no posterior segment pathology was found and 38 patients were tested negative for COVID-19. Diabetes was most common systemic disease (32%). 10% of patients had intra ocular pressure over 21 mm of Hg. Retinal detachment was seen in 1 patient and vitreous hemorrhage with retinal detachment was seen in 1 patient of blunt trauma. CT scan orbit in showed no IOFB. Retinal detachment, PVD and Asteroid hyalosis were most common accounting for 4% followed by Posterior staphyloma (2%) and Vitreous hemorrhage (2%). Conclusion: B-scan is extremely efficient and necessary tool in diagnosing various ocular abnormalities and influences surgical planning and postoperative visual outcome. Lockdowns imposed in India due to COVID-19 further increased the incidence of advanced cataracts highlighting importance of performing B scan in such eyes. Knowledge about posterior segment pathologies invisible on fundoscopy is of immense help to surgeons in planning, executing and explaining prognosis to patients.

120. Study of the Plasma Fibrinogen Levels in Type 2 Diabetes Mellitus Patients in a Tertiary Care Centre
D. K. Sivakumar, C. Ravindranath, S. Malathi, S. Geetha
Abstract
Background: For diabetic people, coronary artery disease is the main cause of death. In addition to the known traditional risk factors associated with complications of diabetes, there is a quest to find out newer markers to predict complications, especially vascular. Fibrinogen is one among such factors. Both medicine and changes in lifestyle can significantly lower fibrinogen levels. This raises the possibility that measuring plasma fibrinogen could aid in the diagnosis and prevention of illness. The aim of the present study was to monitor alterations in the plasma fibrinogen levels of patients with recently diagnosed type 2 diabetes mellitus in a tertiary care setting. Methods: This was an observational case control study conducted among 100 patients aged 25 to 60 years with recently diagnosed type 2 diabetes mellitus who were hospitalised to the medical/diabetic ward and were visiting the outpatient department at Tamil Nadu Government Dental College, Chennai for 6 months (April 2023- September 2023) and were divided into 50 cases and 50 controls. In accordance with ADA guidelines, patients with newly detected type 2 diabetes mellitus were considered as cases. A comprehensive clinical examination and history were taken of each participant. Serum tubes were used to collect fresh peripheral venous blood samples, about 2 ml in volume, which were then submitted for electromagnetic viscosity measurement of blood glucose (postprandial, random, and fasting blood sugar) and serum fibrinogen levels. Results: There was no statistically significant difference between the groups with respect to age and sex distribution. The case group had mean plasma fibrinogen levels that were greater than those of the controls. There was no statistically significant difference in plasma fibrinogen levels among the sexes. There was a positive link between all of the diabetes mellitus measures (RBS, FBS, PPBS, and HbA1c levels) and the plasma fibrinogen levels in individuals recently diagnosed with type 2 diabetes mellitus, but not in the control group. Conclusion: According to this study, plasma fibrinogen and type 2 diabetes mellitus are positively correlated. Additionally, the relationship between plasma fibrinogen levels and other diabetes-related metrics, such as fasting blood sugar, postprandial blood sugar, and glycosylated haemoglobin, was found to be favourable. Thus, fibrinogen has the potential to be a marker for the early detection and treatment of microvascular and/or macrovascular problems in diabetic individuals.

121. A Study of Ocular Manifestations in Diabetic Patients Undergoing Dialysis
R. Padmashri, Dhyan Selvaraj, Sudan Marudhachalam, Meena Devi K.
Abstract
Background: Patients who have ESRD (End Stage Renal Failure) are susceptible to ophthalmic manifestations. This risk is linked to comorbidities such as diabetes mellitus, which is prevalent in ESRD patients, as well as the particular side effects of hemodialysis and the uremic state, which can result in alterations to the conjunctivae, cornea, retina, and macula. Very few studies were available regarding ophthalmic illness among diabetic patients undergoing dialysis. Hence, the present study was conducted to delve into the ocular problems among diabetic patients undergoing dialysis. Methods: This was a cross-sectional observational study carried out in the Department of Ophthalmology in collaboration with the Department of Nephrology at SRM Medical College and Research Centre, Trichy, over a period of two years (November 2020 to October 2022) among 101 diabetic patients aged more than 20 years attending the nephrology department for dialysis. Results: There was a statistically significant association of diabetic retinopathy with gender, education, socio-economic status and residence. Duration of renal disease, duration of dialysis, and duration of DM were significantly associated with diabetic retinopathy, while there was no statistically significant association with stage of renal disease, type of DM, treatment taken for DM or obesity. Conclusion: Our study concluded that diabetic patients with kidney disease undergoing hemodialysis had a higher proportion of ocular problems. Gender, education, socio-economic status and residence in addition to the duration of renal disease, dialysis, and diabetes were significantly associated with diabetic retinopathy. Further research into ophthalmic examinations both prior to and following hemodialysis would facilitate a better understanding of the effects of dialysis on the eyes.

122. Phimosis and Circumcision; A Study at Tertiary Rural Referral Centre in the Marathwada Region of Maharashtra
Nagesh Nagapurkar, Swati Nagapurkar
Abstract
Aims & Objectives: To study, compare and form a standard protocol for ‘Sleeve circumcision with modification and use of bipolar diathermy ‘to minimize morbidity and complications. Methods: The study was conducted at tertiary rural referral center between Jan. 20 to Dec. 22, three years All circumcision performed as an elective procedure including all cases of true phimosis within age group of 5 to 75 yrs. Results: Total 138 cases. Intraoperative uneventful. Postoperative mild to moderate oedema without pain & discomfort i.e., Children 10% to old age 72%which did not required treatment except assurance and counselling. No patient had bleeding or redo procedure. UTI was seen in older age group due to associated co morbid condition, cystitis, prostatitis or upper tract insult. Conclusion: The sleeve circumcision with modification and use of bipolar diathermy shows safe outcome, negligible complications with good cosmetic outcome.

123. Assessment of Morphological Patterns of Dermatophytosis
Jitendrakumar Prabhudas Modi, Parth Jitendrakumar Modi
Abstract
Background and Aim: Dermatophytosis that is recurrent and clinically unresponsive is becoming more common in our country. It has a long history of exacerbations and remissions. However, there is little information in the published literature about the scope of the problem and the characteristics of recurrent dermatophytosis. The goal of our research is to discover the morphological pattern of dermatophytosis in different age groups and genders. Material and Methods: This 6-month prospective descriptive study was conducted in the dermatological outpatient department (OPD) of a tertiary medical centre in India. The study enlisted 200 patients with dermatophytosis who were willing to participate. A comprehensive dermatological, general, and systemic examination was performed. Based on their narrative and inspection, their diagnosis was verified. The patients were categorised based on their age, gender, disease duration, and dermatophytosis morphology. Results: In our study, the majority of the 200 instances (40.5%) were seen in the age group 21-30, with one case (0.5%) seen in the age group 71-80. There were 124 men (62%) and 76 women (38%). Dermatophytosis involving a single site was identified in 188 (94%) instances, with multiple site involvement seen in 12 (6%) cases. Out of the 188 cases with a single pattern of dermatophytosis, 100 cases (53.19%) had corporis pattern, 36 cases (19.14%) had incognito pattern, 23 cases (12.23%) had cruris pattern, 5 cases (2.65%) had faceii pattern, and 6 cases (3.19%) had pedis pattern. Conclusion: Young boys are the most vulnerable group. Tinea corporis is most commonly seen in an annular pattern. Tinea incognito was the second most prevalent manifestation in our study sample. This refers to the uncontrolled use of over-the-counter topical drugs with a mix of corticosteroids and antifungals.

124. Study of D-DIMER in Severe Acute Pancreatitis in Andhra Pradesh Population
Pachalingappa Betageri, Shivaj Thakare, Srinivasrao. G. Shinde
Abstract
Background: Coagulative disorder is known to occur in the early phase of severe acute pancreatitis (SAD), and D-dimmer is a commonly used clinical parameter of hemostasis. The plasma D-dimmer level is a biomarker of severity of acute pancreatitis. Method: 75 patients with AP (Acute Pancreatitis) were admitted with an APACHE-II score. MODS pancreatitis necrosis was diagnosed by a CE CT APACHE-II score assessed daily during 1. 35 days after admission. Apart from S. D-dimmer, S. creatinine, S. bilurubin, S. urea nitrogen, and CRP levels were also studied. The stay at the hospital and ICU were also recorded. Results: The aetiology was 45 (60%) biliary origin, 14 (18.6%) alcohol abuse, 8 (10.6%) hyperlipidemia, and 8 (10.8%) idiopathic. The APACHE-II score was 9 (8–11), and the Ranson score 48 hours after admission was 4 (3-6). CRP level, 150 (103-201) Balthazar Index 6 (5-70), 9 (12%) hospital mortality, 60 (80%) pancreatic necrosis, 23 (30.6%) pancreatic infection, 51 (68%) organ dysfunction, 27 (36%) MODS, 14 (18.6%) surgical intervention, 15 (9.5 to 25) duration of hospital stay, 10 (4 to 18) ICU stay (days) comparison of mean values of D0dimmer in relation to the presence of variable were highly significant (p<0.001). Conclusion: A serum D-dimmer level study in severe acute pancreatitis helps to predict the severity of pancreatitis. It is an easy and inexpensive biomarker.

125. Study of Recurrent Abdominal Pain in Children Below 18 Years in North Karnataka Population
Srinivasrao G Shinde, Panchalingappa Betageri, Shivaji Thakare
Abstract
Background: Recurrent abdominal pain is a quite common health problem for 10 to 15% of school-going children and affects their everyday activities and careers. There are multiple aetiologies associated with RAP. Hence, a detailed study is essential to rule out the cause. Method: 130 school-going children of both sexes under the age of 18 years. Blood examination included CBC, LFT, urine analysis, culture, stool examination for cyst, ova, and parasite; Radiological examinations (x-ray, USG, and CT scan of the GIT if necessary) were carried out. Results: Clinical manifestations were: 40 (28.8%) had pallor, 28 (21.5%) had constipation, 31 (23.8%) had lymphadenopathy, 22 (16.9%) had UTI, 7 (5.38%) had hepatomegaly, and 2 (1.53%) had splenomegaly. Conclusion: In this pragmatic study, there are much different and interacting aetiology. Asymptom-based sub classification may be helpful for clinical management, and the encouragement of family members will also play a vital role in curing RAP in children.

126. Extrafascial Quadratus Lumborum Block versus Subfascial Quadratus Lumborum Block for Post-Operative Pain in Tertiary Care Centre
Vasudha Gupta, Devalina Goswami
Abstract
Introduction: Recently, novel blocks have been suggested as effective analgesic options for both laparoscopic and open nephrectomy procedures. These techniques, including the Quadratus Lumborum Block (QLB), have been integrated into the multimodal analgesia approach for postoperative pain control. Blanco developed the QLB, and it has been proposed as an alternative analgesic method for various surgical procedures. Aim and Objectives: To compare the safety, efficacy and adverse effects of extrafascial quadratus lumborum vs subfascial quadratus lumborum block for postoperative pain relief. Material and Methods: This prospective comparative study was done on 80 patients undergoing surgical interventions. Patients were taken into the operating theatre after confirming that they had fasted for 8 hours before the surgery and underwent a brief preoperative review examination. The anesthesia approach for all patients was standardized. Standard monitors such as non-invasive blood pressure (NIBP), electrocardiogram (ECG), and pulse oximeter were attached, and their baseline vital signs were recorded. Result: The mean duration of performing block in group 1 was 6.7±1.32 min, whereas in group 2 it was 9.45±1.76 min, On comparing there is significant difference with p value <0.01. The mean number of rescue analgesia in group 1 was 3.75±0.54 min, whereas in group 2 it was 3.3±0.46 min, with significant difference between two groups. Time for first rescue analgesia in group 1 was 4.55±0.90 min, and in group 2 it was 5.7±0.96 min with significant difference with p value <0.01. Conclusions: In summary, the study concludes that the quadratus lumborum block provides longer duration of analgesia, which is evident by the time for the requirement of first analgesia. The significant reduction in total VAS score(for 24 hours) and number of rescue analgesia for QL block as compared to TAP block also suggest s that QL block afforts better quality of analgesia.

127. A Study on Acceptability and Adaptability for Using Menstrual Cups amongst Reproductive Aged Females
Garg P, Gupta R, Agrawal H, Verma A
Abstract
Aim: A Study on Acceptability and Adaptability for Using Menstrual Cups amongst Reproductive Aged Females Materials and Methods: A sample of 30 females who were pregnant and delivered by caesarean section was used; they were supplied with a questionnaire to collect information about their knowledge about menstrual cups and were educated regarding the benefits of using menstrual cups. Each participant was followed for 2-3 months through regular visits. Results: 26 patients were willing to use menstrual cup. Maximum females did not experience any pain in insertion and removal of cup and were confident about inserting, removing, washing and sterilizing the cup. Conclusion: There is scope for improving awareness regarding promotion of menstrual health and hygiene amongst the healthcare providers and to advocate use of menstrual cup for the same as this is more eco-friendly. Social media also plays a major role in imparting knowledge, hence qualitatively researched data should be made available to propagate the use of this cheap, safe, eco-friendly and sustainable product for MHM. More awareness campaigns and better availability of menstrual cups should be there in community.

128. Screen Time and Problem Behaviours in Children: Exploring the Mediating Role of Sleep Duration
Vijay Kumar, Kumar Sanjeev, Suryendru Kumar
Abstract
Background: In the digital age, excessive screen time has been associated with various problem behaviour in children. However, the mechanisms underlying this relationship, particularly the role of sleep duration, remain unclear. This study aimed to investigate whether sleep duration mediates the association between screen time and problem behaviours in a sample of 50 children. Materials and Methods: Fifty children aged 8 to 12 years were recruited for this cross-sectional study. Screen time was assessed through parent reported daily hours spent on screens (M = 3.2, SD = 1.1). Problem behaviours were measured using standardized behavioural questionnaires (M = 24.5, SD = 6.8). Sleep duration was derived from both parent reported data and actigraphy (M = 8.5 hours, SD = 0.9). Mediation analysis was performed to assess whether sleep duration mediated the relationship between screen time and problem behaviours, controlling for age and gender. Results: The results indicated a significant positive correlation between screen time and problem behaviours (r = 0.42, p < 0.01). Mediation analysis revealed that sleep duration partially mediated this relationship (β = 0.17, p < 0.05), suggesting that increased screen time was associated with shorter sleep duration, which in turn contributed to higher levels of problem behaviours in children. Conclusion: This study highlights the potential mediating role of sleep duration in the link between screen time and problem behaviours in children. Limiting screen time and promoting healthy sleep habits may mitigate the adverse effects of excessive screen exposure on children’s behaviour. These findings underscore the importance of a comprehensive approach to promoting healthy digital habits and adequate sleep duration in children.

129. The Relation between Cigarette Smoking and the Quality of Sleep: A Cross Sectional Study
Shehaba Sulthana, Santhosh Kumar PV, Prejeesh B
Abstract
Background: Cigarette smoking has been found to have detrimental effects on almost all bodily organs, leading to the development of various illnesses and compromising the overall health of individuals who engage in this behavior. Cigarette smokers have worse sleep quality in comparison to the broader population. There is evidence to suggest that cigarette smoking is linked to sleep disruption, particularly in terms of extended sleep onset latency (SOL). The correlation between diminished sleep quality and heightened nicotine dependency has been seen among those who smoke cigarettes. The primary objective of this investigation is to investigate the impact of cigarette smoking on the overall quality of sleep. Aims and Objectives: The objective of this study is to investigate the correlation between cigarette smoking, as measured by the Fagerstrom Test for Nicotine Dependence, and the quality of sleep, as assessed by the Pittsburgh Sleep Quality Scale, among those who are bystanders of patients hospitalized in Government Medical College, Kozhikode. Materials and Methods: This is a hospital based cross sectional study conducted in 220 bystanders, who were current smokers, of patients admitted in Government Medical College, Kozhikode and their Fagerstrom Test for Nicotine Dependence and Pittsburgh Sleep Quality Scale were obtained. Patient’s Fagerstrom Test for Nicotine Dependence and Pittsburgh Sleep Quality Scale are calculated. Qualitative variables were expressed in percentages, and quantitative variables were expressed in mean and standard deviation. Associating selected variables were statistically tested using Chi-square test. Results: Among 220 subjects, 124 cigarette smokers had low nicotine dependence, 84 cigarette smokers had low to moderate nicotine dependence, 8 had moderate nicotine dependence and 4 had high nicotine dependence. While only 33.06% of cigarette smokers with low nicotine dependence showed poor sleep quality, all of the cigarette smokers with high nicotine dependence showed poor sleep quality. Conclusion: Sleep disruption is a significant factor to consider alongside other ramifications of smoking, since it has the potential to contribute to the development of cardiovascular and cerebrovascular ailments, which in turn can lead to difficulties in concentration, impaired memory, mood disorders, and a decline in overall quality of life. Therefore, the study demonstrates the significance of smoking cessation.

130. Transfusion Practices During Obstetric Emergencies- A Central India Study
Radhika Rai, Priyanka Solanki, Sanjay Pancholi, Yogesh Pawde, Ashok Yadav, Khushbu Likhar
Abstract
Background: Common obstetric emergencies require blood and blood components transfusion. The use of blood and its components has become a lifesaving strategy in management of obstetric hemorrhage. This study was aimed to know what transfusion practices during emergencies in obstetrics cases should be. Methods: A review of 1250 patients of obstetric emergencies requiring blood and its component transfusion was done. Results: Requirement of blood and blood components transfusion in obstetric emergencies in one-year period was 20.4%. Mostly multiparous women required blood transfusions (58.12%) and belonged to rural areas (69%). Anemia is a risk factor for obstetric emergencies and the mean pre-transfusion hemoglobin ±SD was7.54±1.0 (g/dl). Obstetric hemorrhage (59.6%) was the most common indication for transfusion and packed red cells were most commonly (60.07%) transfused. The overall percentage of adverse reactions seen during transfusion was 1.54%. Conclusions: The present study reinforces the importance of Proper transfusion practices during obstetrics emergencies. Specific blood component use avoids many of the hazards associated with use of whole blood. All blood components should be made available at peripheral hospitals as most of the patients require specific blood component and they are referred to tertiary care centre in emergencies which can be avoided.

131. Estimates of Serum Magnesium in Bronchial Asthma Patients of Telangana Population
Juwairia Mohammed Fariduddin, Venugopal Kura, Muddasir Mohammed Fariduddin, Asifa Tabassum Bilgi
Abstract
Background: Bronchial asthma is one of the most common respiratory diseases globally. The magnesium ion has an inhibitory action on smooth muscle contraction. Magnesium has been shown to relax bronchial smooth muscles and influence the function of respiratory muscles. Hypomagnesemia has been associated with diminished respiration and muscle power (movements). Method: In every patient, 2 mL of venous blood was collected to investigate serum Magnesium, CBC and ESR Also, Sputum is collected for AFB and Grams stain. Serum Magnesium was investigated by spectrophotomeric method. CBP and ESR were measured by Impedance and westergren method respectively. Chest x-ray and Spirometry was done for PEFR and FEV. Results: The FEV1 in bronchial asthma patients was 45.85 (± 0.42) and 94.48 (± 1.30) in controlled; the t test was 80.1 and p<0.001. Serum magnesium in Bronchial asthma patients had 1.68 (± 0.13) and the control group had 2.28 (± 0.13); the t test was 41.3 and p<0.41 (p value was highly significant). Conclusion: It is concluded that hypomagnesemia is more prevalent in bronchial asthma. This finding demands that the administration of magnesium will reduce the pathologies of asthma and relieve the patients by bronchodilating the bronchial vessels.

132. Combined Iron and Vitamin B12 Deficiency in Children with Growth Retardation & Psychomotor Retardation
Sangeetha P, Athira T S, Ajitha M, Muraleedharan T D
Abstract
Anemia is an important health problem because of its negative effects on children’s mental and physical development. We identified combined iron and Vitamin B12 deficiency in 5 children who were brought to our hospital for various reasons. All children were around 1 year of age. They had severe pallor, features of malnutrition and significant development delay. 3 children had skin hyperpigmentation most prominent over the knuckles. Complete blood count, Peripheral smear, Iron studies, Vitamin B12 levels, Folate levels, Maternal Vitamin B12 levels were done in these patients. All children had Iron and Vitamin B12 deficiency. Folate levels were normal. We could do Vitamin B12 levels only in 3 mothers and all of them had Vitamin B12 deficiency. All children were successfully treated with Iron and Vitamin B12 supplements. This case series emphasises the importance of early recognition and treatment of Vitamin B12 deficiency which can be present along with iron deficiency.

133. Role of Platelet Rich Plasma in Sensory Neuronal Hearing Loss
Trupti Savariya, Arpit D. Prajapati
Abstract
Introduction: Platelet-Rich Plasma (PRP) emerges as a promising solution for sensory neuronal hearing loss. PRP’s regenerative potential, rooted in its growth factors, offers hope for restoring damaged sensory neurons and improving auditory function. This autologous approach minimizes the risk of adverse reactions, making PRP a safe option for patients. Our study delves into the use of activated PRP in the treatment of Sensorineural Hearing Loss (SNHL), assessing its impact on hearing restoration and quality of life, potentially providing a novel therapeutic avenue for this challenging condition. Material and Methods: In this 12-month prospective study at a tertiary care medical college, 55 eligible participants aged 1 to 45 years with Sensorineural Hearing Loss (SNHL) were enrolled. Fresh PRP was prepared and administered via intratympanic injections over three consecutive weeks. A follow-up at 6 months post-treatment assessed efficacy using Pure Tone Audiometry. Data analysis utilized the Chi-squared test for evaluating the impact of the PRP intervention. Results: In this study of 55 patients with idiopathic Sensorineural Hearing Loss (SNHL), results showed a relatively equal gender distribution (53% male, 47% female) across various age groups. The majority of patients exhibited decreased hearing, with additional symptoms reported in varying percentages. Bilateral involvement was common, and hearing loss severity ranged from mild to profound. Patients with mild hearing loss showed the highest rate of complete recovery (55%), while severe cases had a 5% chance of no recovery. Duration of SNHL and the subsequent recovery levels revealed a strong association, with shorter duration correlating with better recovery. Notably, transient dizziness (35%) and injection pain (58%) were common, but increased tinnitus was not reported as a complication following intratympanic Platelet-Rich Plasma (PRP) injections. Conclusion: Our study suggests that PRP shows promise in the management of Sensorineural Hearing Loss, with potential benefits in terms of efficacy and safety. Further research is warranted to validate and explore the mechanisms underlying these findings.

134. Assessment of Functional Outcomes of Proximal Humerus Fractures Treated by Open Reduction and Internal Fixation using Proximal Humerus Locking Plate
Samiullah MD, Phalgun Kumar. K, Mahesh Sagar Athinarapu, Shaheed Abdul Arshad
Abstract
Background: The management of proximal humeral fractures that are unstable and displaced, particularly in elderly individuals, continues to be a topic of debate. This prospective study aimed to assess both the functional outcome and complication rate associated with employing locking proximal plates in open reduction and internal fixation for treating these fractures. Methods: Patients with fractures in the proximal humerus were eligible for inclusion if they were over eighteen years old, had achieved skeletal maturity, and provided written informed consent before participating in the study. Fractures were considered for operative treatment based on Neer’s criteria (angular articular surface angulation >45° or displacement >1 cm between major fracture segments) or if they demonstrated instability during passive motion under an image intensifier. Results: Proximal humerus fractures are more common in younger adults, with the majority of cases occurring in the 21-30 age group. Road traffic accidents are the leading cause of proximal humerus fractures, especially in men. Three-part fractures are the most common type of proximal humerus fracture. Most patients undergo surgery within 1-3 days of injury. At 12 months after surgery, the mean ROM in all four movements was within the normal range. The mean CMS score at 12 months was 76.61, which is considered to be a good score. The complication rate was relatively low, with the most common complication being stiffness (8%). Conclusion: Among proximal humerus fractures, three-part fractures were identified as the most common type. The majority of patients underwent surgery within 1-3 days post-injury. After a 12-month post-surgery period, the mean range of motion (ROM) across all four movements was within the normal range. Overall, the study underscores the safety and efficacy of employing a proximal humerus locking plate for treating such fractures. There is a significant improvement in shoulder function post-surgery, with most achieving a normal ROM and displaying favorable functional outcomes at the 12-month mark.

135. Clinical Crown Lengthening Procedure: A Case Series
Babita Sahu, Avinash Baliramji Taksande, Bhupendra Gathe
Abstract
The crown portion of the tooth is the only visible part in the oral cavity which also acts as an abutment in the prosthesis. It is essential to maintain sufficient crown height for retention stability, and aesthetics of the prosthetic crown. The crown lengthening is a surgical procedure commonly used to maintain the supporting tissue of the tooth in optimal conditions and improve aesthetics while smile designing. The biological width and width of keratinized gingival are two important key factors for the harmony of supporting tissue of teeth and for the longevity of the restoration.  The aims of the current case reports are to show some light on the importance of the implications of crown lengthening in routine dental practice.

136. A Study Comparing Different Routes of Myomectomy with Fertility Outcome
Monica Singh, Priyanka Verma, Jitendra Gothwal, Mahesh Kumar Singh
Abstract
Objective: To study the association between the myomectomy route and fertility outcome. Methods: It was a prospective cohort study. Comparative Treatment Options for Uterine Fibroids and relation with fertility. Reproductive-aged women undergoing surgery for symptomatic uterine fibroids. Used life-table methods to estimate cumulative probabilities and 95% confidence intervals (CI) of pregnancy and live birth by myomectomy route during 12, 24, and 36 months of follow-up. Also conducted 12-month interval-based analyses that used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals for associations of interest. In all analyses, we used propensity score weighting to adjust for differences across surgical routes. Results: Among 309 women who underwent myomectomy (abdominal=103 hysteroscopic=103, and laparoscopic=103), 68 reported pregnancy and 39 reported live birth during 36 months of follow-up. There was little difference in the 12-month probability of pregnancy or live birth by route of myomectomy overall, or among women intending pregnancy. In interval-based analyses, adjusted ORs for pregnancy were 1.25 (95% CI: 0.71–2.18) for hysteroscopic myomectomy and 1.13 (95% CI: 0.72–1.63) for laparoscopic myomectomy compared with abdominal myomectomy. Among women intending pregnancy, adjusted ORs were 1.2 (95% CI: 0.67–2.31) for hysteroscopic myomectomy and 1.29 (95% CI: 0.72–2.05) for laparoscopic myomectomy compared with abdominal myomectomy. Associations were slightly stronger but less precise for live birth. Conclusion: There is no significant difference in the chances of conception or delivering a live baby by the various myomectomy routes.

137. To Study the Correlation of Quantitative CRP (C Reactive Protein) and CTSS (CT Severity Score) on Admission as a Predictor of Severity of COVID-19
Rituraj Singh Baghel, Sunil Kumar Rajpoot, Neha Jain, Krishna Kumar Tripathi, Chandrabhan Singh Thakur, Roopesh Jain
Abstract
Objective: To determine the correlation of C-reactive protein (CRP) levels and Computed Tomography Severity Score derived from High Resolution Computed Tomography at the time of admission with the clinical outcome among COVID-19 patients. Methods: Single centre, prospective, observational study enrolled all the participants who fulfilled the selection criteria and visited the hospital/emergency. The data were collected in a paper-based questionnaire. For this study, the level of C- Reactive Protein was measured and interpreted. The mean and the median CT severity score was measured. The value of coefficient of correlation between the CRP and CT severity score was seen and results derived. Results: The mean CRP levels among the participants who were alive and died was 143 and 233 mg/dl, respectively. The P-value of the T-test suggest that the difference in the levels of CRP was highly significant (p <0.0001). The mean and the median CT severity score among the participants that did survive the COVID-19 infection was 14.5 and 16, respectively. The mean and the median CT severity score among the participants who did not survive the COVID-19 infection 19.8 and 22, respectively. The difference in the mean CT severity score among the participants who did and did not survive the COVID-19 infection in the present study was statistically highly significant (p<0.0001). The value of coefficient of correlation between the CRP and CT severity score also indicated a liner and strong relationship between CRP levels and CT severity score (r = (+) 0.70) Conclusion: C – reactive protein levels and HRCT score/parameters at the time of admission both successfully predicted the adverse outcome among COVID-19 patients admitted to the ICU. There was high degree of correlation between the CRP and HRCT, thus, either of the two can be utilized for the risk stratification and triage of patients for admission to ICU or Hospital.

138. Immunohistochemical Characterization of M4 Macrophages in Tuberculoid and Lepromatous Leprosy: An Observational Study
Nausheen Sanaullah Khan, Shalini Suman, Mayank Anand, Javed Iqbal
Abstract
Background/Aim: To study the immunohistochemical expression of M4 macrophages in Tuberculoid and Lepromatous leprosy to substantiate the existing pool of knowledge and to assess its clinical significance. Material and Methods: It was a single center, observational study conducted under a period of March 2021 to September 2022 which included skin biopsies of 62 cases of leprosy seen in the Department of Dermatology and reported in the histopathology section of the Department of Pathology. The histopathology slides were reviewed under light microscopy and classified according to the Ridley Jopling classification on the basis of BI index. Representative sections of each case were stained simultaneously by immunohistochemistry (IHC) for CD68, MMP7 and MRP8 in the Department of Pathology. Results: CD68 expression was seen in 43.2% of Tuberculoid and 100% of Lepromatous cases. Moderate to strong expression (Score 2 and 3) was seen in 10.8% of Tuberculoid and 62.1% of Lepromatous cases.MMP7 expression was significantly higher in Lepromatous (93.1%) as compared to that in Tuberculoid leprosy (37.8%).MRP8 expression was significantly higher in Lepromatous (93.1%) as compared to that in Tuberculoid leprosy (43.2%).It was seen that TT type was associated with weak expression of these markers whereas LL type was associated with moderate to strong expression of these markers. Conclusion: The findings of the study showed that expression of all the three M4 macrophage markers was significantly higher in lepromatous as compared to tuberculoid leprosy, thus showing different pathogenetic and progression pathways of the disease. Conclusion: The findings of the study showed that expression of all the three M4 macrophage markers was significantly higher in lepromatous as compared to tuberculoid leprosy, thus showing different pathogenetic and progression pathways of the disease.

