International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

Peer Review Journal

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1. A Study to Assess the Proportion of Pulmonary Artery Hypertension in Chronic Kidney Disease Patient
Kushagra Tandon, Pushpendra Singh Sengar, Hindeshwari Rai, Anurag Jain
Objectives: To measure the Pulmonary artery systolic pressure of patients diagnosed with chronic kidney disease using Echocardiogram. Methodology: In this cross-sectional study, Patients seeking medical attention at Sri Aurobindo Medical College and Post Graduate Institute, who have been diagnosed with chronic kidney disease from April 2021 to September 2022 were included. Patients who attend the Emergency/OPD were asked to participate in the study. Informed written consent was taken from all the patients. A pre-structured proforma was used to record the patient data. Detailed clinical examination, Echocardiogram, Chest X ray and biochemical tests was done in all participants. Results: In present study incidence of pulmonary artery hypertension (PAH) in patients with CKD was 53%. Mean SBP was higher in patients with PAH (149.06±14.042) than patients without PAH (147.66±13.386). However, no significant difference was obtained in terms of mean SBP among the patients with PAH as compared to those without PAH. P value of this association was 0.613. Mean DBP was significantly higher in patients with PAH (93.58±4.568) than patients without PAH (88.72±8.107). There was a significant difference obtained in terms of mean DBP among the patients with PAH as compared to those without PAH. Conclusion: It was shown that there is a substantial association between pulmonary arterial hypertension (PAH) and chronic kidney disease (CKD) patients, with a prevalence rate of 53%. Furthermore, it was observed that the severity of PAH tends to rise as renal function deteriorates in individuals with CKD. Anemia, hypertension and left ventricular failure have been identified as risk factors associated with the development of pulmonary arterial hypertension (PAH). The mitigation of these risk factors has the potential to attenuate the progression and severity of pulmonary arterial hypertension (PAH), thereby leading to a reduction in the morbidity and mortality rates associated with chronic kidney disease (CKD).

2. Intraoperative Lidocaine Infusion Reduces Analgesic and Anesthetic Requirements in Patients with High Body Mass Index Undergoing Laparoscopic Cholecystectomy
Stuti Kumari, Satyendra Kumar, Nitin Ojha, Bijoy Kumar, Rakesh Kumar Raju
Background: The administration of lidocaine by intravenous (IV) means has been found to possess analgesic, antihyperalgesic, and anti-inflammatory characteristics. The utilization of lidocaine infusion during laparoscopic cholecystectomy procedures has been shown to decrease the need for analgesics and anesthetics. Aims and Objectives: The objective of this study was to examine the impact of administering lidocaine during surgery on the need for opioids, anesthetics, and neuromuscular agents, as well as the occurrence of adverse effects in individuals with a high body mass index who are undergoing laparoscopic cholecystectomy. Materials and Methods: The present study is a prospective, randomized, double-blinded investigation carried out in a tertiary hospital. Out of the initial cohort of 38 participants who were recruited in the research, a total of 33 individuals successfully concluded the study. This reduction in sample size was mostly due to cancellations and conversions to open surgery. The remaining participants were divided into two groups: the control group (C) consisting of 16 individuals, and the lidocaine group (L) consisting of 17 individuals. Patients from both groups were administered the test medication, either lidocaine or normal saline, as a bolus of 2 mg/kg during the induction phase. This administration was followed by a continuous infusion at a rate of 2 mg/kg/h throughout the surgical procedure, which concluded 30 minutes after extubation. The study involved an analysis of the patients’ perioperative analgesic, anaesthetic, muscle relaxant need, and side effects. Results: The average visual analogue scale (VAS) score during the first- and second-hour following surgery was lower in the group that received intravenous lidocaine infusion compared to the control group. Specifically, the VAS scores were 7.5 ± 7.8 and 10.5 ± 11.8 in the lidocaine group, and 12.5 ± 8.1 and 23 ± 24.6 in the control group, respectively.  The lidocaine group exhibited a reduction of 43% in the intraoperative opioid need. The lidocaine group had a 53% reduction in the cumulative dosage of rocuronium. There was no discernible disparity observed in the sedation ratings between the two groups, and no untoward effects were reported in either cohort. Conclusion: The study presents evidence supporting the efficacy of intravenous lidocaine infusion as a supplementary method for administering anaesthesia, resulting in reduced requirements of opioid, anaesthetic, and neuromuscular blocking drugs.

3.  Clinical Comparative Evaluation of Bupivacaine with Fentanyl and Ropivacaine with Fentanyl in Upper Limb Surgery Under Supraclavicular Brachial Plexus Block
Sunil Rajpoot, Anuj Dubey, Pooja Makhija, Chandrabhan Singh Thakur
Introduction: A supraclavicular block is often recommended for surgeries conducted on the upper limb not involving the shoulder. The supraclavicular block is a safe regional anaesthesia technique associated with rapid onset and reliable anaesthesia. Aim: The present study was conducted to compare the clinical effectiveness of supraclavicular block using ropivacaine (0.5%) and bupivacaine (0.5%) given along with Fentanyl. Materials and Methods: This was a clinical comparative, cross-sectional study involving a total of 60 patients (30 patients in each group) aged 18 to 60 years belonging to American Society of Anaesthesiologists (ASA) status 1 or 2, admitted to JK Hospital, Bhopal. Group B received 0.5% bupivacaine and group R 0.5% ropivacaine into the supraclavicular region, by a nerve-stimulator technique along with Fentanyl. We collected data on the onset and total duration of sensory and motor block for both bupivacaine and ropivacaine. Results: The mean time for the onset of complete sensory block observed with bupivacaine and ropivacaine was 558 seconds and 402 seconds, (p = 0.004) respectively. The mean time for the onset of complete motor block observed with bupivacaine and ropivacaine was 986 seconds and 813 seconds, (p = 0.002) respectively. The mean total duration of the sensory block with bupivacaine and ropivacaine was 442 and 388 minutes, respectively (p<0.001). The mean duration of the motor block with bupivacaine and ropivacaine was 414 and 353 minutes, respectively (p<0.001). The preoperative, intraoperative and postoperative heart rate, systolic & diastolic blood pressure and oxygen saturation were comparable among the two study groups (p>0.05). There were zero incidents of side effects or adverse events in either of the two local anaesthesia groups. Conclusion: The onset of sensory and motor block was significantly different among the participants given bupivacaine and ropivacaine. The total duration of sensory and motor block was significantly different among the participants given bupivacaine and ropivacaine.

4.  Analysis of Thrombocytopenia in Critically ill COVID-19 Patients: A Single Centre Retrospective Study
Amudhavalli Singaram, Premalatha Sundarasen, Babiya Infant Arockiasamy, Arunbabu Chinnadurai, Amitesh Krishna S
Introduction:  In 2019, the world witnessed the outbreak of a group of viruses known as corona virus, mainly affecting lungs and the disease is termed as COVID-19.To correlate with the severity of illness, many potential biological markers are being analysed in Covid-19 patients, chiefly haematological parameters. Among this thrombocytopenia seem to be of more significance and a prognostic marker for critically ill patients. This study aims to analyse the meticulous relation between critically ill Covid-19 patients and thrombocytopenia. Materials and Methods: A retrospective observational cohort study was conducted in the Department of Pathology, Government Medical College and Hospital, Omandurar Government Estate, Chennai, Tamil Nadu. COVID positive cases admitted in Government Omandurar Medical College Hospital during the month of October 2020 were included for the study. Clinical and demographic details like age, sex, comorbidities (Hypertension, diabetes mellitus, cardiovascular disease), clinical manifestations and CBC reports were collected from medical records. A total of 1176 cases were included, comprising 803 males and 373 females. Observation and Results: Among 803 males, 186 had thrombocytopenia and among 373 females, 45 had  thrombocytopenia. The age group ranges from 7- 98 years, with peak age group at 51-60 years followed by 61-70 years. Among the comorbid illnesses, diabetes mellitus is more commonly seen compared to  Systemic Hypertension. The hematological abnormalities observed in our study are Lymphopenia (34.12%), Raised NLR (27.72%), thrombocytopenia (19.6%), neutrophilia(20.49%) and leukocytosis (17.51%). Conclusion: Compared with clinical symptoms, platelet count changes occur earlier and can be easily determined, so clinicians should pay more attention to the changes to personalize the therapeutic interventions and treatment procedures.

5. A Study of Association Between Fundus Changes and S Lipid Profile in Patients of Essential Hypertension
Santosh Kumar Singh, Pummy Roy
Background: People with essential hypertension, a form of cardiovascular disease, frequently experience end-organ injury, such as retinal abnormalities. There is a substantial correlation between dyslipidemia and essential hypertension. The relationship between alterations in the fundus and a person’s lipid profile in Bhagalpur patients with essential hypertension is not fully understood at this time. Methods: The aim of this research was to examine the connection between fundus alterations and lipid profile in Bhagalpur residents who have been diagnosed with essential hypertension. The study was conducted between October 2020 to May 2021.Patients with essential hypertension were called from area hospitals and clinics for this cross-sectional study. Retinal alterations were evaluated via fundus examinations, and lipid profile variables were analysed per protocol in the lab. The potential relationship between fundus alterations and lipid profile was investigated using statistical methods including correlational analysis and multivariate regression. Results: Two hundred individuals diagnosed with essential hypertension (mean age of 55,6 years; 60% men, 40% women) participated in the study. Upon examination of the fundus, abnormalities including cotton-wool patches, arterial constriction, arteriovenous nicking, and haemorrhage were observed on the retina. Other modifications included patches of cotton fibre. 75% of the participants displayed retinal alterations characteristic of hypertensive retinopathy. Significantly elevated levels of total cholesterol (mean 230 mg/dL, standard deviation 40 mg/dL), triglycerides (mean 180 mg/dL, standard deviation 30 mg/dL), and low-density lipoprotein cholesterol (mean 160 mg/dL, standard deviation 25 mg/dL) were indicative of dyslipidemia in a substantial number of patients. Higher total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels were associated with more severe retinal abnormalities (p 0.001 for all three variables). Even after controlling for parameters such as age, gender, and blood pressure, the multivariate regression analysis revealed a significant (p 0.05) independent association between fundus changes and lipid profile. Conclusion: According to our results, fundus alterations are strongly linked to lipid profile in Bhagalpur patients with essential hypertension. The need of a thorough examination and therapy strategy addressing both symptoms of hypertension and dyslipidemia is highlighted by the occurrence of retinal abnormalities in these patients. The risk of cardiovascular problems from essential hypertension may be reduced or avoided altogether with early detection and treatment. To better understand the mechanisms at play here and assess the clinical consequences over the long run, more study is needed.

6.  Statin Lipophilicity and the Risk of Incident Heart Failure: A Retrospective Study
Rakesh Kumar, Sudhanshu Shekhar Jha
Background: Cholesterol-lowering statin therapy is a mainstay in the fight against cardiovascular disease. There has been some debate over whether or not statin lipophilicity increases the risk of heart failure in recent studies. The purpose of this retrospective cohort study is to look at the association between statin lipophilicity and incident heart failure. Methods: Electronic health records were used for retrospective cohort research. All participants had to be 18 or older, and there had to be a history of statin use. Statins were divided into two groups: highly lipophilic and less lipophilic. Heart failure rates were evaluated during a mean of three years of follow-up. Hazard ratios and 95% confidence intervals were calculated using a statistical model that accounted for confounding variables. Results: Overall, the rate of heart failure was slightly more significant among those taking highly lipophilic statins (6.7 cases per 1,000 person-years) compared to those taking less lipophilic statins (5.0 cases per 1,000 person-years) in our research of 200 patients. The risk of heart failure was trending upwards with highly lipophilic statins, although this difference did not achieve statistical significance (Hazard Ratio: 1.32, 95% CI: 0.89 – 1.96). Conclusion: Consistent with previous research, this study emphasises the nuanced connection between statin lipophilicity and heart failure risk. While the observed trend was not statistically significant, the complicated nature of the association calls for additional investigation in larger, more representative cohorts. In the absence of definitive evidence, clinicians should take individual patient features into account when administering statins.

7. Analysis of the Relationship between Hamstring Graft Dimensions and Anthropometric Variables in Patients Undergoing Anterior Cruciate Ligament Reconstruction
Ali Mohammed P, K Senthil Kumar, Prasanna T Y, Sarang Patki
Background & Objectives: Damage to the Anterior Cruciate Ligament (ACL) is a commonly occurring knee injury which frequently necessitates operative intervention for restoration. The utilization of hamstring autografts is a common practice in the surgical procedure known as anterior cruciate ligament reconstruction (ACLR). The selection of graft is determined by numerous factors. There is a limited body of research in the existing literature that presents evidence of a correlation between patients’ anthropometric measurements and the size of the hamstring tendon graft utilized in anterior cruciate ligament reconstruction (ACLR). The objective of the current study was to conduct a comparative analysis of the length as well as graft diameter obtained using anthropometric measurements. Material & Methods: Study participants were hospitalized patients at the Government Medical College and Hospital of Southern India, where a prospective observational study was conducted in the Orthopedics Department. A total of 47 patients, all over the age of 18, who had quadrupled hamstring autograft ACL reconstruction, were assessed in accordance with the guidelines set by the institutional ethics committee and after obtaining informed written consent from each participant. A patient’s anthropometric parameters were taken before surgery, while intraoperative measurements of the quadrupled graft’s diameter and the lengths of the gracilis and semitendinosus tendons were taken. All of the collected data was analyzed in SPSS, a statistical tool version 22. The association between graft diameter & graft length, as well as anthropometric parameters, was analyzed using the Pearson correlation test. Results: The study demonstrated a affirmative association between height with both thigh length as well as graft diameter (p=0.045 & p=0.041, respectively). Both gracilis and semitendinosus length were positively correlated with height (p<0.001). Furthermore, there was a positive association between thigh length and semitendinosus length (p=0.046). No correlations between graft diameter, graft length, or any other measured variable were found to exist. Conclusion: Anthropometric parameters serve as straightforward indicators for evaluating graft size in anterior cruciate ligament reconstruction (ACLR) surgery. In the context of anterior cruciate ligament reconstruction (ACLR), it is possible to utilize positive correlation factors such as height and thigh length to make predictions on the likelihood of achieving a superior-quality of graft.

8.  Prognostic Factors in Paediatric Open Globe Injuries
Sony K Jose, Lekshmi H, Vijayamma N
Background: Ocular trauma is a major cause of monocular visual loss among children. The epidemiology and clinical characteristics of paediatric ocular trauma vary in different geographical locations. Various prognostic factors for final visual outcome in paediatric open globe injuries has been described by many investigators. At present, not many studies in this regard have been reported from the region where our study was conducted. The knowledge about prognostic factors give the clinician valuable inputs for counseling parents regarding the probable visual outcome that can be expected in these children. Objectives: To determine the clinical features and visual outcome in traumatic open globe injuries in children and to identify the factors contributing to a poor visual outcome. Methods: We conducted a retrospective study of 58 eyes of 58 consecutive patients aged less than 15 years with open globe injury over a period of 8 years. The baseline demographic data, details regarding the mechanism of injury, ocular findings at presentation including initial visual acuity and complications encountered were noted from patient records. The final visual outcome at 6 months and the factors affecting it were analysed using appropriate statistical tests. Results: This study was conducted on 58 paediatric patients with open globe injury. Open globe injury was seen more in males [79.3%] and most of them were under 10 years of age [53%]. Penetrating injury was found to be the most common mechanism of injury [93.1%]. Injury with household objects while playing was present in 72.4% of which majority were sharp objects like scissors and knives. Majority of our patients had injury in Zone 1(cornea) [69%]. A poor final visual acuity <20/200 at 6 months was found in 23 patients (39.7%). Initial visual acuity[p<0.001], wound location[p=0.021] and wound length[p=0.001], traumatic cataract[p<0.001], retinal detachment[p=0.021], endophthalmitis [p=0.005], posterior segment involvement[p=0.005] and presence of globe rupture[p=0.021] were found to be statistically significant in determining the final visual outcome[p < 0.05] on univariate analysis. On further analysis using binary logistic regression, factors like having wound length > 10 mm {AOR=32.128 (p=0.024)}, presence of traumatic cataract {AOR=43.413 (p=0.008)}, endophthalmitis {AOR=131.192 (p=0.031)} and central corneal opacity {AOR=14.395(p=0.049)}  were the independent predictors of final visual outcome in the study population. Among the factors predisposing to endophthalmitis in these patients it was found that found that injury with organic matter and contaminated wounds were most likely to develop endophthalmitis[p=0.012]. Conclusion: In our study we found that penetrating injury is the most common type of open globe injury in children less than 15 years of age. Majority of children suffered injuries with household objects. The presence of factors like wound length > 10 mm, traumatic cataract, endophthalmitis and central corneal opacity were the independent predictors of final visual outcome. The knowledge about these prognostic factors will aid the ophthalmologist in proper counseling of parents of such children. This also stresses the importance of improving parental awareness regarding eye trauma and adopting appropriate measures to avoid domestic accidents.

9.  Clinico-Epidemiological Study of Dermatological Complications in Post Allogenic Bone Marrow Transplant Patients: A Cross-Sectional Study
Prasanjeet Dash, Ransingh Tanwar, Vinay Kumar, Saurabh Sarda
Background: Dermatological complications are quite prevalent in post-allogeneic bone marrow transplant patients but are often overlooked. Although several studies have been dedicated to systemic complications in post-allogeneic bone marrow transplant patients, only a few reports have been published on dermatological complications. Furthermore, to the best of our knowledge, no systematic study has been done to classify and compare the prevalence of various dermatological complications in post-allogeneic BMT patients. Thus, we have planned this study to develop a better insight into dermatological complications in post allogeneic BMT patients which will further help in its effective prevention, control and treatment in the future. Objectives: To study different dermatological complications in post allogeneic bone marrow transplant patients. Methodology: This study was conducted in the Department of Dermatology, Venereology and Leprosy in collaboration with the Bone Marrow Transplant unit of Maharaja Yeshwantrao Hospital, Indore from October 2020 to September 2021. All patients undergoing allogeneic bone marrow transplantation in the Bone Marrow Transplant unit of MY hospital, Indore were included in the study. Results: The mean age of patients in the study was 7.82 years. The majority (17/37) of the patients were between 6-10 years of age. The most common indication for allogeneic bone marrow transplantation in the study was Thalassemia major (26/37). Dermatological complications were more frequent in patients belonging to the lower-middle socio-economic class (19/37) and patient who received BMT in the winter months from January to March (6/13). However, the association was not statistically significant. Among non-dermatological complications, the most frequent complication seen was mucositis (16/37) followed by hypertension (13/37) and veno-occlusive disease (5/37). Conclusion: Post-allogeneic BMT patients experience various dermatological disorders, including side effects of different drugs and common infectious diseases (such as herpes zoster and tinea corporis), with an unusually high frequency. Prompt diagnosis and treatment of these simple skin changes such as erythema multiforme and candidiasis may reduce SJS/TEN and septicaemia rates. Also, early intervention in paediatric transplant recipients may prevent several other diseases like skin tumours, common in adults suffering from complications.

10. A Community Based Study of Association of Body Mass Index with Co-Morbid Conditions in an Urban Population of Delhi
Dipanweeta Routray, Devendra Kumar Taneja, Gajendra S. Meena, N.P. Singh, G.K. Ingle
Background: Overweight and obesity are associated with a significant burden of co-morbidities like hypertension, osteoarthritis (OA), sleep apnea (SA), type 2 diabetes mellitus, asthma, heartburn, etc. There is a paucity of well-dispersed studies to assess the prevalence of overweight and obesity in India. Aims and Objectives: To find out the prevalence of overweight, obesity, and various co-morbid conditions in relation to body mass index (BMI), waist hip ratio (WHR), waist circumference (WC), and hip circumference (HC). Materials and Methods: This community-based cross-sectional study was conducted on a population consisting of all the adults between 18 and 60 years of age residing in Gokulpuri, located in the eastern part of Delhi. Pre-tested, pre-coded, semi structure questionnaire was used to collect data regarding socio demographic and anthropometric measurements. Results: A total of 530 subjects were included as per our inclusion and exclusion criteria. The mean age ± SD of the study subjects was 36.84 ± 12.54 years. This study shows that obesity, measured either as BMI, WC, or percentage body fat, is associated with various co-morbidities, but the association was stronger in the case of BMI. The association of WC was also better appreciated than WHR in the case of most of the co-morbidities. The association between overweight and obesity was strong in cases of hypertension, OA-knee, gastroesophageal reflux disease (GERD), DM type II, and OSA. However, the association of obesity with other co-morbidities like asthma, gallbladder stones, and cholecystitis could not be established statistically. Conclusion: BMI has come out as a better indicator of the risks of co-morbidities associated with overweight or obesity. It is also noted that BMI correlates better with the number of comorbidities compared to other indices. Measurement of BMI is hence recommended in such a community setting to find out the magnitude of overweight or obesity and the related health problems. However, as far as type 2 diabetes mellitus is concerned, WC is a better indicator of risk. Hence, measurement of waist circumference is worth consideration in the risk estimation of type II DM.

11. Menstrual Cycle Effects of COVID-19 Vaccination in Jharkhand
Indrani Dutta, Atima Bharti
Background: The COVID-19 vaccine defends to resist the severe effect of coronavirus infection, but few people were uncertain to get vaccinated due to its influence on the menstrual cycle. Studies that were done to examine the safety and effectiveness of the vaccine do not include after-effects on the menstrual cycle. Objective: This study aims to evaluate the association between the menstruation cycle during the vaccination and the menstruation cycle after taking the vaccine and the irregularities in pre-menopausal and post-maturity women. Methods and Materials: This is a cross-sectional study that includes 600 pre-menopausal and post-menopausal women to investigate the relation linking vaccine and alteration in menstrual bleeding. The online survey was conducted to gather menstrual cycle data. The majority of the women were of the age group of 25-45 years of age. The inclusion criteria were women who get any type of COVID-19 vaccine, none of them expecting a baby. 300 women passed the inclusion criteria. Statistical analysis was done by using chi-square test, t-tests, and logistic regression. Results: In the present study it partly confirmed the findings from earlier research that the vaccine is related to remarkable alterations in the menstruation cycle and bleeding in women. Missed periods, irregularity in the cycle, and spotting was very less significant. Following to the second dosage of the vaccination, there is a reduction in changes in the level of the menstrual cycle. It was detected that 11.2 % of post-maturation women had menstrual signs following the first dose and 37.6% of post-maturation women had signs subsequent to the second dosage. Conclusion: In this research, it was deduced that the vaccine is possibly have negative reaction on the menstrual cycle, but it is short-term.

12. Comparative Evaluation of Equipotent Dose of Cisatracurium and Atracurium in Patients Undergoing Abdominal Laparoscopic Surgeries
Bhausaheb Gaikwad, Balaso Khot, Sangeeta Saymote, Aparna Yadav
Background: Muscle relaxant makes an important part of the balanced anesthesia, especially for abdominal surgery. Over a period of time, newer relaxants have been developed with lower side effects and better recovery profile. This study compared two relaxants – cisatracurium and atracurium, as a part of general anesthesia for the laparoscopic medical procedures. Cisatracurium is comparatively a newer agent and there is still a limited experience in its use in various fields of surgery, including laparoscopic abdominal interventions in which short-term blockade of neuromuscular conduction is usually required. It is the R-cis isomer of atracurium carrying 3-4 times more potency. Unlike atracurium, it has significantly less histamine-releasing effect and creates better hemodynamic stability. These distinctive qualities are the most significant, and according to many publications, these two muscle relaxants practically are not distinguishable from each other. Materials and Methods: This prospective, randomized study was conducted at Prakash Institute of Medical Sciences and research for the period of February 2023 to July 2023 included 60 patients, aged from 18 to 60 y, ASA I-III class, who underwent laparoscopic abdominal surgery. Patients were randomly divided into two groups; Group C received cisatracurium 0.1 mg/kg as muscle relaxant and Group A received atracurium 0.3 mg/kg IV. The mean onset time and duration of action for the two groups was done by Stockholm rules of the pharmacodynamic investigations of muscle relaxants activity. Intubating conditions, hemodynamic changes, and safety profile were noted. Result: The mean onset time and duration of action for cisatracurium were 6.48 ±0.49 minutes, 52.12 ±7.5 minutes while, for atracurium, the values were 5.18 ±0.28 minutes, 43.05 ±2.74 minutes respectively (p <0.001). Intubating conditions, haemodynamic changes, and safety profile were comparable between the groups. Recovery time following administration of cholinesterase inhibitors in the cisatracurium and atracurium group were 4.88 ±0.29 and 5.74 ±0.28 minutes respectively (p <0.001). Conclusion: Cisatracurium(0.2mg/kg) provides better intubating conditions, stable hemodynamic status and no signs of histamine release as compared to atracurium(0.5mg/kg). Thus, cisatracurium appears a better alternative for preventing undesirable effects of atracurium.