139. Clinical Study to Evaluate Importance of Topodiagnostic Tests and Levels of Facial Nerve Involvement: A Prospective Analysis with an 80-Subject Cohort
Abhishek Rajagopal, Smita Soni, Ankita Singh, Aditya Goel
Abstract
Background: Facial nerve dysfunction, which can result from various etiologies, poses a diagnostic and therapeutic challenge. The concept of topodiagnosis, focusing on localization of the site of facial nerve involvement, has emerged as a promising approach to enhance diagnostic accuracy and guide tailored treatment strategies. Aim and Objective: This prospective clinical study aimed to evaluate the clinical utility of a battery of topodiagnostic tests, including the Schirmer test, stapedial reflex assessment, and chemical taste tests, to assess taste sensation. Additionally, the study sought to determine the most common anatomical level of facial nerve involvement across different etiologies. Conventional radiological methods and electrophysiological evaluations were also employed to provide a comprehensive assessment of facial nerve disorders. Materials and Methods: Eighty patients presenting with facial nerve dysfunction were recruited, and a multidisciplinary approach was employed, encompassing clinical assessments, radiological imaging, and electrophysiological testing. The anatomical segments of the facial nerve, including the labyrinthine segment, first genu, tympanic segment, second genu, mastoid segment, and extratemporal part, were evaluated. Results: Chronic otitis media was the most common diagnosis, followed by Bell’s palsy, Ramsay Hunt syndrome, traumatic injury and facial nerve injury as a result of parotid tumor. Precise topodiagnosis, achieved in 98.8% of cases, revealed varying levels of facial nerve involvement, with the tympanic segment being the most frequently affected. Radiological assessments supported clinical diagnoses in 95% of cases, and electrophysiological evaluations confirmed the diagnosis and provided insights into the severity of nerve injury. Conclusion: This study enhances our understanding of the spectrum of facial nerve disorders, emphasizing the importance of otitis media and topodiagnosis in the effective management of facial nerve dysfunction. Larger-scale, multicenter studies with extended follow-up periods are needed to validate these findings comprehensively and provide more comprehensive insights into the clinical utility of topodiagnosis.

140. Comparision of Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus and Gracilis Graft Fixed with Bioabsorbable Interference Screw against Titanium Interference Screw
Nishant Jajee, Nagesh M Inginshetty, G. Rajesh Reddy, Sandeep Sriram, Radha Bawage
Abstract
Background: Knee injuries are more common due to exponential increase in road traffic accidents and more involvement in sports related activities by common people. Anterior cruciate ligament injury is one of the most common injuries around knee and poses quiet a lot management controversy. Aims and Objectives: To do comparative analysis of the functional outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction using quadrupled semitendinosus and gracilis graft with endobutton as femoral fixation device and bioabsorbable interference screw against titanium interference screw as tibial fixation devices respectively. Materials and Methods: 60 Patients with ACL tear attending outpatient department of a tertiary care hospital were recruited in this prospective, comparative study. Detailed proforma consisting of patient information, Lysholm and Gillquist scoring scale were administered pre and postoperatively for patient. The difference in clinical outcome of both groups was compared. Out of 60 patients 30 patients underwent ACL reconstruction using Titanium screw and 30 patients underwent ACL reconstruction using Bioabsorbable screw. All patients were followed up for a period of 6 months post operatively. Improvement in patient condition was measured in terms of improved Knee range of motion, walking with or without support, any instability, any locking of knee, any pain while activity. Results: Mean preoperative Lysholm score for Titanium group was 52.60 and postoperative score is 85.56. Mean preoperative Lysholm score for Bioabsorbable Group is 54.70 mean postoperative score for group is 87.63. The increase in both scores was statistically significant when compared within the groups. And when both groups are compared, there was no significant difference between 2 groups. Few of our patients presented with anterior knee pain in immediate post-operative period which subsided with physiotherapy and medication, none of them had chronic knee pain. Conclusion: Our study shows that there is no difference in functional outcome whether bioabsorbable or titanium interference screw was used.

141. Functional Outcome of Tibial Fractures in Children Treated by Supracutaneous Locking Plates
Nishant Jajee, Sandeep Sriram, Nagesh M Inginshetty, G. Rajesh Reddy, Radha Bawage
Abstract
Background: Tibial shaft fractures are third most common type of long bone fractures in children after femur and forearm. Aim: The purpose of the study is to evaluate the functional and radiological outcome results of Closed reduction or open reduction of tibial fractures and fixation using locking plate as supra cutaneous external fixator in children. Methods: In this observational study 32 children with tibial fractures having soft tissue injury underwent external fixation with locking plates. There were 22 male and 10 female children with mean age of 10.59 years (range 6 to 15 years) who sustained fracture in RTA. 84.4% cases had closed fractures, and 15.6% cases had open fractures. Out of the cases with open fractures, 60% had grade 1 injury, and 20% each had grade 2 and grade 3b injury respectively. Results: 7, 9, 11, 13 Holed LCP were used in 34.4%, 25%, 25% and 15.6% patients respectively. Screw tract infections were observed in two patients who had serious discharge and was relieved with oral antibiotics. No deep infections were reported. All the fractures united by the end of 24 weeks after bone grafting. In all most all the patients skin condition was found to be good in follow up. Conclusion: The present study though in small number (32) shows that use of LCP plate as supra cutaneous external fixator is an effective method in terms of stability of fixation, utilisation as permanent fixation method and less complication rate.

142. Emerging Trends in Extended Spectrum Beta-lactamase and Carbapenemase Producers Among Gram-Negative Bacteria in the Intensive Care Unit
Bithika Ray, Parul Singhal, Ritu Agarwal
Abstract
Background: The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICUs) poses a significant threat to patient clinical outcomes. Understanding the epidemiology and resistance patterns of these bacteria is crucial for effective infection control and treatment strategies. Studies from various regions have reported varying rates of MDR bacterial infections in ICUs, necessitating ongoing surveillance and tailored interventions to combat this growing public health concern. This study aimed to contribute valuable insights into the prevalence, distribution, and antibiotic resistance profiles of MDR bacteria in a specific ICU setting, helping guide evidence-based clinical practices. Methods: This cross-sectional study was conducted in a tertiary care ICU over two years, we collected data on demographics, comorbidities, prior antibiotic use, and infection sources. Blood cultures were processed, and antimicrobial susceptibility testing was performed. ESBL and carbapenemase production were assessed. Descriptive statistics characterized infection rates, bacterial species distribution, and resistance patterns. Results: The study included 323 patients in the intensive care unit. Gram-negative bacteria, particularly Klebsiella pneumoniae (20.8%) and Escherichia coli (26.3%), were the most prevalent pathogens. High levels of resistance were observed in commonly used antibiotics, with ceftriaxone and ceftazidime showing resistance rates of 45.5% and 44.9%, respectively. Extended-spectrum beta-lactamase (ESBL) production was detected in 29.3% of isolates. Carbapenemase production was identified in 16.4% of isolates. Clinical outcomes indicated longer ICU stays and higher mortality rates among patients with ESBL and carbapenemase-producing infections. Conclusion: In this study, we found a concerning prevalence of multidrug-resistant Gram-negative bacteria, including ESBL and carbapenemase producers. High rates of resistance to commonly prescribed antibiotics emphasize the need for antimicrobial stewardship.

143. Mortality Profile, Risk Factors, and Aetiology Associated with Neonatal Hyperbilirubinemia
Tarun Kumar, Sanjeev Kumar
Abstract
Background: The most usual and chronic early disease that affects the newborn is Hyperbilirubinemia otherwise called jaundice. This disease often requires immediate treatment and detection and may also require readmittance to the hospital for complete diagnosis. The occurrence of hyperbilirubinemia in neonates is estimated to be 65% – 85% approximately. This study deals with the analysis of etiology, risk factors and morbidity of hyperbilirubinemia in neonates at a tertiary care hospital. Materials and Methods: It was a prospective study which was conducted at a tertiary care centre in BMIMS Pawapuri (Nalanda) Bihar with newborn babies and also babies aged from 0 to 28 days were included in this study. Results: A total of 50 neonatal babies were included in this study of which 30 were male and 20 were female babies. Of the 50 neonatal babies selected, 15 were less than 37 weeks development and the remaining 35 were more than 37 weeks development. Conclusion: The primary cause for neonatal hyperbilirubinemia was ABO incompatibility and spontaneous jaundice continued by Rh factor and blood poisoning by bacteria. Elevated bilirubin levels are the initial symptoms of hyperbilirubinemia. Phototherapy is an excellent tool for diagnosing this disease in neonates and helps in reducing the levels of bilirubin in newborn babies.

144. Diagnostic and Clinical Profile of Dengue Fever Patients in a Tertiary Care Centre with Limited Resources
Tarun Kumar, Sanjeev Kumar
Abstract
Objective: The study aimed to investigate the clinical and diagnostic profile of Dengue fever in a resource-limited setting, focusing on different age groups and their living environments. Material and Methods: In this study, a cohort of 50 patients diagnosed with Dengue fever was examined to explore the clinical and diagnostic profile of the disease in a resource-limited healthcare environment. The study was conducted at BMIMS, Pawapuri (Nalanda) Bihar, India and the duration of the study was one month, starting from July 2023 to August 2023. Patients were categorized into three age groups: 5-7 years (Group 1), 8-10 years (Group 2), and 11-14 years (Group 3), allowing for age-specific analysis. Result: Among the 50 patients, the majority were above 10 years old, with children in rural areas experiencing a higher incidence of Dengue fever. The most prevalent symptoms included nausea, itching, and headache, while high fever (temperature >101°F), coughing, and rash was also common. Age-specific patterns revealed variations in symptom presentation, with erythema more frequent in patients aged 11 and above. Conclusion: In conclusion, the research provides valuable insights into the clinical and diagnostic aspects of Dengue fever in a resource-limited setting. Nausea, itching, and headaches were the most prevalent symptoms among the patients. High fever was also a common symptom.

145. Study of Comparison between Vaginal Misoprostol and Intracervical Dinoprostone Gel for Induction of Labour
Prafullita Maida, Meenakshi Samriya, Anil Samriya, Bhawana
Abstract
Introduction: Induction of labour is an intervention to artificially stimulate uterine contractions leading to progressive dilation and effacement of cervix. This results in delivery of foetus before the onset of spontaneous labour. Dinoprostone gel and Misoprostol are commonly used drugs for cervical ripening. We wanted to compare the efficacy and safety of Dinoprostone with Misoprostol for cervical ripening and induction of labour in women with unfavourable cervix. Methods: This is a prospective study conducted among 100 antenatal women who required induction of labour for different indications. 50 patients with an indication for induction were given 25 mcg of intravaginal misoprostol and repeat dose up to a maximum of 3 doses every 4 hours as needed. The other 50 patients were given 0.5 mg of intracervical dinoprostone gel and repeated for a maximum of 3 doses every 6 hours as needed. Progress of labour was monitored. Bishop score was determined. Result: Postdatism was the most common cause of induction (45% and 58%) in both the groups. The difference in values of mean induction delivery time in both primipara and multipara was not significant statistically for both the drugs. Study showed that the number of caesarean sections was significantly (p-value 0.028) reduced with the use of misoprostol for induction of labour. The most common indication for operative delivery was foetal distress (11% in the misoprostol group and 17% in the dinoprostone group). Maternal and foetal complication rate in both the groups was similar. Conclusion: Caesarean rate was significantly less with intravaginal misoprostol group compared to dinoprostone group. Other factors had no statistical significance. Vaginal misoprostol is thus a better option for induction of labour.

146. Impact of Thyroid Dysfunction on Hematological Parameters: A Cross Sectional Study
Shashank Tyagi, Narendra Rahaengdale, Vishnu Kumar Gupta, Nandini Shukla
Abstract
Background: Thyroid function disorders are among the most common endocrine diseases, Thyroid hormones have direct effect on blood parameters by stimulating erythrocytes precursors and indirectly by enhancing erythropoietin production. Aim: This study was done to evaluate the various types of thyroid function abnormalities and their effects on different hematological parameters. Materials & Methods: This was a cross sectional observational study, which included total 300, subjects who were grouped as hypothyroidism, hyperthyroidism and euthyroid. Two blood samples were collected from all the patients in EDTA tubes and plain tubes for estimation of hematological parameters by cell counter and thyroid hormonal assay by Enzyme linked immuno-sorbent assay (ELISA). The results were analysed using SPSS software. Results: Out of total 43.3% were euthyroid, 36.7% hypothyroid and 20% were hyperthyroid. Majority of the patients (44%) were 31-45 years age group, the mean age was 48.85+9.62 years, with females dominance comprising about 73.3% of cases. Analysis of data obtained showed that there was a significant statistical difference in Hemoglobin, RBC, PCV, MCV, MCH, MCHC, TLC, RDW, and hematocrit (p <0.05) among hypo, hyper and euthyroid groups. However, there was no significant correlation of platelets count in thyroid groups (p>0.05). Conclusions: Thyroid dysfunction impacted female more frequently than males. Thyroid dysfunction significantly associated with the all hematological parameters except platelets count.

147. To Assess the Acceptability, Safety, Efficacy, Continuation Rate and Rate of Expulsion of PPIUCD Insertion
Pratima Kumari, Anjana Lakhra
Abstract
Background & Methods: The aim of the study is to assess the acceptability, safety, efficacy, continuation rate and rate of expulsion of PPIUCD insertion. After taking informed consent.In vaginal delivery. Bimanual exam was performed to evaluate the cervix and the uterus after the delivery of the placenta and ensured empty cavity with contracted uterus and evaluation of postpartum hemorrhage. Results: Out of 255 patients, 230 (90.19%) came for 1st followup, 25 (9.8%) patients lost followup during 1st followup at 6 week. Out of 230 patients 19 (8.26%) patients excluded from study due to removal of PPIUCD after 1st followup at 6 weeks and 1 (0.4%) patient excluded from study after 1st follouwp due to expulsion of PPIUCD. During 2nd followup at 6 months, out of 210 patients, 180 (86%) patients came for 2nd followup at 6 months. 30 (14.3%) patients lost to followup during 2nd followup. Out of 180 patients, 15 (8.3%) patients excluded from study due to removal of PPIUCD after 2nd followup and 1(0.5%) excluded from study after 2nd followup due to expulsion of PPIUCD. Conclusion: PPIUCD is one of the best contraceptive method because it is easy to apply, cheap and easily available and patients are highly motivated at postpartum period though expulsion rate was 1% still the result can be improved the motivating the women by periodic checkup of IUCD. Acceptance rate is poor. It can be improved by motivating the patient during antenatal period and counselling. This could be attributed to the fact that many women were unaware and to be informed about the benefits of PPIUCD only when they were admitted for delivery. Also the refusal of family members for PPIUD usage adds the burdens of refusing contraception.

148. Measurement of the Electrolytes, Total Proteins, and Salivary Flow Rate of Type II Diabetes Individuals
Ashraf Bahleem, Mukesh Kumar Soni
Abstract
Background: A chronic metabolic condition called diabetes mellitus (DM) is defined by hyperglycemia abnormalities in the metabolism of proteins, lipids, and carbohydrates. It frequently leads to the emergence of neuropathies, microvascular and macrovascular problems. It is well recognised that the quantity and quality of saliva, both of which may be affected in diabetes, are related to the health of oral tissues. Materials and Procedures: This study involved 150 subjects in total, of whom 40 did not have diabetes and 80 had Type II DM (which included both controlled and uncontrolled diabetes) (controls). Both sexes were represented in the study’s population, which ranged in age from 40 to 70. The study participants were split up into three groups. Results: In version 16.0 of SPSS software, multiple comparisons between the groups were made using the analysis of variance and post hoc Tukey honestly significant difference analysis based on the values of total protein, sodium, potassium, and salivary flow rate among controls, controlled diabetes, and uncontrolled diabetes. InVersion16.0 of the Statistical Package for the Social Sciences (SPSS), IBM Corporation, Chicago, United States of America, the values of total protein, sodium, potassium, and salivary flow rate among controls, controlled diabetes, and uncontrolled diabetes were gathered, formulated, and subjected to multiple comparisons between groups using analysis of variance and post hoc Tukey honestly significant difference analysis. The average fasting blood sugar value for Group 1was 88.9 mg/dL, with values ranging from 79 mg/dL to 96 mg/dL. Conclusion: The exact valuation of controlled and uncontrolled Type II DM in terms of salivary flow rate, salivary electrolytes, and total protein warrants studies with larger sample size.

149. Effects of Psychological and Physical Stress on Patient’s Lipid Profile
Mukesh Kumar Soni, Ashraf Bahleem
Abstract
Introduction: The primary risk factor for atherosclerosis, which causes coronary heart disease, cerebral vascular disease, and peripheral vascular disease, is this. There are several lipid problems throughout the world. Stress on the body and mind is one of their modifiable risk factors. Materials and Methods: A thorough clinical examination was done. A detailed questionnaire containing questions on health, diet, smoking, drinking habits and lifestyle was recorded. Laboratory investigations such as weight, height, waist circumference, hip circumference, ECG and BMI were done. Results: There were 65 subjects of high stress and 35 of low stress with TG >200, 55 subjects and 40of high and low stress respectively with TC >240, 45 high stress and 43 low stress with LDL > 165 and 35 males and 25 females with HDL >45 and 55 respectively. The difference was significant (P< 0.05). Conclusion: Psychological stress was a risk factor for lipid disorders, and proper physical activity was protective in this situation. One of the physical activities is work activity; work activity without stress could be harmless and useful. However, psychological stress could be eliminated in the workplace.

150. A Comparative Study of Minimal Invasive Essex – Loprestireduction and Fixation Technique Versus Open Reduction and Plating in Treatment of Displaced Intra-Articular Fracture of Calcaneum a Retrospective Study
Binit Diwakar, Ranjit Kumar Singh, Shambhu Kumar
Abstract
Background: Displaced intra-articular calcaneus fractures are a highly complex fracture in orthopaedics since they can have long-lasting effects on a patient’s mobility and quality of life. Calcaneum and its articular surfaces are complex, making it difficult to treat these fractures in a way that would result in full recovery. Methods: This retrospective study aimed to compare the efficacy of the minimal invasive Essex Lopresti reduction and fixation technique to the standard open reduction and plating procedure for treating displaced intra-articular calcaneus fractures. The 100 calcaneal fracture patients (53 males and 47 females) were studied who were admitted in Nalanda Medical College & Hospital Patna, Bihar during period October 2021 to August 2023. The Ankle-Hindfoot Scale created by the American Orthopaedic Foot and Ankle Society (AOFAS) was utilised to evaluate clinical outcomes, such as functional improvement and enhanced range of motion. Patients were evaluated for union malunion wound complications, infections, and exposed implant over twelve months. Bohler’s angle was calculated to asses bon reduction. Results: According to the study, clinical outcomes differed substantially between the two surgical groups. Compared to patients who underwent open reduction and plating, minimal invasive Essex Lopresti technique patients had an AOFAS score 82.4. In the minimal invasive group, the average range of motion of the joints was 34.6 degrees, while it was only 28.9 degrees in the open reduction group. Only 15% of the minimal invasive group and 21% of the open reduction group reported complications following surgery. According to statistics, calcaneus fractures are more prevalent in middle-aged adults. Conclusion: This research emphasises the critical nature of deciding on the best surgical strategy for displaced intra-articular calcaneus fractures. The merits and disadvantages of open reduction and plating are illuminated by a comparison with the minimal invasive Essex Lopresti reduction and fixing procedure. This study adds to the growing body of information regarding orthopaedic procedures for calcaneus fractures by providing insight into variations in outcomes, complications, and patient demographics; this knowledge will help orthopaedic surgeons provide better care for their patients.

151. Synovial Hemangioma of Knee Joint in Children and Adolescents a Case Series
Shambhu Kumar, Ranjit Kumar Singh, Binit Diwakar
Abstract
Background: Synovial hemangiomas are benign vascular tumors that can occasionally develop in the knees of infants and adolescents. These malignancies are uncommon. Due to a lack of information, the radiological appearance, histological characteristics, and clinical presentation of this disease in this population need to be better understood. Materials and Methods: Fifty-five patients of synovial hemangioma of knee joint in child and adolescents were selected for retrospective study who came for treatment in the Department of Orthopedics in Nalanda Medical College and Hospital Patna, Bihar, India from January 1, 2020, to December 31, 2022. The selection of patients was based on the outcomes of clinical examinations, imaging tests (such as Magnetic Resonance Imaging [MRI] and ultrasonography), and pathology confirmation. Results: Recent research indicates that synovial hemangiomas of the knee in adolescents are uncommon. The average age of the patients was 12, and marginally more men than women made up the total population. Edema, tenderness, and limited joint mobility were the most prevalent clinical symptoms in the affected joints. Multiple radiological investigations indicated that the synovial membrane contained vascular lesions. Histopathology provided conclusive proof of abnormal endothelium proliferation and blood vessel formation. Conclusion: This case series is incredibly fascinating due to the rarity of synovial hemangiomas. The results improve our comprehension of the clinical symptoms, radiological findings, and histological characteristics of this disease in this population. Through prompt diagnosis and treatment, it is possible to preserve the patient’s joint function and achieve improved outcomes overall. More research is necessary to determine which treatments are the most effective and generate the best long-term results for these patients.

152. A Cytohistopathological Study to Evaluate the Diagnostic Role of Fine-Needle Aspiration Cytology (FNAC) in Salivary Gland Lesions
Ankita, Shiksha, Dharitri Rabha, Mahesh Prasad
Abstract
Background: Swelling of the salivary glands, in particular the parotid and submandibular glands, is a common issue that causes patients a lot of trouble since it is so obvious. Additionally, parotid/submandibular swellings continue to be difficult to diagnose for clinicians. In order to diagnose salivary gland abnormalities, this study assessed the sensitivity and specificity of fine needle aspiration cytology (FNAC). Methods: This 12-month prospective observational study was conducted at SKMCH in Muzaffarpur, Bihar, from July 2022 to June 2023. Total 42 cases of salivary gland lesions received for FNAC in the pathology department for the present study. Results: We included 42 cases of salivary gland lesions in the current investigation. Twelve (28.5%) of the 42 cases were neoplastic, while thirty (71.5%) were not. Out of 12 neoplastic cases, 8 (67%) were determined to be benign, and 4 (33%), to be malignant. The majority of malignant lesions (50%) are mucoepidermoid carcinoma, Carcinoma-ex pleomorphic adenoma, and Adenoid cystic carcinoma. Conclusion: The FNAC may be an effective pre-operative diagnostic method for SGs lesions given its excellent sensitivity, specificity, and diagnostic accuracy. In order to help with the planning of further care, this study emphasizes the diagnostic significance of FNAC in identifying benign from malignant tumors.

153. A Tertiary Hospital Based Study of the Clinical Profile, Outcome, and Prognostic Factors of Acute Kidney Injury
Aaruni Rahul, Shailesh Kumar
Abstract
Background: Acute kidney damage (AKI) is a significant factor in hospital mortality, particularly in patients who are critically unwell. Different clinical presentations are seen. To determine prospective areas for intervention, a thorough understanding of AKI is necessary. The course of renal disease can be stopped by early detection and treatment of AKI in a possibly reversible stage. These study objectives were to evaluate the clinical profile of acute kidney injury, including its etiologies, and to identify its prognostic factors and results. Methods: This observational study took place in a hospital. The study population was evaluated once the relevant inclusion and exclusion criteria had been applied. The clinical profile of AKI was evaluated, including the etiology, symptoms, indicators, and blood tests. AKI’s stage and result were identified. In an effort to better monitor patients with AKI, factors that influence AKI outcome were sought for. Using the chi square test and Kruskal Wallis tests, associations were identified. Results: The study population clinical profile was discovered to be comparable to prior research. The most frequent type of renal failure was intrinsic, and sepsis was the most frequent cause. A significant correlation between the result and eGFR, hospital days, and KDIGO stage of AKI was found. Poor outcome was linked to the need for hemodialysis, ventilator support, and inotropes. The 24 hour urine output, blood urea, and serum creatinine were the best predictive indicators. Conclusion: Any patient who is brought to the hospital should be kept on an input-output chart and have their urine output regularly watched for any changes. Hypotension and sepsis need to be treated right away. In the case of AKI, conservative treatment is the recommended course of action because, as with all diseases, prevention is always preferable than cure.

154. A Clinical Study of Colostomies in Infancy and Childhood
Ayush Kumar, Mohamad Ashraf Ali, Md. Mazharul Haque
Abstract
Background: The Greek term stoma, which means mouth or entrance, is where the name stoma comes from. An intestinal stoma is a surgically made aperture that joins the anterior abdominal wall with a portion of the gastro-intestinal tract. The usage of different colostomies can save lives. This clinical investigation was carried out because colostomies are frequently performed at our facility to treat a variety of problems in children. Methods: This clinical study was conducted in the Department of General Surgery at KMCH, Katihar, Bihar. The study was conducted during the period from January 2020 to June 2020. The patients aged day 1 to 12 years were admitted. Results: 33 pediatric colostomies were carried out during the duration of the six-month trial period. Males made up 17 (51.5%) while females made up 16 (48.5%). The majority of the patients were in the early neonatal stage at the time of the colostomy. At our hospital, colostomies were performed on a total of 22 (66.6%) cases, while just 11 (33.4%) patients had done so elsewhere. The majority of colostomy cases were of the sigmoid loop form, while 9 individuals (27.3%) had transverse loop colostomies. Twelve individuals (or 36.36%) had significant post-colostomy problems that required medical treatment. Conclusion: The child is a socio-psycho-biological unit, and having a colostomy causes both the child and parents significant psychological pain. The first step in diagnosis and treatment is a thorough examination. It is usually unavoidable and life-saving to have a properly indicated, properly created temporary stoma.

155. Analysis of Incidence, Etiology and Risk Factors Associated in Acute Burn Injury in Adults
Ayush Kumar, Mohamad Ashraf Ali, Md. Mazharul Haque
Abstract
Background: Due to the high rates of morbidity, disability, and mortality among young and middle-aged persons, burn injuries are a serious health concern. Social issues are also connected to burn damage. It could have unintentional, homicidal, or suicide reasons. There isn’t much study on burn injuries in India, despite the clinical and societal importance of burn injuries. Thus, we made an effort to draw attention to our findings in this study, which was conducted to determine the etiology of burns, their clinical characteristics, and the prognosis for burn patients treated at our Institute. Methods: From July 2020 to December 2020, this observational study of burn injury patients admitted to the surgery wards and burn ICU at Katihar Medical College & Hospital, Katihar, Bihar, was carried out. We examined 226 burn patients who were hospitalized to our institute’s general surgery units and burn ICU. Both sexes and burn patients over the age of 18 were included in the study. Results: Burn injuries were present in 226 patients in total. 64 women and 162 men, or a M:F ratio of 2.53:1.Compared to females, men (71.68%) were more commonly impacted. In this study, the majority of the burn victims were between the ages of 21 and 30.i.e.42.02%. Patients between the ages of 50 and 75 were less numerous. Regarding the causes, it is evident that the majority of instances occur during household tasks, with electricity accounting for the second-highest number of cases (26.99%). Suicidal thoughts are less common (3.53), and seven cases have an unclear etiology. Conclusion: Although preventing burn injuries is a very challenging endeavor, it is necessary to reduce the high morbidity and death that accompany a burn injury. We must take all necessary steps to limit its occurrence. The prevalence of burn injuries in India can only be reduced by social workers, medical and paramedical staff, and administrators taking a coordinated and committed approach.

156. A Functional Outcome Assessment of Distal Tibial Fractures Stabilized Using a Distal Tibial Locking Plate
Bimlendu Kumar, Mahesh Prasad, Rajeev Anand
Abstract
Background: After the femur, the tibia is the largest long bone in the skeleton. The tibia’s shaft is triangular in form and has enlarged ends. From the smaller distal end, a powerful medial malleolus protrudes distally. The tibia is now the long bone in the body that fractures most frequently. Tibial plafond/pilon fractures, which are serious wounds, are frequently used to characterize distal tibia fractures. In the current study, locking compression plates for the distal tibia in lower tibial fractures that were treated with open reduction internal fixation and a minimally invasive plate osteosynthesis approach are being evaluated. Methods: Patients with distal tibial fractures who attended the outpatient department (OPD) or emergency OPD at Patna Medical College and Hospital, Patna, Bihar between October 2020 and March 2021 were the subject of a prospective and retrospective study. The inclusion and exclusion criteria for the patients treated with locking compression plates using minimally invasive plate osteosynthesis (MIPO) or open reduction internal fixation (ORIF) are examined. Epi-info software was applied to collect and assess all of the data. Results: Out of 52 patients, 48.4% underwent open reduction internal fixation with outstanding results, while 28.6% underwent surgery using the MIPPO approach. The p value, which is 0.352, is not significant. 40.4% of patients had excellent outcomes overall. In our study, 1.9% of patients with type B and C fractures and 32.6% of patients with AO/OTA type A fractures obtained outstanding scores. This is explained by increased comminution and ankle joint involvement. 40.4% of patients scored excellent overall. The P value, which is 0.863, is not significant. Conclusions: We observed excellent/ good functional outcome in 65.3% of patients.

157. Comparison of Aescula and Tomofix Plate for Biplanar Open Wedge High Tibial Osteotomy in the Medial Compartment of Knee Arthritis
Bimlendu Kumar, Rajeev Anand, Mahesh Prasad
Abstract
Background: One of the treatments for unicompartmental osteoarthritis of the knee joint is high tibial osteotomy (HTO), which can be carried out using an open wedge, closed wedge, or dome osteotomy. Due to its exact angle correction, restoration of knee joint stability, and fibula preservation, open wedge HTO is currently widely used. This study compared the outcomes of biplanar open wedge high tibial osteotomies performed with Aescula and TomoFix plates in medial osteoarthritis of the knee joints with varus deformity. Methods: Biplanar open wedge high tibial osteotomies in 50 consecutive patients were retrospectively assessed. 25 instances were treated in Group A using the Aescula plate, and 25 cases were treated in Group T using the TomoFix plate. In groups A and T, full weight-bearing was permitted at 6 weeks and 2 weeks, respectively, following surgery. At the last follow-up, clinical assessments were carried out utilizing postoperative knee scores and functional scores. The postoperative mechanical femur-tibia angle, the change in posterior tibial slope angle, and implant-related problems were also examined on radiographs. In group A, the mean follow-up length was 30 months, while in group T, it was 26 months. Results: At the final follow-up, both groups’ knee and functional ratings had improved (p <0.05), but there had been no differences between the two groups (p > 0.05). 52% of group A and 84% of group T both received an acceptable correction angle (p = 0.015). The posterior tibial slope was better maintained in group T, as evidenced by the bigger change in posterior tibial slope angle in group A than in group T (p <0.001). Three screw loosening cases and four delayed union cases were found in group A. Seven cases (6 in group A and 1 in group T) also had persistent varus abnormalities. Conclusions: Compared to the Aescula spacer plate, firm fixation utilizing a TomoFix plate for open wedge high tibial osteotomy results in improved radiologic outcomes and a lower complication rate.

158. Risk Factors for Sinonasal Masses in Correlation with Their Clinical, Radiological, and Histopathological Diagnoses
Md. Ale Imran Ansari, Md. Ozair, Md. Shakir
Abstract
Background: Sinonasal masses are a spectrum of lesions that can be found in the sinonasal tract, spanning from non-neoplastic to neoplastic lesions. Despite sharing a similar clinical presentation, these lesions have very distinct histopathological diagnoses and require very different treatment plans and prognoses. Optimizing clinical treatment requires an understanding of the clinicopathological spectrum of these masses. The goal of the current research was to identify the risk factors for sinonasal masses in correlation with their clinical, radiological, and histopathological diagnoses. Methods: From August 2022 to July 2023, 120 patients of any age and sex who presented with sinonasal masses at the ENT department and pathology department of DMCH, Laheriasarai, Bihar, were randomly chosen for the current research. Routine haematological and biochemical testing, nasal endoscopy, x-ray paranasal sinuses/CT scan, and biopsy were performed on these patients. Hematoxylin and eosin stain was used to regularly process tissues for histopathological sections that were 5 microns thick. When necessary, special labelling with reticulin, von gieson, PAS, and masson’s strichrome was done. The information was collected, examined, and a reliable result was reached. Results: In the current research, 84 cases of inflammatory polyps were found to be the majority by histopathology. According to radiology, out of 120 cases, 86 (71.66%) had non-neoplastic conditions, 20 (16.66%) had benign conditions, and 14 (11.66%) had malignant conditions. The clinical diagnosis in all 120 patients was consistent with the radiologic Histopathological Examination (HPE) report, with the exception of 12 (10%) patients in whom a unilateral sinonasal mass was given a clinically inconclusive diagnosis. In the remaining 108 patients (90%) the clinical and HPE diagnoses were identical. All 12 patients had a clinically inconclusive diagnosis of a unilateral sinonasal mass, which was reported after HPE in 2 cases as an extramedullary plasmacytoma and in 4 cases as an esthesioneuroblastoma. There were also 2 cases of maxillary ameloblastoma, 2 cases of inverted papillomas, 2 cases of rhinoscleroma, and 4 cases of round cell tumours. Conclusion: A careful histopathological investigation (HPE) is required to determine the precise type of a lesion, according to a comparison of histopathological results with clinical findings. In order to provide the accurate diagnosis of the different conditions identified as a sinonasal mass, HPE of the removed tissue is required.

159. A Retrospective Study on Histopathological Spectrum of Testicular Lesions
Pawan Kumar Shah, Kiran Kumari, Chand Prakash Jaiswal
Abstract
Background: Both neoplastic and non-neoplastic diseases can affect the testis. Although they are uncommon, testicular neoplasms have been the focus of the majority of testis research in the past. Aim: Aims of our study to determine the histological range, age-wise distribution, laterality, and clinical manifestation of all testicular lesions (both neoplastic and non-neoplastic). Material and Methods: This was a one year retrospective study including all the testicular specimens referred to Department of Pathology, NMCH, Patna, Bihar from March 2022 to February 2023. Results: The study comprised a total of 57 cases. Non- neoplastic testicular lesions were more common than the neoplastic ones (93 vs. 7%). In the second decade of life, non-neoplastic lesions were most prevalent in people between the ages of 5 months and 80 years. The most frequent non-neoplastic lesions (n=53) were undescended testicles (39.62%), inflammatory lesions (24.53%), infarcted testicles (torsion, 18.86%), and atrophic testicles (16.98%). Non-specific epididymo-orchitis (15.1%), testicular abscess (5.66%), and tubercular epididymo-orchitis (3.77%) were among the inflammatory lesions. During the study period, there were only 4 diagnoses of testicular neoplasm (7%)—only 1.33 cases per year. With an age range of 14 months to 35 years and a mean age of 20.54 years, all 4 cases were germ cell neoplasms. Seminoma, yolk sac tumor, immature teratoma, and mixed germ cell tumor (teratoma and seminoma) were all diagnosed in one case each. All of the lesions were unilateral, and 58% of them were non-neoplastic. Testicular (scrotal/inguinoscrotal) edema was the most prevalent symptom in both neoplastic and non-neoplastic lesions (87%). Empty scrotum and soreness were the second-most frequent presenting complaints (36.84% and 36%, respectively). Additionally, fever was a history for the inflammatory lesions (22.8%). In contrast to western countries, no tumor was discovered in undescended testes. Conclusion: The majority of testicular lesions are benign, whereas neoplastic lesions are uncommon—most commonly, germ cell tumors. Neoplasms are typically observed in younger age groups, although non-neoplastic lesions are present in all age groups. Clinically, non-neoplastic lesions can resemble neoplastic ones; testicular enlargement is the most typical symptom. So that an appropriate diagnosis of testicular swellings may be made, histological examination is required. Our results align with those of the majority of studies.

160. A Study of Hematological Parameters in Dengue Positive Cases in a Tertiary Care Hospital
Priyali, Anita Sharan, Pradeep Mahindrakar
Abstract
Background: In tropical nations, dengue fever has been recognized for more than a century. Today, dengue fever is the most widespread arboviral disease in the world. Globally, the incidence of disease has increased along with the frequency of DF, DHF, and associated epidemics over the past 20 years. The clinical profile of dengue fever is unclear, and it must be distinguished from other febrile disorders such leptospirosis, typhoid, and malaria. Reverse transcription polymerase chain reaction (RT-PCR) and enzyme immunoassay and immunochromatographic testing are used to diagnose dengue and to find the NS1 antigen and matching IgM and IgG antibodies. In many hospitals, the serology for certain diagnoses is expensive and unavailable. So the hematological parameters like platelet count, hematocrit, leucocyte count, and peripheral smear findings will aid in the diagnosis of Dengue Fever. Methods: The study was carried out over duration of four months, from June 2015 to September 2015, at the pathology department of the D Y Patil Medical College in Navi Mumbai. The study comprised patients with verified NS1 positive. An automated hematology analyzer, the Horiba Pentra XLR, was used to get the hematological analysis, and subsequent peripheral smears were checked for the estimation of platelets and differential counts. Results: The adult age group, with a small male preponderance, had a higher prevalence of dengue infection. The majority of cases had hematological indicators such increased hematocrit, reduced platelet count, and abnormal lymphocytes. Conclusion: Early detection of dengue infection will be aided by elevated hematocrit, thrombocytopenia, leucopenia, and atypical lymphocytes on the peripheral smear. For a successful treatment of the disease, early detection and prevention of consequences are more important than treatment.

161. Study of Hematological Profile of Malaria Patients at a Tertiary Care Hospital
Priyali, Anita Sharan, Pradeep Mahindrakar
Abstract
Background: India is one of the developing countries where malaria is the most lethal and contagious illness. Mosquitoes serve as the primary transmission vectors for this illness, which is brought on by Plasmodium parasite species. In order to quickly diagnose malaria, hematological tests such as RBC, WBC, and platelet parameters, as well as peripheral blood testing that changes depending on parasitaemia, must be examined in diverse malaria-affected regions. Early identification and treatment can help prevent unpleasant malarial consequences. Methods: The current observational cross-sectional study was conducted to determine the hematological profile of malaria cases identified at D Y Patil Medical College in Navi Mumbai. With regard to clinical information, all patients with malaria who were sent to the Hematology department of the Department of Pathology were assessed. Data collection took place during a six-month period from October 2015 to March 2016. 50 cases of malaria were examined in total. On an EDTA blood sample, CBC/PBS testing was performed. The influence of malarial parasitaemia was investigated using the RBC parameters, WBC parameters, and platelet counts. The smear revealed a parasite index, and a fast kit test was used to confirm the diagnosis of malaria. The data was manually examined, and all the findings were entered into an MS-Excel sheet 2012. Results: In the current investigation, P. vivax-related malaria predominated. In the current study, patients between the ages of 15 and 30 were more severely impacted, i.e., younger people. There was a male predominance. In the current investigation, fever was the most typical presenting symptom, followed by chills and rigor. Hb, RBC count, and PCV values that were below normal levels indicated that anemia was the most prevalent hematological alteration in the current study. Red cell indices, such as MCV, MCH, MCHC, RDW, and peripheral blood smear, all showed values within the normal range, indicating normocytic, normochromic RBCs in the current study. In the current study, patients with malaria who developed leucopenia after having normal TLC were more prevalent. The most frequent hematological alteration identified in this investigation was thrombocytopenia. Conclusion: Measureable blood indicators known as hematological parameters are used to diagnose malaria.

162. Study of Anemia Pattern and its Correlation with Hematological Parameters in a Tertiary Care Centre
Priyali, Anita Sharan, Pradeep Mahindrakar
Abstract
Background: Low levels of hemoglobin (Hb) and insufficient capacity to carry enough oxygen for the body’s physiological requirements are characteristics of anemia. The aim of the present study was to examine the hematological markers of anemia in a tertiary care setting. Methods: The current investigation was a cross-sectional observational study that involved patients with hemoglobin levels less than 11 g/dl who were between the ages of 18 and 60 and might be male or female. Samples were processed at the central clinical laboratory at our hospital. All samples were run via a hematological analyzer and a peripheral blood smear examination. Results: 926 of the 2366 samples evaluated for the current investigation were eligible for analysis. The majority (55.51%) of people were women, aged 51 to 60 (35.85%). According to anemia severity, the majority had mild anemia (9.1–11 gm%), which was followed by moderate anemia (7.1–9 gm%) and severe anemia (7 gm%) (12.31%). Based on the results of the peripheral smear test, anemia was typed. Less frequent forms included macrocytic (9.61%), dimorphic (5.94%), hemolytic (3.13%), and pancytopenia (0.54%), whereas microcytic hypochromic (53.24%) and normocytic normochromic (27.54%) were the most prevalent. On the basis of the histogram and red cell indices, anemia was typed. Less frequent forms included macrocytic (9.83%), dimorphic (7.24%), hemolytic (2.38%), and pancytopenia (0.43%). The most prevalent types were microcytic hypochromic (57.24%) and normocytic normochromic (22.89%). Red cell indices and peripheral smear results were examined to determine the anemia pattern; neither group showed statistically significant differences. Conclusion: Red cell indices should be used as a screening technique to identify problematic samples, then a peripheral smear test should be performed for a definitive diagnosis.

163. A Case Control Study of Investigating the Relationship between Vitamin D Level and Polycystic Ovarian Syndrome
Rajshri Kumari, Puja Mahaseth
Abstract
Background: Patients with polycystic ovarian syndrome (PCOS) typically experience vitamin D insufficiency, which has been demonstrated to have a variety of negative impacts on the illness process. The purpose of this study is to compare vitamin D levels in the PCOS and control groups. Aim to examine the relationship between PCOS women’s serum 25(OH)D levels and metabolic risk factors. Methods: 49 women with PCOS were selected as cases, while 49 individuals without the condition served as controls. Age, BMI, menstrual cycle, and clinical traits including hirsuitism and acne were documented for the patients and controls, respectively. Measurements were made of the metabolic indicators and serum 25(OH)D. The primary result was the variation in vitamin D status between cases and controls, and the secondary results were correlations between serum 25(OH)D levels and metabolic risk variables in PCOS-affected women. Results: When compared to controls, patients had significantly reduced vitamin D levels (P <0.05). In cases, there was a substantially higher prevalence of IR in the Vitamin D insufficiency group (P <0.05), but not for BMI or fasting insulin. Additionally, the frequency of obesity and an abnormal lipid profile was not noticeably higher in the PCOS patients with vitamin D deficiency. Conclusion: Vitamin D deficiency is common, especially in PCOS women with IR and metabolic risk factors like HDL-C. For PCOS women, larger sample sizes are required to investigate the association with other metabolic risk factors.

164. Cerebro Placental Ratio at 30–34 Weeks’ Gestation in the Prediction of Perinatal Outcome in Low-Risk and High-Risk Pregnancy
Rajshri Kumari, Prashanta Krishna Gupta
Abstract
Background: Doppler ultrasonography velocimetry of the fetal and umbilical veins is a well-established technique for prenatal monitoring that enables non-invasive evaluation of the neonatal circulatory system. The CPR is becoming a crucial indicator of a poor pregnancy outcome. Therefore, the purpose of this study is to determine whether CPR is effective in evaluating perinatal outcome and whether it should be used as a tool for assessing fetuses having third-trimester Doppler examination. The purpose of this study is to assess CPR in early severe fetal growth restriction and late moderate fetal growth restriction and to predict perinatal outcome in low risk and high risk pregnancies in late onset FGR. Methods: 82 pregnant women between 30 and 34 weeks of gestation made up the study group. They had an ultrasound Doppler evaluation, as well as other standard tests and CPR calculations. Fetal outcome was recorded after monitoring the women up until delivery and classifying them into high-risk and low-risk pregnancies. Results: When compared to low risk patients, the period of extension was noticeably shorter with high risk patients. When compared to low risk patients, high risk patients had a considerably higher rate of NIUC hospitalizations. When compared to high risk patients, low risk patients had a much higher percentage of vaginal deliveries. Individuals with faulty CPR have considerably smaller gestational periods, birth weights, and prolonging periods than individuals with normal CPR. Conclusion: For high risk cases and late onset (beyond 32 weeks) moderate FGR, Doppler velocimetry becomes a crucial technique. CPR can help predict peripartum fetal distress and is helpful in high-risk pregnancies.

165. Lateral Internal Spincterotomy for Chronic Fissure in ANO-Comparative Study between Spinal Anaesthesia Vs Local Anaesthesia
Sunil Kumar Ranjan, Brajesh Kumar, Khursid Alam
Abstract
Background: Anal fissure instances, when patients present with hematochezia and acute, painful anal spasm lasting for many hours following bowel movement, are frequently seen in normal clinical practise. Traditionally, if medical therapy fails, lateral sphincterotomy under spinal anaesthetic is the preferred surgery. There have only recently been a few attempts to conduct lateral sphincterotomies under local anaesthetic in an outpatient setting. This study will compare open lateral anal sphincterotomy under local anaesthetic to spinal anaesthesia in order to compare post-operative pain, typical hospital stays, and cost effectiveness. Methods: Applying the following inclusion and exclusion criteria, patients admitted to the surgical wards of the Govt. Medical College and Hospital, Bettiah, Bihar, who have been identified as cases of chronic fissure in ANO through clinical history and per rectal examination, are included in this study. The study, which had 90 instances, was carried out from May 2022 to April 2023. The cases were randomly assigned to Group A (local) and Group B (spinal) groups. Each chosen patient’s pertinent information is gathered using a pre-structured pro forma. SPSS software is used to examine the data, which are tabulated in an Excel sheet. Results: Both spinal anaesthetic and local infiltration are options when performing LIS. However, a patient from LA spends less time in the hospital and pays less money than a patient from SA. Early post-operative pain scores are higher in the LA group; however there is no difference at 5 hours or on post-operative day 1. In the LA group, patients are more satisfied than surgeons, who are equally satisfied in both groups. Conclusion: Under local anaesthesia, LIS can be performed effectively and safely as a day-care procedure and offers an alternative to SA, which is advantageous in terms of a shorter hospital stay and lower cost.

166. Effectiveness of the Lateral Closing Wedge (LCW) Osteotomy Fixed with a Reconstruction Plate as a Treatment Approach for Cubitus Varus
Sandeep Garg, Nitesh Meena, Khushwant Singh Rathore
Abstract
Background: Most common long-term issue associated with pediatric supracondylar humerus fractures is cubitus varus deformity. While cubitus varus is often seen as a cosmetic concern, it can also lead to posterolateral instability, an increased risk of subsequent fractures, tardy ulnar nerve palsy, and a snapping elbow.Various surgical methods, osteotomy configurations, and fixation techniques have been detailed in the literature. In our opinion, the lateral closing wedge (LCW) osteotomy, fixed with a reconstruction plate, yields the best results and is often sufficient for the treatment of most cubitus varus cases. Plate fixation facilitates early rehabilitation, with elbow mobilization starting as early as the second day post-surgery. Objectives: Evaluating the effectiveness of the lateral closing wedge (LCW) osteotomy fixed with a reconstruction plate as a treatment approach for cubitus varus, aiming to enable early rehabilitation. Methods: In a study at NIMS Hospital, Jaipur, from June 2017 to December 2021, 19 children (both genders) with cubitus varus deformity, aged 9 to 14 years (average age: 11.5 years), underwent Lateral closing wedge (LCW) osteotomy with reconstruction plate fixation after comprehensive pre-operative assessments. Post-surgery, X-rays determined the carrying angle. Follow-up after bone union included assessment of clinical, functional, and radiological outcomes. Results: Mean follow-up: 2.5 years (range: 15 months to 3.5 years). Broberg and Morrey rating system assessed the results: 17 excellent, 2 good, 89% had improved or maintained motion. All patients achieved union within 8 weeks. Conclusion: Lateral closing wedge osteotomy effectively corrects deformities; proper stabilization reduces complications and aids early rehabilitation.

167. Outcome of 0.5% Ropivacaine Versus 0.25% Ropivacaine in USG Guided Transverse Abdominis Plane Block for Post-Operative Pain Relief in Below Umbilical Surgeries
Arun Pandey, Chandra Shekhar Singh, Neha Mishra, Manoj Kumar Chaurasiya
Abstract
Background: After any surgery, pain is the most dreaded issue by an individual. The transverse abdominis plane (TAP) nerve block has recently become more popular for two reasons: the use of ultrasound to improve block placement and the desire to reduce the need for perioperative narcotics. Considering that postoperative pain following a cesarean section primarily arises from the abdominal incision, we hypothesized that incorporating a Transversus Abdominis Plane (TAP) block as part of a multimodal analgesic approach would effectively diminish the requirement for supplementary analgesics during 48 hrs after surgery (primary outcome), severity of pain and prolong the demand for first analgesic and improve patient satisfaction during postoperative period (secondary outcome).In this study we are comparing outcome of ropivacaine of 0.25% and 0.5% in USG guided TAP block for post op pain relief in below umbilicus surgeries. Methods: A prospective Randomized Open Label study was conducted in 60 patients of ASA class 1 & 2 of either sex of more than 18 yrs age in GSVM medical college, Kanpur from January to October 2021. They were randomly divided into two groups of 30 each in which first group received 0.50% of ropivacaine for TAP block and 2nd group received 0.25% of ropivacaine. This study was approved by the Ethical Committee of the Faculty of GSVM medical college, with approval number EC/361/Nov/2022. Results: In our study, duration of post-op pain relief in group 1 using 0.50% ropivacaine is more as compared to group 2. There is no statistically significant difference of quality of analgesia between two groups. In comparison of parameters (systolic and diastolic blood pressure, heart rate, respiratory rate, SpO2) between two group before and after giving TAP block only systolic blood pressure shows statistically significant difference (<0.05%). Conclusion: We hereby concluded with the help of this study and available literature that in USG guided TAP block for postop pain relief in below umbilical surgeries 0.50% ropivacaine is better than 0.25% ropivacaine.

168. Comparative Evaluation of Pap Smear and Colposcopy for Cervical Cancer Screening: A Tertiary Care Study in North India
Archana Agarwal, Ritika Agarwal
Abstract
Background: Cervical cancer is a major global health challenge, particularly in developing regions. Early detection through effective screening is essential for reducing its prevalence and mortality. The Pap smear test, a widely used screening tool, has inherent limitations such as sensitivity and specificity concerns. Colposcopy, which offers a closer examination and guided biopsy, complements Pap smears. However, its accessibility and operator dependence vary. Histopathological examination, the gold standard, delivers detailed information but is invasive and may involve delays in results. Evaluating these screening methods is crucial for optimizing cervical cancer screening strategies, especially in diverse healthcare settings. This study aims to provide a comprehensive assessment of Pap smear cytology and colposcopy compared to cervical biopsy/histopathology as the reference standard for cervical carcinoma and precancerous lesions detection. Methods: This cross-sectional comparative study was conducted over two years from July 2021 to June 2023 at a North Indian tertiary care hospital after obtaining ethical approval from the Institutional Review Board, adhering to the Declaration of Helsinki. The study included 143 women aged 18-55 years, focusing on high-risk clinical presentations related to cervical abnormalities. Data collected covered demographics, clinical history, and physical examinations. Statistical analysis, including sensitivity, and specificity, was performed using SPSS version 20.0 with a significance threshold of p < 0.05. Results: The study included 143 women aged 18-55 years with high-risk clinical indications. Pap smear cytology demonstrated an overall positivity rate of 58.04%, with ASCUS (15.38%) and LSIL (19.58%) being the most common abnormalities. Colposcopy showed a higher positivity rate of 70.63%, with abnormal findings including inflammation (9.79%) and LSIL (14.00%). Histopathological examination confirmed cervical abnormalities in 69.23% of cases, with LSIL (16.78%) and HSIL (13.29%) being the most frequent. Sensitivity and specificity for Pap smear were 56.52% and 71.62%, respectively. For colposcopy, sensitivity and specificity were 98.55% and 82.43%, respectively. Conclusion: A combination of both techniques could enhance early detection and intervention, thereby reducing the burden of cervical cancer in this region. As cervical cancer remains a significant public health issue in this region, the results of this study may contribute to the development of more effective cervical cancer screening programs and policies.

169. Ultrasound Guided Pericapsular Nerve Group Block for Analgesia during Positioning for Spinal Anaesthesia and Postoperative Period in Adult Patients Undergoing Hip Fracture Surgeries
Roopal R Garaniya, Kamala H Mehta, Devyani D Solanki, Bhaumik J Patel, Meet K Joshi, Patel Mihirkumar Atulbhai, Nirti V. Patel
Abstract
Backgrounds: Spinal anaesthesia is a preferred mode of anaesthesia for hip fracture surgeries. Various analgesic technique was used to relieve pain during positioning for spinal anaesthesia, pericapsular nerve group block (PENG) is a relatively newer technique. Articulate branches of anterior hip capsule, which is the main target for analgesia, can be block with PENG technique. So, we conducted this study to evaluate the clinical effect of PENG block for analgesia during positioning for spinal anaesthesia and postoperative period. Methods: Sixty patients ≥18 years with ASA I-III posted for hip fracture surgeries were randomly divided into two groups; patients in Group P received PENG block while in Group C received conventional analgesia. Intra and post operative VAS score, patient acceptance for positioning, anaesthetist satisfaction providing spinal anaesthesia and associated side effects were compared in both groups. Results: VAS score 10 minutes after performing the block and during positioning for spinal anaesthesia were significantly lower in Group P (1.5±0.44) compare to Group C (7±0.46). Anaesthetist providing spinal anaesthesia had satisfactory level of good or optimal in 27/30 patients in Group P while in Group C it was only 3/30 patients (p < 0.00001) . Patients ‘acceptance for poisoning was higher in group P (27/3 versus 20/10). Postoperative VAS score in both the Group were comparable. Conclusion: PENG block is easy to perform, motor sparing, effective for positioning during spinal anaesthesia without any complication with better anaesthetist and patients’ satisfaction.

170. Application of SEPTA Block in Performing Surgeries Done for Benign Anorectal Pathologies in Comorbid Patients: A Prospective Observational Study
Shwetabh Pradhan, Prakhar Nagar, Sophiya
Abstract
Objectives: The present study was conducted to apply SEPTA technique for the conduction of surgeries done for benign Anorectal pathologies in comorbid patients. Methods: SEPTA (Simplified Easily reproducible Pudendal nerve block Technique for Anorectal surgery) block  was applied for the surgeries done for benign anorectal pathology. In the SEPTA technique, the anaesthetic solution was simply injected into the centre of the ischioanal fossa from where it percolates down to the pudendal neurovascular bundles. Hemorrrhoidectomy was done for hemorrhoid patients. Lateral anal internal sphincterotomy was done for fissure patients. Fistulotomy was done for uncomplicated low lying anal fistula patients. Results: Anorectal surgeries were done for 50 patients of benign anorectal pathology by the application of SEPTA technique. Among them 30 patients were males and 20 patients were females. Most of the patients 27(54%) were in age group of 40-50 years. Mean age of patients was 45.23±9.43 years. Most of the patients had hemorrhoids 30(60%), 10(20%) patients had low-lying uncomplicated anal fistula and 10(20%) had fissure in ano. No conversion to spinal anesthesia was required in any of the patients. There was no significant complications and pain seen in the intraoperative as well as post operative periods. Conclusions:  SEPTA technique applied in the surgeries done for benign anorectal pathologies obviates the need of giving spinal anaesthesia and at the same time, allows safe and  painless surgery in  those patients who are otherwise deemed unfit because of comorbidities like heart disease, diabetes and hypertension. Hence SEPTA technique is a good alternative to spinal anaesthesia in anorectal surgeries done for benign anorectal pathologies in comorbid patients.

171. Clinical Profile and Biochemical Abnormalities in Tumour Lysis Syndrome Secondary to Adult Haematolymphoid Malignancies
Pankaj Khobragade, Darpan P. Jakkal, P.S.Jirvankar, Kailas N.Chintale
Abstract
Introduction: Tumour lysis syndrome (TLS) is a metabolic complication that may follow the initiation of cancer therapy. It is characterized by a metabolic abnormality including hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia which occurs due to rapid lysis of tumour cells and leads to severe renal impairment, cardiac arrhythmia, or seizure and death. It is one of the oncologic emergency encounters in patients with haematological and other malignancies which cause death. Spontaneous TLS is a rare occurrence, but it may result in more severe clinical outcomes because of the lack of benefit of pre-treatment. Drugs used for the treatment of Tumor lysis syndrome are allopurinol, rasburicase and supportive care. In patients with acute renal failure patients needs Hemodialysis with intensive care management. Material and Methods: This was a cross sectional, observational and Descriptive study conducted in tertiary care centre & teaching institute during the period from December 2019 to December 2021. Total 50 patients of Adult Hematolymhooid Malignancies with diagnosis of Tumour Lysis syndrome as per Guidelines were included in this study after satisfying inclusion and exclusion criteria. Results: The Mean ± SD of study population was 42.32 ± 18.93 years. Among all cases males were 54% and females were 46%. On distributing cases according to diagnosis of TLS, most cases were of B- ALL (32%) followed by T-ALL (24%), Burkitt’s lymphoma (14%), DLBCL (14%) and CML, MM, AML, CLL 4% each. In the present study Tumor lysis patients were presented with or without signs and symptoms, few cases were presented with the following symptoms, Fatigue (6%), oliguria (10%), nausea and vomiting(6%), altered sensorium(4%),anorexia (4%) and seizures(2% ). In the biochemical abnormalities LDH level was seen to be raised, more than 280 U/L in 86% cases showing significant association with Diagnosis of TLS (P value of 0.0142) Uric acid level was significantly raised in all cases i.e. more than 7 mg/dl. Serum creatinine was found to be raised (> 1.2 mg/dl) in 66% cases. Serum calcium level was seen significantly low < 8.6 mg/dl in 61% cases with P value of 0.0252. No significant association was seen in serum phosphate level and diagnosis of TLS in this study (p value of 0.2091). Serum potassium level and Diagnosis of TLS has shown significant association with p value 0.0361. Conclusion: Tumour lysis syndrome is a common and life-threatening event in patients with haematological malignancy undertaking chemotherapy. The incidence is increasing because of more effective cancer treatments and needs due attention in these malignancies. The early recognition and treatment of metabolic abnormalities usually prevents the severe and life-threatening complications associated with tumour lysis syndrome.

172. Study on Surgical Management in Dynamic Small Bowel Obstruction in Adult
Anshul Meena, Seema Meena, Surendra Kumar, Radheshyam Meena, Nihir Gupta
Abstract
Background: Intestinal obstruction is reported in ancient literature and is defined as, “Interference in the passage of food, liquids and contents of the intestine either due to mechanical or neurological cause”. There are various etiologies for acute intestinal obstruction from more common causes like adhesions, hernia, malignancy to uncommon conditions like intussusception. The classical presentation is pain abdomen, vomiting, constipation and distension of abdomen, it needs a complete understanding of surgical anatomy, pathophysiology, symptoms and signs of obstruction and necessary investigations for diagnosis. Materials and Methods: study was conducted for small bowel obstruction from 2020 to 2022. On 50 no of patient for requiring surgical intervention based on Cause, Anatomical & pathological nature, Age related factors, Mode of presentation, Investigation modalities, Surgical procedure done and Outcome after surgery and complications. Results: In the present study the most common cause being adhesions & bands followed by hernia and In this study 56% of the cases belongs to 31-50 years age group, there are 25 male and 25 females. Male and female are in equal ratio. Conclusion: Intestinal obstruction an important surgical emergency. demand vigorous correction of fluid and electrolyte Adhesions and bands are the common cause to produce intestinal obstruction. imaging techniques helped in early diagnosis and hence improved health care. Patients with intestinal obstruction due to adhesions and band are more likely to develop postoperative complications. Early operation is mandatory to avoid the development of peritonitis and systemic sepsis associated with multi-system organ failure.

173. Examining the Relationship Between HbA1c Levels and the Occurrence of Diabetic Retinopathy in Patients with Type 2 Diabetes: A Cross-Sectional Observational Study in a Hospital Setting
Riazul Hoque Ahmed, Bharati Devi, Kalpana Chetia, Usha Rani Pegu, Tapan Gogoi
Abstract
Diabetic retinopathy remains a significant cause of vision impairment among individuals with type 2 diabetes mellitus. This cross-sectional hospital-based observational study aims to investigate the correlation between HbA1c levels and the prevalence of diabetic retinopathy in a cohort of type 2 diabetes patients. The study included 40 patients, who underwent HbA1c measurements and retinal examinations. The results of the study demonstrated a clear association between elevated HbA1c levels and the presence of diabetic retinopathy. Patients with higher HbA1c values exhibited a greater likelihood of developing retinopathy, highlighting the importance of glycemic control in managing diabetic complications. Subgroup analyses were conducted to assess other potential risk factors, such as the duration of diabetes, blood pressure, and lipid profiles. The findings underscore the significance of routine HbA1c monitoring as a valuable tool in assessing the risk of diabetic retinopathy in type 2 diabetes patients. This research contributes to a better understanding of the relationship between glycemic control and retinopathy, offering insights that could guide clinical practice and improve the prevention and management of diabetic complications in this patient population. Further longitudinal studies may be warranted to confirm these findings and investigate the potential benefits of early intervention in high-risk individuals. Materials and Methods: This study involved a total of 80 participants, comprising two distinct groups: 40 patients diagnosed with type 2 diabetes mellitus (T2DM) and concurrent retinopathy, and 40 patients with T2DM but without retinopathy. All patients are subjected to the detailed history taking, ocular examination and investigations like FBS, PPBS and HBA1C estimation. Result: Among the 40 patients diagnosed with diabetic retinopathy, the group with proliferative diabetic retinopathy demonstrated the lowest level of glycemic control, with a mean glycated hemoglobin (HbA1c) value of 11.47 ± 2.21. Statistical analysis using a one-way analysis of variance (ANOVA) revealed a highly significant result, with a p-value of less than 0.001. This underscores a strong and statistically significant association between the severity of diabetic retinopathy and glycemic control, particularly in the context of proliferative diabetic retinopathy. Conclusion: This study has unveiled a compelling association between glycemic control and the severity of diabetic retinopathy in a cohort of 40 diabetic retinopathy patients. Notably, among these patients, those afflicted with proliferative diabetic retinopathy exhibited the poorest glycemic control, as reflected by their markedly elevated mean glycated hemoglobin (HbA1c) level of 11.47 ± 2.21.