13. Sub-Anaesthetic Bolus Dose of Intravenous Ketamine for Postoperative Pain Following Caesarean Section
Archana Rani, Annet Thatal, Rakhi Goyal, Rakesh Kumar
Background: The significance of providing efficient analgesia after Caesarean Section surgery lies in the fact that parturients have an elevated susceptibility to thromboembolic events resulting from immobility. Inadequate pain treatment has been linked to an increase in the risk of postpartum depression (PPD) and disruption of the breastfeeding process. The administration of ketamine at sub-anesthetic levels has been evaluated as a potential method for mitigating postoperative pain and reducing the need for analgesics after caesarean section procedures. Aim and Objectives: This research aimed to determine the degree to which sub-anesthetic doses of ketamine eased pain after caesarean delivery. Material and Methods: A total of 108 pregnant women participated in a randomised, double-blind, placebo-controlled study being conducted. They were split into three groups of 36. After 5 minutes, patients in Group C received 2 ml of 0.9% normal saline, patients in Group K1 received 0.15 mg/kg of ketamine (2 ml), and patients in Group K2 received 0.3 mg/kg of ketamine (2 ml). Postoperative pain was measured using the Visual Analogue Scale (VAS), and the number of doses of rescue analgesic used within 24 hours and the occurrence of adverse events were recorded. The statistical methodology employed in this study was the use of methodology of Variance (ANOVA) for continuous variables and the Chi-square test for categorical variables. Significance was attributed to p-values that were less than 0.05. Results: The postoperative Visual Analogue Scale (VAS) scores were found to be substantially greater in the control group. On the other hand, the time before the first analgesic was needed was significantly longer in both the K1 group (mean time of 5.44 ± 1.45 hours) and the K2 group (mean time of 6.18 ± 1.61 hours) compared with the control group (mean time of 4.97 ± 1.48 hours). The K1 group and K2 group had a considerably lower overall number of doses and total dosage of rescue analgesic (tramadol) needed during a 24-hour period, with values of 194.44 ± 53.15 mg and 152.78 ± 50.63 mg, respectively, compared to group C with a value of 136.11 ± 48.71 mg. Conclusion: The administration of sub-anesthetic dosages (0.15 mg/kg and 0.3 mg/kg) of iv ketamine resulted in an augmentation of postoperative analgesia and a decrease in the overall intake of rescue analgesics within the initial 24 hours following caesarean section. The administration of ketamine at a dosage of 0.3 mg/kg resulted in a significant prolongation of the duration until the very first request for postoperative analgesic medication.

14. Knowledge, Attitude, and Practices Related to Hypothyroidism in a Tertiary Care Hospital Bangalore
Balachandra G, Veena RM, Sonia Y, Keerthana AB, Ashfaq Ahammed BA, Neenu MR
Background and Objective: Hypothyroidism is the clinical state resulting from decreased production of thyroid hormones or very rarely from tissue resistance. Better knowledge and awareness regarding the disease in primary hypothyroidism patients can significantly improve compliance of treatment and decrease the associated morbidity. There is a paucity of data on knowledge, awareness, and practices (KAP) of patients with hypothyroidism in India. This study was designed to assess the knowledge, attitude, and practice (KAP) of hypothyroidism among patients with hypothyroidism. Methods: A prospective observational study was performed in an outpatient attending the Department of General Medicine, BGS Global Institute of Medical Sciences, Bangalore. We used a validated questionnaire to assess hypothyroidism KAP. Using frequency counts (n) and percentages (%), discrete data were summarized. Results: The mean age of patients was found to be 35.98±12.21 years. It was found that 52.9% of the patients were aware of the correct meaning of the term hypothyroidism. Regarding consequences of hypothyroidism, 54.7% of the study patients most properly recognized as weight gain (68.9%), followed by 58.5% of swelling in the neck and 54.7% of generalized weakness. All patients (100%) adhered to their medications. Conclusion: Many patients with hypothyroidism had adequate basic knowledge about the disease was observed in the study. Further, we recommend that if healthcare providers could provide patients to understand with data sheets explaining the disease or have some pictorial/pamphlets about the disease’s reality and myths will be more beneficial.

15. Comparison of Outcomes of Selective Treatment Modalities in Chronic Kidney Disease Patients Admitted in a Tertiary Care Hospital in Vadodara: A Retrospective Study
Shalini Ranjan, Chaitanya Reddy, Aditya Doshi, Eesha Gupta, Gaurav Gehlot, Fatema Gunderwala
Background: Due to the rising incidence of diabetes mellitus, hypertension, other non-communicable diseases, and the aging of the population, chronic kidney disease (CKD), considered a severe ailment, is now at epidemic levels. Aims & Objectives: This study is aimed to fill the dearth in literature in a local hospital in a developing country like India, where CKD is highly prevalent and needs a quicker, efficacious and standard interventional approach. Study Objectives were centered on comparison and narrowing of the single best outcome for particular CKD stage patients for improving their quality of life. Materials & Method: This is a retrospective study, using data from the General Medicine Department and Renal Unit Database. It included all the patients between Jan 2018 and Dec 2022 who were admitted in the General Medicine wards for treatment of CKD Stages 3a to 5. The data collection focused on parameters such as improvement and reduction rates in gross clinical variables as recorded in patient’s medical records; biochemical urinalysis reports, Complete blood count (CBC) as well as renal function test (RFT); in addition to mineral and bone disorder parameters in regression over the course of treatment such as drug therapy (I.V or I.M or Oral), dialysis and/or transplant in the in-patient setting. The findings were grouped into categories and percentages, described in ratio and proportions. Mean, median, mode for the data was calculated using univariate analysis wherever feasible and necessary. Significance was considered if p < 0.05. Results: Total 384 patients diagnosed with CKD Stages 3a to 5 were enrolled in the study. Mean age of CKD patients was 49.09 ± 12.50 years. Majority of the patients were in the 51 to 60 years age group (126, 32.8%). 78.4% were male and 21.6% were female. Furthermore, 82.6% were treated with only dialysis and these patients were categorized as Group D. Remaining 16.9% were on dialysis and anti-hypertensive medicine, 0.3% were on dialysis and antibiotics and another 0.3% were on dialysis, antihypertensives and oral hypoglycemic agents where these patients were categorized as Group O. No statistically significant difference was found between both groups when the mode of treatments were compared (p>0.05).   Conclusion: The preferred treatment modalities showed good prognosis and were all equally effective in improving the clinical condition of the patients. There was no superior or inferior mode of treatment reported.

16. Analyzing Uncommon Variations in the Femoral Artery and Profunda Femoris Artery through Cadaveric Examination
Prasenjit Bose, Kapil K Malviya, Soumya Khanna, Anand Mishra, Gunjan Rai
The standard femoral artery branching pattern typically involves the common femoral artery dividing into the superficial and deep femoral arteries, followed by the lateral and medial circumflex femoral arteries branching off after the deep femoral artery. The femoral artery is a vital blood vessel for the lower extremity, with the deep femoral artery serving as a critical conduit for the thigh, supplying blood to the hip joint, femur, and thigh muscles. The primary blood supplier to the hip joint is the medial femoral circumflex artery, while the lateral femoral circumflex artery provides blood to the surrounding hip tissues. Understanding variations in these arteries is crucial for vascular surgeries and lower extremity orthopedic procedures. We encountered two unique cases during cadaver dissections, one involving a tetrafurcation of the common femoral artery, and the other where the profunda femoris artery had an atypical origin behind the inguinal ligament, with distinct branching patterns. These variations are significant for clinical and surgical applications.

17. Serum Electrolyte Profile of Children less than Five Years Old with Dehydration due to Acute Diarrhoea
Krishna Kumar Das, Vijay Deep
Background: Dehydration due to acute diarrhea remains a significant cause of morbidity and mortality in children under five years old, particularly in developing countries. Electrolyte imbalances play a critical role in the severity and management of this condition. This study aimed to assess the serum electrolyte profile at the time of admission of children less than five years old with dehydration caused by acute diarrhea. Materials and Methods: A total of 100 children aged less than five years presenting with dehydration due to acute diarrhea were included in this one-year study conducted at Bhagwan Mahavir Institute of Medical Sciences, Pawapuri, Nalanda. Serum electrolyte levels including sodium (Na+), potassium (K+), chloride (Cl-) and bicarbonate (HCO3-) were measured at the time of admission using standard laboratory methods. The severity of dehydration was assessed clinically, and data were analyzed using descriptive statistics. Results: The study revealed the following serum electrolyte values in children with dehydration due to acute diarrhea: mean serum sodium level was 133.5 ± 3.8 mEq/L, mean serum potassium level was 3.8 ± 0.5 mEq/L, mean serum chloride level was 95.2 ± 4.2 mEq/L, and mean serum bicarbonate level was 17.3 ± 2.1 mEq/L. Additionally, 40% of the children exhibited hyponatremia, 32% had hypokalemia and 28% showed hypochloremia at the time of admission. Conclusion: This study underscores the significance of assessing serum electrolyte levels at the time of admission in children less than five years with dehydration due to acute diarrhea. The prevalence of electrolyte imbalances, particularly hyponatremia, hypokalemia, and hypochloremia was notable in this population. Timely recognition and appropriate management of electrolyte disturbances are crucial in improving the clinical outcomes of these children.

18. Comparing the Diagnostic Efficacy of Fine-Needle Aspiration Cytology and Core Needle Biopsy for Clinically Palpable Breast Lumps: A Comparative Study
Rajiv Ranjan Singh, Renu Kumari, Ajit Kumar Chaudhary
Background: Breast lumps are a common clinical concern, and accurate diagnosis is crucial for appropriate management. Fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) are two commonly employed diagnostic techniques. Materials and Methods: A retrospective analysis of 150 cases of clinically palpable breast lumps was conducted in Department of Pathology, Darbhanga Medical College, Laheriasarai, Biharover a period from January 2020 to August 2020. Patients underwent both FNAC and CNB procedures, and the results were compared. The diagnostic accuracy, sensitivity, specificity, and complications associated with each technique were assessed. Results: Out of the 150 cases analyzed, FNAC yielded a diagnostic accuracy of 82%, with a sensitivity of 75% and specificity of 88%. CNB, on the other hand, demonstrated a higher diagnostic accuracy of 92%, with a sensitivity of 88% and specificity of 96%. Complication rates were minimal for both FNAC and CNB, with no major adverse events reported in either group. Conclusion: In diagnosing clinically palpable breast lumps, core needle biopsy (CNB) appears to be a more accurate and reliable diagnostic technique compared to fine-needle aspiration cytology (FNAC).

19. Assessment of the Effect of Smoking on Haematological Profile and SpO2 of Hemoglobin, A Comparative Research
Renu Kumari, Rajiv Ranjan Singh, Sheela Kumari
Background: Smoking is a prevalent global health concern known to have a wide range of detrimental effects on various physiological systems. Materials and Methods: A comparative research study was conducted in Department of Physiology in conjunction with Department of Pathology, Laheriasarai, Bihar over a period from January 2019 to June 2019, involving 200 participants, consisting of 100 smokers and 100 non-smokers, matched for age (21-31 years) and gender. Hematological parameters, including complete blood count (CBC) and SpO2 levels were measured and compared between the two groups. Smoking history and habits were documented, and participants with other confounding factors affecting hematological parameters were excluded. Results: The results demonstrated significant differences between the smoker and non-smoker groups in several hematological parameters. Smokers exhibited higher mean levels of white blood cells (WBC) (7.2 ± 1.4 vs. 6.1 ± 1.2 x 10^9/L, p < 0.05) and neutrophils (4.5 ± 1.2 vs. 3.9 ± 1.0 x 10^9/L, p < 0.05) compared to non-smokers. Additionally, smokers had lower mean levels of hemoglobin (Hb) (13.8 ± 1.2 vs. 14.7 ± 1.0 g/dL, p < 0.05) and SpO2 (96.2% ± 1.1% vs. 97.8% ± 0.8%, p < 0.05) compared to non-smokers. Conclusion: This comparative study suggests that smoking has a significant effect on hematological parameters, leading to elevated WBC and neutrophil counts, as well as lower Hb levels and SpO2.

20. Study of Aspiration Sclerotherapy in the Management of Hydrocele in Telangana Population
Manepalli Uma Mounica, Pradeep Kumar N, Pamu Shivaramulu
Background: Aspiration sclerotherapy is popular because it is economical, can be treated in an outpatient department, and patients can resume their duties on the same day of treatment. Though surgery is the gold standard, treatment is traumatic, expensive, and can cause morbidity. Method: Out of 50 (fifty) patients with hydrocele, 25 were treated surgically by Jaboulay’s procedure, and aspiration sclerotherapy (AS) was carried out by aspiration of fluid by an 18-gauge needle under aseptic conditions. 2% lignocaine was injected with a 24-gauge needle at the puncture site, the canula was left in situ, and 10% of the aspirated volume of STDs and 2% xylocaine were instilled. The aspirated fluid was sent for cytological binding, which was followed for 7 days, 1 month, and 6 months. After the procedure, the recurrence was treated surgically. Results: There were significant results in aspired volume of fluid, hospital stay, and work resumption with a significant p value (p<0.001). The recurrence of mild volume in the IS group was 8%, and 4% was gross volume cure percentage was 8.33% in 5 patients, 66.6% in 8 patients, and 100% in 7 patients. Remaining recurrences were rectified surgically. Conclusion: Aspiration sclerotherapy (AS) is safe, quick, far less costly, and reasonably effective, but recurrences require surgical intervention.

21. Study of Mindfulness Based Stress Reduction Therapy in Irritable Bowel Syndrome in Maharashtra Population
Ravindra Bhumanna Narod, Rathod Rahul Narayanrao, Pankaj Punaram Khobragade
Background: Irritable bowel syndrome (IBS) impairs the quality of life, and high costs are incurred in the health care system. IBS focuses on diet and lifestyle management, which includes stress, emotion, and negative interpretations of social relations, which enhance the IBS symptoms. Method: 60 adult patients aged between 25-60 years with IBS symptoms were counselled with IBS-SSS, VSI, FFMQ, and PHQ-12 questionnaires and followed up for three months. The clinical variables FFMQ, VSI, and IBS-SSS were compared after 3 months. Results: Five-facet mindful Questionnaires were compared at baseline studies and after three months of treatment (follow-up). Except for the FEMQ non-react score, all MBSR variables had a significant p value (p<0.001). Conclusion: MBSR could be considered a new effective and stable efficient method in psychotherapy for irritable bowel syndrome patients.

22. The Influence of Maternal Age on Pregnancy Outcomes and Neonatal Health: A Retrospective Study
Sarita Sharma, Sunita Singh
Background: The mother’s age significantly impacts pregnancy outcomes and newborn health. Maternal hypertension, diabetes, premature birth, and low birth weight are only a few of the pregnancy issues that this study examines about the mother’s age. Public health and clinical applications are also discussed. Method: Data from 200 births were examined in a retrospective study. Maternal age was used to divide the participants into three groups: those under the age of 20, those between the ages of 20 and 35, and those older than 35. Descriptive statistics, comparative analysis, and multivariate regression models were utilised to determine how much of an effect maternal age had on each outcome. Results: Maternal hypertensive disorders (16.2%), gestational diabetes (12.4%), and caesarean section delivery (36.4%) were all more common in women of advanced maternal age. In addition, the advanced-age group had significantly higher rates of both low birth weight (11.9%) and premature delivery (10.8%). Conclusion: The study’s results highlight the need for individualised prenatal treatment based on the mother’s age. Different measures are needed to reduce the risk of problems for mothers of advanced ages. Implications for healthcare practitioners and public health policy are highlighted, including the need for person-centred care and contraceptive education.

23. Exploring the Environmental Factors in the Development of Polycystic Ovary Syndrome (PCOS): A Retrospective Study
Sunita Singh, Sarita Sharma
Background: The clinical significance of polycystic ovary syndrome (PCOS), an endocrine disorder, cannot be underestimated. Understanding the environmental factors in the development of polycystic ovarian syndrome (PCOS) is crucial for making an accurate diagnosis and developing an effective treatment plan. Methods: We used a retrospective study design with 500 participants to examine the impact of environmental factors. People’s lifestyles were examined from a number of angles. Results: In our study of 500 people, there were no statistically significant differences between the PCOS and control groups with respect to age, race, or socioeconomic level. Weight gain, lack of exercise, and diets heavy in foods with a high “glycaemic index” have all been linked to polycystic ovarian syndrome.  A high glycaemic index interacted to increase the risk of polycystic ovary syndrome (p = 0.004). Conclusion: Our results show that PCOS is a complicated disorder with multiple contributing factors, including lifestyle. The findings might lead to enhanced criteria for making diagnoses and tailored treatment strategies. Future research must focus on the intricate relationship between environment and lifestyle.

24. Thyroid Cytopathology Reporting According to Bethesda System with Histopathological Correlation
Shashikala Kosam, Veenapani Mire
Objective: The objective of present study was to classify and report the thyroid lesion by using the Bethesda system in reporting thyroid FNAs and To correlate cytological with histological finding and to assess the value of TBSRTC in the distribution of diagnostic categories and to evaluate the specificity of system. Material and Method: This study was prospective cross sectional study conducted for one year duration from Feb 2020 to March 2021 at Pt. JNM Memorial Medical College Raipur. A total number of 100 patients belonging to age group of 11- 80 years were include in the study. All fnac are classified according to TBSRTC and histopatholgical correlation was done with all available sample. Result: A total of 100 patients included in this study. Age ranged from 11- 80 year. Most common age group affected was 31-40 years. Mean age of patient was 38 years. Male female ratio was 1: 4. Distribution of cases according to Bethesda category was as follows: Cat I 18% Cat II 57%, Cat III 02%, Cat IV 08%, Cat V 07%, Cat VI 08%. Histopathological specimen was available in 60 sample. Histopathological diagnosis was found consistent with cytological diagnosis in 66.66% cases. Sensitivity and specificity for diagnosis of thyroid malignancy were 76.9% and 89.4% respectively. Overall accuracy was 86.27%. Conclusion:  The Bethesda system of reporting thyroid cytopathology is a valuable classification of thyroid aspirates. It improves communication between pathologist and clinicians and surgeons. It help them to know prognosis and risk of malignancy in each category, and provides guidelines in patient management.

25. Assessment of Factors Influencing Medication Adherence among Breast Cancer Patients
Reshma V, Shahina Khan, Prakashiny S, Nithyapriya M, Durgesh Kumar, Madhuram, Uma Shanker, NK Warrier
Introduction: Breast cancer (BC) is a complex tumor that is characterized by different molecular and biological types. Currently, there are therapeutic agents available to treat some variants of breast cancer. However, there is no universally available treatment strategy to manage different types of BC. The major concern, however, is the awareness of BC, its prevalence, awareness of symptoms, treatment and preventive measures, and medication adherence that could potentially contribute to improved quality of life and better outcomes. This study was carried out to assess the knowledge, perception, and practice of medication and identify the factors that affect medication adherence among BC patients. Methods: This prospective questionnaire-based study was carried out among 51 women who were diagnosed with BC. The subjects were assessed for various factors that influenced adherence. The factors assessed included family type, reaction to the diagnosis, treatment place, co-morbidities, following instructions, who reminded of taking medication, feeling after medication, taking medication while traveling, who was accompanied on follow-up, asking doubts, feeling like stopping treatment due to cost, felt like stopping treatment due to travel constraints, communication from/with the hospital. Results: Of the total 51 women included in the study, the age was 51.47±11.76 years. More than half (58.2%) of the BC women in this study showed medication adherence. Among the variables assessed for their influence on adherence, feeling after taking medication (p=0.010), medication while traveling (p=0.001), cost associated with medication (p=0.001), and travel-associated factors (p=0.001) significantly influenced medication adherence. Conclusions: Despite the availability of medication, women diagnosed with BC face several difficulties in following the treatment schedules. Medication adherence was greatly influenced by the positive effects of treatment and the cost associated with treatment and travel.

26. Intra-Operative Difficulties and Complications in Repeat Cesarean Section
Shruti Tailor, Vijyeta Jagtap, Kuldeep Rathod, Ragini Verma
Objective: To study the intra-operative difficulties and complications in women undergoing Repeat Caesarean section.  Methods: An observational study was conducted collecting data from medical records of around 300 consecutive consenting subjects undergoing repeat CS in one unit in a tertiary care centre over a period of May 2019 to November 2020 after HREC approval. Results: In our study, adhesions were encountered in 22% of subjects. While opening anterior abdominal wall, adhesions were encountered between Rectus muscle and sheath in 14% of subjects and between Omentum and parietal peritoneum in 8% of subjects.2.33% of subjects had dense adhesion between bladder and uterus. Placenta previa was noted in 2.67% of subjects, out of which 1.67% had morbidly adherent placenta. Conclusion: Although morbidity related to Caesarean section has reduced markedly over the decades, there is still a definite risk associated with the surgical procedure.

27. A Prospective Assessment of Fatal Head Injuries in Road Traffic Accidents in the Bundelkhand Region
Shailendra Patel, Nunu Nazar, Gaurav Tiwari, Puja Singh, Sanjay Jain
Along with growing urbanization and motorization, India is undergoing a significant economic and demographic shift. Road infrastructure issues, encroachments into pedestrian-safe areas, a lack of safety engineering measures, the mix of traffic, an increase in the number of motorized vehicles, unsafe driving practices, and a lack of valid licenses are some of the factors that raise the risk of road traffic accidents in India.
The study was conducted with the aim to determine the severity of the issue in relation to various host variables.
The study was conducted in the Bundelkhand region and is the first of its kind in this area.  A prospective study of fatal head injury patients was conducted. All the statistical analysis was done using IBM SPSS statistics 26.0. 31 to 50 were the most susceptible, followed by age 21 to 30. Men made up 87% of the victims in this age range. Two-wheeler riders and pedestrians made up 87% of the casualties.
The study concludes that we strongly need to record all traffic accidents nationwide; a national-level registry has to be set up.

28. Epidural Injection of Local Anesthetic As an Adjunct to General Anesthesia Prolongs Postoperative Analgesia in Elective Laminectomy/Discectomy Cases
Prashant Kumar Paikra, Mamta Mahobia, Avinash Kashyap, Meena Singh, Amit Jain
Background: General anesthesia is used worldwide frequently for lumbar spine surgeries and when it combines with regional anesthesia, will give better result in view of recovery, analgesia and postoperative stay. Aims & Objectives: The aim of this study was to compare the intraoperative hemodynamic variables, post-operative visual analog score(VAS score), time to first rescue analgesia and total analgesic requirements in patients undergoing elective one or two lumbar laminectomy/discectomy cases performed under combined epidural-general anesthesia(CEGA) and general anesthesia only. Material & Methods: This randomized controlled prospective study was conducted after taking approval from institutional ethics committee. One hundred twenty patients of either gender between 18 to 60 years, weighing 50-70kg, of ASA grade I & II, undergoing one or two segment lumbar laminectomy/discectomy surgery were included. Patients were divided in two groups of 60 each. In Group CEGA, all patients received epidural(single injection of 11ml of 0.25% bupivacaine plus 1ml (50 µg) of fentanyl was injected epidurally, after confirmation of epidural space by hanging drop method)in sitting position then general anesthesia was induced with standard protocol and Group GA, patients received general anesthesia alone. Patients were monitored for Heart rate(HR), Mean Arterial Pressure(MAP), and Peripheral saturation(SpO2), before induction (baseline), after placing patient in prone position, at the time of incision and 5 min interval thereafter, throughout the procedure. All the surgeries were carried out by a single surgeon. Anesthesia induction, maintenance and monitoring were carried out by a single anesthesiologist. VAS score was evaluated by an anesthesiologist posted ICU, at the time of arrival in the PACU, and 15 mins, 30 mins, 1 hour, 2 hours, 6 hours, and 24 hours thereafter. Time for first rescue analgesia & Total analgesic drug used in 24hr postoperatively was noted. Result: We found that intraoperative heart rate and mean arterial blood pressure were more stable in Group CEGA, receiving combined epidural and general anesthesia. Post-operative pain and total analgesic requirement was significantly less (p value <0.0001) in Group CEGA as compared to Group GA. Conclusion: It can be concluded that single epidural injection of bupivacaine with fentanyl in patients undergoing general anesthesia prolongs analgesia, reduces severity of pain post-operatively and helps in providing stable hemodynamics throughout intraoperatively.

29. Etiological and Clinico-Pathological Study of Thyroid Swelling: A Retrospective Study
Riya Jain, Rishabh Jain, Lata Jain, Vikas Jain, Rajendra Jain, Wakhariya Darshit Narendra
Background: Thyroid enlargement, or goitre, is a common clinical ailment with many causes and presentations. The purpose of this retrospective study is to better understand the clinical importance and public health consequences of thyroid enlargement by examining its etiological and clinicopathological characteristics in a population of 200 people. Methods: The Hospital’s electronic medical records were reviewed in a retrospective study. Patients of any age or gender who had evidence of thyroid enlargement met the inclusion criteria, while those with missing data or a prior history of thyroid surgery did not. Clinical evaluations, diagnostic testing, and treatment histories were also collected with demographic data. Results: Two hundred people participated in the study, with 100 males and 100 females. Seventy participants ranged in age from 40 to 60, while another 60 were in their 20s and 30s. Autoimmune diseases (27.5% of cases) and iodine insufficiency (22.5%) were the predominant etiological causes. Most of the 150 patients had the clinical manifestation of a palpable neck lump. Dysphagia, dyspnea, and compressive sensations were also observed in the clinic. Hyperthyroidism and hypothyroidism, two forms of thyroid malfunction, were common. The significance of early detection and clinical therapy of thyroid enlargement is highlighted by these findings, which shed light on demographic, etiological, and clinical aspects of the condition. Conclusion: The findings of this retrospective study add to our knowledge of thyroid enlargement and highlight the critical nature of managing autoimmune illnesses and iodine insufficiency. The incidence of palpable neck masses highlights the clinical need for careful assessment. Research involving bigger and more diverse groups is required to clarify further understanding and guide methods for the prevention and treatment of thyroid swelling.

30. Understanding the Prevalence and Risk Factors for Pelvic Organ Prolapse in Postmenopausal Women: Retrospective Study
Kanchan Kumari, Priyanka
Background: Pelvic Organ Prolapse (POP) is a common condition among postmenopausal women that has a devastating impact on their quality of life. The purpose of this retrospective cohort investigation of 300 postmenopausal women is to better understand the prevalence and potential risk factors for POP. Methods: Interviews, surveys, and medical records were used to compile data on age, BMI, hormone therapy, parity, and lifestyle factors. We conducted statistical analysis using chi-squared tests, t-tests, and logistic regression. Results: The percentage of postmenopausal women with POP was determined to be 45% in our study. In our analysis of POP severity using the Pelvic Organ Prolapse Quantification (POP-Q) technique, we found that 25% of women had anterior compartment prolapse (cystocele), 15% had posterior compartment prolapse (rectocele), 5% had uterine prolapse, and 10% showed vaginal vault prolapse. Conclusion: To properly assess and counsel postmenopausal women, healthcare clinicians must have a firm grasp on the complex nature of POP. This research emphasizes the importance of individualized interventions, including lifestyle changes, early detection, and individualized treatment techniques, to enhance the health of postmenopausal women at risk for or experiencing POP.

31. The Association between Early-Life Exposure to Maternal Smoking and the Risk of Endometriosis in Daughters: Retrospective Study
Kanchan Kumari, Priyanka
Background: Endometriosis, a complicated gynaecological illness, is caused by hereditary and environmental factors. Here, we examine whether or not daughters who were exposed to second-hand smoke from their mothers were more likely to develop endometriosis later in life. Methods: Electronic health records were used to examine a cohort of 250 people. Endometriosis cases were documented, as was a mother’s history of smoking throughout pregnancy and while her child was an infant. Relationships were analysed using logistic regression models. Results: Results showed a dose-response association between maternal smoking and endometriosis risk. Thirty endometriosis cases were found in the control group (no exposure). There were 35 cases in the low exposure group, a 78% increase in risk (adjusted OR: 1.78, 95% CI: 1.03-3.07). With 45 cases, the adjusted Odds Ratio (OR) for moderate Exposure was 2.35 (95% confidence interval [CI]: 1.32-4.18). There were 55 instances, and the risk was 212% higher in the high-exposure group (adjusted OR: 3.12, 95% CI: 1.67-5.81). Higher levels of Exposure in childhood were linked with a higher risk of developing endometriosis later in adulthood. Conclusion: Public health efforts should target decreasing the prevalence of smoking among mothers and improving the quality of life in early childhood because of the link between maternal smoking and endometriosis in their daughters. When calculating a patient’s endometriosis risk, doctors should factor in their exposure history from childhood.

32. The Association between Endometrial Polyps and Infertility: A Retrospective Analysis of Patient Data
Kanchan Kumari, Priyanka
Background: Throughout the world, many couples worry about infertility. Endometrial polyps have been identified as a possible contributor to infertility. This study uses a retrospective analysis to shed light on the complex interaction between endometrial polyps and infertility. Methods: A study was conducted on a cohort of 200 women who got fertility tests done. Medical records were analysed for demographic information, endometrial polyp status, and infertility diagnosis. Endometrial polyps and infertility were studied using statistical analysis that took patient age and body mass index into account. Results: Our research shows that endometrial polyps are significantly linked to female infertility (p<0.001). Infertility affected 40 of the 45 individuals with endometrial polyps, while only 60 of the 155 patients who did not have polyps had fertility issues. There were no significant associations between age, body mass index and the prevalence of polyps. Conclusion: Consistent with other studies, this one highlight endometrial polyps’ role in sterility issues. Screening for endometrial polyps may enhance reproductive results for infertile patients by allowing for earlier diagnosis and treatment. The research adds to the expanding body of literature on the subject, supporting the value of a holistic strategy for evaluating and treating infertility.

33. Assessment of Factors Influencing Medication Adherence among Breast Cancer Patients
Reshma V, Shahina Khan, Prakashiny S, Nithyapriya M, Durgesh Kumar, Madhuram, Uma Shanker, NK Warrier
Introduction: Breast cancer (BC) is a complex tumor that is characterized by different molecular and biological types. Currently, there are therapeutic agents available to treat some variants of breast cancer. However, there is no universally available treatment strategy to manage different types of BC. The major concern, however, is the awareness of BC, its prevalence, awareness of symptoms, treatment and preventive measures, and medication adherence that could potentially contribute to improved quality of life and better outcomes. This study was carried out to assess the knowledge, perception, and practice of medication and identify the factors that affect medication adherence among BC patients. Methods: This prospective questionnaire-based study was carried out among 51 women who were diagnosed with BC. The subjects were assessed for various factors that influenced adherence. The factors assessed included family type, reaction to the diagnosis, treatment place, co-morbidities, following instructions, who reminded of taking medication, feeling after medication, taking medication while traveling, who was accompanied on follow-up, asking doubts, feeling like stopping treatment due to cost, felt like stopping treatment due to travel constraints, communication from/with the hospital. Results: Of the total 51 women included in the study, the age was 51.47±11.76 years. More than half (58.2%) of the BC women in this study showed medication adherence. Among the variables assessed for their influence on adherence, feeling after taking medication (p=0.010), medication while traveling (p=0.001), cost associated with medication (p=0.001), and travel-associated factors (p=0.001) significantly influenced medication adherence. Conclusions: Despite the availability of medication, women diagnosed with BC face several difficulties in following the treatment schedules. Medication adherence was greatly influenced by the positive effects of treatment and the cost associated with treatment and travel.

34. Assessment of the Skull’s Sexual Dimorphism Indicators: An Accelerated Research
Harsh Kumar Chawre, Vishal Bhadkaria, Rajeev Vijay Joshi, Ashok Najan
Introduction and Objective: Since the skull is resistant to fire, mutilation, and decay, it is the ideal bone for determining the gender of the deceased. In order to determine the reliability of these indices for sexual dimorphism of the skull, the study will examine the usage of the Cranial Index, Nasal Index, and Orbital Index. Materials and Method: The study material consisted of 100 adult skulls of known sex available in the Anatomy department, GMC, Datia (M.P.) from August 2022 to January 2023 (6 months) which includes 60 males and 40 females. After positioning the skull on Frankfurt’s horizontal plane, measurements were collected. A scale, marker, spreading calliper, and Vernier calliper were the tools utilized for the measurement. Two measurements were made at separate sittings, and the average was calculated. Results: Male and female participants’ skulls had mean CIs of 74.22 and 76.12, respectively, and NIs of 48.64 and 55.42. The average OI for male and female skulls was 85.66 and 85.58, respectively. This method only allowed the nasal index to identify 32.16% of male and 5.12% of female skulls, while the cranial index could only identify 5% of male and 20.38% of female skulls. It was discovered that the nose index and the cranial index were both statistically significant (p<0.05). For males and women, respectively, the CI’s demarking points were 62.34 and 86.14. The DP for NI for men was 36.18, and the DP for women was 67.38. Because the skulls of the male and female share a large percentage of overlap, DP for OI could not be determined. Conclusion: Because so few skulls could be recognized, none of the three indices—CI, NI, or OI—promised in isolation for sex identification. The study comes to the conclusion that, in cases of sexual dimorphism of the skull, the validity of these three cranial indices is questionable.

35. An Observational Research on Vaccination Recipients from Various Occupations about COVID Behaviors, Side Effects Following Vaccination
Pradeep Sukla, Anjana Niranjan, Kalpana Arya, Shubhanshu Gupta
Background: Coronavirus has been an important zoonotic pathogen for its emerging and re-emerging potential. Objectives: To evaluate adherence to COVID appropriate behaviours post vaccination among workers based on risk level against COVID-19 infection at workplace. To identify AEFI post-COVID vaccination among vaccinated subjects. Methods: It was an Observational study was conducted under the Department of Community Medicine, GMC, Datia among COVID-19 Vaccine Recipients of different Occupations, over a period of three months, after obtaining informed consent. The total sample size required for carrying out the present study is 384 and online data collection was done using snowball sampling method. Results: Of the total number of participants, over half (55%) fell into the low-risk exposure category, and over 45% were in the medium to very high-risk exposure category for the COVID-19 in their line of work. Of the total individuals included in the study, men made up more than half (51.2%) and women made up slightly less (48.8%). Of the total participants, 78.3% practice frequent hand washing for at least 20 seconds, followed by 18.2% who practice hand washing sometimes and 3.6% who do not wash their hands at all. Conclusion: It is important to maintain public knowledge of AEFI, AEFI reporting, and adherence to COVID-appropriate practices even after vaccination.

36. Observational Study of Clinical Profile of Fracture Patella
Bharath Shekharappa Gadagoli, Raghavendra M S, Sandeep Kubsad, Suresha B, Nitish K, Harish S Pai
Background: Patellar fractures are a common yet significant injury affecting the knee joint’s extensor mechanism, with varying etiologies and treatment modalities. Methods: A retrospective study was conducted on 63 patients with patellar fractures at a tertiary care hospital in Southern India. The study assessed the demographic and clinical profiles, including the mode of injury, fracture type, and treatment procedures. Results: The cohort consisted predominantly of males (61.9%), with a mean age of 49.9 years. The majority of injuries were due to RTAs (55.6%). Transverse fractures were the most common type (55.6%), followed by comminuted (stellate) fractures (31.8%). Tension band wiring (TBW) was the primary surgical procedure performed (66.7%). No significant associations were found between fracture characteristics and sex, age, or occupation. Conclusion: Patellar fractures commonly affect males in their middle ages and are often the result of high-velocity impacts such as RTAs. Transverse fractures are the most frequently encountered, with TBW being the preferred treatment. The lack of association with sex, age, or occupation suggests that patellar fractures may be more influenced by extrinsic factors.

37. A Study of Outcomes in Pregnancies with First Trimester Bleeding
Gaurav Das, Arunav Sharma, Shruthi KS, Mustajib Ali
Background: Threatened abortion during the first trimester of pregnancy can lead to complications that may adversely affect both maternal and perinatal outcomes. This study aims to understand the effect of threatened abortion in the current pregnancy on subsequent maternal and perinatal outcomes. Methods: A total of 150 patients with threatened abortion were assessed. Outcomes measured included the incidence of abortion, premature rupture of membranes (PROM), preterm labor, low birth weight (LBW) babies, fetal growth restriction (FGR), and maternal complications. Results: Of the 150 patients, 29 were lost to follow up. Of the remaining 121, 28 (21%) underwent abortions and 96 reached full term. The study found: The highest frequency of patients was in the age group of 28-32 years (38%). Most patients were multigravida (61%) compared to primigravida (39%). Preterm premature rupture of membranes (PPROM) was seen in 25% of mothers with first trimester bleeding, with 29% resulting in preterm babies. Pre-eclampsia was observed in 15% of mothers, and 33% underwent LSCS. Placental complications were noted in 11% of the cases, with placenta previa and accreta being the most common. Conclusion: While the type of bleeding appears to be a significant predictor for poor pregnancy outcomes, the gestational age at which it occurs doesn’t seem to significantly impact the pregnancy’s outcome. It is imperative to provide intensified prenatal care for pregnancies post-threatened miscarriage to optimize outcomes.

38. A Case-Control Study of the Evaluation of Ischemia-Modified Albumin Level and Metabolic Profile in Alopecia Areata Patients
Manasi Mishra, Sumitra Soren, Swapnesh Mishra, Maheswar Samanta
Background: Alopecia areata (AA) is a dermatological disorder characterized by the autoimmune-mediated impairment of hair follicles, resulting in the manifestation of hair loss in one or multiple circular patches on the scalp or various anatomical regions. The potential association between ischemia-modified albumin (oxidative stress biomarker), and metabolic syndrome remains unexplored in existing scientific literature. Aim: The goal was to determine whether metabolic syndrome was present in AA patients and ischemia-modified albumin (IMA), visfatin and sd-LDL were raised. Subjects and Methodology: A cross-sectional study was undertaken within a hospital environment, encompassing AA patients as well as a control group. This study comprised a group of 70 patients diagnosed with AA and an equal number of 70 healthy controls. The participants were carefully selected to ensure matching in terms of sex, age, and body mass index. The evaluation of laboratory and clinical variables related to metabolic syndrome was conducted in all subjects included in the study. Furthermore, the concentrations of visfatin, IMA, and sd-LDL were assessed and subjected to comprehensive analysis in correlation with the disease pattern, severity, and chance of reappearance. Results: IMA and adjusted IMA levels were found to be significantly elevated in comparison to the control group. Patients presenting with positive pull test findings exhibited significantly increased levels of adjusted IMA concentrations. In the present study conducted within the AA group, a statistically significant positive correlation was identified between adjusted levels of ischemia-modified albumin and waist circumference. Similarly, a significant association was observed between triglyceride and adjusted IMA levels, as well as between adjusted IMA levels and sd-LDL levels. No statistically significant differences were observed in the visfatin, lipid profile, fasting blood glucose, and sd-LDL levels among healthy controls and the patients. Conclusion: AA patients and the control group showed identical metabolic profiles. Elevated adjusted IMA have been observed to possibly be associated with an imbalance between antioxidants and oxidants, thereby potentially increasing the susceptibility to cardiovascular disease.

39. A Study of Role of Hormone Levels in the Development of Hyponatremia in the ED
Chaitanya Y, Arun Kumar Patil
Background: Hyponatremia is linked to a higher likelihood of mortality and morbidity, as well as extended hospitalization, in individuals with various medical conditions. Nonetheless, no previous study has examined hormone levels in emergency department patients with hyponatremia. In this retrospective analysis, we focused on patients transported to our department to explore the connection between the presence of hyponatremia and hormone levels during their hospital stay. Methods: The criteria for inclusion encompassed all patients who had their serum sodium, renin, and aldosterone levels assessed while hospitalized. Additionally, we documented the levels of B-type natriuretic peptide (BNP), thyroid hormones (including thyroid-stimulating hormone [TSH], free T3, and free T4), adrenocorticotropic hormone (ACTH), and cortisol if these hormones had been evaluated. Exclusion criteria pertained to patients who underwent hormone assessments but passed away as outpatients. The subjects were categorized into two distinct groups: the Hyponatremia group, consisting of patients who developed hyponatremia (serum sodium < 135 mEq/L) during their hospital stay; and the Control group, consisting of patients who did not experience hyponatremia. Results: Hyponatremia patients had significantly lower sodium levels than control patients (136.55 mEq/L vs. 141.96 mEq/L, P = 0.012). Hyponatremia patients had significantly higher renin levels than control patients (6.18 ng/mL/h vs. 0.89 ng/mL/h, P = 0.041). Hyponatremia patients had a trend towards lower aldosterone levels than control patients (12.47 pg/mL vs. 9.12 pg/mL, P = 0.085). Conclusion: The findings of the study suggests that the hyponatremia in these patients is not likely caused by other factors, such as hypokalemia, thyroid dysfunction, or heart failure.  Overall, these findings suggest that hyponatremia in critically ill patients is likely to be caused by a defect in the RAAS.

40. Prevalence of Methicillin – Resistant Staphylococcus Aureus in Tertiary Care Hospital
Nidhi Nandan, Kumari Simpi Rani, Nushrat Jahan, Sarita Kumari
Background: Methicillin-Resistant Staphylococcus Aureus (MRSA) negatively impacts patient outcomes, making it a significant problem in healthcare facilities such as tertiary care hospitals. For efficient infection prevention measures and patient care, knowing the MRSA infection rate in these facilities is essential. Objectives: This investigation aims to determine the prevalence of MRSA infections at a Tertiary medical centre. To find out the prevalence of MRSA for 200 admitted patients, the rate at which healthcare workers are colonised with MRSA, threat risk factors related to MRSA acquisition, the antimicrobial susceptibility patterns of MRSA isolates, and the clinical results of patients with MRSA infections. Methods: For this investigation, a cross-sectional study was used. To compile the data, medical records, samples from patients, and test results were analysed. Gender, age, clinical history, use of antibiotics, and other relevant factors were investigated. The research population consisted of 200 patients and hospital workers from various departments. Results: Around 40 person 20% of the 200 hospitalised patients were found to be colonised or infected with MRSA. 10% of the medical staff had MRSA in their colonisation. Prior hospitalisation (45% of MRSA-positive patients), invasive operations (60%) and extended antibiotic use (35% of MRSA-positive patients) were all associated with the risk for MRSA acquisition. Antimicrobial susceptibility testing revealed that 70% of MRSA isolates resisted at least two cycles of treatments. An analysis of medical outcomes revealed that people infected with MRSA had longer hospital stay and a higher incidence of complications when compared to those without MRSA. Conclusion: Colonisation and infestation with MRSA are prevalent among tertiary care hospital admissions, according to the findings of this study. MRSA has been shown to colonise healthcare professionals in addition to patients, emphasising the need for strict observance of infection control protocols. Recent hospitalisation, invasive surgical procedures, and prolonged use of antibiotics all increase the possibility of contracting MRSA. Antimicrobial resistance is prevalent among MRSA isolates; therefore, it is crucial to select antibiotics with care. This study highlights the significance of surveillance, hand hygiene, and effective antibiotic use in preventing the spread of MRSA and improving patient outcomes in tertiary hospitals.

41. Efficacy of Hepatitis B Immunoglobulin and Hepatitis B Vaccine in Prevention of Perinatal Transmission of Hepatitis B
Jyoti Ranjan Behera, Manas Ranjan Mallick, Sanjaya Kumar Jena, Rashmi Ranjan Barik, Debashisha Roy, Anil Kumar Mohanty
Introduction: Hepatitis B is a major global health problem and is a most serious type of viral hepatitis, which puts the people at high risk of death from cirrhosis of the liver and liver cancer. Approximately 30% of the world’s population, or about 2 billion persons, have serological evidence of either current or past infection with hepatitis B virus. Most people in China and India become infected with HBV during childhood. India has intermediate endemicity of Hepatitis B, with Hepatitis B surface antigen (HBsAg) prevalence between 2% and 7% among populations studied. It has been estimated that, in India of the 25 million infants born every year, over one million run the lifetime risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illnesses related to HBV infection. Objectives: To evaluate the efficacy of HBIG and HBV vaccine in infants born to HBsAg/HBeAg positive mothers by testing for Anti-HBsAg Anibody titres, 2 months after completing immunization. To find what percentage of infants are HBsAg positive even after completing the vaccination. Methodology: Hospital based prospective cohort study of sample size 77 babies born from HBsAg/HBeAg positive mothers. Infants were given 0.5ml Hepatitis B Immunoglobulin and 10 µg recombinant DNA Hepatitis B vaccination at birth followed by 2nd and 3rd dose of Hepatitis B vaccination at 6 weeks and 6 months of life respectively. At the age of 8 months of life tested for HBsAg and Anti-HBs antibody. Depending on the antibody titres, infants will be classified as either responders (≥10miu/ml) or non-responders (<10 miu/ml). Data were processed using SPSS software version 20.0. Results: In LBW infants comprises 45.4% of total study subjects. Maximum babies (79.22%) were delivered by LSCS method.27.2% infants were delivered from mothers having positive for HBeAg and HBsAg.3.89% of study subjects were found to be non-responders at the end of primary hepatitis B vaccine immunization. At the end of primary immunization, all the infants were found to be negative for HBsAg. All vaccine non-responders were delivered through vaginal route(p<0.0001) which is clinically significant. Out of total three non-responders all of them were LBW babies(p<0.0001) which is clinically significant. There is no correlation between sex of the infants and maternal HBeAg status. Conclusion: This study indicate that hepatitis B vaccine in association with HBIG administered at birth provides immediate and long term protection against HB virus infection in infants born to hepatitis B carrier mothers. Birth weight of infants has co-relation with vaccine response, with low vaccine response in LBW subjects as compared to normal birth weight infants. Mode of delivery also contributed to vaccine response as babies born through vaginal route had low response to vaccine as compared to babies born through LSCS.

42. Antimicrobial Susceptibility Pattern of the Most Common Pathogensic, Escherichia Coli, in a Tertiary Health Care Centre in Bihar, India
Nirmala Kumari, Nusrat Jahan, Chandan Kumar, Sarita Kumari
Background: Escherichia coli is the most common pathogens that causes urinary tract infections (UTIs), affecting people worldwide. This research aimed to examine the demographic differences in pathogens, antibiotic susceptibility patterns, and UTI cases in a tertiary care facility in Bihar, India. Methods: Patients at NMCH Patna who were thought to have UTIs provided 856 urine samples between September 2022 and August 2023. Standard microbiological methods were used to analyse the samples and identify the isolates. The Kirby-Bauer disc diffusion method was used to test for antimicrobial susceptibility, as the Clinical and Laboratory Standards Institute (CLSI) recommended. Resistance patterns were analysed statistically to look for links to demographic variables. Results: Escherichia coli were found in the most significant number (60.32%) of the 326 samples tested positive for bacterial growth. Klebsiella pneumoniae (12.3 %), Pseudomonas aeruginosa (8.46 %), and Proteus spp. (3.9 %) were also found to be present in the isolates. Women between 20 and 39 had the highest rate of E. coli-caused UTIs (56.6%). Testing for antimicrobial susceptibility showed that Amikacin (82.7% sensitive) and Tobramycin (71.68% sensitive) were the most effective, while Amoxycillin (71.2%), Cefixime (81.4%), and Cotrimoxazole (76.2% resistant) were the least effective. Discussion: The prevalence of pathogens and the diversity of their susceptibilities emphasised the importance of individualised empirical therapy. The demographic differences highlighted by the age and gender distribution of E. coli-induced UTIs have potential implications for clinical treatment. Analyses of correlations hinted at differences in susceptibility with age, highlighting the need for individualised treatment plans. Compared to global literature, regional literature revealed shared and distinguishing features, highlighting the need for both. Conclusion: This investigation investigating pathogens prevalence and antibiotic resistance in a healthcare facility in Bihar, India, is thorough. Given the rates of resistance seen against routinely used antibiotics, it is clear that clinical guidelines need to be revised regularly. We recommend future study approaches to improve our understanding and guide more effective management measures, such as genetic analysis of resistance pathways and longitudinal studies. Constant monitoring is required to adjust to the ever-changing antibiotic resistance landscape and to maximise the efficacy of ad hoc approaches to treating UTIs.

43. Spectrum of Opportunistic Fungal Infections in HIV/AIDS Patients in a Tertiary Care Hospital in India: A Retrospective Study
Sarita Kumari, Nushrat Jahan, Kumari Simpi Rani, Nidhi Nandan
Background: Opportunistic fungal infections are one of the most Common Health related concerns in HIV/AIDS patients particularly in low socio-economic regions such as India. The objective of this study is to prioritize the effective management and preventive measures. Materials & Methods: A retrospective evaluation of HIV/AIDS patients was conducted in a tertiary care hospital between January 2023 to August 2023. Diverse data sources including patient demographics, clinical presentations, laboratory results and therapy outcomes were collected and analysed. Results: 94 fungal isolates were isolated with the isolation rate of 44.6%. The most common species isolated were Candida (61.6%) followed by Aspergillus (22.34%), Cryptococcus (8.51%), Penicillium (5.32%) and others (2.13%). Study demonstrates that oropharyngeal thrush is the commonest clinical presentation among candidiasis followed by oesophageal involvement. Pulmonary involvement was the most prevalent form of aspergillosis followed by sinus involvement. Low CD4 cell counts were associated with a significantly increased susceptibility to OFIs. Conclusions: Oropharyngeal candidiasis was found to be the most common OFIs I among different fungal infections. This study would help to increase the awareness for clinicians to come up with right diagnosis, early treatment of these infections with the proper management of the patients especially in resource limited regions viz. India.

44. Study of Spontaneous Bacterial Peritonitis in Patients of Cirrhosis of Liver with Ascites
Sumesh Yadav, Aakash Andgi, Sumati Kulkarni, Ashwini
Background: Spontaneous bacterial peritonitis is most common life-threatening complications of cirrhosis of liver, with mortality rate of 20-40%. It’s an infectious complication in patients with ascites characterized by abrupt onset of fever, chills, abdominal pain with rebound tenderness over abdomen, leucocytosis. Paracentesis reveals cloudy ascitic fluid with many WBCs, predominantly polymorphonuclear cells (PMN). SBP is defined as the infection of previously sterile ascitic fluid without an apparent intra-abdominal source of Infection. The incidence of SBP in cirrhotic patients varies between 7 to 30% per year. Early detection of SBP is extremely valuable for patients, since the mortality rate among untreated patients is around 50%. Methods: Hospital-based cross-sectional study conducted at Mandya Institute of Medical Sciences, Mandya from June 2020 to May 2021. A total of 80 adult patients of either sex having cirrhosis of liver with ascites from indoor medical departments of above-mentioned hospital is studied. A detailed history of presenting symptoms, past history, drug and personal history taken. Anthropometric and clinical examination including blood pressure (BP) measurement is carried out for each subject. Written consent taken from all participating cases. Ascitic fluid of all cases aspirated under aseptic condition, before initiation of antibiotic therapy. Cytology done for the total and differential cell count and ascitic fluid for culture and sensitivity done. All relevant blood investigations done. Result: The ascitic fluid of 80 participants was analyzed. After the analysis, the prevalence of SBP is 26.2%. The mean age of the participants in the study was 51.07 years with a standard deviation of around ±8.73 years. Among 80 participants 67(83.75%) were males and 13(16.25%) were female. Among 80 study participants 95.2% of SBP and 56.7% of Non SBP were alcoholics. Among 80 participants in the study most of them were presented with pain abdomen (61.25%) among them 90.5% of pain abdomen were having SBP. In 80 participants, 35% were having fever, among them 95.2% of fever were diagnosed to have SBP. All 21 participants of SBP had jaundice, 90.47% of SBP presented with Hepatic encephalopathy (HE). All 21 patients with SBP were in Child Pugh class C and 18.6% of Non SBP is in class C. Conclusion: The ascitic fluid was examined and the results were analysed. After the analysis, our study concludes that the prevalence of SBP is seen in 26.2% of patients with cirrhosis with ascites. Classic SBP is seen in 22.5%, CNNA in 1.2% and BA in 2.5% of patients. SBP is common in alcoholic cirrhotics. Abdominal pain, Fever and jaundice are common in patients with SBP. Child Pugh class C is risk factors for SBP.