174. Mild COVID: Our Experience So Far
Tanushree Maitra, Subhajit Mitra
Abstract
The novel corona virus is the causative agent of covid 19 which has led to a huge loss of lives and resources throughout the world including India. The study was conducted to analyse the clinical profile of patients with asymptomatic / mild COVID-19 admitted in the Covid Emergency Ward of Gauhati Medical College and Hospital during the period of 1st January 2021- 31st December 2021. The mean age of the study population was 46.4 years with a male to female ratio of 1.22:1. 51.8% patients were from urban areas and among the symptomatic patients, fever was the most common presenting symptom. 34.75% patients had associated comorbidities and 1.66%patients succumbed to the illness.

175. A Cross-Sectional Comparative Study on the Basis of Signs of Nutritional Deficiency of Anganwadi Children of Urban, Rural and Tribal Area of Udaipur District
Baranda Brijesh Kumar, Vijay Kumar Meena, Rakesh Meena, Abhishek Bhagora, Ankit Bhagora
Abstract
Background: Micronutrients such as vitamins and minerals are required in small amounts which is essentials to our health, development and growth. As tiny the amounts are, the consequences of their absence are severe. Micronutrients such as iodine, vitamin A and iron are the most important for global public health; their deficiencies represent a major threat to the health and development specially for children and pregnant women in developing countries. Methodology: Facility based cross sectional study was carried outto compare the status of signs and symptoms of micronutrient deficiencies among children attending Anganwadi centers in urban, rural and tribal areas of Udaipur district through two stage sampling technique. Result: 95.4% urban respondents had normal eyes followed by rural (78.8%) and tribal (60.8%). Most common sign was pale conjunctiva and dry conjunctiva, and these were maximum in tribal children as 19.3% and 18.3% respectively. Chielosis was most common (13.8%) sign of undernutrition followed by dental carries (13.1%). Pale tongue, angular stomatitis and dental carries were more common in tribal children.

176. Community-Based Assessment of Exclusive Breastfeeding Practices among Lactating Mothers in Rajasthan
Awadhesh Kumar, Vipin Raj, Bhumika Bhatt, Amol Gite, Devendra Kumar
Abstract
Background: Micronutrients such as vitamins and minerals are required in small amounts which is essentials to our health, development and growth. As tiny the amounts are, the consequences of their absence are severe. Micronutrients such as iodine, vitamin A and iron are the most important for global public health; their deficiencies represent a major threat to the health and development specially for children and pregnant women in developing countries. Methodology: Facility based cross sectional study was carried outto compare the status of signs and symptoms of micronutrient deficiencies among children attending Anganwadi centers in urban, rural and tribal areas of Udaipur district through two stage sampling technique. Result: 95.4% urban respondents had normal eyes followed by rural (78.8%) and tribal (60.8%). Most common sign was pale conjunctiva and dry conjunctiva, and these were maximum in tribal children as 19.3% and 18.3% respectively. Chielosis was most common (13.8%) sign of undernutrition followed by dental carries (13.1%). Pale tongue, angular stomatitis and dental carries were more common in tribal children.

177. Effect of Yoga on Clinical, Biochemical and Doppler Parameters in Infertile Women with Polycystic Ovarian Syndrome
Kumari Jyoti, Bindu Bajaj, Sheeba Marwah
Abstract
Background: Polycystic Ovarian syndrome (PCOS) is one of the common endocrine disorders in women with a prevalence range of 2.2% to 26% in India. It is thought to have a complex etiology involving gonadotrophic dysregulation, genetic predisposition and environmental variables. These women can present with varying symptoms such as infertility, menstrual irregularities, hirsutism, acne, polycystic appearing ovaries, and insulin resistance. When it comes to infertility with PCOS, Lifestyle intervention is the first line treatment. There is role of Yoga on the various parameters in infertile women with PCOS. Objectives: To determine the effect of Yoga on clinical, biochemical and Doppler parameters in infertile women with polycystic ovarian syndrome. Study Design: A Randomized Comparative study was conducted over a period of 3 months in infertility clinic at Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, where in first consecutive 50 infertile women fulfilling the Rotterdam Criteria of PCOS were enrolled after taking ethical permission and written informed consent of each participant. They (along with their partners) were evaluated, subjected to baseline investigations and further managed as per routine standard hospital protocol. The study participants were then divided into two groups-Group A undergoing lifestyle modification with dietary changes and exercises, whereas Group B had the same, with additional well-structured Yoga sessions of 45 minutes, thrice a week including Asanas (yoga poses), Pranayama (proper breathing), Shavasana, and Meditation. After 3 months reevaluation was done by repeating biochemical investigations, hormonal levels and Doppler parameters by transvaginal ultrasound. Data of two groups that was not normally distributed was compared using non-Parametric tests (Wilcoxon-Mann-Whitney Test) at each of the time points. Normally distributed data was contrasted with “independent sample t-test” or “One-Way ANOVA”. The groups were compared with Chi-squared test in case of categorical information. Pearson’s Correlation was conducted to explore linear correlation between two variables (in case of normal distribution of data) and Spearman’s correlation was performed (when data is not normally distributed). Results: Significant improvement in glucose tolerance was observed in Group B, even though no change in body weight was noted. Although decrease in testosterone levels (p = 0.821) and DHEAS levels (p = 0.434) were witnessed, these were not statistically significant. Also, significant differences in Uterine artery Pulsatility index (p = <0.001) and Resistance index (p = 0.004) were detected in Group B, even though the mean Uterine Artery PSV remained unchanged over time (p = 0.262). Conclusion: The effect of Yoga on infertile woman with PCOS alters the biochemical and hormonal profile favourably, besides improving blood flow in uterine artery of such women.

178. Ultrasound Biomicroscopy Image Patterns in Normal Upper Eyelid Vs Congenital Ptosis in Indian Population: A Retrospective Study
Santosh Kumar Singh, Pummy Roy
Abstract
Background: Drooping of the upper eyelid from birth, a condition known as congenital ptosis, is challenging to diagnose and cure. Ultrasound biomicroscopy (UBM) provides a high-resolution imaging technique when evaluating the upper eyelids for structural differences. This research intends to compare the UBM image patterns of individuals born with congenital ptosis to those born with normal upper eyelids in the Indian community. Methods: From October 2020 through May 2021, the Jawaharlal Nehru Medical College and Hospital in Bhagalpur, Bihar, ran a retrospective analysis. On 120 people (60 with normal upper eyelids and 60 with congenital ptosis), UBM imaging was used to assess levator muscle thickness, aponeurosis integrity, and other soft tissue features. Research from UBM was compared using statistical methods. Results: The levator muscles of those with congenital ptosis were substantially thinner (1.45 ±0.27 mm) than those of people with normal upper eyelids (2.18 ± 0.32 mm, p <0.001). 53.3% of congenital ptosis cases showed evidence of aponeurosis disruption (p <0.001). Congenital ptosis soft tissue analyses saw more significant hypoechoic regions and worse echogenicity grades (p <0.001). Conclusion: Understanding the anatomical peculiarities of congenital ptosis in the Indian population is greatly aided by UBM imaging. There was a decrease in levator muscle thickness, disruption of the aponeurosis, and other changes in the soft tissues. Ptosis management may be enhanced by using UBM, as suggested by our results, which have practical implications for precise diagnosis and therapy planning.

179. Effectiveness of Cervical Epidural Steroid Injection for Management of Non-Operative Cervical Pain
Divyanshu Goyal, Mehul Srivastava, Arpita Das, Kshitiz Apoorva Nigam
Abstract
Background & Methods: The aim of the study is to study the effectiveness of Cervical epidural steroid injection for management of non-operative cervical pain. The cervical interlaminar epidural injections in managing chronic neck and upper extremity pain were reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria. Results: The chi-square statistic is 21.4178. The p-value is 0.000086. The result is significant at p < 0.05. The chi-square statistic is 0.0734. The p-value is 0.963945. The result is not significant at p < 0.05. Conclusion: The evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids, fair with local anesthetic only; whereas, it is fair for local anesthetics with or without steroids, for axial or discogenic pain, pain of central spinal stenosis, and pain of post-surgery syndrome. Lower costs are related to the fewer missed work-days in the short term following ESIs.

180. Evaluation of Extracranial Complications of Chronic Suppurative Otitis Media (CSOM) and Their Management: A Retrospective Study
Vyankatesh Ganesh Polawar, Ashok Bhimrao Garje, Ninad Gaikwad
Abstract
Background: To study clinical profile and management of extracranial complications of chronic suppurative otitis media (CSOM). Methods: The present Retrospective study was conducted in the Department of ENT, of Tertiary Health care Hospital during the period of one and half years. All patients of CSOM (Age More than 18 years and both sexes) clinically diagnosed with extracranial complications and diagnosis confirmed by CT scan and willing to give consent were included. Results: The postaural abscess was the commonest complication followed by labyrinthine fistula and mastoiditis. The lateral semi-circular canal was the most commonly involved in labrynthine fistula. The most common age group with complications was 21-30 years. Males were more commonly affected than females (Male: Female =1.5:1). The commonest symptoms were otorrhea and decreased hearing, which were seen in all cases. The duration of ear discharge is not associated with the number of complications. The otoscopic findings of the tympanic membrane were central perforation (36.67%), attic perforation (36.67%), posterosuperior retraction pocket (23.33%), cholesteatoma (26.67%) and granulations (13.33%). The bacterial flora study showed pseudomonas aeruginosa as the commonest organism cultured from ear discharge followed by staphylococcus aureus. The pathology found most common was cholesteatoma followed by both cholesteatoma and granulations. Intraoperative, the ossicle that was found necrosed in most of our cases was the incus. Conclusion: The extra-cranial complications of chronic suppurative otitis media pose a great challenge to the otolaryngologist despite its declining incidence. The postaural abscess was the commonest complication with most common age group 21-30 years with male preponderance. The canal wall down mastoidectomy is preferred treatment. Early diagnosis and prompt surgical intervention are most important for the decreased morbidity and mortality of these patients.

181. Dry Eye Disease among the Staff of the Department of Radiology: A Cross-Sectional Study
Soumi Mallick, Sankha Subhra Chaudhuri, Purban Ganguly, Soumyadeep Majumdar
Abstract
Background: Dry eye disease is one of the common ocular surface disorders and is sometimes asymptomatic. Radiologists are one of the most vulnerable among medical professionals due to heavy computer work in the air-conditioning room. Different clinical and laboratory tests are there to evaluate dry eye disease and ocular surface abnormalities. Measurement of ocular surface disorder burden among the staff of the Radiology department and early intervention can reduce the morbidity. Methodology: The staff (doctors and technicians) of the Radiology department and the same number of control population were taken from the refraction clinic of the Ophthalmology department after applying inclusion and exclusion criteria. After history taking and thorough general and ophthalmological evaluation, the Schirmer test (Schirmer’s test I) has been done to measure basal plus reflex secretion. Tear film breaks up time (T-BUT) measurement and Rose Bengal Staining (RBS score) gradation have been done in each eye. After that Conjunctival Impression Cytology (CIC) specimen was collected using cellulose acetate paper. Then the cytology grading was done in the departmental laboratory. All the data collected before and after the investigational work-up are statistically evaluated and analysed. Results and Analysis: In this cross-sectional study in a tertiary care hospital in West Bengal, the mean age of the Radiology staff group is 50.83 years (+/- 9.268) and the control group is 48.95 years (+/- 7.575). Both groups are comparable in respect to age and gender. Schirmer test in the right eye and RBS scoring in both eyes have shown statistically significant differences) between the groups. Though TBUT values and CIC grading have not shown statistically significant differences between the two groups (p>0.05), they are suggestive of dry eye disease in the Radiology staff group. Schirmer test values have shown a negative correlation with TBUT values a but negative correlation with RBS score, CIC grading in both the eyes in the Radiology staff group, which is also suggestive of dry eye disease. Conclusion: The incidence of dry eye and abnormal ocular surface among the asymptomatic staff of the Radiology department is comparatively high compared to the age-gender matched controls. Early diagnosis and treatment are highly recommended.

182. Serum Levels of Antioxidants Micronutrients in Pregnant Women & Their Neonates: A Prospective Observational Study
Chitra Uppadhyay, Mahesh Bairwa, Shyam Sunder Mittal, Meeta Sharma
Abstract
Introduction: Pregnancy is associated with numerous biological & hormonal changes. An imbalance between the antioxidant agents and oxidative stresses may lead to pregnancy-associated complications. Aims & Objectives: To evaluate the levels of oxidative stress markers and the levels of antioxidants in normal pregnant women & their neonates as compared to non-pregnant women. Material & Methods: This prospective observational study recruited 26 pregnant women from the outdoor/indoor of Zanana Hospital and Mahila Chikitsalaya of SMS Hospital, Jaipur. Pregnant females > 18 yrs of age, with > 28 weeks of gestation, not suffering from any chronic disease affecting the dietary intake pattern were included in the study. Healthy symptomless non pregnant females in the reproductive age group were taken as the controls. Venous blood samples were collected at baseline & after parturition, within 24 hrs. from mothers & their neonates ( cord blood) and sent for biochemical estimation. The Haemoglogin (Hb) %, proteins, albumin, globulin, A/G ratio, SOD, MDA, catalase, Zinc & copper, ascorbic acid, tocopherol, retinol & β carotene levels were assessed. On the basis of weight of the neonates delivered the women were categorised into three groups: Group A – Women who delivered neonates having weight < 1.5 kg. Group B- Women who delivered neonates having weight between 1.5 kg – 2.5 kg. Group C – Women who delivered neonates having weight >2.5 kg. Results: The mean values of Hb % & total proteins were statistically significantly lower in Group A & Group B as compared to Group C. The mean A/G ratio was statistically significantly higher in the Group A as compared to Group B( p< 0.01) & in higher in Group B as compared to Group C( p< 0.05). The mean SOD & MDA levels were not found to be statistically significant between the three Groups. The mean catalase, Cu & Zn levels, ascorbic acid , α tocopherol & β carotene were statistically significantly lower in Group A & B as compared to Group C( p< 0.01).In neonates, weighing  <1.5 kg wt the mean levels of Hb %, total proteins were found to be statistically significantly lower. The mean MDA levels were statistically significantly higher in neonates weighing <1.5. The mean levels of ascorbic acid, α tocopherol & β carotene were statistically significantly higher in neonates weighing >2.5 kg. Conclusion: A gradual decline in the levels of the antioxidant vitamins have been observed along with increase in MDA levels, which correspond to increase in oxidative stresses both in pregnant women & their neonates. Thus, proper diet counselling & vitamin supplementation is essential for the prevention & management of pregnancy associated complications.

183. Safety and Efficacy of Elective Laparoscopic Cholecystectomy in the Elderly Patients: Observational Study
Sushrutha C.S., Balakrishna S.N., Sathish O., Kishan A.V.
Abstract
Background: Increasing age has a greater impact on surgery. Optimisation of pre operative comorbidities have decreased the post operative morbidity to a such an extent that results have been comparable with the younger group. The aim of the study is to access the safety and efficacy of elective laparoscopic cholecystectomy in the elderly patients. Methods: This is a retrospective study done between January 2022 to May 2023. Patients aged > 65 years were grouped as elderly patients. Disease matched control were taken from the same time period.  Preoperative comorbidities such as diabetes, hypertension, neurological disabilities, pulmonary disease were analysed. Operative issues such as ASA grade, conversion, duration of surgery was taken into consideration. Post-operative recovery was analysed using calvein dindo score, time for first feed, time for mobilisation and length of hospital stay. Results: In the study group mean age of elderly was 76.22 yrs. and young patients was 42.03 yrs. Comorbidities were significantly more in the elderly group like Diabetes Mellitus, cardiovascular disease, neurological disease, pulmonary disease but only cardiovascular disease was statistically significant. In the operative issues, ASA was significantly increased in elderly (2.63). Duration of surgery was increased in control group. Post-operative recovery – morbidity was comparable between both the groups. However time to first feed, time for mobilisation, length of hospital stay was comparatively more in the elderly group. Conclusion: Elective laparoscopic cholecystectomy can be safely performed in elderly patients. By proper optimisation of co morbidities & timing of surgery elderly patients will show results comparable results as young patients.

184. Study of Outcomes of Patients with Opioid Dependence Discharged on Buprenorphine or Oral Naltrexone
Satish Kumar Budania, Prabhukiran V Gogi, Hemant Kumar, Vedalaveni Chowdappa Suresh
Abstract
Comparative studies of the naturalistic course of patients of opioid dependence on naltrexone and buprenorphine are likely to be helpful for clinical decision-making. The article aimed to report on the three-months naturalistic outcomes of patients discharged on naltrexone or buprenorphine from the same center. Methods: Patients with opioid dependence who were discharged on either naltrexone (n = 86) or buprenorphine (n = 30) were followed up for three months for retention in treatment. The patients were also followed up telephonically, and the Maudsley Addiction Profile was applied. Results: The days of retention in treatment were significantly higher in the buprenorphine group (69.5 versus 48.7 days, P = 0.009). Heroin use, pharmaceutical opioid use, injection drug use, involvement in illegal activity, and percentage of contact days in conflict with friends in the last 30 days reduced over three months in both the groups, while the physical and psychological quality of life improved in both the groups. Additionally, in the naltrexone group, smoked tobacco use, cannabis use, and percentage of contact days in conflict with family within the last 30 days reduced at three months compared to baseline. Conclusion: With the possible limitations of choice of medication-assisted treatment for opioid dependence being determined by the patient, and prescribing-related factors and sample size constraints, the study suggests that retention outcomes may vary between naltrexone and buprenorphine, though both medications may improve several patient-related parameters. However, a comparison of the outcomes of buprenorphine and naltrexone in a naturalistic setting may be diffcult.

185. A Study of Prevalence, Factors Associated with Anemia and Knowledge Attitude and Practice among Pregnant Women Attending Antenatal Clinics
Jiya Vijaykumar Popat, Deval N. Vora, Sumana M, Mohak U Dave
Abstract
Introduction: Anemia is a pressing global health concern, particularly affecting pregnant women. It is characterized by low hemoglobin levels and poses significant risks, including complications during pregnancy and childbirth. Despite efforts to combat anemia, its prevalence remains high, necessitating a comprehensive understanding of associated factors and their impact on pregnant women’s knowledge, attitudes, and practices. In this study, we investigate the prevalence and severity of anemia, sociodemographic and obstetric determinants, dietary habits, and the overall awareness and behavior of pregnant women attending antenatal clinics at a tertiary care hospital. Material and Methods: This prospective observational study, conducted at a Jamnagar hospital from May to August 2023, focuses on pregnant women attending antenatal clinics. Inclusion criteria involve consenting pregnant women, while exclusion criteria include those declining to participate or with specific medical conditions. We defined anemia levels based on hemoglobin concentrations. Data collection used a structured questionnaire, covering various aspects. Trained personnel collected blood samples for analysis, and data analysis included standard statistical procedures. Results: Our study revealed a high anemia prevalence (75%) among pregnant women attending antenatal clinics, with 58.6%experiencing moderate anemia. Age, marital status, occupation, education, socio-economic class, residence, trimester, irregular menstrual cycles, low iron and folic acid (IFA) intake, and dietary habits significantly influenced anemia. While 79% of participants with irregular cycles had anemia, vegetarians exhibited prevalence of 86.7%. Conversely, non-vegetarian consumers had a relatively lower prevalence of 61.7%. Knowledge, attitudes, and practices related to anemia varied, emphasizing the need for tailored interventions. Conclusion: Our findings underscore the importance of addressing sociodemographic factors and enhancing knowledge, attitudes, and practices to combat anemia effectively in this vulnerable population.

186. Role of MBSR in Decreasing the Frequency and Intensity of Attacks in People Suffering with Chronic Migraine in Tamil Nadu
Prathusha Nerella, Alekhya Vempati, Harshini Makala
Abstract
Background: MBSR is an alternative therapy to treat migraine, which demonstrated potential benefit to patients with chronic migraine. Method: 60 migraine patients were treated with MBSR and compared with a controlled group with various questionnaires arriving pre-intervention (t0), at the end of intervention (t1), and followed up for 7 months was labelled as t2. Details regarding the episodes of migraine, psychological variables, PRSS, SCS, PSQ, and FOI questions were recorded in both groups and compared statistically. Results: Baseline characters like duration of migraine, degree of impairment during attack, percentage of intake of acute medication, percentage of intake of prophylactic medication had a significant p<0.001 comparison of migraine in MBSR group with controlled migraine days per month was p<0.001 (highly significant). The comparison of psychological variables, including PSQ, HADS-D anxiety, HADS-depression, PSRS, DFS, PRSS, and FMI, had a highly significant p value (p<0.001). Conclusion: It is concluded that MBSR showed a reduction in migraine frequency and duration as well as improved psychological functioning as secondary outcome.

187. Study of Maternal and Perinatal Outcomes in Pregnant Women with First Trimester Vaginal Bleeding
Nadella Mounika, Kesari Sravani
Abstract
Background: Vaginal bleeding during the first trimester of pregnancy is associated with spontaneous abortion, ectopic pregnancy or preterm labour and a low birth weight foetus, and 50% of vaginal bleeding had a normal pregnancy. Method: 150 pregnant women with first-trimester vaginal bleeding were studied. General and Obstetrical examinations were carried out. Blood examination included Hb%, CT, BT, ABO Grouping, “Rh” typing, HIV, syphilis, HCV, HBsAg, OGTT, TSH, and urine analysis in every patient. USG was performed to determine the period of gestation, cardiac activity, the size of the sub-chorionic hemomatoma, the adnexal mass, and the free fluid. Results: The clinical manifestations were: 36 (24%) were aged between 18-25, 78 (52%) were aged between 26-35, 36 (24%) were >35 years old. In the bleeding volume study, 111 (74%) had spotting, 33 (22%) had moderate, and 6 (4%) had a high volume of bleeding. No parity in 84 (56%), 1 in 42 (28%), 2 in 15 (10%), or 51 (34.1%) had a history of previous bleeding. 21 (14%) had a history of abortion, 36 (24.1%) had premature rupture of membranes, 21 (14%) had placental abruption, 6 (4%) had IU death, and 6 (4%) had IU growth retardation. 30 (20%) had abortions,  57 (38%) had normal vaginal deliveries, 63 (42%) had caesarean sections, 18 (12%) had a poor 5 minute Apgar score, and 24 (16%) were admitted to the NICU. Conclusion: In the present pragmatic study, it is revealed that vaginal bleeding in first trimester of pregnancy will have complications during pregnancy and foetal complications. Hence, such cases, if not treated, may lead to morbidity and mortality for both mother and foetus.

188. Machine Learning Advancements in Tuberculosis Diagnosis: A Deep Dive into Medical Applications
Binod Kumar Choudhary
Abstract
Tuberculosis, or TB, is a respiratory illness that poses a significant threat to global human health, resulting in a substantial number of annual fatalities. Prompt evaluation and therapy are crucial factors in facilitating the full recuperation of the patient. Computer-aided diagnosis has emerged as a promising modality for the detection of TB. Numerous CAD methodologies employing machine learning techniques have been employed in the realm of TB diagnosis, particularly within the artificial intelligence or AI domain. This has consequently precipitated a notable resurgence of AI within the medical sphere. Deep learning, a prominent subdivision of AI, offers a substantial scope for the diagnosis of TB, a highly lethal disease. This review aims to elucidate the inherent constraints associated with conventional tuberculosis diagnostic methods, while providing a comprehensive overview of diverse machine learning algorithms and their pertinent implementations in the realm of TB diagnosis. Moreover, this study delves into the exploration of diverse deep-learning techniques that have been seamlessly integrated with other sophisticated systems, including genetic algorithm, artificial immune systems, and neuro-fuzzy logic. The current review provides an overview of several advanced diagnostic tools in the field of TB, including Lunit INSIGHT, CAD4TB, InferRead DR Chest, and qXR. These state-of-the-art tools have demonstrated promising capabilities in assisting with TB diagnosis through the application of AI. By summarizing the key features and functionalities of each tool, this review sheds light on the potential future prospects of AI-assisted TB diagnosis.

189. Otomycosis in Patients Attending to a Tertiary Care Centre: A Clinical and Microbiological Profile
Ashutosh Kumar, Gunjan, Vinit Kumar Anand
Abstract
Introduction: Otomycosis, or fungal otitis externa, is a superficial, subacute, or chronic infection of the External Auditory Canal (EAC). It is characterized by tympanic membrane perforation, otalgia, edema, pruritus, scaling, hearing loss, and ear discharge. Fungus-based infections can coexist with bacterial infections as the primary pathogen. Aim of the study: To find the signs and symptoms of otomycosis and the agents responsible for it. Materials and Methods: A tertiary hospital’s Microbiology department and the Ear, Nose, and Throat (ENT) department conducted the current study over the course of six months. 300 samples were taken from individuals with otomycosis who had received a clinical diagnosis. Standard microbiological techniques were used to identify the bacteria and fungi isolates, and the isolates’ predisposing factors, demographics, and employment were evaluated. Categorical data was shown as frequencies and proportions. The test of chi-square was used to analyze various pieces of information, including the prevalence of otomycosis, its risk factors (ear pricking and oil instillation), and others. Major differences were known as P-values of 0.05 or less. Results: This study’s male:female ratio was 1:1.30, indicating males are less than females. Most incidents occurred in people between the ages of 21 and 30 (24.67%), while housewives saw the highest cases (36.67%). The most often found fungi associated with otomycosis were Aspergillus species (70.37%) and Candida species (15.74%). Pseudomonas species (13.33%) was the most prevalent causal agent in bacterial isolates; however, mixed fungus and bacterial infections were also reported. Conclusion: According to the current study, the most prevalent species connected to otomycosis are Aspergillus fungi. The custom of applying oil and poking your ears instillation, which results in otomycosis, must be made known to the general population.

190. A Review on Pediatric Chest Tuberculosis
Binod Kumar Choudhary
Abstract
Tuberculosis (TB) commonly affects the chest in children, with the lungs being the most commonly affected area, trailed by the pleura, chest wall, and lymph nodes. Diagnosing TB in children is challenging due to the absence of obvious indications and difficulties in acquiring samples for the microbiology validation. Therefore, various imaging techniques play a crucial role in the diagnostic process and in monitoring treatment progress. It is essential to establish standardized reporting of chest radiographs when TB is suspected in order to provide an accurate diagnosis and prevent unnecessary diagnoses. This review aims to examine the imaging characteristics of chest TB in children, based on the specific areas affected, as observed through different imaging methods.

191. Investigation of Adenosine Deaminase Activity in Tuberculosis Pleural Effusion
Dayanand Prasad, Rajnish Kumar, Sunil Kumar, Sarbil Kumari, Yogesh Krishna Sahay
Abstract
Background: Adenosine deaminase is an enzyme found in T lymphocytes that increases in the pleural fluid due to the cell-mediated immune response towards mycobacterium. In this study, the role of adenosine deaminase activity as a biomarker is assessed for the diagnosis of tubercular pleural effusion. Methods: 200 participants are studied in this study at BMIMS, Bihar, India. They were divided into two groups, the control group and the group with diagnosis of tuberculosis. Blood samples and pleural effusion were evaluated for haemoglobin levels, total leucocyte count, erythrocyte sedimentation rate, adenosine deami-nase activity, protein, and glucose levels. Results: The adenosine deaminase activity, protein level, and glucose level in the pleural effusion of the con-trol group were 16.6, 5.8 g/dl, and 74mg/dl respectively. The tuberculosis group had adenosine deaminase ac-tivity, protein level, and glucose level in the pleural effusion as 79, 6.35 g/dl and 37.4mg/dl respectively. When the data from both the group is compared the p-value is less than 0.05. Similarly, a statistically significant dif-ference was found in the erythrocyte sedimentation rate among both groups. Conclusion: From this study, it is found that adenosine deaminase activity in the pleural effusion is strongly indicative of tuberculosis. The standard range of adenosine deaminase activity is 40 U/L. If adenosine deaminase activity is found to be greater than the cut-off value, then tubercular pleural effusion is diagnosed. This method of confirming tubercular pleural effusion is reliable, cheaper, and relatively rapid.

192. Attitude and Interest towards Psychiatry among Medical Internship Students
Renu Pandey, Krishna Kumar Carpenter, Abdul Sajid Mansoori, Divya Modi
Abstract
Introduction: Mental health disorders are among the nation’s leading health problems due to their high prevalence and their chronic course. Deep- seated prejudices against people with mental illnesses result from negative attitudes concerning psychiatric problems. Deep-seated prejudices against people with mental illnesses result from negative attitudes concerning psychiatric problems. The general public around the world has negative attitudes and preconceptions about psychiatry as a subject, psychiatry as a profession, and patients with psychiatric problems. Aim: (1) To assess the attitude of medical internship students towards psychiatry. (2) To find interest towards psychiatry as a choice for post-graduation among these students. Materials and Methods: On an average 3-4 students are posted in psychiatry posting for 15 days among which 100 students were taken. To these students following below-mentioned scales and tests were applied after explaining them about the study. The responses were recorded and the data so obtained were analyzed using SPSS version 21 the responses were recorded and the data so obtained were analyzed using SPSS version 21. (1) Informed consent form (Hindi and English). (2) Socio-demographic questionnaire. (3) ATP- 30 (Attitude towards psychiatry questionnaire). Results: Out of total 100 students 30 had favourable response towards psychiatry 3 was neutral and 67 had unfavourable towards the subject. Conclusion: In the current study, we found that the medical students have multiple lacunae in their knowledge about psychiatric patients, psychiatric illness, psychiatric treatment, psychiatrist, and subject of psychiatry. Increasing negative attitude in higher classes might be due to poor social image of psychiatrist, relatively financially unrewarding specialty, poor teaching in under graduation, lesser duration of psychiatric clerkship, ridiculous stereotypic comments and remarks by medical teachers and practitioners belonging to other specialty branches.