45. Impact of Single Dose versus Multidose Prophylactic Antibiotics in Elective Hernia Surgeries
Jyotirmaya Nayak, Gorachand Murmu, Subhashree Mishra
Background and Objective: Prophylactic antibiotics are routinely used in all surgical patients. The inclusion of plastic biomaterial increases the likelihood of problems with the mesh itself, as well as other recognised complications of hernia surgery. Materials and Methods: 320 individuals were hospitalised for elective hernia surgery. Surgery was included in the study. The integrated topics were separated into two categories. groupings with an equal number of participants in each: Group A: This group’s subjects. At the time of induction, they were administered Amoxycillin-Clavulanic acid (2 gm) intravenously. Group B anaesthesia: Subjects in this group were administered (2 gm) amoxycillin-clavulanic acid intravenously now of anaesthesia induction, followed by Amoxycillin Clavulanic acid (1 gramme) intravenously twice a day for two days after surgery. Results: A total of 320 people were included and sorted into groups. There are two groupings. There were 160 participants equally split between groups A and B. Out of 160 in Group A, eight participants had surgical site infection, but none in Group B. Group B. There is no statistically significant difference in the incidence of SSI between the two groups. (p=0.45). Conclusion: Prophylactic antibiotic use in clean elective patients remains a topic of debate. There are several debates. Two studies on antibiotic prophylaxis for hernioplasty were included in this study. Antibiotic prophylaxis courses. Single dosages of the most effective antibiotics were used. The same antibiotics were used in one group and not in the other. Prophylactic dosage in a single dose antibiotic will be effective in preventing post-operative infection.

46. Port Site Infection Due to Atypical Mycobacteria after Laparoscopic Surgery in Tertiary Care Hospital of Eastern India
Jyotirmaya Nayak, Gorachand Murmu, Subhashree Mishra
Introduction: Despite the use of traditional decontamination procedures and protocols, atypical mycobacteria may survive in conditions that make elimination difficult. As a consequence, outbreaks caused by these bacteria might be the result of errors made during the sterilisation of laparoscopic tools. The purpose is to look into an outbreak of post laparoscopic wound infection caused by a rare mycobacterium. Materials and Procedures: A four-month institution-based cross-sectional survey was conducted from February 2021 to May 2021. After being diagnosed with Ziehl-Neelsen (ZN) staining and pus culture on Lowenstein Jensen (LJ) medium, 14 patients were treated with the appropriate antibiotics for postlaparoscopic surgical site wound infections. Environmental samples were collected for further analysis, and the isolation rates (%) of atypical mycobacteria from these samples were calculated. Results: Atypical mycobacteria were the predominant cause of postlaparoscopic surgical site wound infections in all research individuals. Among the sources of atypical mycobacterial contamination detected during infection control inspections of operating rooms (OTs) were laparoscopic surgical instruments and disinfection (gluteraldehyde disinfectant solution). Conclusion: If the findings of regular bacterial culture on samples collected from port areas were negative, atypical mycobacteria that do not grow on routine bacterial culture should be investigated further. High indices of suspicion are indicated since quick and efficient treatment of individuals with post laparoscopic surgical site infections is critical.

47. Diagnostic Efficacy of Ultrasound (using TI-RADS) Compared to Fine Needle Aspiration Cytology (Using Bethesda Classification) in Diagnosing Thyroid Nodule
Srikant Patro, Jyotirmaya Nayak, Subhashree Mishra
Introduction: Fine-needle aspiration cytology (FNAC) is an invasive test used to assess if a nodule is cancerous or whether surgery is required to make a conclusive diagnosis. It would be ideal to have a reliable, noninvasive approach for determining which nodules merit FNAC based on a realistic chance of physiologically relevant cancer. As a result, we compared the Thyroid Imaging Reporting and Data System (TI-RADS) classification of thyroid nodules on ultrasound with the Bethesda System results on fine-needle aspiration cytology (FNAC). Methods and Materials: Prospective research was conducted in individuals with thyroid nodules visiting tertiary care hospitals from April 2022 to December 2022 after ethics committee approval. Purposive sampling was used to recruit 100 patients in the trial after they provided informed permission. Patients who agreed to have ultrasound and FNAC had bedside imaging of thyroid nodules and ultrasound guided FNAC by a single radiologist and pathologist. The following parameters were calculated: sensitivity, specificity, illness prevalence, positive and negative predictive value, and accuracy. Results: The average SD of age was 3412.3. Females made up 74% of the population. According to the Bethesda classification for FNAC, 23 individuals have malignant lesions (Bethesda V and VI) and 77 patients have benign lesions (Bethesda V grade). At 95% CI, the sensitivity and specificity of ultrasonography over FNAC of thyroid nodule were 84.21% (60.42% to 96.62%) and 92.5% (84.39% to 97.20%), respectively, with an accuracy of 90.91% (83.44% to 95.76%). Conclusions: A significant relationship was found in this research between the Ultrasound (TIRADS) and FNAC (Bethesda scores) (X2- 41.74, p 0.001). At 95% confidence intervals, the sensitivity and specificity of ultrasonography over FNAC of thyroid nodule were 84.21% (60.42% to 96.62%) and 92.5% (84.39% to 97.20%), respectively.

48. A Clinical Study on Postoperative Complications of Intestinal Stomas
Srikant Patro, Jyotirmaya Nayak, Subhashree Mishra
Background: An intestinal stoma is a surgically generated or inadvertently formed opening of the intestinal or urinary system onto the abdominal wall. A colostomy is a connection between the colon and the skin of the abdominal wall, while an ileostomy occurs when the ileum is externalized on the skin of the abdomen. Objectives: (1) To study different types of intestinal stomas, their indications. (2) To study various complications that occurred after the construction of intestinal stomas. (3) To study the ways how these complications can be minimized and managed in a better way. Material & Methods: Study Design: A prospective observational study. Sample size: 30 cases were included in our study. Sampling method: Simple Random sampling method. Study tools and Data collection procedure: Patients with postoperative complications of intestinal stomas who had ileostomy or colostomy either electively or in an emergency scenario were included in the research. The indications for stomas, whether temporary or permanent, end or loop or double barrel, ileostomy or colostomy, and their consequences were documented. Patients were followed up on for roughly 6 months after surgery or until the stoma was revised for early and late postoperative problems and their complications were documented and analysed. Results: Ileostomy (76.66%) was the most common kind of stoma (23 out of 30), followed by colostomy (7 out of 30) (23.33%). Loop ileostomy was done on ten patients, end ileostomy on seven, and double barrel on six. The most common procedure was end colostomy, which was followed by descending loop colostomy in 1 patient. and return to regular activities, predict pouching system wear periods, and avoid surgical problems.

49. A Cross Sectional Study on Spontaneous bacterial Peritonitis in Patients With cirrhosis of Liver
Srikant Patro, Jyotirmaya Nayak, Subhashree Mishra
Background: The history of spontaneous bacterial peritonitis Correia and Conn invented the concept in 1975. The phrase was used to differentiate this kind of illness from surgical peritonitis. Although many patients with SBP have an infection (e.g., urinary tract infection or pneumonia), they are classified as having SBP until the illness needs surgical intervention. Objective: To investigate the prevalence of SBP, its clinical profile, clinical course, and microbiology, as well as its responsiveness to therapy and short-term prognosis. Materials and Procedures: Cross-sectional research conducted at a hospital. The research was carried out in the Department of General Medicine, Subbaiah Institute of Medical Sciences, Shimoga, and Karnataka. The study period is from April 2021 to March 2022. Patients with cirrhosis of the liver and ascitis of various aetiologies admitted to medical wards comprised the study population. Our research included a sample size of 100 patients. Method of sampling: Simple random sampling. Prior to the start of the research, authorization was obtained from the Institutional Ethical Committee. Study aids and Data collecting procedure: All of the patients who were chosen received a full history taking on their etiological symptoms. A thorough physical examination was performed to search for the numerous stigmata and symptoms of cirrhosis complications. Results: A total of 22 individuals with spontaneous asciticfluid infection were treated in the hospital and were discharged with oral norfloxacin prophylaxis 400mg Bid and were subsequently followed up on for 6 months. Conclusion: Based on our findings, SBP is a prevalent and recurring consequence of cirrhosis. The most frequent sign of spontaneous bacterial peritonitis is fever. Hepatic encephalopathy is a prevalent symptom in SBP patients. Bad Renal failure, high serum bilirubin, low total blood proteins, and low ascitic fluid protein content are all prognostic indications in SBP.

50. Primary Closure with Suction Drain of Acute Breast Abscess After Incision, Drainage, and Curettage
Jyotirmaya Nayak, D.V Ravi Kumar, Sridhar Panda, Debabrata Barik
Breast abscess is a typical problem for both the surgeon and the patient. Breast abscess may be treated in a variety of ways. We conducted a prospective research on the primary closure of a breast abscess in situ using a suction drain after incision, drainage, and curettage. Over the course of 34 months, 38 patients were included in the research. The third decade was shown to be the most prevalent age group. The most prevalent risk factor was lactation. The most prevalent organism in pus was Staphylococcus aureus. The average length of stay in the hospital was just 4.18 days. The average duration for recovery was 12.03 days (range: 3-16 days). A comparison of other comparable research was performed. We found that primary suturing after incision and drainage with curettage is a better technique for a big breast abscess and should be done whenever feasible to avoid patient morbidity and pain.

51. Evaluation of Safety and Feasibility of Single Incision with that of Conventional TEP Laparoscopic Repair of Inguinal Hernia
Jyotirmaya Nayak, D.V Ravi Kumar, Sridhar Panda
Introduction: As surgical procedures for hernia repair have advanced, tension-free surgery using a prosthetic mesh has become the standard of treatment in herniorrhaphy. There are various benefits to laparoscopic inguinal hernia surgery versus open treatment. As a result, laparoscopic Trans abdominal preperitoneal (TAPP) and completely extra peritoneal (TEP) methods are often employed. As a result, pain and incision-related concerns were decreased. Many surgeons have successfully conducted single-incision laparoscopic surgery (SILS), which was aimed to reduce the invasiveness of standard laparoscopy. Aims and Objectives: The purpose of this research is to determine the effectiveness and safety profile of traditional completely extra-peritoneal and single-incision multiple port laparoscopic completely Extra Peritoneal inguinal hernia management. Methods: Patients who attended our hospital’s outpatient department were included in this prospective research. The patients scheduled for inguinal heria repair were studied to compare their treatments. Patients were offered single-incision multiple port laparoscopic completely Extra Peritoneal (S-TEP) or conventional completely extraperitoneal (C-TEP) surgery based on their age (groups of 40 and >40 years), side of hernia (direct/indirect), and unilateral vs bilateral types. Before the surgical operation, baseline data were established, and complications and safety were measured thereafter. The statistical analysis was carried out across the groups. Results: In order to assess surgical outcomes and cosmetic outcomes, 35 patients from the S-TEP group and 35 patients from the C-TEP group were matched equally. S-TEP for unilateral and bilateral hernia repair had a significantly longer mean surgical time (P = 0.002 and P = 0.003) than its conventional equivalent (C-TEP). The average blood loss in both groups was comparable (P = 0.1). There were no damage to the spinal cord or nerves in either group. The research also discovered that 2 (5.7%) of the S-TEP patients received conventional laparoscopy but no open conversion. The S-TEP group’s mean pain score (VAS) was initially considerably greater (p0.05), but it was comparable on the seventh day. Conclusion: The research concludes that SILS has the potential to provide patients with improved aesthetic outcomes, reduced discomfort, and more patient compliance. The VAS score for the single incision method revealed no benefits in terms of cosmesis or discomfort. Other secondary outcomes, such as postoperative pain (VAS), blood loss, complications, conversion, and duration of hospital stay, showed no statistically significant difference.

52. Pattern and Culture and Sensitivity of Microbes in Patients with Chronic Suppurative Otitis Media at a Tertiary Care Center
Jyotirmaya Nayak, D.V Ravi Kumar, Sridhar Panda, Debabrata Barik
Background: The use of antibiotics has reduced the number of complications associated with chronic suppurative otitis media (CSOM). However, irrational usage may lead to antibiotic resistance. Antibiotic indiscriminate usage has resulted in variance in the antibiogram of organisms causing CSOM. The goal of this research is to look at the pattern and sensitivity of microorganisms in CSOM patients.
Methods: A hospital-based cross-sectional research was conducted on 70 CSOM patients. A detailed history, general examination, and ear examination were performed. A sample of pus was extracted and forwarded to the Microbiology section for culture and sensitivity testing. Reports were gathered and entered. Results: Growth was seen in 85.7% of the 70 ear swabs tested. Only bacterial growth was seen in 57% of the cases, whereas only fungal growth was observed in 8.5%. Bacteria and fungus were found in 20% of the samples.Staphylococcus aureus was found in 40.7% of the 54 bacterial isolates, followed by Pseudomonas aeruginosa in 27.7%. Aspergillus was found in 60% of the 20 fungal isolates and Candida in 40%. Eight of the 22 staphylococcus aureus strains tested positive for amoxyclav. Seven of the 15 instances of pseudomonas aeruginosa were susceptible to ceftazidime. Ceftazidime was effective in 50% of the klebsiella patients. Half of the four E. coli infections tested positive for azithromycin. Conclusion: Staphylococcus species is the most common pathogen in CSOM, and Amoxyclav was determined to be the most effective antibiotic, followed by Gentamicin. Because organisms are growing more resistant to popular antibiotics, a swab from the discharged ear for culture and antibiotic sensitivity is critical in order to pick the proper antibiotic to avoid resistance.

53. A Prospective Study on Clinical Presentation and Management of Cholelithiasis in a Tertiary Care Hospital
Jyotirmaya Nayak, D.V Ravi Kumar, Sridhar Panda
Background: The prevalence of bile stones in India is estimated to be approximately 4%. This frequency is seven times greater among north Indians than among south Indians. In Western nations, the prevalence might reach 10-15%. The majority of them (>80%) are asymptomatic. Every year, around 1-2% of asymptomatic people develop symptoms that need surgery. Aim: To investigate the age and gender distribution, varied forms of presentation, kinds of gall stones, available therapies, and outcomes. Materials and Procedures: A prospective observational study was used in this investigation. The research was carried out in the surgery department of the SCB Medical college and Hospital, Cuttack. The study period is from April 2022 to March 2023. Patients with gallstones admitting to general surgery wards and undergoing cholecystectomy comprised the study population. Our research includes 30 instances as a sample size. Method of Sampling: Simple random sampling. Prior to the start of the research, authorization was obtained from the Institutional Ethical Committee. Procedure for data collection: Demographic information such as age, gender, name, and employment are recorded; clinical symptoms of presentation with duration, related complaints, previous medical and surgical history, personal history such as food history, OCP use, alcohol intake, and family history are also recorded. Statistical Analysis: The data was tabulated in Microsoft Excel 2016. Mean and Standard Deviation were used to depict data on a continuous scale. Numbers and Percentages were used to express categorical data. Graphs and tables were used to display the results. The P value and degree of freedom were computed and evaluated. Pearson’s Chi Square test was used to demonstrate relationship between components, with p 0.05 regarded statistically significant. Observations and Results: The major investigation of choice was USG abdomen, which was performed on all patients included in the research. Multiple stones in the United Kingdom were the most prevalent finding in this research, accounting for 67% of cases. In the United Kingdom, 30% of cases had a single stone. In 17% of instances, the gall bladder wall was thickened. Cholelithiasis with choledocholithiasis was diagnosed in one case (3%). Conclusion: In expert hands, laparoscopic cholecystectomy is regarded the treatment of choice in these individuals because it has superior results and is linked with less postoperative problems and morbidity. If severe adhesions or inflammation are discovered during laparoscopy, the patient should not be afraid to convert to an OC.

54. An Experience in Setting Laparoscopic Surgery at Community Health Centre Level: A Small Step Towards MAS for Masses
Jyotirmaya Nayak, D.V Ravi Kumar, Sridhar Panda
Background: Minimal access surgery (MAS) are revolutionary in the surgical domain. Setting a laparoscopic facility in a CHC (Community Health Centre) from the scratch with minimal infrastructure and well trained staff was challenging. Laparoscopic surgery has become the standard treatment modality for many conditions like gall stone diseases and recurrent appendicitis .But still in India laparoscopic procedure are not routinely carried out in rural setup. Aims and Objectives: Awareness among rural people regarding the new modalities of treatment over conventional one. Materials and Method: A retrospective study was conducted in a CHC, of a village in Odisha. 36 patients undergoing laparoscopic surgery of which 22 underwent laparoscopic cholecystectomy and 14 underwent laparoscopic appendectomy for gallstone disease and recurrent appendicitis respectively. The preoperative, intra operative, postoperative findings were noted and assessed. Patients are followed up for a period 6 months. Results: MAS is better in terms of analgesic requirement, postoperative hospital stay,SSI with better cosmetics and duration of surgery. It can be a cost effective alternative. Conclusion: In rural India, patients have to borrow money or sell their assets to have treatment, and three fourths of them are impoverished by it. The advantages, such as less pain, quick recovery, short hospital stay and less blood loss make minimally invasive surgeries like laparoscopic surgeries the ideal solution for patients in remote rural areas. However challenges like inadequate skilled staff, limited resources makes MAS out of reach from many villages.

55. Obesity Status-Related Functional Gain and Pain Relief Following Total Joint Replacement
Saroj Kumar Parida, Amit Das
Background: There exists a correlation between obesity and decreased functionality as well as heightened pain both prior to and during complete hip or knee replacement surgeries (THR or TKR). This study conducted an analysis on a substantial and representative cohort of individuals in medical college. The goal was to look at any possible relationships between being obese and changes in pain thresholds and functional ability both before and after surgery. Methods: Between January 2019 and December 2022, information was gathered from 129 TKR (total knee re-placement) patients and 120 THR (total hip replacement) patients. The information included body mass index (BMI) classification, which divides patients into different weight groups, and Knee injury and Osteoarthritis Outcome Score, Hip disability and Osteoarthritis Outcome Score, and Short Form-36 Physical Component Summary (PCS) scores for function for joint pain assessment. Results: The average age of total hip replacement (THR) recipients was 65 years, with 59% being female, 94% of white ethnicity, and 13 percent severely or morbidly obese. Higher obesity levels were associated with poorer Physical Component Summary (PCS) scores both preoperatively and six months post-surgery, particularly in severely and morbidly obese patients. More obesity correlated with increased initial pain, but greater pain relief after surgery, resulting in similar postoperative pain scores regardless of BMI. The average age of total knee replacement (TKR) patients was 69 years, with 60% of them being female, 92% being Caucasian, and 24% be-ing extremely or morbidly obese. Obesity was linked to lower PCS scores before and after surgery, but postop-erative PCS score improvement did not significantly differ by BMI. Initial pain increased with higher obesity levels, but pain relief at the 6-month mark equaled out, leading to similar pain scores among different BMI cat-egories. Conclusions: Severe or morbidly obese individuals reported significant functional gain and great pain relief six months following total joint replacement (TJR), which was consistent with other patient findings. Even while obesity raises the likelihood of early problems, obesity shouldn’t be a barrier to receiving TJR to reduce symp-toms.

56. Children with Acute Osteomyelitis Caused by Staphylococcus aureus: Pathologic Fractures
Saroj Kumar Parida, Soumya Nayak, Amit Das
Background: This frequent pediatric musculoskeletal infection, Staphylococcus aureus osteomyelitis, can change the way bones normally form and increase the chance of a fracture that is pathological. The purpose of this research was to assess the pathological fracture risk factors in children with osteomyelitis. Methods: Between January 2020 to December 2022, sixteen children received treatment in a tertiary-care hospital for a pathological long-bone fracture brought on by osteomyelitis caused by Staphylococcus aureus. The 48 children in the control group, who matched in terms of methicillin susceptibility, age, and sex and had osteomyelitis due to Staphylococcus aureus but did not have a fracture, were contrasted with the patients. Results: At a mean age of 8.6 years, those who fractured presented with osteomyelitis. Of the sixteen people, two had methicillin-susceptible Staphylococcus aureus (MSSA) and fourteen had methicillin-resistant Staphylococcus aureus (MRSA) isolates. It took an average of 71.1 days from the start of the illness to the fracture. There were notable differences in the length of hospital stay, The quantity of surgeries, duration of antibiotic treatment, and overall number of issues among each of the groups. MRI scans performed on the patients who had fractures at the time of admission showed a markedly higher frequency and circumferential size of subperiosteal abscesses. Also, more common in these patients was a conspicuous zone of unusually reduced marrow enhancement. Conclusions: A dangerous condition called Staphylococcus aureus osteomyelitis can put kids at risk for pathologic fractures. It is recommended that children who fit the risk parameters described in this study for Staphylococcus aureus osteomyelitis be kept safe when bearing weight and have limited physical activity.

57. Prevalence and Correlates of Bacterial Vaginosis among Young Women of Reproductive Age at a Tertiary Care Hospital, Warangal
Subuhi Kinan, K. Pradeep Kumar, Golla Eshwara Chandra
Background: Bacterial vaginosis (BV) is a prevalent polymicrobial infection and one of the leading causes of abnormal vaginal discharge in sexually active women of reproductive age. This cross-sectional study aims to assess the prevalence of vaginal infections in women aged 15 – 50 years who are seeking care at the Obstetrics and Gynecology Department, primarily due to complaints of increased vaginal discharge. Methods: This prospective study had prior approval from the Institutional Ethics Committee. Women were enrolled following local ethics committee guidelines and with informed consent. Questionnaires were used to collect sociodemographic, behavioral, medical, reproductive, and sexual history. Patients with noticeable vaginal discharge in the Outpatient Department were assessed for inclusion. They were questioned about their symptoms, discharge characteristics, itching, medical history, and prior treatments before undergoing a physical examination. Results: In the present study of the 100 cases BV was found in high frequency in the age group 31-40 years (59%) followed by 21-30 years (27%),41-50 years (9%), and lowest in 15-20 years (5%). Vaginal candidiasis was highest in 21-30 years (46%) followed by 15-20 years (35%),21-40 years (32%) then by 41-50 years (11%). Trichomoniasis was highest in 31-40 years (57%) followed by 41- 50 years and 21-30 years (28%). N. gonorrhea was highest in 41-50 years (75%) followed by 21-40 years (25%). Mixed infections were detected in 41-50 years (50%) followed by 21-30 years (33%) then 41-50 years (16%). Conclusion: The high prevalence of BV is linked to hygiene habits and sociodemographic factors, emphasizing the need for structured healthcare education programs to reduce its incidence and guide resource allocation for future interventions. Among 100 cases, some showed disparities between clinical and laboratory diagnoses, often due to challenges in clinically identifying the causative agent or obscured findings from prior treatments. Therefore, it’s vital to correlate clinical and laboratory results to prescribe precise treatments.

58. The Study of Variation in Origin of Median Nerve
Rohan A Gawali, Madhavi B. Ramteke, SumedhaAnjankar, VarshaPande, Trupti Balwir
The variations in the formation of median nerve by more than two roots are relatively common. The relation of variation of median nerve with brachialartery may have clinical implications during surgeries and nerve blocks. Materials and Methods: 13embalmed cadavers in the Department of Anatomy, DMMC, Nagpur were dissected to note the variations in the formation and relation of Median nerve with brachial artery. Results and Findings: Variations in the formation of median nerve and its relation with the brachial artery were observed in 2 cadavers. Variation was noted in the formation of the median nerve by more than two roots in one cadaver and in 1 cadaver, there was a variation in both formation and its relation with the brachial artery. Further course of the median nerve was normal in arm, forearm and palm. These 2 variations were unilateral in both the cadavers. Conclusion: The knowledge of the variations is important for physicians, surgeons and anaesthetists as there may be a confusion between median nerve compression in carpal tunnel and radiculopathy in case of radiculopathy. The knowledge is beneficial for performing surgeries and giving nerve blocks especially in the axilla and arm.

59. Assessment of  Paediatric Risk of Mortality Score (PRISM III) As A Predictor of Mortality in PICU
Jagadeesh Kumar Manthena, Najma Farheen, Cheguru Sripal Reddy, Varda Khan
Background: The Pediatric Risk of Mortality III (PRISM III) score is a widely used clinical scoring system designed to assess the severity of illness and predict mortality risk in pediatric patients admitted to the Intensive Care Unit (ICU). Developed in 1996, PRISM III builds upon its predecessors, PRISM and PRISM II, refining the predictive accuracy and clinical utility. We in this study tried to assess the pediatric mortality risk using PRISM III in the patients admitted to our hospital. Methods: This study was conducted in the Department of Pediatrics, Nilofer Hospital Hyderabad. The clinical status upon arrival in the Pediatric Intensive Care Unit (PICU) will be documented, with emphasis on the condition at PICU arrival rather than the Emergency department arrival. For variables 1–5 (clinical parameters), the most aberrant reading in the initial 24 hours will be recorded, encompassing the monitoring of vital parameters such as blood pressure, heart rate, temperature, pupillary reaction, and Glasgow Coma Scale. Laboratory parameters will include values obtained at the time of admission. Results: A total of 300 cases were included in the study. Out of patients with a PRISM III score of 7-10, 23.5% died. Out of patients with a PRISM III score greater than 10, 68.4% died. There is a clear relationship between PRISM III score and mortality. The higher the PRISM III score, the higher the risk of death. This is because the PRISM III score is a measure of the severity of illness, and patients with more severe illnesses are more likely to die. Associated factors with mortality are high in patients on ventilators with a risk of 11.2, followed by a GCS score of 7.67 risk. If  7.5 is set as the cut-off value for the PRISM III Score, then the sensitivity is 82.4 and the specificity is 62.1. Conclusion: In conclusion, this study underscores the imperative need for standardized scoring systems for pediatric critical care. The PRISM III score has emerged as a valuable tool for predicting mortality outcomes in the PICU, providing clinicians with a reliable means of assessing severity and making informed decisions.

60. To Determine the Association between Mycological Pathogens and Comorbid Disorders using a Cross-Sectional Design
Satyabrata Tripathy
Background: Epidemiology of dermatophytosis can direct public health policies, assist researchers in comprehending the factors that contribute to the condition, and lead to the development of more effective therapies. Objective: The purpose of this study is to use a cross-sectional design in order to assess the connection between mycological pathogens and comorbid illnesses. Materials and Methods: 102 dermatophytosis samples from patients seen in the Dermatology Outpatient Department (OPD) were handled at the Microbiology Department after receiving consent from the Institutional Ethics Committee. Results: Twenty-one patients were diagnosed with diabetes mellitus, nine were diagnosed with hypertension, seven were diagnosed with both illnesses, fifteen patients were diagnosed with bronchial asthma, three patients were diagnosed with psoriasis, and seven patients were diagnosed with polyarthritis. Forty patients did not have any co-morbid disorders. The results of the Chi-square test have p-values that were lower than 0.001, making them statistically significant. Conclusion: We just identified the very tip of the iceberg; the growth of dermatophytosis might be better explained by many more cases. In India, the National Public Health Program is responsible for providing treatment for dermatophytes. To solve this problem, we need stricter drug regulations and increased awareness among the population. Abuse of prescription drugs and accidental overdoses committed at home may be the result of standards that are not strictly enforced.

61. Prevalence of Childhood Obesity and Role of Physical Activity: A Cross Sectional Study from Telangana
P Shruti, Mohammed Waseem Javed, Md. Ibrahim Siddiqui, Anant A. Takalkar, Aruna Tubachi
Introduction: Because childhood overweight often persists into adulthood, a rising number of adults will be at increased risk of these conditions as well as of cardiovascular disease, osteoarthritis and certain types of cancer. As a whole, the obesity epidemic constitutes a substantial decrease in quality of life and life expectancy and accounts for billions of dollars in health care spending.Insufficient physical activity and poor nutrition are widely acknowledged as the primary mechanisms underlying the rise in excess body weight. Recent studies have described geographic and socioeconomic gradients and identified aspects of children’s lifestyle, including physical and sedentary activities, as risk factors for overweight and obesity. Objective: To study the role of physical activity as influencing over weight and obesity. Materials and Methods: The present school based cross section observational study was carried out in Govt & Private schools of Mulugu Mandal, Siddipet, Telangana during the study period from January 2023 to March 2023 involving 500 high school children of age 12-16 years. Information on individual characteristics like age, gender, time spent for watching TV and outdoor games, etc. is collected. For measuring height, drop down tape measure is used whereas for measuring weight, the modern-day weight scale is used. Data was collected by using a structure proforma. Data thus was entered in MS excel sheet and analysed by using SPSS 23.0 version IBM USA. Results: Out of 250 boys, majority were from 15-15.9 years age i.e. 29.6%. Prevalence of overweight in our study was 9.8%. Prevalence of obesity was 5%. 42.8% cases sleep duration was 6-7 hours. Prevalence of snoring was 7.8%. 64% responded that they are interested in outdoor games. 13.6% children are not playing any kind of games whereas daily outdoor games were practiced by 86.4% children. Almost half of the children responded about use of electronic gadgets 43% which correlates the prevalence of overweight and obesity in our study. Conclusion: Prevalence of overweight in our study was 9.8%. Prevalence of obesity was 5%. Use of electronic gadgets, increased screen time was factors observed in our study associated with overweight and obesity.

62. Spectrum of Frozen Biopsy Processed in Tertiary Care Hospital
N. S. Subbulakshmi, M. Niruba, C. Arunamutharasi, V. Bagiyalakshmi
Background: Frozen section is a process of quick frozen of specimen for rapid diagnosis. Common indications of frozen section include confirmation of malignancy, margin status evaluation and metastasis evaluation. Materials and methods: A retrospective study of frozen section cases (92 cases) was conducted at a tertiary care center. Indications for frozen section, reports of frozen section with final reports of hematoxylin and eosin stained sections were analyzed. Results: Highest number of cases was carcinoma buccal mucosa followed by ovarian carcinoma and gastrointestinal tract carcinoma. Commonly indications were for assessment of lymph node metastasis, tumor confirmation and margin status evaluation. Conclusion: Frozen section is a reliable diagnostic tool intraoperatively for surgeons. Periodic review of functioning of cryostat and following all steps with utmost care can improve the accuracy of frozen reporting.

63. A Co-Related Study of Clinical Evaluation, Magnetic Resonance Imaging, and Arthroscopy in Cruciate Ligament and Meniscal Injuries
Ali Mohammed P, Mohamed Shakeeb K U, Nithin Chandrasekharan, K. Senthil Kumar
Background: Injury to the Knee joint is a very common orthopedic condition resulting in Meniscal tears and tears of anterior cruciate ligaments (ACL) are resulting in unstable movements. Arthroscopy surgeries are commonly performed in such conditions minimizing the tissue trauma. A study was conducted in a tertiary care Hospital to reconstruct the ACL and manage the Meniscus tears. To determine the diagnostic values of clinical examination for Meniscal tears, individually and in combination with MRI scan and Arthroscopy which would further help in improving clinical diagnosis and management of Meniscal injuries and ACL injuries, a study was conducted. Aim of the study: To Identify, classify and grade the injuries of Menisci and ACL injuries to determine the diagnostic values of clinical examination, MRI scan and Arthroscopy and to correlate their specificity, sensitivity, Accuracy and DOR which would provide appropriate treatment plans either Meniscectomy or repair of ACL in Knee injuries. Materials: 48 patients with traumatic Meniscal or ACL injuries attending the Department of orthopedics of a Tertiary care Hospital, were included prospectively, examined clinically, investigated with MRI scan. All the patients were subjected to Arthroscopy for final confirmation of the diagnosis, repair of Menisci/ excision and repair of ACL. Individual clinical tests, composite test and MRI scan were compared one against the others to find out the sensitivity, specificity accuracy and DOR. Results: Among the 48 patients there were 31 males (64.58%) and 17 (35.41%) females with a male to female ratio of 1.82:1. The mean age in males was 34.12±3.10 years and in females it was 36.18±2.15 years. The nature of injuries were varying with sports injuries noted in 19 (39.58) patients, accidental injuries in 12 (25%), Road traffic accidents in 09 (18.75%), assaults in 05 (10.41%) and others in 03 (06.25%). In this study the composite test showed the highest sensitivity, specificity and accuracy (91.66, 87.50% and 89.58% respectively) MRI scan showed the sensitivity, specificity and accuracy of 87.5% in all. The DOR was significant with all the clinical and tests and MRI scans. (p- Value less than 0.05) In patients with ACL injuries Anterior Drawer test showed the highest sensitivity, specificity and accuracy (84.61%, 81.81% and 83.33% respectively) MRI scan showed the sensitivity, specificity and accuracy of 87.5% in all. The DOR was also significant with all the clinical and tests and MRI scans for ACL injuries. (p-value less than 0.05). Conclusions: The reliability of individual tests such as Apley’s test, Joint line tenderness, McMurray’s test, and 20 degrees Thessaly test showed limited reliability, but composite test which combined the joint line tenderness, Apley’s test and MC Murray’s test have shown a greatly improved diagnostic value at par with the MRI scans. In cases of ACL tears, Anterior drawer test was more accurate for predicting, its diagnosis; on the other hand, MRI scan findings showed less accuracy for predicting, their diagnosis.

64. Comparison of I-GEL and LMA Proseal for Airway Management in Pediatric Patients under Controlled Mechanical Ventilation
Shalini Sahu, Dhwani Trambadia, Sargunaraj, S.K. Shah
Background and Aim: I-gel™ and the ProSeal™ laryngeal mask airway (PLMA) are two supraglottic airway devices with gastric channel used for airway maintenance in anesthesia. Present study was designed to compare supraglottic airway devices proseal LMA versus I-gel for evaluation of their effectiveness in pediatric patients under controlled mechanical ventilation for ease of insertion, haemodynamic stability, and changes in ETCO2 and SpO2. Material and Methods: Present study was done at Department of Anesthesia, B.J. Medical College, Ahmedabad, Gujarat, India from February 2018 to January 2019.  A total of 50 patients of ASA grade I &II aged between 2-8 years of either sex scheduled for elective surgical procedures under general anaesthesia lasting less than 60 min were selected. They were randomly divided in to two groups, Group X (pLMA group) &Group Y (I-gel group) of 25 patients each. Patients‟ vitals were measured baseline, after premedication, before induction, immediately after insertion, 5 min, 10 min, 15 min, 20 min, 30 min, 40 min, 50 min and 60 min. after insertion of device/ end of surgery. Intraoperatively patients were watched for any complication like tachycardia/bradycardia, hypotension/hypertension, arrhythmias, hypercarbia, regurgitation/ aspiration, hypoxia, changes in ETCO2. Results: I gel can be inserted in a significantly shorter time as compared to proseal LMA, the difference in time of insertion is extremely significant. Gastric tube insertion was easy in 84% cases, difficult in 12% cases and in 4% cases gastric tube was not able to pass even after 2 attempts. There is statistically no significant difference in perioperative vital Parameters between two groups. Conclusion: Both i-gel and LMA ProSeal are useful airway devices for short duration surgeries under general anesthesia in children under controlled mechanical ventilation. Although the LMA ProSeal takes longer to insert, the ease of insertion is comparable to that of i-gel, with minimal occurrence of complications.

65. The Significance of Immature Platelet Fraction in the Diagnosis and Prognosis of Groups with Thrombocytopenia
Shailesh Patel, Deepika Modi, Anandkumar A. Kanasagara, Rippal Kumar Bhimani, Jayesh Modi
Background and Aim: Accelerated platelet breakdown and decreased platelet synthesis are major causes of thrombocytopenia in immune thrombocytopenic purpura (ITP). In our study, thrombocytopenia instances were classified as hypoproductive, megaloblastic, or hyperdestructive. Our study aims to assess the prevalence of IPF and its importance in various thrombocytopenic groups, with the hope that it can be used as a new emerging prognostic marker in identifying and managing such patients. Material and Methods: 50 thrombocytopenia samples were collected and analysed. Based on the history and final diagnosis, all patients were classified as megaloblastic, hypoproduction, or hyperdestruction. In a k3 EDTA vacutainer, peripheral blood samples were obtained. All samples were analysed within four hours of being collected. All samples had their platelet counts and IPF% determined. Results: The findings revealed that 40% of the 50 cases evaluated were men and 60% were females, with a small female preponderance. The majority of patients were between the ages of 20 and 39. In the Hyperdestructive group, 27 (93.10%) of the 50 cases exhibited increased IPF, but in the Hypoproductive group, only 01 (0.09%) of the 11 cases showed increased IPF. ITP had the highest IPF%, followed by malaria and dengue. Conclusion: Immature Platelet Fraction is a straightforward non-invasive approach for calculating the proportion of reticulated platelets in peripheral blood in order to monitor megakaryocytic activity. IPF is much higher in the hyper destructive group, indicating enhanced thrombopoiesis, and its value is inversely related to platelet count in these situations.

66. The Effect of Probiotics on Surgical Site Infections in Colorectal Surgery
Vijay Vasantlal Paria, Pradip Nautamlal Malaviya
Background and Aim: It is widely recognised that elective colorectal procedures carry a significant risk of surgical site infections (SSI). Alternately, perioperative stabilisation of microflora could be considered. The purpose of this observational follow-up study was to determine the incidence of surgical site infections in elective colorectal cases and the factors that influence such infections, in addition to assessing the burden of elective colorectal surgery at our centre. Material and Methods: The participants in the study were department-admitted individuals whose open colonic surgery was scheduled. The investigation employed various radiological examinations, including X-ray, CT scan; contrast X-ray, MRI, pus culture swabs, and probiotic bacelac PB capsules. In total, two hundred patients participated in the investigation. In accordance with standard preoperative protocol, probiotics were administered, and the occurrence of SSI was monitored for thirty days. The information gathered in this manner underwent descriptive analysis. Results: The average haemoglobin level of the subjects was 12.08 ± 4.2 ± gm/dl. Leukocyte count was 10.95 ± 5.9/l on average. The mean albumin concentration was 4.10 ± 2.97 g/l. Probiotics were administered for a minimum of three to six days prior to surgery and for a minimum of seven days following. Probiotic use persisted for an average of 13.90 ± 4.10 days. Carcinoma rectum emerged as the prevailing malignancy, affecting 50% of all malignancies and 40% of the individuals enrolled in the study. A cumulative of 68 patients underwent an ascending, transverse, descending loop or end colostomy as a palliative measure or to address partial obstruction of the large intestine caused by a distal colonic or anorectal tumour. Conclusion: Perioperative probiotic administration may reduce the incidence of infection-related complications; however, this cannot be demonstrated statistically due to a paucity of data. Additionally, early gastrointestinal function decreases the average length of hospitalisation, which improves surgical outcomes and quality of life.

67. Incidence and Morphometrics Analysis of Sutural, Inca and Epipteric Bones in Adult Human Skulls from Central India
Walulkar S.M., Walulkar M.S., Paikrao V. M.
Background: Sutural, Inca, and Epipteric bones are intrinsic components of the cranial structure in various mammals and reptiles. Additional ossification centres may occur in or near sutures, giving rise to isolated sutural bones. Usually irregular in size and shape, and most frequent in lambdoid suture, they sometime occur at fontanelles.  There are often only two or three, but they appear in great numbers in hydrocephalic skull. Aims and Objectives: The study aims to investigate the prevalence, sexual dimorphism, morphological variations, and clinical implications of cranial sutural, Inca, and epipteric bones in adult human skulls from Vidarbha, India. Methodology: The 430 adult human skulls were collected from various medical colleges in the Vidarbha region, each skull and recording the presence, gross incidence, and distribution of sutural bones, inca, and epipteric bones. The observations were made regarding their occurrence in specific cranial sites, suture locations, and shapes. Anthropometric measurements were taken to determine the maximum length and breadth of each bone. The sexual dimorphism and conducted statistical analyses to identify patterns and trends in the collected data. Result: In our analysis, Wormian bones were present in 34.18% of the 430 examined skulls, with 38.76% incidence in males and 25.97% in females. These bones were most frequently located in the lambdoid suture and Lambda. Irregular-shaped Wormian bones were predominant. Inca bones were found in 2.33% of skulls, with variations in type, size, and shape. Epipteric bones appeared in 18.37% of skulls, demonstrating sexual dimorphism and a range of symmetry patterns. Conclusion: In our comprehensive cranial bone study, Wormian bones were most frequent in the lambdoid suture, primarily on the left side, while Inca bones displayed variations in form and incidence, slightly higher in males. Epipteric bones at the pterion can complicate procedures.

68. Computed Tomography in Diagnosing Appendicitis in Ultrasound Negative Patients
M. Kishore, Kishore Chautakuri, Sarah Aishwarya E, Abdul Rahman
Background: Appendicitis is the most common cause of abdomen pain in patients admitted at the emergency department. The two most common modalities in use are abdominal helical computed tomography (CT) and abdominal ultrasound (US). Aim and Objective: To evaluate the accuracy of CT in identifying appendicitis in ultrasound negative cases. Material and Method: This was hospital based observation study conducted on 120 patients, visited to Department of Radiology, Government Medical College, Siddipet, due to the right lower quadrant pain and negative USG findings, for the duration of one year, after following inclusion and exclusion criteria given bellow and also after approval of institutional ethical committee. Results: In the study we have included 120 patients, after their consent, of them majority were males followed by females. Majority of patients were from the age group of 21 – 30 years of age followed by 10 – 20 years and more than 30 years. Sensitivity and specificity of computed tomography in predicting appendicitis was 100% and 90.54% with accuracy of 94.17%. Conclusion: CT is the gold standard imaging modality to diagnose acute appendicitis in order avoid appendicectomies in this Morden era but also ultrasound can be used as the first line imaging tool in diagnosing  appendicitis.

69. Knowledge, Attitude, and Practices Related to Hypothyroidism in a Tertiary Care Hospital Bangalore
Balachandra G, Veena RM, Sonia Y, Keerthana AB, Ashfaq Ahammed BA, Neenu  MR
Background and Objective: Hypothyroidism is the clinical state resulting from decreased production of thyroid hormones or very rarely from tissue resistance. Better knowledge and awareness regarding the disease in primary hypothyroidism patients can significantly improve compliance of treatment and decrease the associated morbidity. There is a paucity of data on knowledge, awareness, and practices (KAP) of patients with hypothyroidism in India. This study was designed to assess the knowledge, attitude, and practice (KAP) of hypothyroidism among patients with hypothyroidism. Methods: A prospective observational study was performed in an outpatient attending the Department of General Medicine, BGS Global Institute of Medical Sciences, Bangalore. We used a validated questionnaire to assess hypothyroidism KAP. Using frequency counts (n) and percentages (%), discrete data were summarized. Results: The mean age of patients was found to be 35.98±12.21 years. It was found that 52.9% of the patients were aware of the correct meaning of the term hypothyroidism. Regarding consequences of hypothyroidism, 54.7% of the study patients most properly recognized as weight gain (68.9%), followed by 58.5% of swelling in the neck and 54.7% of generalized weakness. All patients (100%) adhered to their medications. Conclusion: Many patients with hypothyroidism had adequate basic knowledge about the disease was observed in the study. Further, we recommend that if healthcare providers could provide patients to understand with data sheets explaining the disease or have some pictorial/pamphlets about the disease’s reality and myths will be more beneficial.

70. A Study on Role of MRI in Detection of Cerebral Ischemic Stroke in Kalaburagi Region
Ananth Dhotre, Kiran Desai, Girish Desai, Mohammed Ali Kabeer
Cerebral ischemic stroke remains the leading cause of death and disability in many countries. The objective are : Role of MRI  in detection of cerebral ischemic stroke. Age and sex distribution of infarcts in an Indian population.  To determine the location and the territory of the involved blood vessels. Incidence of negative cases (stroke mimics). Materials and Methods:  All patients referred to the Department of Radio-Diagnosis with clinically suspected cerebral ischemic stroke in a period of 2 years from November 2014 to September 2016.The main source of data for the study are patients from Basaveshwara teaching and general hospital attached to M R Medical College Kalaburagi. All MRI scans were performed on a 1.5 T Philips Achieva. Sequences used are T2WI axial and coronal, flair axial, gradient echo axial, T1WI axial, DWI axial and ADC maps.  MRA (TOF) – circle Willis (neck) and SWI (optional). Results: 150 patients who were clinically suspected of cerebral ischemic stroke were subjected to MRI study of the brain. Among these 150 patients, 77.33% had infarcts, 10.33% had intracerebral hemorrhage, 5.31% patients had cerebrovenous thrombosis, 4% patients had subarachnoid hemorrhage and 3.03% patients had tumours. However 5 patients had normal scans and was excluded from our series. Predominant risk factors were hypertension and diabetes mellitus. Men were commonly affected. Youngest age group was 17 years and oldest was 84 years. MCA territory (L>R) was the commonest territory involved in patients with cerebral infarction. Conclusion: The present study is a prospective study.  The results obtained from our study are well comparable with other stroke surveys. Differences in pattern of stroke may be related to genetic, environmental or sociocultural factors and to differences in the control of risk factors. MRI is non invasive and there is no radiation hazard. Excellent grey – white matter resolution and multiplanar imaging capability of MRI helps in detection of subtle lesions. Our study observed that diffusion weighted imaging add sensitivity and specificity to the standard MR evaluation.

71. Comparison of Efficacy of Clonidine & Fentanyl as Adjuvants to Local Anaesthetic in Ultrasound Guided Supraclavicular Brachial Plexus Block for Upper Limb Surgeries
Sailaja K., Patnana Pradeep Kumar, Dasari Preethi
Introduction: Regional Blocks Produced With Adjuncts Added To Local Anesthetics Are Of Higher Quality. The Aim Of Present Study Is To Compare The Efficacy Of Clonidine & Fentanyl As Adjuvants To Local Anesthetic In Ultrasound Guided Supraclavicular Brachial Plexus Block For Upper Limb Surgeries. Methods: The Present Comparative Study Was Done At A Tertiary Care Centre Among Patients Admitted To Hospital For Upper Limb Surgeries During One Year Duration Period Of Study. Total 50 Subjects Were Selected By Random Sampling & Were Divided Into Two Groups Of 25 Patients In Each Group Named As Group C & Group F. Version 25.0 Of The Statistical Product For Social Sciences (SPSS) Was Used To Analyse The Data. Results: When Sensory And Motor Block Data Were Examined Between The Two Groups, It Was Discovered That Group F Experienced Faster Onset And Completion Of Sensory & Motor Block Than Group C. When Comparing Group C To Group F, The Length Of The Sensory & Motor Block Was Longer In Group C. Group C Has Experienced Analgesia For A Longer Duration Of Time Than Group F. Conclusion: When Used As An Adjuvant, Fentanyl Has An Advantage Over Clonidine In That It Causes Sensory & Motor Block To Occur More Quickly Whereas Sensory & Motor Block With Clonidine Lasts Longer.

72. An Evaluation of Accuracy of Wound Size Measurement from Digital Photography Compared to Clinical Assessment of Wounds on Living and Dead Bodies: A Prospective Study from A Tertiary Care Centre
Jomon Jacob, Varghese P.S., Deepu T., Seena Sebastian, Nisheed Aubid
Background: This study was conducted to validate the use of digital photographic wound assessment in the evaluation of the size of the wound when compared to clinical assessment and to study the factors influencing digital photographic wound measurement. Methods: This was a cross-sectional study conducted for a period of 2 years among 107 wounds from trauma patients admitted to the ward or patients attending the OPD, emergency department, dressing room, or intensive care unit and dead bodies coming to the forensic medicine department of Tertiary care hospital. Patients who had bleeding disorders, connective tissue or skin disorders, or wounds on an unexposed part were excluded from the study. Results: On comparison of length by manual and photographic methods, it was found that the photographic method is not as accurate as the manual method. While comparing the width using these methods, the same result was obtained. There was a significant change in the accuracy of length measurement according to the site of the body, but no significant change in the accuracy based on the type of wound. where there was a significant change in the accuracy of width measurement according to the type of wound. Conclusion: When comparing the accuracy of wound length and width by photographic and manual methods, it is seen that accuracy depends on different factors like the margin of the wound, type of wound, camera angle, etc. If the wound is small with a clear margin and there is less chance of variation in camera angle based on the site of the wound, the photographic method is a better substitute for the manual or ruler method of wound size measurement.

73. Correlative Study of C – reactive protein with Serum Procalcitonin in Organ Sepsis in Telangana Population
Gandham Venkata Ratna Mani
Background: Sepsis is a life-threatening cause of death if not diagnosed properly and in time for medical treatment. The prognosis of sepsis is closely related to procalcitonin (PCT) and C-reactive protein levels. Method: 60 patients aged between 50-68 years were classified into 4 groups as per the severity of organ dysfunction in sepsis according to sequential organ failure assessment (SOFA). Blood investigations included WBC count, platelet count, S. bilurubin, S. creatinine, arterial blood gas analysis, S. procalcitonin (PCT), and S. CRP, and results were studied with statistical analysis. Results: SOFA score-I 0-6 had 27 (45%), score-II 9512 had 25 (41.6%), score-III 13-18 had 7 (11.6%), score-IV 19-24 had 1 (1.6%), and deaths were 13 (21.6%). Co-morbidities were 25 (41.6%) had type-II DM, 14 (23.3%) had HTN, 26 (43.3%) had pneumonia, and 17 (28.5%) had UTI. The causes of death were: 5 (18.4%) had pneumonia, 4 (30.7%) had UTI, 1 (7.69%) had pneumonia + UTI, 1 (7.69%) had SBP, 1 (7.69%) had diarrhoea, and 1 (7.69%) had DSS. In the comparison of SOFA with the variable SOFA scores studied except S. creatinine, all the parameters like GCS, total bilurubin platelet count, and SOFA score SPCT and SCRP had highly significant p values (p<0.001). Conclusion: In the present pragmatic study, it is concluded that serum prolactin and CRP value levels are significantly correlated, and the elevation of these parameters predicts the prognosis of the severity of sepsis.