193. Topical 0.03% Tacrolimus for Treatment of Post Acne Erythema- A Case Series
Goyal Pallavi, Agarwal Shashank, Goyal Mrinal, Gupta Ruchi
Abstract
Background: Post acne erythema (PAE) is not an unusual occurrence after acne vulgaris and the treatment is challenging in terms of cost-effectiveness and availability of the therapy. Objectives: The main objective is to treat PAE using topical 0.03 % tacrolimus. Method: 7 patients of newly diagnosed PAE were asked to apply tacrolimus ointment & were followed up at 4,8 and 12 weeks. Result: Out of these 7 patients, 5 showed an excellent response and the rest 2 showed moderate response. Conclusion: Topical 0.03% tacrolimus is an effective and cheap treatment modality for PAE.

194. Efficacy of Epidural Dexmedetomidine versus Epidural Fentanyl for Lower Abdominal Surgeries using Combined Spinal Epidural Technique (CSE) with Isobaric Ropivacaine
Faizah Mufti, Sahu Mushtaq, Waquar Amin Wani, Sheikh Irshad Ahmad, Iqra Nazir Naqash
Abstract
Background: Management of post-operative pain is still one the great concerns of anesthesiologists. Various adjuvants have been used with local anesthetics in regional anesthesia to provide good operating conditions and an excellent intra operative and prolonged postoperative analgesia. Dexmedetomidine is the new agent that is being used as a neuraxial adjuvant apart from opioids which is quite a familiar trend. Aim: The aim of this study was to evaluate the ease of performing surgery, effectiveness of post-operative analgesia using visual analogue scale score, patient satisfaction score, total rescue analgesic consumption when fentanyl or dexmedetomidine were given as an additive to ropivacaine for epidural anesthesia. Material and Methods: 100 adult patients belonging to American Society of Anesthesiologists class I and II, of either sex, aged between 18-65 years posted for elective lower abdominal surgeries (mainly low anterior resection that were completed within three hours of duration) were enrolled for the study and were divided into two groups of 50 patients each. Group F received 10ml of 0.5% isobaric ropivacaine with fentanyl 1 μg/kg for postoperative analgesia and Group D received 10ml of 0.5% isobaric ropivacaine with dexmedetomidine 1µg/kg for postoperative analgesia. The study drugs were given in 5ml boluses at 30 minutes and 60 minutes after initial intrathecal administration. The post-operative analgesia scores, rescue analgesic consumption and patient satisfaction scores were observed. Results: It was of great ease for both surgeons as well as patients who received epidural dexmedetomidine and fentanyl as an adjuvant to ropivacaine providing excellent operating conditions, lower post-operative visual analogue scale score and a good patient satisfaction score. Conclusion: Dexmedetomidine seems to be a better alternative to fentanyl as adjuvant to epidural ropivacaine.

195. Thyroid Disorders in Patients with Abnormal Uterine Bleeding
Pooja Singh, Renu Singh, Manjari Gupta, Prachi
Abstract
Introduction: Abnormal Uterine Bleeding is a common problem amongst women and is associated with an array of symptoms. AUB is the overarching term used to describe any departure from normal menstrual cycle pattern. Aim: To evaluate thyroid profile and detect thyroid disorders in patients with Abnormal Uterine Bleeding and menstrual patterns in women found to have thyroid disorders. Method: study conducted on 300 women from menarche to menopausal age group presenting with complaint of AUB presenting in the Department of Obstetrics and Gynaecology, Heritage Institute of Medical Sciences, Varanasi in collaboration with Department of Biochemistry. Proper counselling was done and written informed consent was taken. Women with complaints of AUB attending the Department of Obstetrics and Gynaecology were included in the study. A detailed history was taken with special relevance to age and bleeding pattern. A thorough clinical examination including general physical examination, gynaecological examination, neck examination with special reference to thyroid dysfunction was done. All these patients were subjected to routine investigations and Ultrasound examination. Result: The mean age was 37.89±8.94 years in the study group and 36.89±8.55 years in the control group. 24% subjects were hypothyroid and 43% subclinical hypotyroid in study group. 51.67% had menorrhagia as the chief menstrual complaint. In subjects having menorrhagia as the presenting complaint, hypothyroidism was the chief thyroid dysfunction. In subjects having hypomenorrhea as bleeding pattern, hyperthyroidism was main thyroid dysfunction. Conclusion: Thyroid dysfunction should be considered as an important etiological factor for menstrual abnormality as there is high prevalence of thyroid disorders in patients having Abnormal Uterine Bleeding as the presenting complaint.

196. Assessing Pain and Functional Improvement Six Months after Sacroiliac Joint Injection: an Analysis Based on Anaesthetic Response and Physical Exam Manoeuvres
Madhusudan B, Nitin S M, Prashantkumar
Abstract
Objectives: To evaluate sacroiliac joint (SIJ) injection outcomes with local anesthetic and corticosteroid in sacroiliitis. Methods: Thirty-four patients, diagnosed with SIJ pain, were given SIJ injections containing a combination of 2% lidocaine and triamcinolone 40 mg/ml. Before and after the injection, pain provocation tests were conducted and recorded. Follow-up assessments at two to four weeks and six months included pain levels measured on a numeric rating scale (NRS) and the Oswestry Disability Index (ODI). Results: In the analysis of overall group outcomes (without considering specific PE manoeuvres or anaesthetic blocks), improvements were noted in a 58.8% (95% confidence interval [CI] = +/-16.5%) reduction of ≥2 points on the NRS, a 32.4% (95% CI = +/-15.7%) reduction of ≥50% on the NRS, and a 38.2% (95% CI = +/-16.3%) reduction of ≥30% on the ODI within two to four weeks. Similar enhancements were observed six months post-injection. Stratifying outcomes based on pre-injection PE did not show significant differences at either time point. However, when stratified according to the presence of a 100% post-injection anaesthetic response, a significant difference was found in ≥50% NRS improvement within two to four weeks. Stratification into true positive/true negative groups (TP/TN) revealed significant differences in ≥50% NRS improvement at two to four weeks, and in both ≥50% NRS and ≥30% ODI improvement at six months. Patients more likely to have true SIJ pain (i.e., TP) displayed increased injection response, with a 75% (95% CI = +/-30.0%) improvement of ≥2 points on the NRS and a 62.5% (95% CI = +/-33.5%) improvement of ≥50% on the NRS and ≥30% on the ODI within two to four weeks, with similar results at six months. Conclusion: The effectiveness of SIJ steroid injections solely based on clinical referral diagnosis is doubtful, indicating the need for more precise selection criteria to assess true efficacy.

197. Evaluating Functional Improvement in Early Knee Osteoarthritis: A Prospective Study on Intraarticular Autologous Platelet Rich Plasma (PRP) Treatment
Nitin S M, Madhusudan B, Prashantkumar
Abstract
Knee osteoarthritis (OA) is a common issue among older adults, often managed with lifestyle adjustments, medications, physiotherapy, and injections like corticosteroids, hyaluronic acid, or autologous platelet-rich plasma (PRP) in the early stages. For advanced cases, surgical interventions like arthroscopic debridement, unicompartmental arthroplasty, patellofemoral arthroplasty, and total knee replacement are performed. Increasingly, autologous PRP injections are being used for Kellgren Lawrence grade 1 and 2 knee OA. This prospective study aimed to evaluate the functional outcomes of OA patients treated with intraarticular PRP over a 15-month follow-up period. The study involved 120 individuals aged 50-70 years with Kellgren Lawrence grade 1 and 2 knee OA. They received a single autologous intraarticular PRP injection and were monitored at 1, 3, 6, 12, and 15-months post-injection. The visual analog scale (VAS) score was assessed at each follow-up. Initially, all patients had a VAS score of 100 mm, which reduced to a range between 13 and 45 at the 1, 3, 6, 12, and 15-month follow-up evaluations.

198. Evaluation of Efficacy of Yoga Practices on a Biochemical Parameter in Patients of Type 2 Diabetes Mellitus in Indian Population: A Systematic Review and Meta-Analysis
Tejas P. Ghuntla, Jyoti R. Dholakiya
Abstract
Introduction: Yoga practices have many physical health benefits. There is increase in number of cases of diabetes in India. One of the important biochemical parameters of type 2 diabetes mellitus is fasting blood sugar. Potential of yoga activities has been observed to provide beneficial effect on fasting blood sugar in type 2 diabetes mellitus patients. Aims and Objectives: Based on the existing literature, our meta‑analysis sought to determine effectiveness of yoga practices on fasting blood sugar in patients of type 2 diabetes mellitus in Indian population. Materials and Methods: Researchers used the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines for reporting systematic reviews and meta-analysis. Researchers searched articles on PubMed, Google scholar and by manual search. Searched articles were screened for relevancy. By use of inclusion and exclusion criteria potential articles were selected. Results: Out of 310 articles, ffinally 5 studies were included in current meta-analysis. The standardized mean differences (SMD) for the fasting blood sugar (FBS) in patients of type 2 diabetes mellitus were calculated. Yoga practices have effect on fasting blood sugar (FBS): SMD = 0.91, 95% CI =0.12-1.71, P < 0.01. Conclusion: Yogic practices can provide beneficial effect on fasting blood sugar in patients of type 2 diabetes mellitus. This can decrease requirement of medicines of diabetes mellitus and thus can provide relief from adverse effects of drugs It is also suitable for low-income population.  There is wide scope for further studies to analyse beneficial effects of yoga activities.

199. Prospective Study of Mechanical Complications in Patients with STEMI at Tertiary Care Centre of Western Rajasthan
Rohit Mathur, Vivek Lakhawat, Viplov Kesarwani, Pawan Sarda, Anil Baroopal
Abstract
Objective: This single-center prospective observational study aimed to determine the proportion of mechanical complications in patients with acute ST-segment elevated myocardial infarction (STEMI) and assess the associated mortality rate in these patients. Methods: The study was conducted between June 2021 and May 2022, including 1307 patients admitted with STEMI. Mechanical complications were evaluated using 2D Echo during the patient’s hospital stay. Results: Among the STEMI patients, 17 individuals (1.3%) experienced mechanical complications. The most prevalent complication was free wall rupture (n=9), followed by ventricular septal rupture (n=7). Only one patient suffered from papillary muscle rupture. Mortality was significantly higher in the group with mechanical complications compared to the non-complication group (64.71% vs. 4.81%, p<0.0001). Within the complication group, mortality rates were highest for FWR (88.9%), followed by VSR (42.9%) and PMR (0%). The mean day of complication occurrence was 3.9 days, with FWR presenting around day 4.2 and VSR around day 3.7. Mechanical complication occurrence was more frequent in older age (67.06±10.05 years vs. 57.10±12.33 years, p=0.0008) and in female patients (52.94% vs. 20.39%, p=0.009). Conclusions: This study highlights the relatively low rate of mechanical complications in patients admitted with acute STEMI. However, despite their low incidence, mechanical complications carry a significant mortality burden. Mortality rates were higher in older age and among female patients. Timely recognition and management of mechanical complications remain critical in improving patient outcomes in this population.

200. Conservative Management on Paediatric Bone Forearm Fractures in Tertiary Care Hospital
Aarti Ronak Motiani, Mehta Rajeshri Rajendra, Patel Nihar Anilkumar, Seema Suketu Shah
Abstract
Background and Aim: One of the most common fractures in children is a fracture of the shaft of both forearm bones. There is frequently disagreement on how to treat these fractures. Though there is a growing trend towards surgical treatment of these injuries, conservative care remains popular due to the advantage of good bone remodelling potential in children. The purpose of this study was to emphasise the necessity of cautious care in both bone forearm fractures in children. Material and Methods: The current study was a prospective investigation into the functional effects of conservative treatment for paediatric diaphyseal forearm fractures. This one-year study was conducted at the Orthopaedic Department of the Tertiary Care Teaching Institute of India. Plain X-ray pictures and medical records were used to collect and corroborate data. The study comprised 50 youngsters in total. Results: The results showed that 37 patients (74% were boys) and 13 (26% were girls). There were 32 complete radius fractures and 12 incomplete. There were 31 complete ulnar fractures and 17 incomplete ulnar fractures. Angle deformities were significantly reduced before and after treatment (p0.05). Conclusion: Treatment of paediatric diaphyseal completes both bone forearm fractures yields excellent results; consequently, these fractures can be safely and efficiently treated with conservative therapy. Conservative care can achieve excellent clinical outcomes in the treatment of malaligned diaphyseal forearm fractures in older children and early adolescents. An angulation of 20° or more in children over the age of 10 should not be recognised in order to achieve a satisfactory functional and cosmetic outcome.

201. Clinical Profile of HIV in Pediatric Patients
Pragya Prakash Chandra Khanna, Nitin Kumar Jasvantlal Barot, Bhavesh M Patel
Abstract
Background and Aim: Since the discovery of Human Immunodeficiency Virus (HIV), it has become a serious public health issue and many screening centers had been established in order to ease the counseling of people for the virus. Present study was done with following Objectives: To evaluate the various modes of clinical presentation, to evaluate the modes of transmission, to study the clinical presentation of OI’s and to evaluate the association of tuberculosis in HIV and its relation with CD4. Material and Methods: Present Prospective was conducted at the Department of Pediatrics, Tertiary care institute of India for the duration of 2 years. Children living with HIV/AIDS [CHLA] > 18 months to 12 year of age admitted and attending OPD in pediatric department of my institute. All CLHA are registered in ART centre affiliated with this institute. They are diagnosed by triple test HIV ELISA antibody, investigated, treated and followed up in ART centre as per NACO guidelines. Results: In present study most significant route of transmission is vertical followed by blood transfusion. using clinical criteria maximum numbers of symptomatic CLHA fall in clinical stage 3 and using immunological criteria based on CD4 count maximum numbers of CLHA have either no or mild immunosuppression. Most common presentations are fever and weight loss followed by chronic cough and oral thrush and most common sign is hepatosplenomegaly and lymphedenopathy. Most common form of TB is pulmonary, followed by abdominal, lymph node a disseminated form.37.58% of CLHA suffered from TB. Conclusion: In children most significant route is vertical transmission (nearly 90%). So the risk during pregnancy, delivery and breast feeding can be reduced to 2 % with effective measures under Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT). Progression of disease is directly related to age of onset, mode of transmission and other co-morbid condition.

202. Histopathological Analysis of Ovarian Tumors in a Tertiary Care Centre
Rippal Kumar Bhimani, Shailesh Patel, Anandkumar A. Kanasagara, Jayesh Modi, Deepika Modi
Abstract
Background and Aim: Ovarian tumors have emerged as a prominent cause of mortality, encompassing a diverse range of clinical, morphological, and histological diagnoses.   A study was done to determine the overall occurrence, distribution, and different histological classifications of ovarian neoplasms. Material and Methods: The study was conducted in the Department of Pathology, a tertiary care teaching institute in India, for a length of one year.   The possibility of employing random sampling was taken into consideration.   Women over the age of 18 years, with histologically confirmed ovarian tumours, measuring more than 5 centimeters in diameter, were included.   We evaluated abdominal hysterectomy specimens. A macroscopic examination was performed.   Observations were made regarding the dimensions and coloration of the specimen.   The stained sections were scrutinised using a light microscope to determine the histological diagnosis. Results:  Throughout the duration of the study, a collective of 100 individuals were selected for participation.   Out of them, 83 (83%) were classified as benign tumours (Bet), 6 (6%) were classified as borderline tumours (BoT), and 11 (11%) cases were classified as malignant tumours (MlT). Borderline tumours are the third most prevalent, preceded by malignant tumours.   Out of the total cases studied, 91% were unilateral and only 9% were bilateral, with all of the bilateral cases being BeT. The most frequently observed bilateral tumor was Seromucinous cystadenoma.   Cystic instances account for the highest proportion (74%) of the OTs. The bulk of the histological patterns observed were surface epithelial tumours (SETs), accounting for 83 cases. Germ cell tumours were the second most common, with 8 cases, followed by sex cord-stromal tumours, which accounted for 3 cases. Conclusion: The majorities of tumour cases were found to be benign and were most commonly reported in individuals of reproductive age. On the other hand, malignant neoplasms were more prevalent in those over the age of 40. This study highlights the importance of conducting thorough histological investigation and screening at all stages of life in order to identify and exclude malignancies, given the higher occurrence of OTs. The most prevalent primary malignant tumor was serous cystadenocarcinoma, which belongs to the category of surface epithelial tumours.

203. Efficacy of Low Molecular Weight Heparin Vs Dabigatran in the Prophylaxis against Venous Thromboembolism in High Risk Surgical Patients
Muralidharan Kannaian, Raj S, Bhaskara Rao Bezawada, G. Subash Chandrabose
Abstract
Introduction: After any major general surgery, venous thromboembolism (VTE) can happen. In this population, venous thromboembolism is thought to occur between 0.2% and 0.3% of the time. The best outcomes are obtained when mechanical and pharmaceutical techniques are combined. The last ten years have seen the development of new protocols for the early detection of DVT in patients at high risk, as well as the discovery of more effective newer oral anticoagulants, which has led us to consider the efficacy of newer oral anticoagulants Therapy alone from the day of diagnosis in prevention of DVT. Objectives: (1) To compare efficacy of New Oral Anticoagulants (Dabigatran) vs Low Molecular Weight Heparin (LMWH) in the Prophylaxis against Venous Thromboembolism (VTE) among High risk surgical patients. (2) To compare the risk of bleeding in patients receiving DABIGATRAN and LMWH as Prophylaxis against VTE. Methods: This study is a Prospective Open Labeled Randomized Control Trial in Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry. Patients more than 18 years admitted in surgery and ortho ward were included as per caprini score. Those who were Age<18years, Any recent head injury, Pregnant women, Severe burns, Severe renal insufficiency patient, Cancer patients admitted for Palliation, Severely ill patients with multiple co-morbidities, Bleeding diathesis were excluded from the study. The sample was taken based on the case flow during the study period, with minimum of 20-30 patients in both the group were planned to take, finally 25 in each group was taken as per convenient sampling technique. The participants were randomized and one group received Low molecular weight Heparin and the other group received oral Dabigatran. Universal sampling technique was used. Grey scale & Doppler USG were used to confirm DVTs. Results: Mean age of group1 is 52.20 and group2 is 53.20. According to statistics, there is no age difference between the two groups. P value is 0.69.There are 17 girls and 8 males in group 1. 16 women and 9 men make up group 2.In terms of sex, there are no statistical differences between the two groups.(P=0.765).Height, weight, pulse rate, diastolic blood pressure, urea, creatinine, clotting time, prothrombin time, APTT, haemoglobin, bleeding time, and Caprini score did not differ between the two groups. The mean systolic blood pressure in groups 1 and 2 is 130.96 and 135.20, respectively, and there is a statistically significant difference between the two groups’ blood pressures (P=0.008). Conclusion: Hence, the two groups of low molecular weight heparin and dagabran are comparable in terms of all the factors, it can be concluded that dagabran is not less effective than low molecular weight heparin.

204. Prevalence of ESBL Producing Gram-Negative Bacterial Isolates from Surgical Site Infections in a Tertiary Care Hospital
Siddesh K C, Thimmappa T D, Premalatha D E, Nagaladevi Arumugam
Abstract
Background: Surgical site infection caused by organisms along with ESBL production was increasing from time to time.  The purpose of this study was to detect the prevalence of ESBL producing gram negative bacterial isolates from surgical site infections. Aims & Objectives: (1) To isolate and identify gram negative bacteria from various clinical samples. (2) To determine the antibiotic susceptibility pattern of these isolates. (3) To detect the ESBL production by phenotypic methods. Materials and Methods: A cross sectional study was conducted in the Dept of Microbiology in Shimoga Institute of Medical Sciences attached to McGann hospital for a period of 6 months and during this period, 112 pus samples from clinically suspected patients with SSIs were collected from various surgical wards.  They were identified and antimicrobial susceptibility testing of isolates was done.  Detection of ESBL was done by screening test using antibiotics and confirmatory tests such as combined disk potentiation method and E test was done. Results: A total no of 112 samples were collected of which 92 (82.14%) samples showed bacterial growth whereas remaining 20 (17.85%) samples showed no growth.  Among 112 samples, 67 (59.82%) were males and 45 (40.17%) were females.  Among 92 culture positive samples, 59 (64.13%) samples were Gram negative and 33 (35.86) were Gram positive isolates of which majority are Escherichia coli 25(27.17%) followed by Staphylococcus aureus 21(22.82%), Klebsiella pneumoniae 16(17.39%), Coagulase negative staphylococcus 12(13%), Pseudomonas aeruginosa 10(10.86%), Acinetobacter species 5(5.43%) and Proteus species 3(3.26%).  All the Gram-negative isolates were sensitive to Imipenem.  Majority of isolates showed resistance to Cefotaxime, Ceftazidime.  Out of 59 Gram negative bacterial isolates, 49(83%) isolates were positive for screening test of ESBL.  Among 49 positive screening tests, 26(53%) were confirmed by Combined Disk Potentiation method and 32(65.03%) were confirmed by E test.  The prevalence of ESBL by confirmatory tests was 59.15%.  Majority of ESBL producers were Escherichia coli (32.65%), Klebsiella pneumoniae (18.18%), Pseudomonas aeruginosa (5.1%). Conclusion: The prevalence of ESBL-producing gram-negative bacteria causing SSI was high. So it is necessary for the microbiologists to routinely detect and report ESBL production in the laboratories which would help clinicians in the treatment. It also prevents the spreads of antimicrobial resistance. Strict infection control policies should be made and established along with the continuous review. Also, the clinical labs should be upgraded with appropriate tools and qualified staffs to identify newer drug resistance pattern or any evolving pattern of resistance among the isolates.

205. Study of Ultra-Sonographic Parameters in Predicting Miscarriage in Patients between 6 to 12 Weeks of Gestation
Batte Manasa, Ke. Manga Reddy
Abstract
Aim: To study the association of early pregnancy Ultra Sonographic (USG) parameters, maternal factors in the present pregnancy and the history of previous pregnancy in predicting early miscarriage. Materials and Methods: A prospective cohort study was conducted in the Department of Obstetrics and Gynecology (OBG) at Chalmeda Anand Rao Institute of Medical Sciences (CAIMS). 100 pregnant women who presented between 6-12 weeks to OBG Out Patient Department (OPD) for routine Ante Natal Care (ANC) or with complaints of pain abdomen/bleeding per vaginum (PV)were subjected to Ultra Sonographic examination where the parameters such as Crown Rump Length (CRL), Mean Sac Diameter (MSD), Yolk Sac Diameter (YSD), and Fetal Heart Rate (FHR) were documented and were followed up to 24 weeks. Results: Among the pregnant women with complaints of pain abdomen/spotting/bleeding, chance of miscarriage was found to be 47%. MSD-CRL < 5mm was a significant predictor of early pregnancy loss with sensitivity of 70% and specificity of 92.5%. Abnormal YSD was found to be a statistically significant predictor of miscarriage (sensitivity – 50% and specificity – 78.7%). The sensitivity of fetal bradycardia in predicting miscarriage was 60% and specificity was 98%. Conclusion: Among all the Ultrasound scan parameters fetal bradycardia had a better sensitivity in predicting impending miscarriage. Whenever a pregnant woman presents in early pregnancy, between 6 – 12 weeks of gestation, maternal age and a thorough history of previous pregnancy should be noted, and an ultrasound should be advised.

206. A Study of Relationship of Apathy and Depression with Functional Outcome in First Episode Schizophrenia Patients
K. Bala Ravi Kumar, U. Raghava Rao, Ch Vamsi Krishna, B.J.P Mallika, Thota Sowmya
Abstract
Introduction: Schizophrenia is most prevalent incapacitating psychiatric disorders due to its severe and persistent psychotic symptoms, varied cognitive dysfunction, and severe psychosocial impairment. Apathy-related symptoms, such “indifference” or “lack of interest,” were acknowledged as essential components of the condition in Kraepelin’s and Bleuler’s diagnoses of schizophrenia. Depression has long been recognised as a symptom of schizophrenia, dating back to when Bleuler originally coined the word. Depression is very common among patients with schizophrenia at all stages, especially in the acute phase. Aim: To study the contribution of apathy and depression to functional outcome in first episode schizophrenia. Materials and Methods: A prospective study was conducted over a period of 1 year among 98 participants diagnosed with Schizophrenai recruited from the Out-Patient Department and at the time of discharge from the In-Patient wards of Government Hospital for Mental Care, Visakhapatnam. The Global Assessment of Functioning (GAF) Scale was used to determine the global level of functioning in the patients. Apathy was assessed by using Apathy Evaluation Scale Clinician version (AES – C) in patients. The Hamilton Depression Rating Scale (HAMD) was used to assess the level of depression in patients. Results: Mean scores of Apathy were found to be 28.53 (SD±3.690) at base line, 27.18(SD±2.753) in first follow up and 26.73(SD±1.934) at second follow-up. Mean scores of Depression were found to be 6.02 (SD±1.275) at base line, 5.75(SD±0.750) in first follow up and 5.88(SD±0.768) at second follow up. Mean scores of Functioning were found to be 78.91 (SD±4.506) at base line, 80(SD±3.640) in first follow up and 80.43(SD±3.266) at second follow up. On applying multiple regression analysis on scores pf AES, HAMD and GAF scales at baseline, first follow up and second follow up it’s found that at baseline correlation co efficient between AES and GAF is found to be – 0.728 which is statistically significant at p value of 0.001 (<0.005) but at baseline correlation coefficient between HAMD and GAF scores is found to be – 0.421 which is statistically insignificant with a p value of 0.152 (>0.05). Conclusion: Apathy which is a negative symptom in schizophrenia can occur even in early stages of illness and would predict short term and long term outcome of the patients. Depression which can also present in any stage of illness but can be treated with pharmacotherapy and due to fluctuating course would contribute less to the functional outcome than apathy.

207. HPLC and Haemoglobinopathies: A Deep Dive into Indian Health Statistics
Atul Tiwari, Nidhi Soni, Mayank Dosi
Abstract
Background: Haemoglobinopathies are genetic disorders that affect the structure or synthesis of haemoglobin, the oxygen-carrying protein in red blood cells. These disorders are prevalent in various regions of India and pose a significant public health challenge. Early detection and prevention are crucial to manage these conditions effectively. Materials and Methods: A prospective study was conducted to diagnose and quantify the prevalence of haemoglobinopathies in India. 760 blood samples were collected from different regions across the country. High-performance liquid chromatography (HPLC) was used as a screening tool for this study. HPLC is a technique in analytical chemistry used to separate, identify, and quantify each component in a mixture. It is sensitive and reliable for identifying and quantifying different haemoglobin fractions. Results: It was found that 32.5% of the samples had abnormal haemoglobin variants. The most common variant was beta thalassemia heterozygous, found in 19.47% of the samples. Other haemoglobinopathies, such as Hb E, Hb S, Hb D, and some rare variants were also detected. Conclusion: This study concluded that HPLC is an effective screening tool for identifying and quantifying different haemoglobin fractions. However, it was also noted that molecular tests are necessary for confirmation due to the complexity of these genetic disorders. The importance of early detection and prevention strategies for managing haemoglobinopathies was emphasized, given their significant prevalence in India.

208. Normal and Variant Vascular Anatomy of Coeliac Artery and Portal Vein – Prevalence and Patterns in Indian Population
Alpana Pathak, Rupesh Kumar Sriwastawa
Abstract
Background and Objectives: Upper abdominal vascular anatomy serves as a roadmap for interventional and surgical options for hepato-biliary, pancreatic pathology and liver transplant surgeries. The knowledge of variant vascular anatomy reduces the risk of inadvertent iatrogenic vascular injuries. This study aims to determine the prevalence and patterns of normal and variant anatomy of coeliac artery and portal vein among the Indian population. Methodology: After obtaining clearance from institutional ethics committee, 200 patients who were referred for multiphase MDCT study of abdomen as a part of their management were enrolled. MDCT abdominal angiography was performed using Philips Brilliance 256 slice CT machine with intra-venous administration of non-ionic iodinated contrast having Iodine content of 300mg% at 1.5ml/Kg body weight using automated pressure injector at rate of 4.5ml/min. Arterial phase and portal venous phase images were obtained using the bolus tracking technique. Conclusion: CT Angiography is an accurate modality for evaluation of vascular anatomy and its variants of upper abdomen.

209. Effect of Provider Communication on Perception of Pain during Intravenous Cannulation: A Double Blinded Randomized Controlled Trail
Divyashri C N, Jasvinder Kaur, Shwethapriya Rao, Shiyad M
Abstract
Background: Anaesthesiologists utilize communication skills in their day-to-day practice, in order to reduce the pain perception of patients during any invasive procedures like intravenous cannulation. Our study aimed to know the effect of three different types of communication provided by anaesthesiologists on perception of pain (primary outcome) and behavioural /visual discomfort (secondary outcome) during intravenous cannulation. Methods: About 300 patients were randomly allocated into three groups: Group ST who received the communication that “the intravenous cannula will be placed after giving local anaesthesia and the procedure may sting a bit”, Group 2 (NP): ‘Nil’ pain who received the communication that “the intravenous cannula will be placed after local anaesthesia and it will not be painful”, Group 3 (NU): ‘Numb’ who received the communication that “the intravenous cannula will be placed after local anaesthesia and the skin of your hand will feel numb. Our primary and secondary outcome measures were measured with VAS score and MBPRS score respectively. Results: Out 300, 100 patients were in ‘sting group’, 98 patients were in ‘no pain group’ and 99 patients were in ‘numb group’. VAS scores (p=0.549) were not normally distributed, most of the patients perceived as mild to moderate pain and none of them had severe pain. MBPRS scores were obtained for two injections separately and analysed. MBPRS scores obtained during local injection showed p value of 0.826 and i.v. cannulation showed p value of 0.827. Chi-square test was used for both the scores and results were comparable. Conclusions: The intensity of pain perception and behavioural display of pain during the procedure of intravenous cannulation is similar for patients irrespective of the type of communication.

210. To Study Indications and Feto-Maternal Outcome of Elective LSCS
Kuldeep Rathod, Shruti Tailor, Saral Bhatia, Nilam Prajapati
Abstract
Objective:  To study indications and feto-maternal outcome of Elective LSCS. Methods: A prospective observational study was conducted in Department of Obstetrics and Gynaecology enrolling 130 consenting subjects undergoing Elective Caesarean section over the period of 12 months. Results: In our study, majority of the subjects(77.69%) belonged to age group of 20-29 years. 46.84% of the study subjects underwent their elective Caesarean section after 38 weeks of gestation. In our study, 53.84% of subjects were primipara. Majority of the subjects(35.38%) underwent their elective Cesarean section for previous CS with negative consent for VBAC followed by 15.38% subjects for prev 2 lscs, 14.61% for cephalo-pelvic disproportion. 3% of subjects had developed maternal complications and 2.3% subjects had neonatal complications. Conclusion: As caesarean section being associated with maternal morbidity and neonatal outcome, decision for Elective Cesaerean section should be undertaken after considering all obstetric factors and medical conditions.

211. Radiomorphometric Study of Adult Hip in the Population of Uttar Pradesh
Rajkumar, Sumit Kumar, Namrata Singh, Priyanka Yadav, Chandramani Yadav
Abstract
Objective: The objective of the study is to determine the bilateral inconsistency in the mean value of acetabular angle, modified tonnis angle, lateral centre edge angle in both male and female. Background: The Acetabular angle is formed between line 1 and line 2. ‘Line 1’ between point A at most lateral bony margins of the acetabulum to ‘point B’ at inferior tip of pelvic tear drop. And ‘line 2’ is the extension of horizontal line (Hilgenreiner’s line) connecting the inferior tips of the both pelvic tear drop. Subjects: This study was conducted on 384 X-Ray images of patients (195 males and 189 females). Methods: All the measurements were done using X-Ray images with the help of Wipro Digital Radiography System. Result: Mean value of AA angle on right hip was 36.662° within (SD: 2.9143) in male, 36.77249° within (SD: 3.029305) in female. And on left hip was 37.2° (SD: 2.693252355) in male and 36.91005° (SD: 2.916817) in female. The right side of Acetabular angle is increase in females than in males and the left side of acetabular angle is increase in males than in females. Conclusion and discussion: Variations in the radiological morphology of hip joint between present study and previous studies may be due to different populations. Our analysis showed most of our morphological parameters within normal range.

212. Analysis of Glycemic Profile, Zinc, Magnesium, and Lipid Peroxide Levels in Psoriasis Patients
Satyabrata Tripathy
Abstract
Background: It is quite improbable that sufferers of autoimmune disorders such as psoriasis would come across a natural therapy that is effective enough to compensate for the pathophysiological anomalies that have arisen as a result of their condition. Aim: Comparing and correlating the connection of glycemic profile, zinc, magnesium, and lipid peroxides in people affected with psoriasis and those who do not have psoriasis will be the focus of the current study. Materials & Methods: A total of one hundred (100) volunteers were chosen at random to be divided into two groups: those with psoriasis and those without the disease. All of the participants in both groups underwent examinations through the utilization of the outpatient services. The university’s ethics board gave the researchers permission to proceed, and they did so with the writing of the article. Results: The study’s conclusions showed that blood zinc and magnesium levels were lower in psoriasis patients than in non-psoriasis individuals. Zinc, magnesium, and malondialdehyde (MDA) levels were also different amongst the groups. This difference was statistically significant. In point of fact, the opposite is true.  When the researchers compared the age variable of psoriasis patients to that of control people without the skin disease, they found a statistically significant difference. Conclusion: The fundamental cause of this mismatch is that psoriasis sufferers have lower concentrations of zinc transporters than non-psoriasis sufferers. Psoriasis appears to be linked to changed zinc and magnesium levels in the body, according to the findings of this analysis, which indicates a linkage between the two. It was demonstrated that there is a connection between psoriasis sufferers and healthy controls.

213. To Estimate Vitamin B12 Level and Folate in Children with Infantile Tremor Syndrome
Sunil Kumar Dhaka, Sandeep Shivran, Neha Jaiswal, Manish Kumar
Abstract
Background: Infantile Tremor Syndrome (ITS) is a clinical state characterized by tremors, anemia, pigmentation of skin, regression of milestones, and hypotonia of muscles in infant and young children. Exact incidence of infantile tremor syndrome (ITS) is not known but it was accounted for 0.2 to 2% in peadiatric hospital admissions in 1962 and reduced to 0.2% currently in India. Aims of this study to estimate Vitamin B12 level and folate in children with Infantile Tremor Syndrome. Methods: This Hospital based cross-sectional observational study was conducted in the Department of Biochemistry, XYZ Medical College, District, State, India. Study duration was from xy-2022 to xz-2022. Results: The mean serum B12 level was highest in children aged 13-18 months (117.40 pg/ml) and was lowest in children aged 6-12 months (67.90 pg/ml). This difference in B12 level in different age groups was statistically not significant (p>0.05). The mean serum folate level was highest in children aged 6-12 months (17.32 ng/ml) followed by children aged  13-18 months (15.53 ng/ml) and was lowest in children aged >18 months (13.70 ng/ml). This difference in folate level in different age groups was statistically not significant (p>0.05). Conclusion: Present study findings suggest that serum vitamin B12 and folate levels are decreased in children with Infantile Tremor Syndrome.

214. Epidemiological and Clinical Profile of Ocular Trauma in a Tertiary Care Hospital of Gujarat, India
Dipti Lunaviya, Mitalkumari G Patel, Jaydeep Devaliya, Sneha Patil
Abstract
Introduction: Raising awareness about potential risk factors can play a significant role in preventing ocular injuries. This study aims to evaluate the epidemiological profile of ocular injuries and visual prognosis among patients admitted to a tertiary care hospital of Gujarat. Materials & Methods: This hospital-based prospective observational study was conducted in tertiary care hospital, Gujarat over period of two years. Patients with ocular injuries attending the Casualty and the Ophthalmology department were included in the study. Details such as demographic profile, time, nature and cause of injury, visual acuity, and ocular findings were noted. A comprehensive ophthalmic examination was performed. Results: The mean age of the patients was 31.23 ± 10.65 years. Half of the patients (53.7%) had poly trauma. Only 17.5% of patients reported to the hospital within the first hour. The most common types of injuries observed were lid laceration (66.3%). The majority of patients had a history of road traffic accidents (35.0%) followed by sports-related injuries (20.0%) and  occupational injuries (17.5%). Approximately 96.3% of patients underwent primary repair, while only 3.7% underwent evisceration. Initially, about 70.0% of patients experienced blindness, but after 6 weeks of treatment, this decreased to 53.2%. Conclusion: Our study highlights that young adult males are more susceptible to ocular injuries, with road traffic accidents and sports injuries being the main causes. It is crucial to implement stricter safety protocols in the workplace and increasing awareness about traffic rules.

215. Awareness of Biomedical Waste Management among Nursing Students: A Hospital Based Study in Bihar
Rajesh Ranjan Sinha, Kislay Parag, Aishwarya Krishna, Ajay Krishna
Abstract
Introduction: Biomedical waste is of global subject today. The biomedical waste (management and handling) rules came into existence in 1998 with the latest amendment being made in 2019. Methods: This descriptive cross-sectional study was carried among 163 nursing students to assess the knowledge, attitude, and practices regarding biomedical waste management using total enumeration method. Nursing students who had clinical exposure >6 months and willing to participate were included in the study. Nursing students who were in their 1st academic year were excluded. The questionnaire was divided into four components assessing knowledge, attitude, and practices regarding biomedical waste management. The obtained scores of participants were converted into percentages and categorized as excellent (> 70%) and poor (< 70%). Results: Mean age of participants was 21.54 + 2.49 years with the majority being female (81.6%) and studying in B.Sc. nursing (59.5%). Majority of participants had poor level of knowledge in various domains of biomedical waste management like awareness (78.5%), color coding (84.7%), biomedical waste disposal methods (92.6%), and universal precautions (97.5%) except for biomedical waste hazard symbol (15.3%). About 95.1% of participants had overall poor knowledge regarding biomedical waste management. Nearly 76.1% and 74.2% of participants showed positive attitudes and safe practice patterns respectively. Conclusion: Although nursing student’s attitudes and patterns of practice were excellent yet they had an unsatisfactory level of knowledge related to recent amendments in biomedical waste management rules. Regular teaching and periodic monitoring of practices regarding biomedical waste are highly recommended.

216. Prospective Analysis of the Relationship between Caesarean Scar Defect and Abnormal Uterine Bleeding
Richa Jha
Abstract
Objective: To evaluate the relationship between cesarean scar defect and abnormal uterine bleeding at one year after cesarean section (CS). Study Design: A prospective observational cohort study was conducted in 401 women who delivered by CS for one year. Women were screened for isthmocele with sonohysterography six months after CS and followed by electronic questionnaires at 12, 13 and 14 months after CS. The main outcome measure was the prevalence of postmenstrual spotting. Secondary outcome measures were the duration of menstrual bleeding, prevalence of postcoital bleeding, dyspareunia or dysmenorrhea, usage of painkillers, and absence from work or other activi-ties. Results: The response rate was 88 %. In the isthmocele group, the prevalence of postmenstrual spotting was 20.0 % compared to 8.3 % in women without isthmocele (OR 2.75 [95 % CI 1.39-5.44]; P = 0.004). Addi-tionally, women with isthmocele reported more frequently postcoital bleeding (8.3 % vs. 2.4 %; OR 3.73 [95 % CI 1.18-11.83]; P = 0.026). The prevalence of postmenstrual spotting was even higher in the subgroup of large isthmoceles, (25.9 % vs. 9.5 %; (OR 3.34 [95 % CI 1.72-6.49]; P < 0.001). Conclusion: The prevalence of postmenstrual spotting among isthmocele patients was 20.0 %. Additionally, postmenstrual spotting was associated with the presence of isthmocele inquired at 1 year after CS.

217. Selfie Taking Behavior and its Correlates among College Students of West Bengal
Raston Mondal, Sandip Kumar Ghosh, Debobroto Roy, Sudip Ghosh
Abstract
Background: The tendency of taking own pictures through smart phone has turned into a madness among the people and it is more commonly seen especially among younger age groups. It has become so common that it is now been recognized as a separate disease entity. Objectives: This study aimed to find out the frequency & characteristics of selfie taking behaviour and to assess its correlates among the college students of Eastern India. Materials and Methods: This was a cross-sectional study carried out among 509 college students conducted from March, 2020 to May, 2020. Study population comprised of Science, Arts and Commerce undergraduate students from West Bengal. 12 colleges were approached and 06 colleges agreed to participate in the study. Approval was taken from the respective colleges. Data was collected through distribution of online questionnaire. Finally, 509 college students responded. Findings: Study tracked down that mean narcissistic score of the undergrads was 5.12 (2.84) which is at moderate level. 9.44% of the understudies fall under the class of serious narcissistic highlights, 40.15% of the undergrads under moderate narcissistic highlights and 50.41% of the understudies under gentle narcissistic highlights. Narcissistic highlights had a huge relationship with number of selfies on a normal day, inclination of represent selfies, alter selfies prior to posting and untag themselves from bunch selfies. Posting of selfies on Facebook had critical relationship with narcissistic highlights at p level <0.05. Conclusion: Study inferred that greater part of the selfie taking undergrads had narcissistic manifestations. Medical services proficient has critical part in early screening of web clients and selfie takers so that fitting measures/mediations can be wanted to forestall mental side effects like narcissism in not so distant future.

218. Clinicopathological Factors and Treatment Outcomes of Neoadjuvant Chemotherapy Among South Indian Patients with Osteosarcoma: A Single Institute Retrospective Study
Satheesh Kumar D, Kannan J, Raja G, Pandidurai M, Arun Ramanan V, Divya Bharathi S, Karthikeyan S, Narapaneni Kiranmayee
Abstract
Introduction: Osteosarcoma, despite its classification as a rare condition, paradoxically stands as the most common form of primary bone cancer that afflicts the pediatric and young adult population. This retrospective study delves into the clinicopathological characteristics, treatment outcomes, and overall survival of individuals with metastatic and non-metastatic osteosarcoma within the context of a selected tertiary care center in South India. Methodology: This is a record based retrospective study that was conducted at a tertiary care hospital in South India. This research study was carried out over the period between January 2012 to December 2022. The collected data were entered into Epidata version 3.1, and subsequent data analysis was conducted using STATA version 12.0. Continuous variables were summarized as Mean (SD), while categorical variables were presented as Frequency (Proportions). Survival analysis is done by Kaplan–Meier method and is graphically represented with comparison between two factors done by log-rank test. For this study, a p-value of less than 0.05 was deemed as indicative of statistical significance. Results: Out of 93 study participants with osteosarcoma, 80 study participants were non-metastatic. Among them, 75 study participants had undergone neoadjuvant chemotherapy. Among male patients, 40.4% were treated with AP, 8.5% with IAP, and 51.1% with MAP which was not found to be statistically significant. (P=0.508) No significant difference between the type of Neoadjuvant chemotherapy and the parameters such as clinical response and level of necrosis was found. Though MAP exhibited good responses but was also statistically insignificant. Out of 75 non-metastatic cases, 70 patients underwent surgery. While limb salvage was achieved in majority (51 patients) of them, there was no statistically significant difference was found between NACT groups. (P=0.278) Grade 4 neutropenia was reported in 29.6% in the AP group, 22.2% in the IAP group, and 48.1% in the MAP group, while Grade 4 mucositis was reported in none in the AP group, none in the IAP group, and 4 (100.0%) in the MAP group. Grade 3 CINV was reported in 27.3% in the AP group, 9.1% in the IAP group, and 63.6% in the MAP group. Among the 13 study participants with metastatic disease, the mean (SD) was found to be 30.54 (22.08), with male predominance (61.5%). Neurovascular deficit and joint space involvement was seen only in 2 (15.4%) patients and 2 (15.4%) patients respectively. Nodal metastasis was seen in 5 (38.5%) patients, while M1a (lung metastasis) contributed for 53.8% of the study participants. Conclusion and Recommendations: In conclusion, the implications of this study include an enhanced understanding of osteosarcoma in the South Indian population, the tailoring of treatment approaches based on regional characteristics, the identification of prognostic factors, improved patient management, and the insight into further research and collaborations.

219. Cytomorphological Evaluation of Palpable Head and Neck Lesions: A Comprehensive Analysis at a Tertiary Care Facility
Gautam R, Gupta V, Chaudhary A, Devdhar S
Abstract
Introduction: Fine Needle Aspiration Cytology (FNAC) is a valuable diagnostic tool in the evaluation of palpable head and neck lesions which encompass a wide range of conditions, including benign and malignant tumors, cysts, inflammatory processes, and infections. Objectives: In the present study, we aim to observe the cytomorphologic spectrum of lesions occurring in the head and neck region and explore the importance and applications of cytomorphological analysis in diagnosing head and neck lesions. Materials and Methods: A total of 154 cases of all age groups were included in the study, spanning various anatomical locations within the head and neck region. Fine needle aspiration (FNA) was performed using 22-23 G needles. Smears were stained with May Grunwald Giemsa, Hematoxylin & Eosin, and Papanicolaou stains. Cytomorphological analysis was done and diagnosis given. Results: Out of 154 FNA that were done; 56.5% were from lymph nodes followed by thyroid gland (18.2%), skin and soft tissue (17.5%), and salivary gland (7.8%). Reactive lymphadenitis was the most common lesion diagnosed. Slight female preponderance was observed in this study. Conclusion: FNAC offers several advantages, including minimal invasiveness, rapid results, and the ability to guide clinical management decisions. When combined with clinical and radiological findings, cytomorphological analysis plays a crucial role in providing accurate and timely diagnoses, facilitating appropriate treatment planning, and ultimately improving patient outcomes in the challenging field of head and neck pathology.

220. A Study of Variations in the Origin and Branching Pattern of Popliteal Artery: A Cadaveric Study
Mohammed Awais Ahmed, Aditya Moota, Anitha T
Abstract
Background: The popliteal artery is a major blood vessel located in the posterior region of the knee joint in the human body. The incidence of normal branching pattern of popliteal artery ranges between 92 – 96%. Knowledge of branching pattern of popliteal artery is of immense help to surgeons. Aim and Objective: To understand variation in the origin, length, diameter and branching patterns of popliteal artery. Materials and Method: This study was under observational study, conventional dissection method, in which 45, embalmed human adult lower limb specimens were included in the study. Adult lower limb specimens were obtained from the embalmed cadavers allotted for routine dissection to the first year MBBS students at our  Institute for the duration of two year. Results: Mean length of popliteal artery was 18.8 cm. (16.9cm-20.7cm). Mean diameter of PA was 7.65mm.( 6.9mm- 8.4mm). 97.78% of the specimen showed normal branching pattern while only 1(2.22%) Originated of inferior genicular artery (ILGA) from ATA. Out of 45 specimens, 43 specimens showed normal pattern of terminal division of PA. In one specimen, high division of PA was observed. In another specimen, trifurcation of PA was identified. Conclusion: Origin of the popliteal artery is the continuation of femoral artery in all the specimens, unusual origin of inferolateral genicular artery from anterior tibial artery was documented in one specimen & Variations of terminal branching pattern of popliteal artery were observed which included, high division of popliteal artery, trifurcation of popliteal artery into anterior tibial, posterior tibial and peroneal arteries.

221. Single Layer Versus Double Layer Uterine Closure in Lower Segment Cesarean Section: A Comparative Study
Bolleni Navya, Batte Manasa
Abstract
Aim: To compare single layer versus double layer uterine closure in lower uterine segment in terms of duration of surgery, amount of suture material used, amount of blood loss, number of extra hemostatic suture needed, to assess immediate postoperative complications and duration of hospital stay. Materials and Methods: The study is prospective and comparative study of single layer closure of uterus without visceral and peritoneal closure versus double layer closure of uterus with both visceral and parietal peritoneal closure in the lower segment caesarean section in the Department of Obstetrics and Gynaecology in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar. The present study was undertaken in 100 cases where they were randomised into study group (Group A) and control group (Group B). Cesarean section performed according to the indication. Patients were followed up postoperatively until discharge. Results were analysed using Chi square test or Fischer’s exact test using Microsoft excel 2010 and SPSS software. Results: The incidence of caesarean section was 25.3%. Mean duration of surgery in single layer group was 29.56 mins and double layer group was 38.02 mins with average reduction in operating time of 8.46 mins in single layer group with a significant p value of 0.0000. The amount of suture material used was less in single layer group when compared with double layer group with a significant p value -0.001. The amount of blood loss which was calculated as average perioperative hemoglobin fall was 0.75 in single layer group and 0.904 in double layer group with significant p value of 0.0000. Number of extra-hemostatic sutures needed were less in single layer group when compared to double layer group with a significant p value.  The average duration of hospital stays in 7.92 days in group A and 8.92 days in group B with a significant reduction in 1 day between the two groups with p value – 0.0000 which is significant statistically. There were no cases of uterine rupture or scar dehiscence in the subsequent pregnancy who were followed among both the groups. Conclusion: On conclusion, single layer uterine closure without peritonisation was having several advantages over double layer closure with peritonisation at Lower Segment Cesarean Section.

222. Comparison of Autologous Fibrin Versus Sutures in Conjunctival Limbal Autografting Following Pterygium Excision
Yasam Raghavendra Reddy
Abstract
Background: Pterygium is a frequently occurring ocular surface lesion with characteristic wing shaped fleshy growth, encroaching from conjunctiva upon the cornea. Surgical excision of pterygium is the most widely accepted modality of treatment. Among the various techniques limbal conjuctival autograft is the best method because of low recurrence and high safety. Aim: To compare the efficacy and safety of Autologous fibrin and Sutures in pterygium excision. Materials and Methods: The study included 60 patients and were divided into two groups. 30 patients (group 1) underwent pterygium excision with conjunctival autografting using autologous fibrin and the other 30 patients (group 2) underwent pterygium excision with conjunctival autografting using 10-0 nylon sutures. The operating time was noted for both the groups. The post operative symptoms, signs, complications and recurrence was assessed. Results: The mean operating time for group 1 was 22.1 minutes and group 2 was 43.33 minutes. The post operative symptoms, complications was significantly less in the autologous fibrin group when compared to sutures. The recurrence rate was similar in both the groups. Conclusion: Autologous fibrin use was found to be safe, effective and economical procedure.

223. Appendiceal Mucinous Neoplasms-LAMN and HAMN: A Case Series and Review of Literature
Jaison J, Zope R, Murgod P, Kate P, Wankhade S, Bhide S
Abstract
According to the WHO Digestive System Tumors 5th ed, Appendiceal Mucinous Neoplams (AMNs) are defined as mucinous epithelial proliferations with extracellular mucin and pushing invasion pattern. They are further classified into Low-grade appendiceal mucinous neoplasms (LAMN) and High grade appendiceal mucinous neoplasms (HAMN) based on cytological grading.
The classification of these tumors has undergone significant refinement over the years and so there is a need to be abreast with the new guidelines published in the World Health Organization Classification of Digestive System Tumors 5th edition, AJCC 8th Cancer Staging Manual, Peritoneal Surface Oncology Group International (PSOGI) modified Delphi consensus and College of American Pathologists (CAP) protocol regarding AMNs.
In the present article, we discuss three cases of LAMN and one case of HAMN in the light of the recent diagnostic criteria, terminologies, tumor grading, pathologic staging, biologic behaviour, treatment, and prognosis of AMNs. The accurate diagnosis of AMNs is clinically important because management may include treatment modalities such as cytoreductive surgery and hyperthermic intraperitoneal chemotherapy etc. and post treatment follow up in certain cases.

224. Multidrug-Resistant Pathogens in Medical ICU Patients
Mehnaz Talat, Noorulla Kas, A. Krishnaveni
Abstract
Introduction: The risk of infections increases in ICU patients and even the drug resistance of pathogens is more common in ICU patients than other hospital ward patients. This study which is high lightening the MDR pathogens and their antibiotic susceptibility pattern among intensive care unit patients in this community will help to draft an empirical antibiotic therapy. Materials And Methods: In this prospective study a total number of 302 clinical isolates were identified after receiving samples under aseptic precautions including sputum, ET aspirates, urine, blood, BAL, pus and other fluids were collected from the patients and processed according to CLSI guidelines. Results: Out of 226 isolates predominant pathogens were Klebsiella species (30.08%), Acinetobacter species (28.7%), and Pseudomonas aeruginosa (17.69%). Ps.aeruginosa, Klebsiella, Acinetobacter pathogens isolation was high from endotracheal aspirates, sputum and bronchoalveolar lavage samples. Around 60% of Gram negative isolates were sensitive to piperacillin+tazobactum, ceftazidime+clavulanic acid and around 70% of isolates showed sensitivity to ertapenem, meropenem, ciprofloxacin, amikacin. Out of 16 isolates of Staphylococcus aureus, 10 (62.5%) were MRSA. Conclusion: Research works focusing on antimicrobial resistance especially gram negative bacilli is utmost important in India as they can cause outbreaks in ICU settings which is going to be add on morbidity and mortality of critically ill patients.

225. To Evaluate the Site of Stricture by Uroflowmetry, Rcu / Mcu, and Urethrosonogram
Rakesh Pancholi, Neha Choudhary, Yash Bhardwaj, Amit Katlana, Richy Goyal
Abstract
Background & Methods: The aim of the study is to evaluate the site of stricture by uroflowmetry, rcu/mcu, and urethrosonogram. Per abdomen examination, external genitalia examination, per rectal examination, routine examination of blood, urine, respiratory, cardiovascular, nervous system examination will be carried out. Patients with posterior urethral trauma were initially managed by fluid resuscitation, if required blood transfusions and suprapubic cystostomy to divert urine. Results: The youngest patient was 10 years old and the oldest was 65 years. From the above table it is seen that maximum no. of cases (35.3 %) belong to 21-30 years age groups i.e. 106. The maximum numbers of cases were found to be of length of 1.1-2.0cm. Two cases were of pan urethral stricture. Mostly catheter was removed on 21 to 30 day as keeping catheter for long duration would increase the chances of infection. Conclusion: The modern approach to urethral stricture disease begins with a full evaluation including urethral imaging, so a treatment plan can be based on the location and length of the stricture. The maximum numbers of strictures (25%) were found to be of length of 1.1-2.0 cm and 3.1-4.0 cm. Epithelial strictures without spongiofibrosis should be treated by dilation. Optical urethrotomy should be employed for epithelial stricture less than 1 cm, In long strictures (>1.5 cm) it had to be carried out for more than one time along with active and passive dilatations.

226. A Comparative Study of the Efficacy of Pioglitazone versus Vildagliptin as Add-on Therapies for Type 2 Diabetic Patients Who Had Poor Glycemic Control with Metformin and Sulfonylureas: A Prospective Study
Ashish Ranjan, Deepak Kumar
Abstract
Background: Vildagliptin has recently received approval in Europe as an adjunctive therapy to metformin, Sulfonylurea, or thiazolidinedione. Vildagliptin offered an additional HbA1c decrease in comparison to metformin alone and was comparable to pioglitazone, the only one to cause weight gain. Aims and Objectives: A comparative study of the efficacy of pioglitazone versus vildagliptin as add-on therapies for Type 2 diabetic patients who had poor glycemic control with metformin and sulfonylureas. Materials & Methods: The present prospective observational study consisted of 80 poorly controlled Type 2 DM patients with metformin and sulfonylureas of both genders attaining out-patient departments or emergency care at the Department of Medicine in collaboration with the Department of Pharmacology. Results: The Mean age of patients in the Pioglitazone group was 52.48±10.26 years and in the Vildagliptin group were 56.80±9.79 years, respectively. The mean HbA1c levels at the beginning of the study were 10.02±1.60% and 11.50±0.08% in the pioglitazone and vildagliptin groups, respectively. At the end of the study, HbA1c levels were reduced from baseline by 1.60% in the pioglitazone group and by 1.25% in the vildagliptin group (p <0.002 for both groups). Conclusion: The results show that pioglitazone is slightly more efficacious than Vildagliptin, but the cost of Vildagliptin can be a limiting factor for its wider use in India.

227. A Comparative Study of the Functional Outcome of Dynamic Hip Screw (DHS) vs. Cannulated Cancellous (CC) Screws in Managing Femur Neck Fracture in Young Patients: A Hospital-Based Prospective Study
Ayush Banka, Ranjay Kumar, Vinod Kumar Singh
Abstract
Background: There will have been 21.3 million hip fractures globally by 2050, compared to 1.26 million in 1990. Hip fractures are linked to a number of problems, such as hospital-acquired infections, avascular necrosis, non-union, metal work failure, and death. Objectives: The present study Compare the Functional Outcome of Dynamic Hip Screw (DHS) vs. Cannulated Cancellous (CC) Screws in Managing Fracture of the Neck of the Femur in Young Patients. Materials & Methods: The present prospective cohort study was conducted in the Department of Orthopaedics. 110 young adults (under the age of 55) of both genders with femoral neck fractures treated with DHS and CC screws were included in the current study based on predetermined inclusion and exclusion criteria after the Institutional Ethical Committee approved it. Results: At the end of the last follow-up, in the DHS group, functional outcomes were excellent to good in 83 (75.45%) patients, whereas fair and poor outcomes were seen in 22 (20%) and 03 (2.73%) patients, respectively. A very poor outcome was seen in 02 (1.82%) patients, while in the CS group, it was excellent to good in 65 (59.09%) patients, whereas a fair and poor outcome were seen in 32 (29.09%) and 8 (7.27%) patients, respectively. A very poor outcome was seen in 5 (4.54%) patients. After applying the chi-square test, it was noted that the DHS group had a significantly (P = 0.001) higher proportion of satisfactory outcomes as compared to the CC Screw group. Conclusion: The results of the present study showed that the DHS group had a significantly higher proportion of satisfactory outcomes as compared to the CC Screw group in cases of femur neck fractures.

228. A Comparative Study of Proximal Femoral Nail (PFN) versus Dynamic Condylar Screw (DCS) in Management of Unstable Femoral Trochanteric Fractures
Ranjay Kumar, Ayush Banka, Vinod Kumar Singh
Abstract
Background: Trochanteric fractures are the most common fractures of the proximal femur that occur due to ground-level falls, especially in the elderly population. Studies have predicted that in 2050, approximately 4.5–6.2 million fractures will occur all over the globe, and more than 50% will occur in the Asian region. Objectives: compare PFN versus DCS in treating trochanteric femoral fractures with respect to intraoperative and postoperative assessment, and complications. Materials & Methods: The present randomised prospective study included 60 patients with unstable trochanteric fractures attaining opd/emergency in the orthopaedic department. All the study participants were briefed about the study, and written informed consent was obtained, after approval from the institutional ethical committee. Results: The mean age of group A was 58.91±12.05 year and group B was 56.50±14.06 years, respectively. In group A (DCS), male patients were more (54.17%) than female patients, and in group B (PFN), female patients were more (72.22%) than male patients. Trivial falls were the most common mode of injury in both groups, with group A (DCS) at 62.5% and group B (PFN) at 69.45%. Conclusion: In the present study, the proximal femoral nail showed less operative time, a higher union rate, a shorter duration for fracture union, a better functional outcome, and fewer complications than the dynamic condylar screw.

229. A Prospective Study of Platelet Indices and Their Interpretation in Thrombocytopenia at a Tertiary Care Hospital
Anil Kumar, Pranav Bharti, Asim Mishra
Abstract
Background: Thrombocytopenia is defined as a platelet count of <150 × 109/L, although patients with a platelet count >50 × 109/L are usually asymptomatic. Severe spontaneous bleeding is rare in thrombocytopenia. It is more common when the platelet count is <20 × 109/L, and particularly when <10 × 109/L. Aims and Objectives: The present study was conducted to evaluate platelet indices and their interpretation in thrombocytopenia in a tertiary care hospital. Materials and Methods: An observational, prospective study was conducted on 100 patients with a platelet count <150×103/μL were enrolled as a study group, along with another set of 50 healthy control samples with a platelet count ≥150×103/μL were included in the study. Four ml of venous blood was collected in an EDTA vacutainer. An auto-analyzer was used for the evaluation of the hematological profile. After evaluation of the hematological profile, 50 patients with a platelet count <150×103/μL were divided into each Group 1 (hyperdestruction of platelets) and Group 2 (decreased production of platelets) based on clinical and hematological details. Results: A total of 100 thrombocytopenia cases and 50 controls were analyzed. The mean age of the patients was 42.65±16.37 year in hypo‑productive, 29.45±12.74 years in hyper‑destructive, and 34.50±11.68 year in control years respectively. The mean platelet count (10^3 µL) in the hypo‑productive, hyper‑destructive and healthy control groups was 82.50±33.25, 65.82±36.42, and 225.91±68.41 (10^3 µL) , respectively. The mean MPV in the hypo‑productive, hyper‑destructive and healthy control groups was 10.65±1.94 fl, 12.35±1.53 fl and 9.64±1.68 fl respectively. The mean PCT in the hypo‑productive, hyper‑destructive and healthy control groups was 0.08±0.06 %, 0.09±0.05% and 0.22±0.06% respectively. Conclusion: All the platelet indices were higher in hyper‑destructive thrombocytopenia as compared to hypo‑productive thrombocytopenia except platelet count, whereas PCT in healthy controls was higher than that in hypo‑productive and hyper‑destructive thrombocytopenia patients.