74. A Retrospective Study on Maternal and Neonatal Outcomes in Teenage Pregnancy in a Tertiary Care Hospital in Karwar
Spandana S, Pavan Kumar D, Janet Thomas, Santosh Ankalagi
Introduction: WHO defines the period between 10-19 years of age as the adolescent period also called as teenage. It is a serious health problem, more so in developing countries like India. Pregnancy in this transitional stage puts them in a stressful condition. Teenage pregnancy is a common public health and social problem with adverse medical consequences worldwide. Aims and Objectives:  (1) To study the period prevalence of teenage pregnancy in our hospital. (2) To study maternal and neonatal outcomes in teenage pregnancy. Material and Methods: This retrospective observational study was conducted in the Department of Obstetrics and Gynaecology in a tertiary care hospital in Karwar. Data was retrieved from hospital records for a period of one year. Results: During the study period of 1 year, there were total 899 deliveries in our hospital. Out of which the number of teenage pregnant women who delivered were 41. Thus, giving the incidence of teenage pregnancy as 5% among the total teen mothers, 63% delivered vaginally and 35% underwent LSCS. Incidence of hypertensive disorders of pregnancy in teenage mothers are usually high compared to adult mothers but in our study there were no cases of hypertensive disorders of pregnancy in teenage mothers .Preterm delivery constitutes 17% of total teenage deliveries .In the present study 14% were Low Birth Weight Babies, and 17% had NICU admissions. This shows that neonatal outcome is poor in teenage mothers as compared to adult mothers. Conclusion: Teenage pregnancy is associated with a significantly higher risk of preterm labor and neonatal morbidities. Our strategy to tackle the problems of adolescents should be directed to reach out to this vulnerable group with our health care system.

75. Fetal Outcome in Elective versus Emergency Caesarean Section at a Tertiary Care Center
Aarti Narula, Shalini Garg, Satinder Pal Kaur, Nancy Grover, Tarvinderjit Khurana
Objective: To study the fetal outcome in Elective versus Emergency Caesarean section at a tertiary care center. Material and Method: The study spanned one year and included patients undergoing caesarean sections at our tertiary referral center, regardless of their gestation age. The study was conducted after the approval of institutional ethics committee. In this study two   groups of pregnant females were studied. Group 1: Women who underwent elective caesarean section. Group 2: Women who underwent emergency caesarean section. Results: There was total 3296 deliveries during the study period. Among all deliveries, 1306 women with singleton pregnancies underwent LSCS. There were 917(70.2%) emergency LSCS and 389(29.8%) elective LSCS. Fetal outcomes were recorded and compared between elective and emergency LSCS group. In the present study, Fetal complications like respiratory distress, meconium aspiration syndrome and NICU admissions >24 hours were significantly more in emergency group as compared to elective group.  Mean birth weight in elective group was 2.58±0.47 kg and 2.43±0.56 kg in emergency group, which was statistically significant. 1 minute APGAR score was <6 in 2.1% subjects in elective group as compared to 6.8% subjects in emergency group. 5 minutes APGAR score was <6 in 0.8% subjects in elective group as compared to 3.3% subjects in emergency group. It was found to be statistically significant. Conclusion: Fetal complications like respiratory distress, meconium aspiration syndrome and NICU admissions >24 hours were significantly more in emergency group as compared to elective group. There was no statistically significant difference in the occurrence of transient tachypnea of newborn in the two groups.

76. Subanesthetic Dose of Intravenous Ketamine for Post Cesarean Delivery Analgesia in Spinal Anesthesia Prospective Randomized Study
Shaikh Abdul Nasir, Hiral Ranchhodbhai Chavda, Chethan L B, Ravi Bathia, Kiran Rathod
Poor pain control after caesarean section may interfere with walking, breastfeeding, early attention and nutritional care of the newborn. Multimodal therapy for postoperative analgesia blocks multiple pain pathways. Use of opioid-free analgesia should be preferred in the perioperative period to reduce adverse effects like nausea, vomiting, pruritus, and respiratory depression. Tissue trauma causes central sensitization of the spinal dorsal horn neurons through N-methyl-D aspartate (NMDA) receptor-related mechanisms which in turn produces secondary hyperalgesia. Ketamine is a selective noncompetitive NMDA receptor antagonist. Also, it reduces pain by reducing the NMDA receptors, mediated secondary pain. Aims and Objectives: To study the Subanesthetic dose of intravenous ketamine for post caesarean delivery analgesia, haemodynamic changes intra-operatively, Total doses of analgesia in 24 hrs. APGAR score after delivery of baby, Time of first rescue analgesic agent given, Adverse effects intraoperatively and postoperatively 24 hours, Ramsey sedation scale and Patients satisfaction during postoperative period. Material and Methods: 60 females with age group of 18-35 years undergoing cesarean delivery were included and divided. Group A and Group B(n=30): Inj. Bupivacaine 0.5% heavy 2.2cc intrathecally given. After 5 minutes of baby delivery Inj. ketamine 0.2mg/kg intravenously in A group and Saline 0.9% in Group B. Results: No significant changes in demographic parameters, APGAR score and hemodynamic parameters in both the groups. VAS scores were lower in ketamine group than another group. Higher incidence of nausea vomiting in ketamine group. No patient had Ramsey sedation score more than 2 in both groups. All patients were satisfied for analgesia in ketamine group. Time for rescue analgesics were prolonged in ketamine group. Conclusion: Subanesthetic doses (0.2 mg/kg) of intravenous ketamine after 5 minutes of baby delivery leads to enhanced postoperative analgesia without any significant side effects, additional benefit in increasing the time to first postoperative rescue analgesic request with excellent satisfaction for postoperative pain.

77. A Study of Correlation between Vitamin D Levels and Paediatric Epilepsy in a Tertiary Care Hospital of North Eastern India
Abir Lal Nath, Sanjib Debbarma, Prasenjit Das
Background: Vitamin D deficiency is common among epileptic patients. Several studies have investigated the correlation between vitamin D levels and paediatric epilepsy, but it is still unclear and further research is needed. Therefore, present study was designed to investigate correlation between vitamin D levels and paediatric epilepsy. Methods: The current study comprised a cross-sectional analysis of vitamin D levels in 60 children (37 male and 23 female) with epilepsy aged 1 to 12 years. A self-created case record form was used to record demographics, clinical symptoms, signs, and laboratory values, including vitamin D levels, which were classed as normal, insufficiency, or deficient. Results: The study comprised 60 paediatric epilepsy children aged 1 to 12 years, who were receiving anti-epileptic therapy. The total prevalence of hypovitaminosis D in paediatric epilepsy was found to be 80%. The study included 37 (61.67%) male children and 23 (38.33%) female children. In terms of vitamin D prevalence, there were 20 (86.96%) females and 27 (72.97%) males with hypovitaminosis D. Females had a higher frequency of hypovitaminosis D. It was also discovered that older children were more prone to hypovitaminosis D. Furthermore, the longer the duration of epilepsy, the greater the likelihood of hypovitaminosis D. Moreover, present findings also suggest that children with multidrug therapy have higher probability of hypovitaminosis D. Conclusion: The study found that hypovitaminosis D is prevalent in paediatric epilepsy patients. Females have a higher prevalence, and longer epilepsy duration increases the likelihood of hypovitaminosis D. Children with multidrug therapy also have a higher risk. Larger-scale research is needed to validate these findings.

78. A Retrospective Study of Scrub Typhus Associated Acute Kidney Injury: A Tertiary Care Hospital Experience
Ashutosh Soni, Jagdish Vishnoi, Nilesh Patira, Saurabh Gupta, Kamlesh Bhatt, KR Sharma, Mohd Shakeel
Background: Scrub typhus is a vector borne rickettsial disease commonly found in many parts of India. This study is planned to report the clinical profile of acute kidney injury (AKI) associated with scrub typhus. Methods: Retrospective study of hospitalized patients of acute febrile illness who were diagnosed scrub typhus and had AKI was planned at  Department of Medicine, Pacific Medical College and Hospital, Udaipur, Rajasthan from sept -22 to sept-23. Total 50 patients has been taken. Results: All 50 (100%) patients presented with fever and 32(64.00%) patient were have less than 7 days fever and 18(36.00%) were have more than 7 days fever. Other common symptoms were vomiting 30(60.00%) ,abdominal pain 20(40%), headache 17 (34%),myalgia 18 (36%), altered sensorium 14 (28.00%), cough 8(16.00%), seizure 6 (12.00%), diarrhea 6(12.00%), respiratory distress 7(14.00%), oliguria 3(6.00%), bleeding 3(6.00%). Conclusion: This study shows that AKI in scrub typhus is common and a severe disease. The patients with scrub typhus associated AKI have worse biochemical parameters and suffer from various complications.

79. Five-Year Demographic Profile, Prevalence, and Pattern of Refractive Errors in Age Group of 03-17 Years and Their Correlation with Axial Length of Eye Ball, at a Tertiary Care Institute in North India
Vikrant Sharma, Nandita Chaturvedi, Shrishti Mishra, Dinesh Kumar Sahu
Background: Refractive errors are main cause of visual impairment in children. Myopia especially is more prevalent in society. Untreated refractive errors may lead to other ocular disorders like squint and amblyopia. Aim: The present retrospective hospital based clinical study was aimed at assessing the demographic profile, prevalence, and pattern of refractive errors in children of age group 03 to 17 years. Methods: The study included 829 patients aged 3 to 17 years old with refractive errors, divided into only myopia (229 subjects), myopia along with astigmatism (465 subjects), only hypermetropia (30 subjects), and hypermetropia with astigmatism (105 subjects) who visited the Ophthalmology OPD during the span of last five years. Unaided visual acuity was recorded. Visual acuity with previous glasses was recorded for the patients who were already using spectacles. Cycloplegic refraction was done. Retinoscopy after dilating pupil with cycloplegic/ mydriatic drug was done. Thorough ocular examination, including retina examination after pupil dilatation to rule out any underlying retinal cause of diminution of vision was done. Final refraction was done and spectacles were prescribed. Best corrected visual acuity with glasses was recorded. State of isometropia or anisometropia was recorded. Axial length by optical bio meter was measured in undilated state of pupil. Results: The refractive error cases were aged 03 to 05, 06 to 08, 09 to 11, 12 to 14 and 15 to 17 years respectively, with a mean age of 7.8±3.21 years. In the myopia group, myopia with astigmatism group aged 03 to 05, the hyper myopia group 06 to 08 year, and in the hypermetropia with astigmatism group was 09 to 11 years of age. The axial length of the eyeball on the right eye was 22,66±1.51, in myopia cases were 5, 353, 279, 48, and 9 and left eye was 22.70±1.50, were 3, 349, 284, 50, and 8 cases, respectively. Conclusion: The study findings revealed that, 06 to 08 age groups are more susceptible to Refractive Error. The most common refractive error in children was myopia then hypermetropia, which became more common as children aged. The more was axial length; degree of myopia was also high in such patients. While in case of hypermetropia, the eye ball was relatively shorter in length. Thus, the axial length was directly related to type of refractive error and is major predictor of progression of myopia.

80. Impact of Stress on the Immune System in Cancer Patients
Arun Kumar Singh, Kumar Nitin
Background: Strong evidence indicates that stress has a significant negative effect on people’s health, primarily by disrupting the immune system’s normal functioning and causing a low-chronic inflammatory state that increases the risk of infections, metabolic disorders, and other illnesses. The current study intends to assess the stress levels of some patients being treated in an anti-cancer facility and look for any potential links to their immune system status before implementing a physical/psychological programme to prevent health deterioration. Methods: From a psychological and immunological standpoint, we investigated 50 patients and looked at neutrophil chemotaxis and phagocytosis, lymphocyte chemotaxis and proliferation, and natural killer (NK) cell activity in particular. Results: Women were shown to have greater depression symptoms than men. Chemotaxis levels of lymphocytes and neutrophils in women were much lower than in men. We also discovered a strong inverse relationship between depression and NK cell activity. This association was strong regardless of gender. Conclusion: We conclude that stress has an effect on NK activity, and we propose that a combined treatment of cognitive behavioural therapy and physical activity programmes may ameliorate patient health deterioration.

81. Correlation of Adipokines Level with Anthropometric and Blood Sugar Profile (Insulin Level, Fasting Plasma Glucose and Hba1c) in T2DM Patients
Onkar Nath Tiwari, Shreya Nigoskar
Background: obesity is recognized as one of the primary elements in the pathogenesis of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Visceral fat is reported to be far more dangerous than any other form of obesity. Visceral adipose tissue (VAT) is known to be an independent risk factor of myocardial infarction (MI) in elderly patients. Aim: To correlate the adipokines level with anthropometric and blood sugar profile (Insulin level, fasting plasma glucose and HbA1c) in T2DM patients. Methodology: The present case-control study was conducted at Index Medical College Hospital & Research Center (IMCHRC) on 160 diabetes, males and females between 35-65 years of age group patients and 160 healthy similar age and sex in control group were enrolled in this study. The screening and management of patients was as per American Diabetes Association guidelines. Serum level of Visfatin and adiponectin was estimated by Enzyme linked immuno sorbent assay (ELISA) as per manufacturer’s protocol. Result: The serum levels of adipokines (Visfatin) level were significantly higher in the case group (45.35±4.64) in comparison to control group (21.44±4.51) (P<0.05). But adiponectin level was significantly lower in the case group (5.86±0.94) in comparison to control group (10.68±1.54) (P<0.05). The Visfatin positively significant associated with weight, BMI, Waist circumference and Waist Hip Ratio; while it was negative significant correlated with HIP Circumference. It was positive insignificant correlated with age and negative insignificant correlated with height. But in case of Adiponectin negative significant associated with weight, BMI, Waist circumference and Waist Hip Ratio; while it was positive significant correlated with HIP Circumference. Conclusion: The association of visfatin and adiponectin with weight, BMI, waist circumference and waist/hip ratio may partly explain the lower levels of adiponectin found in individuals with diabetes.

82. A Study on the Evaluation of Adverse Drug Reactions Associated with Antiretroviral Therapy in Tertiary Care Hospital
Kaushal Kumar Mishra, Ashoka Kumar Chowdhury, Satyendra Kumar Pathak
Objectives: The present study was to evaluate the sociodemographic profile of HIV patients and adverse drug reaction in HIV patients with antiretroviral therapy in tertiary health care centre of Bihar, India. Methods: Socioeconomic status (SES) of the patients were assessed by Modified Kuppuswamy score.  Drug reactions like anaemia, skin rashes, lipodystrophy and nephrotoxicity were diagnosed by routine investigations (CBC, RFT, LFT, Viral load) done during the regular follow up. Reactions like giddiness and peripheral neuropathy were described by patients during the visit. Results: A total of 150 diagnosed cases of HIV were included. Most of the cases 80(53.33%) were in age group of 31-43 years. And 100(66.66%) HIV cases were males. most of the patients 93(62%) were belonged in lower middle class. 73 (48.66%) cases had shown adverse drug reaction with ATR. Among (73) them cases had 36(49.31%) anaemia, 17(23.28%) nephrotoxicity, 9(12.32%) skin rashes, 5(6.84%) giddiness, 4(5.48%) peripheral neuropathy and 2(2.73%) lipodystrophy. Anaemia being the most common drug reaction was associated with the zidovudine-based regimen. Tenofovir was associated with the development of nephrotoxicity. Conclusions: Most common adverse reaction of ART associated with ziduvudin based regimens is anaemia. Second common ADR are nephrotoxicity, skin rashes, giddiness and peripheral neuropathy. And lower middle class socioeconomic strata and middle age male population are more preponderance for HIV infection.

83. A Case of Epilepsy Presented with Phenytoin Toxicity
Pankaj Akholkar, Hitesh Kumar, Meera Patel, Yash Mandavia, Pritesh Patel, Naresh Rathod, Parth Jani
Epilepsy is a common neurological disorder. The main goal of treatment is to achieve seizure control without adverse effects. Phenytoin is a widely prescribed drug in treatment of epilepsy due to its low cost and easy availability. It has well-documented safety and efficacy profile. The toxic effects of chronic therapy of phenytoin may present with wide variety of clinical features from minor gum hypertrophy to central and cardiovascular system involvement. Here we report a case of 21-year-old male presenting with complain of difficulty in walking since 2 months with multiple fall downs without any history of trauma, fever, headache, loss of consciousness, hearing loss, vertigo, tinnitus. Patient was a known case of epilepsy taking phenytoin since last 10 years. Patient was investigated and phenytoin toxicity was diagnosed, and treatment was given accordingly. Patient improved with treatment and discharged with regular follow up.

84. Evaluation of Haemoglobin E and Haemoglobinopathies in Patients with Anaemia Attending a Tertiary Care Hospital of Assam, India
Sajida Sultana Rahman, Jilimili Devi
Introduction: One of the common variants of haemoglobin (Hb) is haemoglobin E (HbE). The purpose of the present research is to assess the frequency of Hb E and other haemoglobinopathies among patients attending a tertiary care hospital of Assam, India. Methods: Patients who visited the Advanced Clinical Biochemistry Laboratory of the Assam Medical College & Hospital in Dibrugarh, Assam, India between September 2021 and September 2022 were the subjects of the present time-bound cross-sectional study. Prior institutional ethics committee approval was obtained for this study. The cell counter (SYSMEX XN-500, Japan) was used to perform the Complete Blood Count (CBC).  A High-Performance Liquid Chromatography (HPLC)-based D10 Haemoglobin Testing System (BioRad Laboratories, USA) was used to screen for different haemoglobin variants. The statistical package for the social sciences (IBM SPSS Version 16) was applied for the analysis of data. The difference between groups was statistically evaluated using the Chi-square test considering a p-value below 0.05 as significant. Results:  A total of 266 numbers of participants were included in the study. The mean age (±S.D) of the participants was 30.86 (±16.13) years. Hemoglobinopathies were detected in 51.5% of the participants and are common in 20-29 years age group (15.5%). HbE disease (21.1%) was the most frequently observed Hb variant followed by HbE trait (17.3%). Mean haemoglobin of HbE disease patients was 8.19± 2.23. Patients with b-thalassaemia trait shows the lowest mean haemoglobin level of 4.12±2.56. Substantial variation in hemoglobinopathies were observed among patients belonging to the native Assamese community and those of other immigrant communities (p-value<0.01). Also, prominent variation noticed within the various aboriginal groups (p-value<0.01); particularly predominance of HbE hemoglobinopathies among the tribal and other backward native Assamese groups. Interpretation & Conclusions: Hemoglobinopathies are prevalent in the study population. Hb E disease is the commonest type of haemoglobinopathies among the study participants. Awareness towards haemoglobinopathies is necessary for better clinical utility.

85. A Study of Cardiovascular Manifestations in Hyperthyroid Patient
Pramod R. Jha, Sachin Gadiya, Jayant Mayavanshi
Background: Hyperthyroidism is a vastly prevalent endocrine disorder with wide array of symptoms and signs with multi system involvement. One of the most critical systems involved is the cardiovascular system. Objectives: With an aim to study prevalence of cardiovascular manifestation in hyperthyroid patients. The objectives to study cardiovascular symptoms and signs, ECG changes, 2 D ECHO in hyperthyroid patients and correlation between duration of hyperthyroidism and severity of cardiovascular manifestation. Methodology: This cross-sectional study was carried out in 55 patients with hyperthyroidism in the Department of General Medicine, SBKS MIRC, Sumandeep Vidyapeeth over a span of one and half year. Detailed evaluation was done through clinical examination, ECG and 2D echocardiography. Statistical data analysis was made based on frequency distribution, mean, standard deviation and association of cardiovascular involvement in hyperthyroidism was evaluated. Results: Among 55 patients with hyperthyroidism, palpitation was the most common cardiac symptom found to be present in about 78% of patients. Other cardiac symptoms were breathlessness and chest pain, present in 31% and 14.5% of patients respectively. Tachycardia was the most common cardiac sign present (80%). About 32% patients had hypertension; and atrial fibrillation was present in 20% patients. Electrocardiogram abnormalities noted was sinus tachycardia present in 67% patients and was the commonest ECG abnormality. Atrial fibrillation (20%), LVH (10.9%), ST T changes (7%), RBBB (5.4%), RVH (3.6%) were other electrocardiogram abnormalities noted. On Echocardiography; systolic dysfunction (16.3%), chamber enlargement (14.5%), diastolic dysfunction, mitral regurgitation, mitral valve prolapse were the abnormalities present in decreasing order of frequency. Hyperthyroid patients having cardiac symptoms had significantly low levels of TSH than patients who did not have cardiac symptoms. Conclusion: Hyperthyroid patients present clinically with various nonspecific signs and symptoms which are difficult to attribute to cardiovascular involvement. Hence, a high index of suspicion is the key for early diagnosis of cardiovascular involvement in hyperthyroidism. So, early and frequent evaluation by ECG and 2D echocardiography is crucial to assess the patients for cardiovascular changes so that prior interventions could be performed to improve the clinical outcomes.

86. Etiopathological and Clinical Study of Anemia of Children between 1 Year to 12 Years of Age
Rakesh Kumar, Puja Kumari, K.K. Sinha
Background & Objectives: To study etio-pathological and clinical aspects of different types of anemia in age group of 1 year to 12 years. Methods: This study was conducted in Department of Pediatrics, Jawahar Lal Nehru Medical College and Hospital, Bhagalpur, Bihar from October 2020 to October 2022 among children between 1 year to 12 years of age. the study was prospective and time bound. Results: The study group which consisted of total 100 hospitalized patients who were admitted with anemia according to WHO classification. Out of 100, 45 were females and 55 were males. In the study group, maximum cases belonged to school going age group (64% of total). Maximum cases had moderate anemia (65% of total). When we studied the distribution of different causes of anemia within the study group, IDA (74%) is the most common type followed by anemia of chronic disease and malaria among all age group. The incidence of generalized lymphadenopathy and hepatosplenomegaly were maximum in case of IDA. All cases of aplastic anemia and leukemia had bleeding manifestations.6 out of 27 patients of severe anemia had koilonychia. Conclusions: Incidence of anemia is very high in age group of 1 year to 12 years. IDA is the most common cause. Specific public health actions are urgently required to stop the damaging impacts on physical and mental health as well as their long – term consequences.

87. Outcome and Complications of Endoscopic Dacryocystorhinostomy without Stenting
Pramod Ramachandra Shiralkar, Nikesh Meghji Gosrani
Introduction: DCR is a surgical treatment for adult “Nasolacrimal Duct Obstruction (NLDO)”. NLDO produces severe tearing and drainage. Surgery creates a tear drainage nasal passage. It can be done without stents. Stents are disputed; some say they maintain patency, while others say inflammation causes failure. This study compares endoscopic DCR success rates with and without stents to determine stent efficacy. Aim and Objectives: This study aims to assess the various results and potential problems associated with stent-free Endoscopic Dacryocystorhinostomy. Method: In a study conducted at Vedantaa Institute of Medical Sciences and Research Centre, Endonasal Dacryocystorhinostomy (DCR) with and without stent insertion was compared in 42 patients with chronic dacryocystitis between the ages of 10 and 60. A two year evaluation of relief from the symptoms was done using a modified Likert scale. People in one group were given stents whereas those in the other group were not. The study design emphasises the effectiveness of stents in endonasal DCR. Result: The effectiveness of Endoscopic Dacryocystorhinostomy (DCR) was evaluated at three, six, and twelve months using a modified Likert scale. Twenty-one patients who had received stents and twenty-one patients who had not received stents were compared. There were no statistically significant differences between the two groups at any point of time, suggesting that stents had no major impact on the functional or anatomical outcomes in individuals with chronic dacryocystitis. Conclusion: In  most  cases of chronic dacryocystitis, a   stent-free Endonasal Dacryocystorhinostomy is recommended since it is safe, effective, and requires less downtime than stented treatments.

88. To Establish Imprint Cytology Technique as a Routine Procedure for Intra-Operative Assessment of Margin Status in Carcinoma Breast Cases
Meha Ghodawat, Ali Abbas Sabunwala, Rajesh Kumar Agarwal, Ayushi Chouhan
Background & Methods: the aim of the study is to establish imprint cytology technique as a routine procedure for intra-operative assessment of margin status in Carcinoma Breast Cases. Detailed clinical history and thorough physical examination were done in each patient. Complete pre-operative work-up investigations and medical fitness for surgery were obtained. Each patient was informed about the procedure and informed consent was obtained. Primary diagnoses were obtained by fine-needle aspiration cytology, stereotactic core biopsy, or other open biopsy procedures. Results: Plan for all our cases to start, was BCT with Axillary Sampling.  Further course was based on Intra-op Imprint Cytology reported by pathologist.  Imprint quoted free margins for 60 lumps out of which NO further dissection was done in 52 cases and surgery was completed after finishing Axillary Sampling. Inspite of negative Imprint, 08 cases were converted to MRM because of patient’s preference towards it. Involved margins were reported in 26 cases, out of which 24 were converted to MRM. For single case, patient refused MRM, hence margins were extended further 2 cm. Conclusion: Effective breast-conserving surgical techniques for early-stage disease were developed to improve breast cancer women’s quality of life. BCT may offer an advantage over MT in terms of body image, psychological and social adjustment, but BCT may be associated with higher rates of positive margins than MT and the incidence of local failure. Imprint cytology although not a substitute for conventional histopathology, but as complementary to it, is useful for rapid diagnosis of malignant conditions as well as benign conditions.