230. To Assess the Significance of Histopathology in the Diagnostic Process of Lytic Bone Lesions at a Tertiary Centre
Anil Kumar, Manoj Kumar, and Asim Mishra
Abstract
Background: The presence of lytic bone lesions is a common radiographic finding seen in patients seeking orthopaedic care. The histopathology’s plays a crucial role in providing guidance to orthopaedic surgeons in the management of patients with lytic lesions. Aims and Objectives: The purpose of this study is to assess the significance of histopathology in the diagnostic process of lytic bone lesions. Materials and Methods: The selection criteria for patients included those with radiologically evident bone disease. A total of 50 cases were identified, and radiographic diagnosis confirmed the presence of lytic bone lesions in all patients. Histopathological biopsies were conducted in all patients to diagnose lytic bone lesions. The biopsy procedure mostly included the use of the scraping technique as well as the incision and excision methods. In the laboratory, soft tissue samples were immersed in a solution of 10% formalin for fixation. As for bone samples, slices with a thickness ranging from 3 to 5 mm were prepared and then fixed in a 10% buffered formalin solution. Decalcification of the bone specimens was then performed by immersing them in a 5% nitric acid solution for duration of 2 days. Results: The findings of our investigation revealed that out of a total of 50 instances, there were 18 cases of inflammatory lesions, 22 cases of benign lesions, 3 cases of initial malignant lesions, and 7 cases of subsequent malignant lytic lesions. So, the most prevalent lytic lesion was a benign neoplastic lesion of bone. There were a total of 22 instances in the study. Out of a total of 18 inflammatory lytic lesions, 8 cases were of pyogenic osteomyelitis, and 10 cases were of tuberculous osteomyelitis. So, tuberculous osteomyelitis was slightly more common than pyogenic osteomyelitis in inflammatory lytic lesions. Out of a total of 22 lytic lesions classified as benign neoplastic, 14 instances were diagnosed as giant cell tumors, while 3 cases were identified as fibrous dysplasia. Giant cell tumors have a greater frequency of occurrence compared to other benign lytic lesions. Conclusion: It has been determined that the identification of lytic bone lesions is an often used radiological finding utilized by orthopaedic surgeons in the evaluation of several individuals. Histopathology serves as the definitive diagnostic method for a wide range of disorders that result in lytic lesions, establishing itself as the benchmark for accuracy and precision.

231. Retracted

232. Effect of Vitamin D3 Treatment in Hyperthyroidism with Hypercalcemia
Shivaraj Gurupadappa Sajjanshetty
Abstract
Introduction: A hormone with receptors in many bodily tissues, vitamin D has been associated with reduced chronic disease risk. Vitamin D deficiency affects over a billion people. Research suggests vitamin D may help with hypothyroidism and musculoskeletal issues. Deficient vitamin D is also common in Graves’ illness. Hyperthyroidism causes hypercalcemia in 0.2–4% of people. Aim and Objectives: This research examines how vitamin D3 supplementation affects thyroid function in hyperthyrodism and hypercalcemia patients to fill information gaps. Method: This is a prospective, randomised, single-blinded, parallel-group study which compared 12 months of vitamin D3 supplementation with that of patients receiving vitamin D3 as a complement to antithyroid medication (ATD) treatment in newly diagnosed Graves’ disease (GD) patients with hypercalcemia. The study conducted a comparison between a 12-month supplementation of vitamin D3 and a control group receiving no additional vitamin D3, in conjunction with antithyroid medication. The present investigation evaluated the prevalence of hypercalcemia, the presence of thyroid-related antibodies, levels of blood calcium, markers of bone metabolism, and mineral density. Result: Table 1 shows key characteristics of Vitamin D and ATD patients. The Vitamin D (32 males, 18 females) and ATD (26 males, 24 females) groups averaged 55.01 and 55.89 years old. Table 2 shows baseline, 6-month, and 12-month calciotropic hormone levels, especially in Vitamin D3 administration. Table 3 shows thyroid function results, with Vitamin D3 affecting FT3, FT4, and TSH more. Table 5 shows Vitamin D3’s greater bone density improvement than ATD treatment. Conclusion: The study has concluded that the adjuvant vitamin D3 is effective in the management of thyroid dysfunction and abnormal bone metabolism in hyperthyroidism.

233. A Study on the Reduction of Type-2 Diabetes Incidence with Metformin and Lifestyle Modification
Shivaraj Gurupadappa Sajjanshetty
Abstract
Introduction: This study discusses how DM causes persistent hyperglycemia due to insulin resistance or decreased production. In 2015, there were 415 million cases of DM while by 2040, morethan   200 millions of DM patients will be added. Diabetes and hyperglycemia damage organs, raising coronary disease risk. The three primary kinds of DM are T1DM (autoimmune-driven insulin loss), T2DM (insulin resistance), and gestational DM. The main T2DM treatment is metformin. Aim and Objectives: This study aims to assess the effectiveness of metformin and lifestyle modifications in lowering the incidence of Type-2 Diabetes. Method: This prospective study was conducted with 120 participants. The study included adults aged 25+ with BMI ≥24 (≥22 for Asians) and high glucose, excluding severe diseases. Fasting glucose 95-125 mg/dL, post-glucose 140-199. At least 50% were minorities. The study formed 3 groups, namely, metformin, placebo and extreme lifestyle change. Starting at 850 mg, adjusted metformin. Goal: ≥7% weight loss, personalised plan, moderate exercise. Main focus: glucose testing for diabetes. Analysed diabetes evolution, lifestyle, and metformin effects utilising various prediabetes therapy. Result: Table 1 shows the baseline characteristics of 120 placebo, metformin, and lifestyle subjects. The lifestyle group demonstrated stable weight and physical activity changes across 2-12 months (Figures 1 and 2). Medication adherence (%) differed by metformin and lifestyle group in Figure 3. Table 2 compares diabetes prevalence by age, gender, BMI, etc. across treatments. Figures 4 and 5 show glucose and glycosylated haemoglobin trends. In Table 3, metformin caused higher gastrointestinal symptoms. Conclusion: In conclusion, lifestyle adjustments and metformin delay type 2 diabetes. Diabetes is prevented in 1 in 7 patients after three years, lowering social damage.

234. Titanium Elastic Anchoring System for Surgical Management of Midshaft Clavicle Fracture
Siddhartha Kumar Shrest, Prashant Priyadarshi, Maseeh Azam
Abstract
Background: About 76% of all clavicular fractures are midclavicular fractures, which are frequent clinically. A previously unknown prevalence of malunion and non-union after conservative treatment of more severe midclavicular fractures has been found by recent investigations. This study’s objective was to assess the clinical results of titanium elastic nail treatment for midclavicular fractures. Methods: A prospective hospital-based study carried out at JLNMCH, Bihar, India. 60 patients between the ages of 18 and 50 who had displaced midshaft clavicle fractures underwent intramedullary titanium elastic nailing after clinical evaluation and radiographic confirmation. Average operating time, problems after surgery, and union time were noted. Results: 56 patients involved closed surgery using a titanium elastic nailing device, while 4 cases involved a mini-open procedure. All patients who underwent satisfactory reduction were monitored for an average of 10 months. The average length of the union was 11.2 weeks. No patient experienced a serious problem. 10 months after surgery, the titanium elastic nailing system was removed; none of our patients had a re-fracture or a non-union. Conclusion: For dislocated midshaft clavicular fractures, intramedullary repair using a titanium elastic nailing system may be an efficient and secure procedure with few risks, positive clinical therapeutic effects, functional recovery, and cosmetic results.

235. A Prospective Comparative Study of Arthroscopic versus Open Surgical Treatment for Recurrent Anterior Instability of the Shoulder
Sanjeev Kumar, Vikash Ranjan, Utkarsh
Abstract
Introduction: Recurrent anterior shoulder instability is a common orthopedic concern, particularly among active individuals. This was treated by Open Bankart procedure but with time and developing technology arthroscopic and less invasive procedures have been developed.  In this prospective study, we delve into the comparative analysis of open Bankart procedure versus arthroscopic procedure for instability in the shoulder, shedding light on the evolving landscape of treatment options for this challenging condition. Materials and Methods: The investigation was conducted at a tertiary care centre. It aimed to compare the outcomes of two distinct surgical approaches: open surgery (Group A) and arthroscopic surgery (Group B) in addressing the condition. A total of 100 patients were taken in the study and divided equally in each group. Both the groups were compared on the basis of pre and post op characteristics and intraoperative responses. Results: The results revealed that open surgery (Group A) was associated with a significantly shorter surgical duration but required longer hospital stays and led to increased post-operative hemorrhage compared to arthroscopic surgery (Group B), the hospital stay was just 4 days for the Arthroscopic procedure whereas it was 8 days for the Open procedure. Time taken for the Arthroscopic procedure was 96 minutes approximately but for the Open Procedure took 68 minutes. Conclusion: In conclusion, this study highlights the comparative outcomes of open and arthroscopic surgery for recurrent anterior shoulder instability. Open surgery appears to offer better stability (higher Rowe scores) but with longer hospital stays and increased post-operative hemorrhage. Arthroscopic surgery allows for quicker recovery and shorter hospital stays but requires further evaluation regarding stability. The choice between these approaches should be individualized, considering patient needs and surgical expertise.

236. Association Between Restless Legs Syndrome and Anaemia in Elderly Patients: A Hospital Based Cross-Sectional Study
Sandhya Shukla, Avinash Kumar, Shivangi Sharma
Abstract
Background: Restless Legs Syndrome (RLS), or Willis-Ekbom disease, causes leg discomfort and an irresistible urge to move, particularly at rest, disrupting sleep and quality of life. RLS affects up to 10% of adults, with a higher prevalence in the elderly. Simultaneously, anaemia is a global health concern, especially among older individuals. Despite their significance, little research has explored the potential connection between RLS and anaemia in the elderly. This study assessed the prevalence of RLS in this population and its relationship with anaemia, aiming to improve diagnosis and management for better overall health and quality of life. Methods: In this one-year cross-sectional study (January-December 2022) among elderly patients (≥60 years) at a tertiary care hospital, ethical approval and informed consent were obtained. Exclusions included terminal illness, recent major surgeries, severe physical disabilities, and substance abuse, except medication-related studies. With a targeted sample size of 320 participants, data collection involved structured interviews, anaemia severity categorization based on WHO criteria, and assessment of Restless Legs Syndrome (RLS) severity using the International RLS Study Group Rating Scale. Chi-square tests evaluated the RLS-anaemia association (p<0.05). Results: Among 320 elderly participants, RLS prevalence was 19.1%, with mild, moderate, severe, and very severe RLS in 7.8%, 6.3%, 3.4%, and 1.6%, respectively. Anaemia prevalence was 52.5%, predominantly mild (39.7%) and moderate (10.9%). A significant association was observed between RLS severity and anaemia severity (p=0.003). Very severe RLS showed the strongest association with severe anaemia. Age, gender, socioeconomic status, and living arrangements did not significantly affect the RLS-anaemia relationship. Conclusion: Healthcare providers should be vigilant about assessing both RLS and anaemia in elderly patients, especially when evaluating unexplained symptoms such as fatigue, sleep disturbances, and leg discomfort. Screening tools like the International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale can aid in RLS assessment.

237. Clinicoetiological Profile & Outcome of Acute and Persistent Diarrhoea in Under-5 Children with Special Reference to Severe Acute Malnutrition
Jyoti Ranjan Behera, Samir Sethi, Sanjaya Kumar Jena, Debi Prasad Jena, Saroj Kumar Satpathy
Abstract
Introduction: In children under five, diarrhoea continues to be the second most common cause of mortality worldwide. With between 3 and 5 billion cases and about 2 million deaths annually, diarrhoea is a major worldwide health burden. It is responsible for more than 20% of all paediatric fatalities. In India in 2005, diarrhoea was the cause of 0.3 million of the 2.3 million child fatalities recorded between the ages of one and fifty-nine months. The mortality rate was greater in girls than in boys. Three quarters of all childhood fatalities globally among children under five are caused by diarrhoea, and India leads the list of 15 nations. In India, acute diarrheal illnesses cause 13% of mortality in children under five; in 2009, there were around 11.2 million cases and 1,762 deaths from these illnesses. Material and Methods: A standardized questionnaire was used to gather data on the residents’ address, sex, age and birthdate, socioeconomic situation, prenatal history, and eating habits. In addition to the kind, frequency, and duration of the diarrhoea, additional complaints such as fever and cough were also received. The frequent diseases and co-morbid disorders linked to malnutrition, such as AIDS, TB, malaria, septicemia, pneumonia, and urinary tract infections, were evaluated in the enrolled children. Additionally, a history of chronic illnesses including TB and HIV/AIDS was asked about. Every piece of evidence and conclusion is documented in pre-established Performa, and statistical analysis was done on the data. Results: A total of 310 SAM  patients enrolled in the study between 45 days to 60 month of age during this period of 2years( December 2015 to November 2017).Out of these 90 patients were excluded as per exclusion criteria and 15 patients got LAMA (left against medical advice) during study period. So from the remaining 205 patients 112 cases are presented with diarrhoea, which constitute the study population. Conclusion: Diarrhoea is one of the leading causes of childhood mortality in India and its association with severe acute malnutrition can contribute mortality and morbidity to the under-fives children. Young age, impaired immunity, poor socio-economic status, lack proper breast feeding and unhygienic feeding practice are the risk factors for a SAM child to develop infectious diarrhoea. Moreover, these factors when associated with malnutrition, the chances of developing chronicity and persistent diarrhoea increases. Acute respiratory tract infection, septicaemia and UTI are common infections encountered in SAM population other than diarrhoea. Acute diarrhoea mostly bacterial and viral in nature & persistent diarrhoea are mostly bacterial and parasitic in nature and it worsens the severity of malnutrition and is a high risk for mortality. This study is a hospital based study and does not truly reflect the burden of disease in the community.

238. Aetiological Profile of Early and Late Onset Neonatal Sepsis
Jyoti Ranjan Behera, Manas Ranjan Mallick, Sanjaya Kumar Jena, Sonali Prajna Paramita Bhanja, Bijayalaxmi Mallick
Abstract
Introduction: Neonatal sepsis is defined as a systemic condition of bacterial, viral, or fungal (yeast) origin in newborn infants less than 28 days old that is associated with hemodynamic changes and other clinical manifestations and results in substantial mortality and morbidity. Sepsis continues to be an important cause of neonatal morbidity and mortality.  It is a common problem in the newborn intensive care unit (NICU) population particularly in premature neonates. Sepsis is classified as early onset sepsis (EOS) presents within 72 hrs of life, and late onset sepsis (LOS) presents beyond 72hrs of life. EOS presents where the maternal genital tract is the source of infection. Materials and Methodology: This study was undertaken in new born unit, in department of Pediatrics, in SCB Medical College and SVP Postgraduate institute of Pediatrics, Cuttack, Odisha during the period of 1 year from September 2021 to September 2022. This is a tertiary care unit which caters to a large area of population from odisha and peoples from east west Bengal. The unit functions as an intramural unit round the clock. On an average of about 300 neonates are admitted every month in the new born unit for various reasons. The study was commenced after getting the formal approval of the ethical committee of our hospital. The study population includes all the babies admitted in the neonatal ward with the history and clinical features suggestive of sepsis. Results: Out of 200 suspected sepsis, 62.5% (n=125) were term neonates and 37.5% (n=75) were preterm neonates. About two fold increases in culture positivity was seen in preterm neonates (44%) when compared to term neonates (22.4%). Gram negative bacilli (70.5%) constituted the majority of culture isolates in this study when compared to Gram positive cocci isolates (29.5%). Klebsiella pneumoniae (54.1%) was found to be the most com- mon GNB isolate followed by Acinetobacter baumannii (9.8%) and Escherichia coli ( 6.5% ) . Among the Gram positive isolate Staphylococcus aureus (16.4%) was the most frequent organism followed by Coagulase negative Staphylococcus (6.5%) whereas both Group B Streptococci and Enterococcus faecalis constituted only 3.27%. Amikacin was sensitive in 60% of S. aureus, 75% of CONS. Gentamicin showed moderate sensitivity (50-60%) among the Gram positive isolates. Third generation cephalosporins had sensitivity of 60% among S. aureus, 75% among CONS and 100% among GBS. Cefepime showed sensitivity of 87.5% in S. aureus and 75% in CONS. Conclusion: In this study the risk factors commonly associated with neonatal sepsis were found to be prematurity, LBW, instrumental delivery (AVD). EOS was more common than LOS. Gram negative sepsis was predominantly seen and was highly susceptible to Imipenem and Tigecycline. CRP was found to be a sensitive tool for early diagnosis and predicting the outcome of sepsis. But it is neither 100% sensitive nor 100% specific to be relied as a sole marker. The greatest predictability can be achieved by the combination of assays rather than a single biomarker and as of now blood culture remains the gold standard in diagnosing sepsis. Strict antibiotic policy to address the issue of antimicrobial resistance in addition to good infection control and earnest search for an early diagnostic marker widen the horizon of successful encounter with sepsis and lead the neonates to the road of health.

239. Effectiveness of Tamsulosin Compared with Mirabegron in Treatment of Double-J Stent-Related Lower Urinary Tract Symptoms: A Retrospective Study
Abhishek Tiwari, Swati Mishra, Ramesh Kumar Ajai
Abstract
Background: Lower urinary tract symptoms (LUTS) are a typical side effect of Double-J stents, widely utilised in urological practise but can negatively affect patient comfort. The purpose of this research is to evaluate the relative efficacy of Tamsulosin and Mirabegron for treating LUTS caused by a Double-J stents.Methods: In a retrospective cohort analysis, 250 individuals aged 18 and up who were prescribed Tamsulosin or Mirabegron were analysed. Electronic health data were mined for information on patient age, gender, race/ethnicity, stent insertion duration, symptom severity, and the occurrence of any adverse events. Both drugs were evaluated statistically to see how well they worked. Results: The average score for LUTS severity was reduced by 3.4 points with Tamsulosin and by 3.7 points with Mirabegron. There was no statistically significant difference in the rates of adverse events between the two groups (p = 0.82). Conclusion: Our research shows that Tamsulosin and Mirabegron are equally effective in treating LUTS brought on by a double-J stent. The necessity of tailoring treatment to each patient is highlighted by this discovery, which offers doctors two promising new pharmacological choices. To further refine treatment techniques and improve patient comfort during stent indwelling, more studies should investigate subpopulations and long-term results.

240. Uncommon Microorganisms in Corneal Ulcers: Case Series from a Tertiary Care Centre in Central Kerala.
Laly TU, Lekshmi Sankar K, Sabna Sasidharan, Faiza Ibrahim
Abstract
Corneal  ulcer  is  an  epithelial  defect  with  infiltration  of  underlying  stroma  and  tissue  necrosis.  It  is  a  potentially  sight  threatening  infection  caused  by  bacteria,  fungus,  virus,  and  parasites.  Fungi  commonly  responsible  are  Aspergillus,  Candida  and  Fusarium.  Common  bacteria  causing  ulcer  include  Staphylococcus,  Pseudomonas,  Pneumococcus,  Enterobacteriacea  and  Neisseria.  Corneal  ulcer  may  be  caused  by  other  not  so  common  microorganisms  whose  detailed  case  description  is  seen  only  rarely.  Rare  bacterial  pathogens  that  cause  corneal  ulcer  include  atypical  Mycobacteria,  Nocardia  spp.,  Chryseobacterium  spp.,  Enterobacter  spp.,  Bartonella  henslae.  Rare  fungi  causing  corneal  ulcer  include  Alternaria  spp.,  Acremonium  spp.,  Cladosporium  spp.,  Curvularia  spp.,  Pseudallescheria  spp.,  and  others.  Pathogens  vary  among  geographical  locations  depending  on  the  local  climate.  The  clinical  presentation,  microbiological  picture  and  response  to  empirical  therapy  may  be  different  for  corneal  ulcer  with  these  uncommon  organisms.  We  describe  a  case  series  of  patients  with  corneal  ulcer  caused  by  not  so  common  organisms  in  a  period  of  four  and  a  half  years  from  July  2018  to  January  2023  that  presented  to  a  tertiary  care  teaching  hospital  at  central  Kerala.  The  data  was  retrieved  from  the  corneal  ulcer  register  maintained  at  the  cornea  clinic  of  Department  of  Ophthalmology  at  the  study  institute.  Photos  were  retrieved  from  stored  data  of  the  computer  and  were  anonymized.  Details  including  history,  clinical  examination  findings,  investigation  results,  treatment  given  and  follow  up  details  entered  in  the  register  was  used  for  filling  proforma.  Some  cases  may  progress  rapidly  in  the  absence  of  specific  therapy  leading  to  perforation  and  visual  loss,  which  can  be  prevented  by  early  identification  of  causes  and  specific  therapy.  Knowledge  on  the  uncommon  causes  of  corneal  ulcer  describing  its  clinical  features  and  differences  from  the  more  common  causes  of  corneal  ulcer  will  help  in  managing  future  similar  cases.

241. Difficult Laparoscopic Cholecystectomy and Associated Preoperative Factors: A Prospective Study from North India
Girish Pandey, Rajeev Ranjan
Abstract
Background: The majority of patients with symptomatic gallstones can benefit from laparoscopic cholecystectomy, according to the 1992 National Institute of Health (NIH) consensus development conference. As there is paucity of the studies assessing the preoperative factors associated with the difficult laparoscopic cholecystectomy, so we conducted this study with an aim to assess the preoperative factorsassociated with the difficult laparoscopic cholecystectomy. Methods: The present hospital based prospective observational study was conducted in the Department of General Surgery, among 89 patients admitted with clinical diagnosis of cholelithiasis for laparoscopic cholecystectomy during 1 year of study period. For the enrolled patients, they underwent a though clinical examination and history taking. A pretested proforma was used to collect the patients details such as baseline and clinical characteristics laboratory and radiological parameters. All the cases were categorised to be easy, and difficult for laparoscopic cholecystectomy based. The analysis was carried in the MS excel and the association between independent and dependent variables was carried out using Chi-square test (for discrete variables). A p value <0.05 was considered as statistically significant.  Results: In our study a total of 89 patients underwent laparoscopic cholecystectomy. The mean age of patients was 47.82±20.42 years. The female patients were 66.3% and male patients were 33.7%. The Body Mass Index (BMI) was ≥ 25.0 kg/m2 among 28.1% of patients. In our study, the gallbladder wall thickness of ≥4mm was seen in 59.3% of patients with difficult laparoscopic cholecystectomy, whereas 11.3%of patients with easy laparoscopic cholecystectomy.The variables such as raised TLC, elevated SA, deranged LFT, gallbladder wall thickness, contracted gall bladder and presence of Pericholecystic fluid were significantly associated with difficult laparoscopic cholecystectomy procedure. Conclusion: In our study, a third of the patients had a difficult laparoscopic cholecystectomy, which was often followed by conversion to open cholecystectomy due to complications. So, a suitable tool for evaluating a challenging laparoscopic cholecystectomy is the clinical assessment.

242. Laparoscopic Versus Open Appendicectomy: A Comparative Prospective at a Tertiary Hospital of North India
Girish Pandey, Rajeev Ranjan
Abstract
Background: Laparoscopic appendicectomy is becoming more common, especially in young, childbearing women whose right lower quadrant pain has a wide range of differential diagnoses, including gynaecologic pathology. Approaches to surgical disorders have undergone notable alterations as a result of the modern development of laparoscopic surgery. As there is paucity of the studies comparing the outcome of laparoscopic appendicectomy with open appendicectomy, so we conducted this study with an aim to compare the postoperative outcome of the laparoscopic appendicectomy procedure with open appendicectomy technique. Methods: The present study was conducted in the Department of General Surgery, at a tertiary care hospital among patients admitted with clinical diagnosis of acute or recurrent during 1 year of study period. For the enrolled patients, they underwent a though clinical examination and history taking. In our study, made two groups laparoscopic appendicectomy group and open appendicectomy group and, the enrolled the patients, were randomly allocated to the both groups using random number table. A pretested proforma was used to collect the patients details. The collected data was entered in the MS excel sheet. The association between independent and dependent variables was carried out using Chi-square test and independent T- test. Results: In our study, a total of 130 patients underwent appendicectomy (65 patients underwent laparoscopic approach and 65 patients underwent open approach).In our study, the abdominal pain and tenderness as the presenting symptoms and signs in all patients in laparoscopic appendicectomy group and open appendicectomy group.In our study among patients in laparoscopic appendicectomy group wound infection rate was in 7.7%, and intraabdominal abscess was seen in 4.6% patients, whereas, wound infection rate was in 10.8%, and intraabdominal abscess was seen in 12.3%patients.In our study, the return to the normal daily life activities by the patients was earlier among laparoscopic appendicectomy group (5.86±1.92 days) as compared to open appendicectomy group (9.62±1.73 days). Conclusion: Laparoscopic appendicectomy’s duration of operation was also lesser. In selected patients with acute or recurrent appendicitis, laparoscopic appendicectomy is generally superior to open appendicectomy. For performing an appendectomy, the laparoscopic approach is safe, effective, and has advantages over the open method that are clinically advantageous.

243. Awareness of Biomedical Waste Management among Nursing Students: A Hospital Based Study in Bihar
Rajesh Ranjan Sinha, Kislay Parag, Aishwarya Krishna, Ajay Krishna
Abstract
Introduction: Biomedical waste is of global subject today. The biomedical waste (management and handling) rules came into existence in 1998 with the latest amendment being made in 2019. Methods: This descriptive cross-sectional study was carried among 163 nursing students to assess the knowledge, attitude, and practices regarding biomedical waste management using total enumeration method. Nursing students who had clinical exposure >6 months and willing to participate were included in the study. Nursing students who were in their 1st academic year were excluded. The questionnaire was divided into four components assessing knowledge, attitude, and practices regarding biomedical waste management. The obtained scores of participants were converted into percentages and categorized as excellent (> 70%) and poor (< 70%). Results: Mean age of participants was 21.54 + 2.49 years with the majority being female (81.6%) and studying in B.Sc. nursing (59.5%). Majority of participants had poor level of knowledge in various domains of biomedical waste management like awareness (78.5%), color coding (84.7%), biomedical waste disposal methods (92.6%), and universal precautions (97.5%) except for biomedical waste hazard symbol (15.3%). About 95.1% of participants had overall poor knowledge regarding biomedical waste management. Nearly 76.1% and 74.2% of participants showed positive attitudes and safe practice patterns respectively. Conclusion: Although nursing student’s attitudes and patterns of practice were excellent yet they had an unsatisfactory level of knowledge related to recent amendments in biomedical waste management rules. Regular teaching and periodic monitoring of practices regarding biomedical waste are highly recommended.

244. Chronic Otitis Media in Patient of Diabetes Mellitus
Md. Razique Anwar, Kamlesh Chandra, Sheelu Shafiq
Abstract
Introduction: In the senior population, diabetes is a significant cause of hearing loss. The diagnosis of chronic otitis media (COM) denotes a permanent abnormality of the pars tensa or flaccida, most often the outcome of prior acute otitis media, negative middle ear pressure, or acute otitis media with effusion. Middle ear and mastoid mucosa are not inflamed, but inactive mucosal COM causes a persistent perforation of the pars tensa. Method: This study was carried out from 2017 to 2019 at the Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh, and the Rajiv Gandhi Centre of Diabetes and Endocrinology and Department of Otorhinolaryngology. Result: 64 (64%) of the 100 patients were from urban regions, and 36 (36%) were from rural areas, although this difference was statistically significant (p=0.00511).   Of the 100 patients, the majority (87%) of the patients had hearing loss, followed by ear discharge (54%), vertigo (13%), tinnitus (12%), otitis externa (10%), and otomycosis (9%), but this was statistically significant (p<0.05). Conclusion: Because of this, the current study has shown that hearing loss in otological problems is a significant side effect of diabetes.

245. Bacteriological Profile of the Patients of Diabetes Mellitus
Md. Razique Anwar, Sheelu Shafiq, Kamlesh Chandra
Abstract
Introduction: Diabetes mellitus is a common metabolic condition characterised by chronic hyperglycemia and disruptions in the metabolism of proteins, lipids, and carbohydrates.  The three most common bacteria found in bacterial isolates from patients with ear discharge were S. aureus, Proteus spp., and P. aeruginosa. Method: From 2017 to 2019, this research was conducted at the Rajiv Gandhi Centre of Diabetes and Endocrinology and the Department of Otorhinolaryngology at the Jawaharlal Nehru Medical College and Hospital, AMU, Aligarh. Result: The majority of diabetic patients with ear discharge tested positive for staphylococcus aureus (37%) and pseudomonas species (30%), while some also tested positive for proteus mirabilis (15%), E. coli (11%), and klebsiella species (4%). Statistics showed that this was significant (p <0.05). Conclusion: Gram-negative bacteria predominated among the recruited patients, according to the results of our investigation. The most frequent bacteria found in ear discharge pus cultures were staphylococcus aureus and pseudomonas species.

246. Study on the Sex Identification using Maxillary Sinus in Northern India
Shamim Raza, Piyush Kumar Gangwar, Amrendra Kumar
Abstract
Introduction: In forensic identification, the pelvis, skull, and maxillary sinuses are used to determine sex. The comprehensive musculoskeletal imaging of “cone beam computed tomography (CBCT)” is helpful in forensic research. Post-mortem radiograph comparisons are used for radiological identification when DNA or fingerprints are unavailable. Radiological evaluation of maxillary sinus size helps determine gender in forensic anthropology and human remains because human maxillary sinuses show sexual dimorphism. Aims and Objectives: The objective of this research is to examine the efficacy of maxillary sinus features in Northern India as a means of determining the sex of individuals. Methods: The cross-sectional observational study was conducted from June, 2022 to May,. 2023. 70 Northern Indian non-pathological headache patients (40 male and 30 female) were examined. The right and left maxillary sinus height, depth, and breadth were measured using SYNGO software. Calculated maxillary sinus volumes. Descriptive statistics showed male and female measures, while t-tests or ANOVA estimated gender differences. We followed ethical guidelines and acquired patient permission for ethical research. Results: Table 1 compares male and female right maxillary sinuses using Mann-Whitney U-tests. Male sinuses are higher, longer, broader, and larger than female ones. Table 2 mimics left maxillary sinus outcomes. Figures 1 and 2 show the major variations in height, length, and breadth in the right and left maxillary sinuses between men and women. It shows sexual dimorphism in maxillary sinus diameters. Conclusion: The research shows gender-specific maxillary sinus characteristics for forensic identification. Sexual dimorphism is helped by maxillary sinus measures, notably right sinus volume. CT imaging properly measures these dimensions, improving forensic investigations.