89. Investigation on Utilisation of Biomechanical Measurements of the Cervix for Labor Prediction
Priyanka Kumari, Rahul Ranjan, Krishna Sinha
Objective: The induction of labor is a frequently performed procedure in the field of obstetrics. The capacity to anticipate the length of labor has the potential to enhance both planning processes and patient happiness. The main objective of this research was to assess the efficacy of a novel biomechanical assessment approach for the cervix, using the aspiration method, in predicting the length of labor subsequent to induction. Study design: The study used a prospective single-center design. The inclusion criteria for this study consisted of nulliparous pregnant women with an unfavourable cervix who required induction of labour. The study included the use of digital assessment (Bishop score), sonographic evaluation (cervical length and cervical consistency index (CCI)), and aspiration measures (closure pressure) of the cervix. These measurements were then compared to the duration of labour. The study investigated the technical feasibility and acceptability of the measures. Findings: The sonographic and aspiration measures did not exhibit any technical problems. The measurement of the Bishop score has been documented as the most uncomfortable evaluation. There exists a substantial correlation between the duration of the active phase of labor as well as the time to delivery and the Bishop score, whereas no such correlation is seen with respect to cervical length, cervical collagen content index (CCI), or cervical closure pressure. Conclusion: In conclusion, the use of the aspiration approach for biomechanical evaluation of the cervix has been shown to be both technically possible and well-received. No significant connection was seen among our limited sample between closure pressure and the length of labour.

90. Evaluation of Serum Albumin Levels and Serum Cholesterol Levels as Risk Factors for Developing Surgical Site Infection Following Elective Surgery: A Prospective Observational Study
Raj Kumar Paliwal, M.M. Mangal
Background: Post operatively surgical site infection is one of the most common complications resulting in significant physical, mental, financial impact and burden on healthcare. Hypoalbuminemia & hypocholesterolemia have been reported to be one of the risk factors for developing surgical site infection. Aims & Objectives: To assess the role of serum albumin & serum cholesterol levels as risk factors for developing surgical site infection following elective surgery. Material & Methods: This prospective observational study recruited 150 patients who were admitted for elective surgery in department of General Surgery. Procedures included under elective surgery were inguinal hernia surgery, appendectomy and colorectal surgery, cholecystectomy, breast surgeries and other major elective procedures. Preoperatively, complete blood count, liver function tests, lipid profile, bleeding time, clotting time, urine examination, chest x-ray and ECG were performed. The duration of surgery & number of hospitalization days were recorded. Daily monitoring of pulse rate, blood pressure, temperature, surgical dressing of the study participants was done until their discharge. Any surgical site infection observed was registered. Results: Hypoalbuminemia was observed in 92 (61.4%) & surgical site infections in 42 (28%) patients. Prevalence of total cholesterol levels were observed to be less than 100mg % in 30 (20%), between 100-200mg % in 99(66%) patients and more than 200 mg% in 21(14%) of the patients. Mean albumin levels were statistically significantly lower in patients with SSI (3.01±0.27) as compared to none(3.31±0.49) (p<0.05).Mean serum cholesterol levels observed no statistically significantly difference in patients with SSI (157.53±66.36) as compared to none (158.29±55.81) (p 0.68). No statistically significant difference was observed in the incidence of surgical site infections with respect to serum cholesterol levels (p 0.162). Conclusion: Preoperative low serum albumin levels below 3mg/dl has been observed to be a significant & reliable risk factor for the development of surgical site infection. Serum cholesterol levels were not found to be statistically significantly associated with the development of surgical site infections.

91. A Comparative Study of Hemodynamic Stability in Patients Receiving Propofol with Fentanyl and Propofol with Dexmedetomidine during Tracheal Intubation in Laparoscopic Cholecystectomy
Nikhil Rani, Manish Khandelwal, Varun Kumar Saini, Priyanka Saini, Vignesh Gunasekaran, Nidhi Khandelwal
Background and introduction: Laparoscopic surgery have many advantages such as reduced postoperative pain, speedy recovery. Most of laparoscopic cholecystectomy is performed under general anaesthesia. Direct laryngoscopy and intubation often results in a profound sympathetic response which leads to tachycardia, hypertension. The techniques such as increasing the depth of anaesthesia, various drugs such as opioids (fentanyl), local anesthetics (lignocaine), beta adrenergic blockers, vasodilators (nitroglycerin), calcium channel blockers (diltiazem) and alpha 2 adrenergic agonists (clonidine, dexmedetomidine) have been used to minimize these adverse responses. Methodology: Patients were divided randomly in 2 groups (40 patients in each group) using block randomization. Patients in Group F were administered with IV Fentanyl 2 mcg/kg in 100 ml normal saline loading dose over 10 minutes. Patients in Group D were administered with IV Dexmedetomidine 1 mcg/kg in 100 ml normal saline over 10 minutes. Hemodynamics was monitored throughout the entire procedure of laryngoscopy, intubation, 2 and 5 minutes post intubation. Maintenance of anaesthesia was done as standard protocol. Patients were monitored for pain intensity using Visual Analogue Scale (VAS), at interval of 30 minutes till 2 hours. Observation and Results: Demographic profile were similar in both groups. Heart rate and MAP at baseline and before premedication was similar in both groups (p>0.05). After study drug and induction, Heart rate decreased in both groups and was significantly lower in Group F as compared to Group D Just after intubation, at 2 minutes and 5 minutes post intubation, heart rate remained higher in Group F than in Group D. After study drug and induction MAP was lower in Group D  as compared to Group F. Just after intubation, at 2 minutes post intubation and at 5 minutes post intubation MAP was higher in Group F than in Group D. Conclusion: Hence, from the present study it can be concluded that though both the study drugs are effective in blunting the hemodynamic stress response, dexmedetomidine is better among the two study drugs. Both the drugs provide good analgesia but dexmedetomidine provided better analgesia in the postoperative period.

92. Comparative Analysis of Anesthesiologists Communication Styles on Patient Pain Perception and Behavioral Discomfort during Intravenous Cannulation
Divyashri C N, Jasvinder Kaur, Shwethapriya Rao, Shiyad M
Objective: This study aimed to analyze the impact of anesthesiologists’ communication styles on patient pain perception and behavioral discomfort during intravenous cannulation. Methods: A total of 100 patients undergoing elective surgery were randomly allocated into three groups (ST, NP, NU) and subjected to different communication styles before intravenous cannulation. Pain perception was measured using the Visual Analogue Scale (VAS), and behavioral discomfort was assessed through a behavioral rating scale. Results: The NU group, informed of ‘numbness,’ reported the lowest mean VAS score (2.8 ± 1.0), while the NP group, assured of ‘no pain,’ exhibited the highest (4.2 ± 1.5). Behavioral discomfort scores were also significantly higher in the NP group compared to the NU group. Pre-procedure anxiety levels were lowest in the NU group (4.2 ± 1.0). The differences in pain perception and discomfort across groups were statistically significant (p<0.01). Conclusion: The study concludes that communication emphasizing a sensation of numbness is more effective in reducing pain perception and discomfort during intravenous cannulation. These findings highlight the critical role of communication in patient care and the need for targeted training for healthcare professionals in this area.

93. Prevalance of Acute Leukemia in Children with Special Reference to Immunocytochemistry
Jyoti Ranjan Behera, Manas Ranjan Mallick, Sandeep Kumar Tripathy, Pranati Kumari Behera, Narendra Behera
Introduction: There are 50 to 200 cases of paediatric cancer for every million children worldwide. In developing nations, juvenile cancer accounts for 2% of all cancer cases and 0.5% of those in more industrialised nations. Children’s malignancies that are common worldwide include lymphoma and leukaemia. Childhood cancers most commonly diagnosed in industrialised and developing nations include leukaemias, which are the most prevalent kind, and lymphomas. It is estimated that leukaemia makes up one-third of childhood cancer cases, with acute lymphoblastic leukaemia (ALL) being the most prevalent kind. Material and Methods: a prospective observational research that included all patients with newly diagnosed acute leukaemia admitted to the paediatrics department at MKCGMCH. Parents were asked for their informed permission. A thorough history of fever, joint pain, weakness, bleeding areas, and edoema was obtained upon admission. A clinical examination was then performed to check for signs of hepatomegaly, splenomegaly, purpuric, petechial patches, lymphadenopathy, and moderate to high grade fever. When the patient was admitted, further factors including age and sex were noted. To search for blast cells, studies such as DC TLC, TPC, and haemoglobin with peripheral smear were conducted. Additional testing, such as uric acid. Results: Being a hospital based study; it is not strictly representive of background populations. The data of a large number of patients could not be retrieved. Only 76 patients were included as per the case availability and time constraint. In our study because of the non-availability karyotyping and cytogenetic profile as a prognostic factor was not studied which could have yielded noteworthy results. Finally, because of various treatment protocols used by physicians, the outcome, based on therapy, could not be evaluated. Conclusion: Acute leukaemia was 0.80% common, according to the study. Males and children under the age of 10 had higher rates of the illness. The most prevalent symptoms in children were fever, bleeding, and generalised weakness. The most common symptom in all leukaemia patients was lymphadenopathy, which was followed by hepatosplenomegaly. Anaemia affected most of the patients. Two further crucial peripheral blood markers for the diagnosis of acute leukaemia are thrombocytopenia and leukocytosis. It was discovered that acute lymphoblastic leukaemia frequently occurs in children. Acute myeloid leukaemia, T cell acute lymphoblastic leukaemia, and B cell acute lymphoblastic leukaemia were the three most frequent types of leukaemia. Using bone marrow analysis and flow cytometry, the diagnosis of leukaemia is more conclusive.

94. Impact on Cost and Laboratory Service for ABG Analysis with Training Related to ABG Collection and Transport
KR Gopala Krishnan, Hina Baraiya, Piyush Tailor, Sapna Patel, Subhankar Jha, Sanjay Parmar
Introduction: Arterial blood gas (ABG) analysis is an essential part for diagnosing and management of critical to monitor a patient’s oxygenation status and metabolic disorder. The usefulness of this diagnostic tool is dependent on accuracy of analysis for interpret the results as well as unbroken testing service for continue monitoring of patient. Objective: To evaluate improvisation on the cost of ABG analysis with sample flow. Methods: This study is done retrospectively from data of number of arterial blood gas analysis performed, ABG cartridge utilized and amount of rupees utilized for purchase of ABP cartridge, in period of December 2022 to July 2023. After continued use of these instrument for 3 months, training to reduce pre-analytic error was conducted on 24th February 2023 for resident doctor of medicine department and respiratory medicine department. Data of cartridge utilized were collected from instrument database and verified with laboratory purchase order. Results: It is found that in Pre-training each cartridge life was 12.2 days and Af-ter-training, each cartridge lives was increased to 19.83 day. Average ABG sample run in a day was 17 and average ABG Sam-ple run in day is increased to 30. In Post-training aver-age ABG Sample Estimation in Per-centage is increased approximately twice (17 to 30 sample per day, 72% ) in compare to pre-training period. Conclusion: Root cause analysis in laboratories is vital for implementing effective corrective actions and preventing recurring issues. Pre-analytical training reduces problems like ABG instrument breakdown and lowers the overall cost per analysis. This approach boosts laboratory efficiency, extends instrument life, and instills clinician confidence in the reliability of testing services.

95. Study of Domestic Violence and Psychiatric Morbidity among Spouses of Patients with Psychiatric Disorders
B.J.P Mallika, Phani Ram Vavila, Ch Vamsi Krishna, U. Raghava Rao, Kanaka Mahalaxmi. A, G. Suresh Kumar
Introduction: Domestic violence is the most common and significant public health problem. The World Health Organization defines violence as “the purposeful use of physical force or power, threatened or real, against oneself, another person, a group, or a community, resulting in or likely to result in damage, death, psychological distress, maldevelopment, or deprivation [1]. Domestic violence is described as “any act of force or coercion that significantly compromises the life, body, psychological integrity, or autonomy of a person in a family or kinship.” DV is frequently used interchangeably with “intimate partner violence,” which is when one spouse or partner abuses the other when they are in a close relationship [5] Violence against women can harm one’s mental health in a variety of ways, including behavioral issues, eating and sleeping disorders, PTSD, depression, anxiety, self-harm and suicide attempts, low self- esteem, and dangerous alcohol and drug usage [2]. Identifying the extent to which certain mental diseases are related to violence towards a spouse is essential since it will inform violence prevention strategies. Hence our study focused on screening the spousal mental and their experiences of violence by partners with common mental disorders attending tertiary care centers. Aim: To evaluate the presence of an association between domestic violence and psychiatric morbidity among spouses of psychiatric patients. Materials and Methods: A hospital-based Cross-sectional Study was conducted at Government hospital for mental care, Visakhapatnam in 200 Spouses of Psychiatric In patients & Outpatients attending the hospital for One year (August 2021- July 2022). REVISED CONFLICT TACTICS Scale (CTS2) to assess Domestic violence among spouses of psychiatric patients and MINI INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW SCHEDULE to assess psychiatric morbidity among spouses of psychiatric patients. Results: Out of 200 subjects, the majority 65% (n=130) of spouses experienced domestic violence by their partners. Females 74.4% (n=90) experience more domestic violence than males 50.6% ( n=40) Of the 200 spouses, 65% reported experiencing negotiation, mainly emotional violence. This was followed by psychological violence in 54.5% (n = 109), physical violence in 38.5%, and sexual violence in 14%. When compared to male spouses, female spouses had a statistically significant higher likelihood of experiencing psychological aggression. 47.9% (n=58) of females were more likely to experience physical assault when compared to 24.1% (n=19) of males which was statistically significant (p-0.001). 14% (n=28) of study spouses had sexual coercion more in female spouses compared to 6.3% (n=5) of males which was statistically significant (p<0.05). Conclusion: This study had evaluated the prevalence of domestic violence among spouses of psychiatric patients and its impact on their mental health. Domestic violence was highly prevalent among female spouses of alcohol- dependent male partners followed by schizophrenia and bipolar disorder. Most common type of domestic violence experienced by study spouses was emotional followed by psychological, physical and the other types like sexual and injury were less likely in male spouses.Most common type of psychiatric morbidity reported being Major depressive disorder among both men and women.

96. Clinical Study on Efficacy of Injection Botulinum Toxin in the Management of Spasticity in Cerebral Palsy
Surykanth Kalluraya, Anand Varma, Vinodkumar J. Makannavar, Mallappa
Background: Cerebral palsy (CP), a group of disorders in movement and posture resulting from non-progressive injury of the immature brain is the most common cause of disability in the paediatric population.  Among various subtypes grouped, spastic type is most common. Physiotherapy and occupational therapy remain the mainstays of treatment in spastic CP. Objectives: To evaluate the effectiveness of injection botulinum toxin used in the management of spasticity in children with cerebral palsy. Method: This is a prospective, longitudinal and interventional study which includes 25 cases of Botulinum toxin injection in the management of spasticity in cerebral palsy seen at Karnataka Institute of Medical Sciences (KIMS) hospital, Hubballi for a period of one year from July 2022 to July 2023. Children between 2-12 years age diagnosed with spastic cerebral palsy with any level of Gross motor function classification system were included in study. Results: Maximum number of patients 15(60%) had unilateral cerebral palsy and 10(40%) patients had bilateral cerebral palsy. About 15(60%) patients had hemiplegia and 10(40%) patients had diplegia. The GMFCS level frequency was same as that of 12 weeks among patients even at 6months. There is no statistically significant difference between before and after treatment at 6months in GMFCS level.  There was no statistically significant difference in MAS grading for elbow flexors and forearm pronators before and after treatment at 12 weeks.  Maximum number of patients 15(60%) were in MAS grading 1+ followed by 10(40%) patients in MAS grading 2. 10(40%) patients were in MAS grading 1 and 1+ each and 12(48%) patients were in MAS grading 1 and 1+ each at 12weeks and 6months respectively. This difference is statistically significant. There was a significant improvement on the MAS and R1 on the MTS for Calf muscles and Hip adductors at three follow-ups compared to before treatment. As for R2 on the MTS there was a significant improvement in tone in muscles of Hip adductors and Hamstring muscles. Conclusion: It demonstrates that multilevel BTX-A injection as part of the integrated approach can be used for focal treatment of spasticity especially of hamstrings, hip abductors and calf muscles in non-ambulatory young children. Such a treatment affords the possibility of delaying/avoidingorthopaedic surgeries for children especially for those who are at high risk for general anaesthesia.

97. Study of Clinical Profile and Post BFM-90 Induction Outcome of Adult Acute Lymphoblastic Leukemia (ALL)
Tanvi K. Ranka, Darpan P. Jakkal, P. S. Jirvankar, Kailas N. Chintale
Introduction: Acute leukemias are classified into Acute Myeloid Leukemia (AML) and Acute Lymphoid Leukemia (ALL). India has the highest population of adolescent and young adults globally, and most centers see a significant proportion of patients in this age group.The proportion of ALL among adult patients diagnosed with acute leukemia reporting at Indian institutions are ranged from 7.3% to 57.8%. There are Different protocols used for the treatment of Adult ALL, among adults with ALL, although the complete remission rates (CR) have approached to 74% to 93 %, the overall survival rate has only approached to 27% to 54%. The present study has analyzed the response rates of the adults treated by the BFM-90 protocol. Material and Methods: This was a prospective, observational and descriptive study conducted in tertiary care centre & teaching institute during the period from December 2019 to July 2021. Total 50 patients of ALL were included in this study as per Guidelines after satisfying inclusion and exclusion criteria. Results: This study shows 54% of cases were < 20 yrs of age. There were 60% of males. Most of the patients had fever (86%), pallor (100%) and 06% cases showed CNS involvement. In the present study mean HB (g/dl), Total TLC (cells/ and platelet count (cells/ was 7.124 ± 1.58, 106831.4 ± 49328.32 and 78880 ± 77303.18. In this study 34 cases were of B-cell type of adult ALL whereas 16 cases were of T-cell type of adult ALL. The present study showed that before induction of BFM-90 protocol Bone marrow Blasts were > 20% in all cases of ALL. Post induction at Day 35 showed remission in 72% of cases. Also there was significant association between pre and post induction BFM-90 (p=0.0001). On multivariate analysis it had showed significant association between TLC (p=0.0001) and platelets counts (p=0.003) with Bone marrow Blasts (%). Conclusion: Our study data supports that BFM-90 Protocol is feasible chemotherapy regimens for adult patients with ALL, with efficacy that appears comparable to outcomes observed with other regimens used in the treatment of adult ALL.

98. Clinical and Mycological Study of Onychomycosis
Rajesh Somkuwar, Ishita Dani, Priyanka Hemrajani, Chetan Oberai
Introduction: Onychomycosis is dermatophytic infection of the nails. Aims: To study the epidemiology, clinical presentations and to identify the various causative fungi causing onychomycosis. Methods: The study was a prospective study with 100 random patients with nail problems and 50 patients of clinically suspected untreated fungal infection. Results: Onychomycosis accounts for upto 50% of all nails problems. Risk factors for the disease include trauma, occupation, immunocompromised persons, diabetics and others. Distal and Lateral subungual onychomycosis is commonly found. Majority of dermatophytic infection is caused by Trichophyton rubrum while Aspergillus in non-dermatophytes. Conclusions: The purpose of this study is to document the incidence, prevalence, contributing factor, associated diseases, the common types and the causative agents of onychomycosis and also, to observe the psychosocial and occupational consequences of onychomycosis amongst the patients.

99. Comparative Study of Various Treatment Modalities in Management of Keloids and Hypertrophic Scars
Sandeep Kulkarni, Bhuvaneshwari Dewangan, Saumita Ghosh Biswal, Manish Dewangan
Keloids and hypertrophic scars are benign cutaneous lesions produced by uncontrolled synthesis and deposition of dermal collagen. Both the lesions follow injury to the skin of predisposed individuals but keloids can occur spontaneously. Amongst the various regimens used intralesional steroids, cryosurgery and their combination are simple techniques without gross complications and can be performed on outdoor patient basis without local anaesthesia and the overall results are satisfactory compared with the results reported using alternative regimens. The study was conducted on 45 selected patients from amongst group of 60 patients attending Department of Dermatology of Jawaharlal Nehru Hospital & Research Centre, Bhilai, and Chhattisgarh, India diagnosed as having either keloids or hypertrophic scars during the period from June 2008 to June 2010. A total of 45 patients having 45 lesions (30 keloids and 15 hypertrophic scars) were treated. Recurrence was seen in 2 keloids (33.3%) treated with intralesional triamcinolone alone and 1 keloid (14.2%) treated with cryosurgery alone. The treated lesions were treated followed up for 6 to 12 months. Recurrence was seen in 2 keloids (33.3%) treated with intralesional triamcinolone alone and 1 keloid (14.2%) treated with cryosurgery alone. No recurrence was seen in lesions treated with combination therapy. There was no recurrence in hypertrophic scars treated with any of the three modalities. The average number of sittings required for the keloids and hypertrophic scars that showed good to excellent response; were least with the combination therapy whereas it was almost equivalent with cryosurgery and intralesional triamcinolone alone with cryosurgery faring marginally better.

100. Role of FNAC in the Diagnosis of Salivary Gland Tumours
Naima Aziz, Roop Rekha Das, Antariksha Sharma, Mayuri Saikia
Background: Tumours of salivary gland constitute 1% to 5% of all head and neck tumours. Fine needle aspiration cytology (FNAC) is a cytodiagnostic method used for initial diagnosis of salivary gland swelling which is rapid, reliable, safe and inexpensive where individual or group of cells are studied to arrive at a pre-operative diagnosis.  The aim of this study is to evaluate cytological spectrum of salivary gland tumours and its correlation with age, gender and anatomical site. We have done a retrospective study of FNAC of salivary gland tumours for a period of 1 year (2020-2021) in a tertiary care center of Northeast India. Results: Out of 46 cases of salivary gland tumours, 65.2% were benign lesions and 34.8% malignant tumours. The majority of benign lesions were seen in the age group of 31 to 40 years. The male to female ratio of salivary gland lesions was 1.9:1 and parotid gland (65.2%) was found to be the most commonly involved site. Pleomorphic adenoma was the most common benign tumour (52.2%) and mucoepidermoid carcinoma was the most common malignant tumour (17.4%) among all the neoplasms. Conclusion: Fine needle aspiration cytology is a rapid, cost-effective, and safe diagnostic procedure useful in the initial preoperative diagnosis of salivary gland tumours to plan for appropriate treatment. However, it should be correlated with histopathological confirmation.

101. Comparative Analysis of Intrathecal Bupivacaine Plus Clonidine Vs Bupivacaine Plus Dexmedetomedine for Gynaecological Procedures
Duraiya Gulamali, Ravindra Gandhi, Zohara Bamaniyawala
Background and Aim: The incorporation of adjuvants into intrathecal medications that are routinely administered is essential for the safe and effective extension of single-shot spinal blocks used in gynaecological surgery. In resource-constrained nations, where the expense of epidural anaesthesia typically prevents its use, adjuvants are frequently employed to extend the duration of regional anaesthesia. Comparing the efficacy of intrathecal bupivacaine and clonidine to that of bupivacaine and dexmedetomedine for gynaecological procedures was the purpose of the present study. Material and Methods: A prospective, randomised, and double-blind study was conducted to enrol a cohort of 80 adult females who were scheduled to undergo gynaecological surgery under subarachnoid block and were members of the American Society of Anesthesiology (ASA) Grades 1 and 2. Forty patients were divided into two distinct categories. A participant in Group I was administered 17.5 mg of bupivacaine in combination with 45 mcg of clonidine. In Group II, they were administered 17.5 mg of bupivacaine in addition to 5 mcg of dexmedetomidine. The duration of spinal anaesthesia, the onset and duration of sensory block, the highest level of sensory block, the time required to reach the highest dermatomal level of sensory block, the time required to complete motor block recovery, and the highest level of motor block were all documented. Results: There were no significant statistical differences observed in the demographics of the patients, ASA grade, or duration of surgery. Group I experienced sensory block for 350.14±32.34 minutes, while Group II did so for 404.24±23.69 minutes. Group I encountered motor block for 210.22±40.16 minutes, while Group II experienced it for 369.54±53.22 minutes. In comparison to group B, the duration of sensory and motor block was considerably extended in group A (p0.05). In comparison to group B, the duration of spinal anaesthesia was comparatively reduced in group A. Conclusion: Adjunctive use of intrathecal dexmedetomidine in conjunction with bupivacaine appears to be a viable substitute for fentanyl and clonidine in the context of lengthy surgical procedures. This is attributed to the potent anaesthetic and analgesic properties of intrathecal dexmedetomidine, which are complemented by its minimal adverse effects.

102. Cumulative Impact of Alcohol Use in Tribal Patients with Alcoholic Liver Disease [ALD] in North Odisha, India
Smita Patra, Bibhuti Sethy, Pradeep Kumar Padhi
Aim: To estimate the cumulative impact of alcohol use in tribal patients with alcoholic liver disease (ALD) and their families in North Odisha, India. Methods: The demographic and socioeconomic data were collected from tribal patients hospitalized for alcoholic liver disease and from their attendants using a self-designed non validated questionnaire and analyzed. Results:  Study subjects included100consecutive tribal ALD patients [all males]. 60% were between 30–50 years. Most were married (96%), literate (63%), either businessmen (37%) or employed (30%) and belonged to middle socioeconomic class. 90% started alcohol use before age 30 years and half during teenage. Mean alcohol intake was 190ml/day [mean duration 23 years]; 60% consumed alcohol daily. Concomitant tobacco abuse was noted in 79%. Average expenditure on alcohol was Rs 3800/month. Average hospitalizations for ALD related problems was 2.6 times/year with average expenditure of Rs 30,000 (~ 440 US$) during each hospitalization. For treatment expenses, 86% patients borrowed money from friends/relatives, 36% used saving deposits and 4% sold personal belongings. 11% lost their job and 7% sold immovable property. In 43% cases, children were deprived of education. Besides, 52% had disturbed social and family life, 34% abused their spouse, 20% suffered accidents and 37% indulged in physical violence. Conclusion:  Majority of tribal patients admitted for ALD and their families had disturbed social and family life, and incurred severe financial loss arising of alcohol use.