247. Evaluation of Sub-Arachnoid Block using Isobaric Ropivacaine with That of Hyperbaric Bupivacaine in Caesarean Section
Anuradha Kalyan Jogdand
Abstract
Introduction: Caesarean sections with spinal anaesthesia reduce aspiration risk and allow aware patient involvement. Limited pain alleviation, urine retention, and complications are negatives. Bupivacaine is widely used but can cause hypotension. With bupivacaine, dexmedetomidine and magnesium sulphate boost results. For spinal anaesthesia, ropivacaine, a less strong anaesthetic, is sought, with isobaric formulations becoming popular for their reliability. Aims and Objectives: This study aims to compare the anaesthetic effects of isobaric ropivacaine and hyperbaric bupivacaine in the context of caesarean section procedures. Method: The study comprised 70 elective lower-segment caesarean section patients with ASA Grades I and II. Prior to surgery, thorough screening ruled out medical and obstetric difficulties, respiratory or cardiovascular issues, allergies, and other health issues Intravenous medicines, hydration preloading, and baseline vital signs were preoperative preparations. Patients were randomly randomised to hyperbaric bupivacaine or isobaric ropivacaine for lumbar punctures. An oxygen supplement was given throughout the surgery. Results: Table 1 compares Group B with Group R by numerous factors. Both groups had similar mean ages, weights, heights, and surgical times, with non-significant p-values (0.86, 0.18, 0.24, and 0.46). Table 2 shows group variations in sensory levels, timing, and analgesia. Figure 1 shows group differences in dermatome regression, sensory block length, effective analgesia, motor block start, and recovery. Group B had slightly greater rates of nausea/vomiting, hypotension, and shivering, but no significant vital sign changes (Table 3).

Conclusion: For elective caesarean sections, 15 mg of isobaric ropivacaine provides adequate anaesthesia with sensory block and safety above bupivacaine.

248. Hepatitis A: A Clinical Spectrum of the Disease in Children Admitted in a Tertiary Care Hospital
Saurabh Kumar Singh, Mala Kumar
Abstract
Introduction: HAV causes acute hepatitis worldwide, mostly through oral-faecal pathways. While rich nations have lower infection rates, injection drug users, men who have sex with males, travellers to endemic areas, and secluded populations are at risk. HAV doesn’t cause chronic liver illness like hepatitis B or C. Children over 12 months should be vaccinated. Poor sanitation causes high endemic rates in impoverished countries. Aims and Objectives: This study aims to examine the clinical spectrum of Hepatitis A in paediatric patients. Method: The Paediatric Department of Hind Medical college Ataria, Sitapur conducted this cross-sectional study from February, 2022, to February, 2023, to investigate acute hepatitis in children aged 1-12. The Institutional Ethical Review Board approval had been taken for the study, excluding children with preexisting liver disease and including those with acute hepatitis symptoms lasting ≤21 days, high ALT, and parental agreement. Demographics, clinical symptoms, ELISA blood samples for anti-HAV and anti-HEV IgM antibodies, and laboratory data were collected. Results: Table 1 shows 150 youngsters with HAV-induced acute viral hepatitis. The average age was 7.3±3.0 years, with 42% aged 6-10 years. Male patients made up 53.33% and rural residents 55.33%. Maternal education varied, and 36.66% were lower-middle-class. Table 2 lists HAV-related symptoms including fever (72.66%), jaundice (65.33%), and black urine (70.00%). Table 3 shows increased bilirubin, ALT, AST, ALP, and INR, emphasizing the necessity for early medical intervention in acute HAV patients. Conclusion: The majority of HAV-induced acute viral hepatitis cases occur in 6-10-year-olds, highlighting the need for routine immunisation and public health education.

249. Evaluation of Maternal and Neonatal Risk Factors and Outcomes of EOS
Saurabh Kumar Singh, Mala Kumar
Abstract
Introduction: Maternal and neonatal risk factors affect the development of “early-onset sepsis (EOS)” in infants. Group B Streptococcus infection and preterm membrane rupture are two examples of maternal causes. Prematurity, low birth weight, and mother colonization are all factors that pose a danger to newborns. Preventing EOS and its severe repercussions, like septic shock and long-term developmental difficulties, requires prompt diagnosis and treatment. Aim and Objectives: This study aims to evaluate the impact of various maternal and neonatal variables on the outcomes of early-onset sepsis. Method: From September 2014 to August 2015, K.G. Medical University’s Lucknow NICU observed term and preterm infants at risk of Early-Onset Sepsis. Babies who left the NICU within 24 hours or died were eliminated. Antenatal, peripartum, maternal, and neonatal EOS risk factors and pre-admission antibiotic exposure were examined. For a better understanding of NICU EOS, neonates were divided into “High Suspicion of EOS (HS-EOS)” and Low Suspicion groups. Result: Figure 1 and Table 1 shows culture-positive “Early-Onset Sepsis (EOS)” and neonatal EOS isolates.  Table 2 shows antibiotic susceptibility for treatment decisions. Table 3 shows baseline commonalities in culture-proven and most probable EOS newborns. Table 4 lists frequent EOS symptoms. Figure 2 stresses TLC’s role in culture-proven sepsis detection. Figure 3 shows neonatal pneumonia risk factors. Table 5 and 6 shows maternal neonatal meningitis risk factors and early diagnosis and treatment enhance newborn outcomes for culture-positive EOS. Conclusion: Escherichia coli and Staphylococcus aureus cause most NICU early-onset sepsis; ampicillin, cephalosporin, and amoxicillin resistance is widespread; piperacillin and amikacin are first-line treatments.

250. The Association between Elevated D-Dimer Levels and Heightened Ischemic Stroke Risk in Non-Valvular Atrial Fibrillation Patients: A Retrospective Study
Saubhagya Chhotaray, Bhupesh Kumar Nayak, Rakesh Ranjan Swain, Chhatray Mrndi, Gopabandhu Patra
Abstract
Objective: This study looked at the association between elevated D-dimer levels and the ischemic stroke risk in order to determine whether these levels could be a predictive ischemic stroke risk factor in individuals with non-valvular atrial fibrillation (NVAF). Methods: The NVAF patients participating in this retrospective single-center study had not received anticoagulant treatment. Two groups of patients were identified: those who had experienced an ischemic stroke and those who had not. A thorough examination of the patients’ medical records, clinical and demographic evaluations, and an overview of the test results were all part of the study. Results: This investigation included 105 NVAF in-patients (68 men, 37 women, median age 74.18 ± 9.46 years) who were eligible and had not been treated with anticoagulants. 26 patients had acute ischemic stroke. D-dimer levels improved with age and correlated positively (P <0.001) with stroke risk scores, such as CHADS2 and CHA2DS2-VASC. Even after controlling for gender and age, the connection remained substantial (P<0.001). Stroke patients had significantly higher baseline D-dimer levels (1.24 vs. 0.60 mg/L, P <0.001), although there was no relevant difference between the two groups (0.60 vs. 0.56 mg/L, P = 0.320). Logistic regression study identified D-dimer levels on stroke onset and OMI as independent ischemic stroke risk factors (P <0.001), while the rise from baseline did not predict stroke likelihood (P = 0.125). Conclusion: D-dimer levels were favorably connected with ischemic stroke risk classification in NVAF patients, but not with actual occurrence. Although elevated D-dimer levels do not predict ischemic stroke in this patient population, the study did find a possible correlation between them and stroke risk factors. Recommendation: Further research is needed to explore additional factors contributing to ischemic stroke risk in NVAF patients and to identify more robust predictive markers for this specific population.

251. Evaluating Pulmonary Embolism among Emergency Department Patients with Chest Pain: A Retrospective Study
Chhatray Marndi, Rakesh Ranjan Swain, Bhupesh Kumar Nayak, Saubhagya Chhotaray , Gopabandhu Patra
Abstract
Introduction: Chest pain is a frequent complaint in emergency departments, and one of the potential underlying causes that clinicians are concerned about is pulmonary embolism. However, there are no established guidelines for determining which chest pain patients should undergo a formal evaluation for pulmonary embolism. This study aimed to assess the proportion of chest pain patients who underwent a pulmonary embolism diagnostic workup and to characterize the clinical profiles of these individuals. Methods: This retrospective, multicenter study took place at ‘Bhima Bhoi Medical College, Balangir’ and included all patients who presented with chest pain over a two-month period. The primary outcome was the initiation of a pulmonary embolism workup, and secondary objectives included identifying factors associated with this outcome. Results: Among the 110 patients with chest pain included in the study (mean age 50 years, 55% men), 28% (95% confidence interval 26–32%) underwent a formal pulmonary embolism workup, leading to the diagnosis of pulmonary embolism in 2.5% (95% confidence interval 1.0–5.2%) of cases. Factors independently associated with a pulmonary embolism workup included female sex, younger age, absence of ischemic heart disease, recent flight history, and concurrent dyspnea. Conclusion: In the emergency department, approximately 28% of patients presenting with chest pain received a pulmonary embolism workup. This study identified five clinical variables that were independently associated with a higher likelihood of undergoing such a workup. Recommendation: Healthcare providers in emergency departments should consider a pulmonary embolism workup in patients with chest pain, particularly those who are female, younger, without ischemic heart disease, have recent flight history, or present with concurrent dyspnea, as these factors were found to be associated with a higher probability of undergoing such an evaluation.

252. The Potential of Circulating Tumor Cells as Biomarkers for Oral Cancer Detection and Monitoring
Saloni Bharti, Harsha Vardhan
Abstract
Circulating tumour cells (CTCs) are cancer cells that have detached from the tumour and are now floating around in the blood. Their ability to serve as biomarkers in the detection and tracking of cancer has been acknowledged. A less invasive diagnostic approach called a liquid biopsy may be utilized to discover CTCs in blood. By identifying circulating biomarkers such as exosomes, circulating tumour DNA (ctDNA), proteins, and microRNAs (miRNAs), liquid biopsy can enhance oral cancer diagnostic procedures and pave the way for tailored therapy. The late diagnosis of oral cancer, which increased morbidity and death rates, remained a significant health problem worldwide. While conventional diagnostic procedures did a good job overall, they only sometimes had the specificity and sensitivity needed for monitoring and early detection. Oral malignancies were among the many tumours for which circulating tumour cells (CTCs) had shown promise as biomarkers. The possibility of CTCs as non-invasive indicators for the identification and monitoring of oral cancer was discussed in that abstract. It also emphasized new technologies that had recently emerged, such as nanotechnology and microfluidics that helped isolate and analyze CTCs. Additionally, that presentation explored clinical research that showed how CTCs might have been helpful for oral cancer patient’s prognosis, therapy response evaluation, and monitoring. The problems and limitations of CTC-based tests were also discussed, highlighting the need for more extensive validation studies and standardized methodologies. The use of CTCs as biomarkers had the potential to significantly improve patient outcomes in the management of oral cancer via the implementation of tailored treatment plans, early identification, and real-time monitoring. Due to the high cost of the technologies used to detect CTCs and the tiny numbers seen in blood, a common standard has yet to be established. Additional research is necessary to determine the DNA types of all cancers and to develop methods that detect CTCs with higher sensitivity and precision.

253. Evaluating the Efficacy of Targeted Therapies in Advanced Stage Oral Cancer
Saloni Bharti, Harsha Vardhan
Abstract
The conventional methods of dealing with advanced oral cancer usually have unsatisfactory results and may bring about undesirable adverse effects, making the condition a major global public health problem. This study examines whether targeted treatment can function as a viable alternative. These therapies aim to stop the spread of cancer cells, often by suppressing certain biochemical pathways or mechanisms which enable them to multiply. Patients suffering from oral cancer undergoing specialised treatment face problems like tumor heterogeneity, drug delivery difficulties, how to find biomarkers and resistance mechanisms. However, it is important to note that these therapies have demonstrated better outcomes in other forms of cancer. This work explores recent developments, problems and possible solutions to enhance the efficacy of targeted treatments for advanced oral cancer.

254. Comparison of Intralesional Infiltration of Dexamethasone plus Hyaluronidase in Management of Patients with OSMF
Md. Barkat Ali, R. P. Thakur, Sana Ahmed Rao
Abstract
Background: The purpose of this investigation was to compare the efficacy of intralesional dexamethasone and hyaluronidase therapy with and without ultrasound therapy in the treatment of OSMF patients. Methods: The present investigation included 30 OSMF patients of both genders based on their medical history and clinical manifestations. Patients of all ages, gender, and stages of OSMF were randomly divided into two groups using a single-blind randomization procedure. Each cohort had 15 individuals. Results: In group A, the mean age was 35.4 years, while in group B, it was 32.8 years. 14 males and 6 females were enlisted in the study out of a total of 30 participants. All patients in group A experienced a complete reduction in burning sensation, while two patients in group B experience a moderate persistence of burning sensation. All patients demonstrated a highly significant increase in mouth opening, although group A demonstrated a marginally greater degree of improvement than group B. Conclusion: Future directions for the management of OSMF should therefore include the development of treatment regimens that combine multiple medications or employ sequential therapy.

255. Acamprosate as the Remedial Molecule in Sensorineural Tinnitus
Mukesh Chandra Das, Abhinav Paul Minj
Abstract
Background: The management of tinnitus remains a significant clinical hurdle for otolaryngologists in the field. Numerous aspects pertaining to the pathophysiology of this condition still remain elusive, giving rise to a diverse array of therapeutic approaches, yielding inconsistent outcomes. Acamprosate, a pharmacological agent, is commonly employed in the therapeutic management of alcohol use disorder. This drug exerts its effects by modulating glutamatergic and GABAergic neurotransmission. Notably, acamprosate has not been previously utilised in the treatment of tinnitus. To assess the effectiveness and safety of acamprosate in the management of sensorineural tinnitus. Methods: A cohort of 50 individuals diagnosed with sensorineural tinnitus were enrolled in a three-month prospective double-blind study. The primary objective of this study was to evaluate the effectiveness and safety of a specific intervention. The subjective score, ranging from 1 to 10, provided by each patient was utilised as a measure of efficacy. Results: A significant success rate of approximately 86.9% was observed in the alleviation of tinnitus. In 47.8% of the observed instances, a significant reduction of more than 50% in symptoms was observed. The prevalence of adverse reactions was found to be minimal, specifically 12%, with all reported cases being of a mild nature. Conclusion: Acamprosate, a drug used in the treatment of alcoholism, is a safe and successful alternative for sensorineural tinnitus’ treatment.

256. Influence of Manual Small Incision Cataract Surgery on Pre-Corneal Tear Film
Deepankar Sinha, Kumari Sandhya, Deepak kumar, Uday Narayan Singh
Abstract
Introduction: Dry eye disease (DED), which affects postoperative patient satisfaction and resulting in subpar visual acuity, is a typical adverse effect following cataract surgery. During cataract surgery, the tear film is disturbed, which causes dry eye illness. There are incredibly few studies that evaluate dry eye after manual small incision cataract surgery (MSICS) in the South Indian population. Consequently, this study was carried out to assess the tear film after manual small incision cataract surgery and to ascertain the occurrence of dry eye. Materials and Methods: In order to evaluate the severity of dry eye following MSICS, a prospective study was conducted in the Department of Ophthalmology at Jawahar Lal Nehru Medical College and Hospital. Dry eye indices used were tear meniscus height, tear film break up time, Schirmer’s Test 1, and Rose Bengal staining. Preoperatively, as well as a week, a month, and three months after surgery, the patients were evaluated. Result: 67 (33.3%), 83 (41.3%), and 6 (3.2%) of patients who underwent manual small incision cataract surgery suffered mild, moderate, and severe dry eyes, respectively, in the first week after the procedure. 70 eyes (34.9%), 60 eyes (30.2%), and 3 eye (1.6%) experienced mild, moderate, and severe dry eyes, respectively, one month following MSICS surgery. At the one-week and one-month postoperative reviews, the mean dry eye indices were significantly lower than they were preoperatively, which was typical. Conclusion: Following cataract surgery, the dry eye condition started to appear right away and peaked on day seven. Dry eye symptoms were shown to lessen over time. Dry eye sickness is a common post-cataract surgery complaint that, despite a normal visual recovery, has a negative impact on patient satisfaction and needs to be quickly diagnosed and treated.

257. Clinical Analysis of the Use of Latissimus Dorsi Flap in Repairing Defects after Oncological Surgery
Anuradha Kishor, Omkarnath Nandkumar Deshpande, Vidyapati Choudhary
Abstract
Background: Cancer resections often lead to significant defects, necessitating reconstructive surgery for functional and aesthetic restoration. The Latissimus Dorsi (LD) flap is a versatile, robust musculocutaneous flap widely used in reconstructive surgery due to its ample size, consistent vascularity, and adaptability to various defect types. The study aims to evaluate the role of the latissimus dorsi flap in the reconstruction of various defects following cancer resections. Methods: This prospective study involved 45 patients undergoing LD flap reconstruction post-cancer resection at E.S.I.C. Andheri, Mumbai during 2021 to 2023′. The study evaluated the flap’s effectiveness in covering defects in the chest wall, breast, arm, axilla, shoulder, head, and neck. Flap dimensions, surgical techniques, and patient outcomes were analyzed. Results: The patient cohort comprised 36 females and 9 males, with an age range of 23 to 82 years. The majority (42 out of 45) of reconstructions used myocutaneous flaps. Breast reconstructions were the most common (25 cases), followed by chest wall and axilla. Complications included complete flap loss (4%), partial flap necrosis (16%), seroma formation (11%), and shoulder dysfunction (4%). These results demonstrate the LD flap’s versatility and applicability across various reconstruction sites.Conclusion: The LD flap is a reliable and effective option for reconstructive surgery post-cancer resection, offering versatility across different anatomical locations. While the procedure is generally safe, attention to potential complications and patient-specific factors is crucial for optimal outcomes. Recommendation: Future research should focus on long-term functional and aesthetic results, as well as patient satisfaction, to further refine the use of LD flaps in reconstructive surgery.

258. A Comparative Analysis of Different Scalp Reconstruction Techniques and Their Results
Anuradha Kishor, Omkarnath Nandkumar Deshpande
Abstract
Background: Scalp defects, arising from various causes like trauma or burns, pose significant challenges in reconstructive surgery due to the complex nature of the scalp. This study aims to enhance understanding of different scalp reconstruction techniques, their efficacy, outcomes, and complications. Methods: A prospective interventional study was conducted at E.S.I.C. Andheri, Mumbai, over a period of 24 months (2021-2023), involving 30 patients aged 0-70 years with non-malignant scalp defects. Data on demographics, defect characteristics, treatment methods, and outcomes were collected and analyzed. The study focused on various reconstruction techniques, including primary closure, skin grafting, and local flaps. Results: The study included predominantly middle-aged patients (31-40 years), with a higher incidence in males (70%). Trauma was the most common cause (50%), followed by burns (33%). The temporal region was most affected (40%). The majority of defects were medium-sized (9-100 cm²), with most patients seeking treatment within 24 hours of injury. The primary treatment method was transposition flap with split skin grafting (50%). Conclusion: Scalp defects are more prevalent in middle-aged males, with trauma being the leading cause. The temporal region is most susceptible to defects. Efficient treatment, primarily transposition flap with SSG, is vital for positive outcomes, especially for medium-sized defects. Recommendation: Customized reconstruction strategies considering individual patient profiles and defect characteristics are essential for optimal results. Early intervention and tailored treatment plans are recommended to reduce complications and hospital stays.

259. A Prospective Study Comparing Healing Times after Modified Radical Mastoidectomy with or Without Mastoid Cavity Obliteration
Ashutosh Kumar, Vinit Kumar Anand, Dharmendra Kumar
Abstract
Background: Chronic otitis media is a common middle ear condition necessitating surgical intervention, with modified radical mastoidectomy (MRM) being a well-established approach. A debate exists regarding the incorporation of mastoid cavity obliteration during MRM surgery, which aims to expedite healing and reduce complications. Methods: A prospective comparative study was conducted involving 100 patients diagnosed with chronic otitis media. Patients were randomized into two groups: Category A (MRM with mastoid cavity obliteration) and Category B (MRM without obliteration). Gender and age distributions were analyzed. Healing times were assessed using an independent T test. Results: Gender and age distributions did not significantly differ between groups. Notably, Category A exhibited a faster healing time (10.83 weeks) compared to Category B (12.62 weeks), with a statistically significant difference (p = 0.007). Conclusion: Mastoid cavity obliteration in MRM surgery appears to accelerate healing, which may enhance postoperative recovery. This finding aligns with previous studies, emphasizing the potential benefits of this technique in surgical outcomes. Recommendations: Based on these results, we recommend considering mastoid cavity obliteration as a valuable adjunct in MRM surgery for chronic otitis media.

260. A Prospective Study on Assessment of Nasal and Paranasal Sinus Fungal Infections at Tertiary Care Hospital
Ashutosh Kumar, Dharmendra Kumar, Vinit Kumar Anand
Abstract
Background: Fungal infections of the nasal and paranasal sinuses pose significant clinical challenges, with diverse causative organisms and varying clinical presentations. This study aimed to comprehensively investigate the epidemiology, clinical features, and management of these infections, with a focus on improving diagnostic accuracy and optimizing patient care. Methods: A prospective observational study was conducted on 70 patients presenting with clinical features suggestive of nasal and paranasal sinus fungal infections. A systematic evaluation, including clinical assessments, diagnostic tests, radiological imaging, microbiological investigations, and endoscopic examinations, was performed. Data were analyzed using descriptive statistics, and ethical considerations were upheld throughout the study. Results: The majority of patients were younger adults, with males predominating (65%). Nasal obstruction, discharge, and headaches were common clinical symptoms. Ocular symptoms were observed in 25% of cases. CT scans revealed extensive sinus involvement, particularly in the maxillary sinus (75%). Complications, including intraoperative hemorrhage and synechiae formation, were noted. Recurrence rates were higher in longer-term follow-ups. Aspergillus species, notably Aspergillus flavus, were the primary causative agents. Conclusion: This study sheds light on the complex nature of nasal and paranasal sinus fungal infections. It emphasizes the importance of early recognition, careful management, and prolonged monitoring, especially in high-risk patients. The identification of Aspergillus species aids in targeted antifungal therapy, contributing to improved patient outcomes. Recommendations: Healthcare providers should maintain a high index of suspicion for fungal infections in patients with compatible symptoms, especially in regions with environmental risk factors. Comprehensive evaluation, including imaging and microbiological assessment, should guide timely intervention and management.

261. A Retrospective Study of Comparative Analysis of Surgical Outcomes in implant Vs. Autologous Costal Cartilage
Anuradha Kishor, Omkarnath Nandkumar Deshpande
Abstract
Background: Rhinoplasty, a procedure for enhancing the nose’s aesthetic and functional aspects, often involves dorsal augmentation using materials like implant and autologous costal cartilage (ACC). This study aims to compare these materials in terms of surgical outcomes, aesthetic enhancements, and potential complications. Methods: A retrospective study was conducted on 130 patients who underwent dorsal augmentation with implant or ACC. Data were collected through patient records, pre and postoperative photos, and anthropometric measurements. Two otolaryngologists independently assessed the aesthetic outcomes to minimize bias. Results: The study included 93 patients in the implant group and 37 in the ACC group. Complications were observed in 6 implant patients (6.5%) and 7 ACC patients (18.9%). The implant group experienced minor complications like implant displacements, while the ACC group had more significant issues such as resorption and warping. However, both groups showed similar aesthetic outcomes with mean scores of 2.99. Conclusion: Both implant and ACC are effective for dorsal augmentation in rhinoplasty, but they differ in complication profiles. Implant is associated with a lower complication rate, making it a safer option, whereas ACC, despite a higher complication rate, provides more substantial augmentation. The choice of material should be based on individual patient needs and goals. Recommendations: Future studies should focus on prospective designs and include long-term follow-ups to provide more comprehensive insights. Surgeons should consider both materials’ strengths and weaknesses for tailored patient care.

262. Evaluation of Patient Reported Outcomes in Burn Surviors Undergoing Reconstructive Surgery in the Rehabilitation Period
Onkar Dew, Vidyapati Choudhary
Abstract
Background: This study examines reconstructive surgery outcomes in 165 adult Burn Model System participants, focusing on factors influencing surgical interventions and their impact on patient-reported outcomes. Methods: A retrospective analysis of data gathered from burn survivors within a 24-month post-injury period was conducted. Logistic regression was used to estimate predictors of surgery, and patient-reported outcomes were assessed using the Short Form-12/Veterans RAND 12 questionnaires. Results: Approximately 24.8% of participants underwent burn-related surgeries, primarily for scar-related issues. The number of surgeries during the index admission, and specific burn locations were associated with surgery likelihood. Patient-reported outcomes varied among surgical and non-surgical cohorts. Conclusion: Factors influencing reconstructive surgery in burn survivors include age, sex, surgical history, and burn location. Patient-reported outcomes showed differing trends between surgical and non-surgical groups. Recommendations: Healthcare providers should consider these factors when planning burn rehabilitation and reconstructive surgery. Further research is needed to explore the long-term effects of surgical interventions and improve patient care.

263. Hemisoleus Muscle Flap for Middle One-Third Leg Defect- An Institutional Experience
Sanjay Kumar, Sanjay Kumar Gupta
Abstract
Background: Middle one-third leg defects resulting from trauma or surgical excision present a challenge in reconstructive surgery. The hemisoleus muscle flap, known for its robust blood supply and versatility, has gained prominence in addressing such defects. This study assesses the effectiveness of hemisoleus muscle flap reconstruction, focusing on wound healing, complications, functional restoration, and patient satisfaction. Methods: This retrospective cohort study included 105 adult participants who underwent hemisoleus muscle flap reconstruction for middle one-third leg defects. Data were collected from medical records and analyzed using descriptive statistics, subgroup analyses, and logistic regression. Results: Successful wound healing was achieved in 91.4% of cases, with a mean closure time of 4.2 weeks. Complications occurred in 20.0% of participants, primarily including wound infection (8.6%) and hematoma (6.7%). Functional improvement was reported by 82.9% of participants, and 93.3% expressed satisfaction with the procedure. Subgroup analyses revealed no significant differences based on age, gender, or comorbidities. Predictors of complications were diabetes (OR: 2.34) and smoking history (OR: 2.18). Conclusion: Hemisoleus muscle flap reconstruction is effective for middle one-third leg defects, offering favorable outcomes in wound healing, complications, function, and patient satisfaction. Careful patient selection and risk assessment are crucial. Collaboration among specialists is recommended. Recommendations: Surgeons should consider the hemisoleus muscle flap for leg defect reconstruction. Preoperative risk assessment is essential. Prospective studies and interdisciplinary collaboration are encouraged.

264. A Clinical Study of Various Methods of Reconstruction of Scalp Defect and its Outcomes
Sanjay Kumar, Sanjay Kumar Gupta
Abstract
Background: Scalp defects, arising from various causes, present intricate challenges in reconstructive surgery, demanding tailored approaches to restore both function and aesthetics. The aim of this study is to comprehensively evaluate and compare various techniques for reconstructing scalp defects, exploring their efficacy, safety, and cosmetic outcomes. Methods: This prospective cohort study, conducted at a tertiary care facility, evaluated and compared different scalp defect reconstruction techniques in 74 adult participants. The study incorporated randomization, blinding, and standardized assessments to ensure robust findings. Participants were assigned to four surgical technique groups: skin grafting, local flap reconstruction, tissue expansion, and microsurgical free tissue transfer. Results: Notably, skin grafting and local flap reconstruction demonstrated faster wound healing, while tissue expansion and microsurgical free tissue transfer had longer healing times. Complications were observed in 24% of cases, with the latter group experiencing the highest rate. Cosmetic outcomes were generally favorable across techniques, with high patient satisfaction. Age and surgical technique were identified as predictors of outcomes. Conclusion: This study provides valuable insights into optimal scalp defect reconstruction strategies, offering potential enhancements in patient care and quality of life. Recommendations: Based on the study’s findings, it is recommended that clinicians carefully consider patient-specific factors and defect characteristics when selecting the most suitable scalp defect reconstruction technique. Additionally, further research should explore ways to refine and optimize these techniques for improved patient outcomes.

265. Lateral Calcaneal Artery Skin Flap for Coverage of exposed Tendoachhillis
Sanjay Kumar, Santosh Kumar, Sanjay Kumar Gupta
Abstract
Aim:  Experience of five patients  with exposed tendoachhillis treated with the lateral calcaneal artery skin flap. Methods: Case series was conducted at department of Plastic Surgery PMCH Patna, from October 2018 to march 2021. Five patients with soft-tissue defects over the tendoachhillis underwent reconstruction using a lateral calcaneal artery skin flap. The etiology was, post burn chronic ulcer in two and surgical wound dehiscence in three. The flap sizes ranged from 3.5 × 2.0 cm to 6.5 × 3.5 cm and the mean follow up was 6 months. Results: All five flaps survived completely with no subsequent breakdown of the skin. The skin flap donor sites were grafted with split thickness skin grafts in all patients. Donor site healed well in all patients. One patient showed marginal flap skin desquamation. Conclusion: The lateral calcaneal artery skin flap is reliable and sensate and can be used safely to provide sensory skin coverage to exposed tendoachhillis.

266. A Clinical Study on Post Burn Contracture of Axilla at a Tertiary Care Centre
Sanjay Kumar, Sanjay Kumar Gupta
Abstract
Background: Axillary post-burn contractures represent a challenging issue in burn rehabilitation and reconstructive surgery, impacting both physical and psychological aspects of patients’ lives. Surgical interventions, including Z-plasty and local flap reconstruction, have been developed to address these contractures. This study aims to assess the efficacy of these techniques in improving functional outcomes and scar quality while enhancing patient satisfaction. Methods: A retrospective observational study was conducted. Forty-two patients with axillary post-burn contractures were included based on strict inclusion and exclusion criteria. Data were collected from electronic medical records, encompassing patient demographics, burn history, contracture severity, surgical procedures, a