103. Evalution of Lung Fibrosis in Post COVID-19 Patients in Tertiary Care Centre
Harshit Jain, Ravendra Singh, Shubham Mishra
Introduction: An outbreak of novel coronavirus was responsible for coronavirus disease-19(COVID-19) which was first reported in Hubei province, Wuhan, China, on November 17, 2019. It had rapidly spread all over the world with approximately 66.4 crore cases, 64.40 crore recoveries and 67.1 lakh deaths (200,000 deaths within first four month) till now. In India there were 4.46 crore cases of which 4.41 crore recovered and there were 5.30 lakh deaths till now (JHU CSSE COVID-19 Data). Aims: Assessment of lung fibrosis in post COVID-19 follow up cases. Materials and Method: The prospective observational study was carried out at R.D. Gardi Medical College, Ujjain in the Department of Respiratory Medicine. All post COVID-19 cases attending post covid clinic was included in the study with minimum 119 patients. Result: In our study, out of total 119 post covid follow up cases, lung fibrosis was seen in 67(56.3%) patients of which only in 3 patients had residual lung fibrosis while other improved. Conclusion: the patients who had lung fibrosis were fewer than expected (<5%). These sequelae were mostly occurring in the elderly patients with comorbidities, longer hospital stay, severity of covid infection and smoking are the other risk factors for its development. Post Covid patients had various symptoms like weakness, cough, breathlessness etc which required symptomatic management.

104. Continuous Rectus Closure versus SMEAD JONES Intermittent Rectus Closure in Midline Laparotomy Wounds: A Comparative Evaluation
Karthik K, Ahemadi Firdous Nikhat, Ranjana D Telkar
Introduction: The efficacy of midline laparotomy is contingent upon the use of precise surgical methods and the subsequent careful closure of the abdominal wall, which serves to facilitate optimum wound healing and minimise the likelihood of problems. The present comparative study was designed to assess continuous rectus closure versus SMEAD JONES intermittent rectus closure in midline laparotomy wounds. Material and Methods: Sixty-four participants required midline laparotomy above 18 years of age were recruited. Participants were randomly allocated to Group S managed with SMED JONES interrupted closure and group C managed with continuous rectus closure. Post-operative follow up was done at the end of 1st week, 4th week, 3rd month and 6th month of post-operative period. Results: Ruptured abdomens occurred in roughly 12.5% of group S patients and 9.38% of group C patients by the end of the first week after surgery. After 4 weeks, 15.62 percent of group S patients and 6.2 percent of group C patients had incisional hernias; after 3 months, 9.38 percent of group S patients and 3.13% of group C patients developed incisional hernias; and after 6 months, 18.75 percent of group S patients and 9.38 percent of group C patients developed incisional hernias. Conclusion: The SMEAD JONES midline laparotomy wound closure technique, which is superior to continuous rectus closure, resulted in a considerable decrease in the incidence of wound infection, wound dehiscence, and incisional hernia.

105. A Study to Compare the Use of Atracurium in 2ED95 Dose with Cistracurium in Different Doses 2ED95, 3ED95 and 4ED95 in Patients Undergoing Abdominal Surgery under General Anaesthesia in Indian Population
Devendra Gautam, Tejaswi G M, Naveen G, Priya
Background: The time interval between suppression of the protective reflexes by induction of anaesthesia and the development of satisfactory intubating conditions is a critical period. Atracurium (2×ED95 dose) is more effective neuromuscular blocking agent than cisatracurium (2×ED95) for favourable intubating condition. Objective: To understand these differences, we compared potency and duration of action of atracurium and incremental doses of cisatracurium. Materials and Methods: It was a prospective randomized controlled clinical trial in which 80 patients divided in four groups of 20 each undergoing abdominal surgery under general anaesthesia at our hospital. The Group-1 received 2×ED95 (0.5mg/kg) dose of atracurium, Group-2 received 2×ED95 (0.1mg/kg) dose of cisatracurium, Group-3 received 3×ED95 (0.15mg/kg) dose of cisatracurium, while Group-4 received 4×ED95 (0.2mg/kg) dose of cisatracurium. Relaxograph [NMT-MINDRA, CE0123, PN:115-018518-00, SN: CGB4C000574, Ver:1.0] was used for neuromuscular monitoring. Results: HR, MABP was statistically significant increased post-intubation with administration of 2×ED95 dose of atracurium in Group-1 and the same dose of cisatracurium in Group-2 but 5-20 min later was not statistically significant with administration of 3×ED95 and 4×ED95 doses of cisatracurium in Groups-3 and 4, respectively. Onset time was found to be significantly lower with 2×ED95 dose of atracurium than with the same dose of cisatracurium. At the same time, higher doses of cisatracurium (3×ED95 and 4×ED95) showed onset time and longer duration of action that was significant with atracurium and with lower dose of cisatracurium (2×ED95). 4×ED95 & 3×ED95 dose of cisatracurium showed statistically significant difference versus the atracurium dose with higher percentages of patients with excellent condition of intubation 100% and 95% respectively. Conclusion: The same dose (2×ED95 dose) atracurium is more effective neuromuscular blocking agent than (2×ED95) cisatracurium, while higher doses of cisatracurium 3×ED95 and 4×ED95 provide more effective, more rapid neuromuscular blocking with longer duration of action, stable hemodynamic status, and no associated signs of histamine release clinically.

106. Serum Urea and Serum Creatinine in Patients with Type-2 Diabetes Mellitus and their Prognostic Role as Effective Renal Markers in Type-2 Diabetes
Romy. W. Marshnil, Archana Mony, Ganesh G, Aaron Vetha Jose J
Context: Type 2 diabetes mellitus is the leading risk factor for impaired renal function, and approximately 20 to 30% of diabetic patients progress to diabetic nephropathy. Objective: This study was conducted to study the relationship between blood glucose, serum urea and serum creatinine levels in diabetic patients and non-diabetic healthy individuals, so as to find out the prognostic role of serum urea and creatinine as effective renal markers in type-2 diabetic patients. Materials and Methods: The study group consisted of 100 patients with type-2 diabetes and 100- nondiabetic healthy controls. Fasting and Post Prandial blood sugar, serum urea and serum creatinine were assayed. Data was analysed using student’s ‘t’ test and linear regression analysis. Results: There was a statistically significant increase in the serum urea (p<0.001) and creatinine levels (p<0.05) in diabetic patients. Also, there was a statistically significant difference (p<0.001) observed in diabetic patients with increasing duration of diabetes and with associated diabetic complications. Conclusion: Good glycemic control, along with routine monitoring of serum urea and creatinine levels is absolutely needed in diabetic patients to prevent progressive renal impairment.

107. A Randomized Control Study to Compare Between the Macintosh Laryngoscope and the Video Laryngoscope in Endotracheal Intubation at Tertiary Care Center
Achyut Bharat Kumar Faldu, Jayendrakumar C. Makwana, Hetal Sonavane, Khushali V. Nayak
Background and Aim: Laryngoscopy and intubation are noxious stimulus which results in sympathetic response leading to hypertension and tachycardia. This can in turn produce adverse cardiovascular events, especially in patients with cardiac co- morbidities. Present study was carried out to evaluate and compare the laryngeal view, intubation time, stress response by direct laryngoscope using Macintosh blade with video laryngoscope using king vision video laryngoscope in adult patients requiring endo-tracheal intubation. Material and Methods: This prospective observational study was conducted at our institute with total 132 adult patients aged 18-65 years of either sex and average weighing around 60 kg belonging to ASA grade I/II, patients having Mallampati grade I/II and normal thyro- mental distance were included in this study. All patients were divided into two groups: Group V: patients were intubated using King Vision video laryngoscope and Group M: – patients were intubated using direct laryngoscope with Macintosh blade. We studied and compared the laryngeal view, the time taken for intubation, number of attempts and maneuvers required to facilitate intubation and hemodynamic response to the laryngoscopy and intubation in both groups. Results: Cormack and Lehane grade I/II/III/IV was 59/7/0/0 patients in group V & 30/36/0/0patients patients in group M. The total time taken for intubation in Group V was 18.63 ± 5.04 seconds & 19.26 ± 5.18 seconds for Group M. Hemodynamic response was less during laryngoscopy and intubation with King Vision video-laryngoscope (Group V) as compared to Macintosh laryngoscope (group M). Conclusion: King vision video laryngoscope offers a better laryngeal view with less hemodynamic response during laryngoscopy and intubation in as compared to direct laryngoscopy with Macintosh blade.

108. Video Gaming and its Experiences with Enhanced Skills and Improved Well Being in First Year M.B.B.S Students
Sheetal R Salvi, Gitartha J Goswami
Introduction: Learning and studying by new media technologies have taken shape for new academic experiences which, nowadays preferred by many college students. Video gaming can be categorized as first in the list. It can have impact on skill development and mental well-being also in the lives of medical students. Assessment of playing video games in freshers; first MBBS medical students, their experiences and its impact on wellbeing is the motive of our study. Materials and Methods: Study was conducted in medical students at Dr DY Patil medical college Pimpri, Pune. Framed questionnaire was answered and analysed. Results: Our study had video game genre, its description, examples with gender preferences, reason for playing, onset, hours of playing. On the other hand problem solving, logical thinking and hand eye coordination skills was good in male gamers while female gamers, found to be average and positive outlook of well-being in gamers. Conclusion: Video games can be beneficial. Skills like problem solving, logical thinking and hand eye coordination was identified more in male gamers than female gamers. These skills can be useful professionally and personally as well. It can be enhanced, wellbeing seems to be  improved. Gamers had a positive outlook with better wellness than non-gamers, but at the same time can have an influence on health maybe in long run.

109. Serum Inflammatory Markers in COVID-19 Disease: A Retrospective Analysis
Rahul Kanade, Ramsingh Maniram, Nitin Nahar, Simmi Dube
Background: To combat the spread of coronavirus illness 2019, a rapid clinical diagnosis is required to give symptomatic medication, immediate access to the intensive care unit, and patient isolation (COVID-19). The elevated inflammatory markers might be independent biomarkers for identifying severity of the disease and its poor clinical outcomes. Aims and Objectives: To study the serum inflammatory markers and their correlation with disease severity and outcome in patients with covid-19 disease. Materials and Methods: Three hundred laboratory-confirmed COVID-19 patients were studied in a retrospective observational study at the Department of Medicine, Gandhi Medical College, Bhopal, from June 2021-June 2022. Patients were divided based on WHO criteria of clinical severity of Covid 19 into Mild Disease (n=100), Moderate Disease (n=100), and Severe Disease (n=100). Detailed history, vital signs, Hb, WBC, neutrophil, lymphocyte, monocyte, platelet count, NLR, LMR, ESR, CRP, D-dimer, HbA1c, S ferritin, LDH, S PCT, Troponin-I, PRO-BNP, HRCT chest were recorded. NLR and LMR in all patients were calculated. The duration of hospital stay and outcome of each patient, along with the type of respiratory support needed by each patient, was also recorded. Results: Incidence of COVID-19 infection was more common in patients aged 41-50 years (24%), 51-60 years (18.7%), and 31-40 years (18%). Males outnumbered females (58.3% to 41.7%). The mean NLR in severe Covid-19 instances was considerably greater (6.963.8) compared to moderate cases (4.483.45) and mild cases (3.312.44) (p0.001). There was no significant relationship between LMR and illness severity (p=0.154). According to receptor operating curve analysis, NLR, LMR, and CRP were important predictive markers for disease severity. Among the important parameters, NLR had the highest area under the curve (0.846; p0.001). The area under the curve for LMR was 0.154, indicating that it is a poor instrument for predicting the outcome based on the AUC value. Conclusion: Inflammatory markers, especially CRP, d-dimer, PCT, ferritin, Pro-BNP, WBC, Neutrophils, NLR and LDH, were positively correlated and lymphocytes, monocytes and platelet counts were negatively correlated with the severity and outcome of COVID-19. Measurement of inflammatory markers might assist clinicians to monitor and evaluate the severity and prognosis of COVID-19.

110. An Investigation on the Impact of Series of Small Group Oral Examinations on Student Performance in Pharmacology among Second Year Medical Students
Prakash Krishnan, Sanitha Kuriachan, Sancy Mary Sam, Naga Guhan, Thilak Sura Anjanappa
Background: Traditional, summative viva ineffectively imparts deep knowledge. This study assessed the impact of conducting a series of group viva on pharmacology learning. Methods: After the first and second internal assessment (IA), students attended a series of 84 group viva voce sessions during the revision hours followed by a third internal assessment in pharmacology. Student performances were grouped as poor (<50%), good (50-75%) and excellent (75-100%) based on first and second IA written exam marks. The marks scored by students in written internal assessment exams (Pre and post group viva) and university exams were analysed retrospectively. Results: The mean written exam scores (out of 40 marks) of first (M1), second (M2) internal assessment, first paper (M3) and second paper (M4) of third internal assessment were 15.97±5.72, 25.60±5.77, 22.36±5.59 and 22.64±5.30 respectively. The mean pre and post viva written exam scores were 41.57±10.36 and 45.00±10.42 respectively (out of 80 marks).  The mean scores Post viva of written exam (M3 + M4) was statistically greater than pre viva (M1 + M2) for all the students across all categories except excellent performers. Students’ achievement in university exams post viva was noteworthy. About eighty-eight percent of pre-viva poor performers improved to become good performers in university examinations, and 12% excelled as well; 76.3% of good performers became excellent. There were no poor performers in university exams. Conclusions: Conducting a series of group viva voce had a positive impact on student performance in pharmacology.

111. A Study of Bacteriological Profile of UTI in a Tertiary Care Hospital in Western Up
Amit Kumar, Divya Sharma, Muzaffari Yasmeen, Swati Verma
Introduction: Urinary tract infection ranges in severity from asymptomatic (which is carrier status in the urine) to symptomatic acute infections of the kidney with resultant sepsis. This study was done to determine Prevalence of UTI, bacteriological profile and antimicrobial susceptibility of organism causing UTI and to evaluate the rate of CAUTI. Material and Methods: All samples were processed by standard microbiological procedures including wet mount of urine, Culture on CLED Media, Morphology, Gram Stain, Motility, Biochemical test and Antimicrobial susceptibility test. Results: Prevalence of UTI was found to be 25.7%. CAUTI was found in 25% of UTI. There were 32% Gram positive cocci, 63.5% Gram negative bacilli and 4.5% Candida species isolated. Conclusion: Increasing multidrug resistance in bacterial uropathogens is an important and emerging public health problem. The UTI standard treatment guidelines must be adjusted accordingly.

112. Effect of Duration of Exposure to Digital Screen on Visual & Auditory Reaction Time among Undergraduate Medical Students
Jagdish Hundekari, Bhumika Badjatiya, Sanjay Wasnik, Chandeep Kaur, Lokendra Singh Kot, Krushna Trankatwar
Introduction: In undergraduate medical students, use of Digital screens have been increased due to the fact that students engage themselves in studies on online platforms by watching videos, reading E books even after the online regular classes. Apart from these for their leisure time they use mobile phones for scrolling on social media platforms, chatting and playing games which involve activity of the eye. The Reaction Time (RT) is one of the frequently used tests in the experimental physiology to assess the sensory-motor performance. Reaction time (RT) is a measure of the quickness with which an organism responds to some sort of stimulus. Objectives: To assess the effect of mobile use on visual & Auditory reaction time in undergraduate medical students aged 18-25 years. Method: A total of 147 subjects aged 18-25 years were selected and depending on duration of mobile phone usage, participants were divided into three groups – Group I(N=17)  Less than 1 year, Group II (N= 41)  Between 1-2 yrs& Group III (N=89)  more than 2 yrs. Procedure was explained to all the participants. Visual & Auditory Reaction time was evaluated using ruler drop test and the data was statistically analyzed. Result: The mean value and standard deviation for age was 20.60 ± 1.72 years, Mobile phone usage was 2 -6 hours per day and Visual & Auditory Reaction time was increased non-significantly as duration of mobile usage increases. Conclusion: The study concludes that there is non-significant correlation between visual & auditory reaction time and mobile phone usage in undergraduate medical students aged 18-25 years.

113. Clinical Profile of Laryngopharyngeal Reflux Disease and Effect of Treatment with Proton Pump Inhibitors
Alekh Kumar, Mahesh Kumar
Background: Laryngopharyngeal reflux disease (LPRD) is a common problem all over world caused by the back-flow of stomach contents into the laryngopharynx. Symptomatology of laryngopharyngeal reflux includes chronic cough, hoarseness of voice, throat-clearing, globus sensation and difficulty in swallowing. LPRD is seen in about 10% of patients visiting outpatient departments of otolaryngology clinics and in more than 50% of patients presenting with changes in voice. LPRD can have association with sleep disorders, dental problems, food habits and various otolaryngological disorders. Gastric acid reflux with LPRD is considered causative factor for   granulomas of the larynx and malignancy. Materials and Methods: This was a hospital based descriptive cross sectional study, conducted at the department of ENT at IGIMS, Patna. Patients having symptoms of Laryngopharyngeal reflux disease were included in the study. Data collection was done using clinical examination forms and written questionnaire and data was processed and analysed using SPSS. Results: This study was done on 292 subjects where 158 were males and 134 females. The mean age was 40.54 ± 12.68 years. Prevalence of LPRD was found to be 17.46% and there was slight male preponderance (18.35% in males, 16.41% in females). The common presentations were sensation of lump in throat, hoarseness of voice, sensation of mucus sticking in throat and urge to clear throat. Common findings were thick mucus, erythema of vocal cord, edema of vocal cord. Obesity, diabetes, hypertension, tobacco use, drinking alcohol, eating spicy foods were risk factors for LPRD. Patient’s positive for LPRD were treated with oral PPIs, life style and dietary modifications, and showed statistically significant improvement in symptoms and signs post treatment.

114. Comparative Study of Visual Inspection of Cervix by Acetic Acid Application and Pap Smear Cytology in Screening of Cervical Cancer in Asymptomatic Woman
Nikhil Sonawane, Sachin Vedpathak, Sujata Shisode
Introduction: In India Cervical cancer is second most common cancer in woman. Every year around 1.23 lakh new cases are diagnosed with cervical cancer and 67,500 of these woman die in India. There are various screening various screening techniques such as visual inspection with acetic acid, visual inspection with Lugol’s iodine, visual inspection with magnification devices-Magna visualizer, Pap smear and HPV-DNA testing have been suggested and tried under low-resource settings of our country, and cervical cytology screening has been found effective in reducing incidence of the disease. Material and Methods: It is prospective observational study. This study was be conducted in the Department of Obstetrics and Gynaecology in medical college and tertiary health centre comprising of woman who are sexually active during 2020 -2022 with sample size of 236. Results: Out of 236 cases, 39.80% were positive and 60.20% were negative according to visual inspection of cervix with acetic acid. According to cytology (Pap smear) reports, 56.8% were normal, 41.6% were inflammatory, 1.2% was having LSIL/ atypical and 0.4% was having HSIL. VIA has, the sensitivity of about 43.58% and specificity of about 41.70%. Pap smear has the sensitivity of about 43.58% and specificity of about 41.70%. Conclusion: Visual inspection with acetic acid is simple and easy. It is effective and can be used as an alternate strategy in low resource settings where screening for cancer cervix by Pap smear is not always possible due to inadequate cytologists.

115. Nephropathy in Sickle Cell Anaemia Children in a Tertiary Health Care Centre
Jyoti Ranjan Behera, Manas Ranjan Mallick, Rashmi Ranjan Barik, Sudhir Ranjan Senapati, Budhia Majhi
Introduction: When sickled erythrocytes are present in the renal medulla, it causes ischemia, microinfarcts, and papillary necrosis in the kidneys. This condition is known as sickle cell nephropathy (SCN), which is the renal manifestation of sickle cell disease (SCD). Clinically presenting as increased GFR as a result of localised prostaglandin production and enhanced nitric oxide synthase in response to hypoxia, glomerular hyper filtration is the initial sign of SCN. This leads to an increase in renal blood flow and albuminuria 2. Proteinuria types 1 and 4 affect 20–30% of SCD patients. Material and Methods: We also measured height and weight using anthropometric techniques. The individuals’ shoes and top clothing were taken off before these measurements were taken. Every subject’s weight was recorded using digital weighing equipment, which was calibrated as needed and had its accuracy confirmed on a regular basis, to the nearest 0.1 kg. Using a portable stadiometer, the standing height was measured to the closest 1 cm. Weight (in kilogrammes) divided by height (in metres squared) was used to calculate BMI (kg/m2). Using a suitable blood pressure cuff size for the child’s upper arm and a relaxed forearm on the examination table, the resting Systolic blood pressure (SBP) was measured. Results: Similar to earlier studies, we discovered 5.83% of AKI patients in our investigation. According to Baddam S et al., 17% of vaso-occlusive pain crises had an AKI3 connection. Vasoocclusive pain crises were a frequent side effect in kids with SCA and a known risk factor for AKI, with 2.5–17% of kids admitted to the hospital due to a VOC going on to develop AKI136–38. Acute infection (malaria and sepsis), hypovolemia (insensible loss due to fever, reduced intake, diarrhoea, and vomiting), and the use of NSAIDs to manage Vaso-occlusive crises are recognised risk factors for AKI. Conclusion: Hospital based cross-sectional study design with selection bias, lead   time bias and diagnosis bias which limits its potential to make conclusion. Estimated GFR (e GFR) using Schwartz formula is inferior to ideal measured GFR using cystatin-C or inulin and noble biomarkers for diagnosing AKI like KIM-1 & NGAL are quite expensive which was beyond the scope of our study.

116. A Comparative Study of Topical 1% Ozenoxacin Cream and 2% Mupirocin Cream for the Treatment of Impetigo in Children
Prasanjeet Dash, Farah Khan, Saurabh Sarda, Ransingh Tanwar
Background: Ozenoxacin, a novel topical antibiotic with potent bactericidal activity against gram-positive bacteria, has recently received food and drug administration approval for the appropriate therapeutic management of impetigo which a extremely contagious bacterial skin infection. Objectives: To evaluate the safety, bacteriological efficacy, and clinical outcomes of 1% ozenoxacin cream against 2% mupirocin cream following a 7-day, twice-daily topical treatment period for paediatric impetigo patients. Methods: This single-centre, open-label, random allocation study included 33 subjects with impetigo who attended the dermatology outpatient facility of a tertiary care hospital in central India. Subjects were randomized into two groups; group A received topical ozenoxacin whereas group B received mupirocin. Clinical and bacteriological efficacy was assessed using the skin infection rating scale and microbiological culture. Safety and tolerability were also evaluated. Results: The clinical efficacy of ozenoxacin was shown to be superior to that of mupirocin, as evidenced by a more rapid achievement of positive treatment outcomes after a 4-day period. (8 of 16 vs 2 of 17; p-value = 0.038). Ozenoxacin also demonstrated superior clinical (14 of 16 vs 13 of 17) and microbiological (15 of 16 vs 14 of 17) success as compared with mupirocin, after 7 days of therapy. Both the drugs were well tolerated, with only one subject on topical mupirocin experiencing adverse effect which was not serious. Conclusion: Both ozenoxacin and mupirocin have demonstrated efficacy and excellent tolerability as topical treatments for impetigo in paediatric patients aged 2 to 10 years. The study revealed that Ozenoxacin had a notable benefit in terms of its prompt onset of response.

117. A Cross Sectional Study on Demographic Profile and Determinants of Globus Sensation
Faiz Ahmad, Harender Simar, Dinesh Kumar, Rishu Garg, Sandeep Kumar Rana, Ruchika Kathuria, Ishita Gupta, Mahendra S Naik
Introduction: Globus pharyngeus, is a sensation of something stuck in the throat and it is a very common clinical condition in ENT practice. It is intermittent or persistent sensation of lump or foreign body in throat. It is relieved by solid food or liquid ingestion and aggravated with dry swallow. It commonly involves middle aged females and this clinical condition is long lasting, difficult to treat and has tendency to occur again and again. It is very difficult to stabilize any standard protocol of diagnosis of globus sensation due to its varied etiology. Careful history, examination and investigation are crucial steps in the diagnosis of globus pharyngeus. Globus pharyngeus is defined as: (1) Persistence/intermittent sensation of lump in throat or foreign body sensation in throat for at least 12 weeks. (2) Sensation occurs in between meals. (3) Absence of any dysphagia/odynophagia. (4) Absence of achalasia, pathological GERD, motility disorder like scleroderma of esophagus. Aim and Objectives: (1) To estimate the common cause of globus sensation in patients attending ENT OPD of MAMC, Agroha. (2) To study the demographic profile of patients with globus. Methodology: This cross-sectional study was conducted at Maharaja Agrasen Medical College, Agroha, Hisar. Based on the findings by Moloy et al (The globus symptom, incidence, therapeutic response and age and sex relationship. Moloy PJ, Charter R; Arch Otolaryngology. 1982; 108(11):740.), the prevalence of Globus sensation in the general population is estimated to be 4.1%, assuming a relative precision in the estimate of 80%. Result: The study showed that globus pharyngeus was a clinical condition with a female predominance (62.7%). The most common age group affected was 31-40 years (33.3%), with a mean age of 39.5 years. The condition was more common in the rural population (75.3%), with the most affected occupations being farmers/labourers (32.0%) and the most affected education level being illiterate (34.6%). The majority of those affected were married (88%). The common causes were gastroesophageal reflux disease (36.6%), upper esophageal sphincter dysfunction (19.3%), esophageal motor disorder (12%), pharyngeal inflammatory cause (7.9%), psychological factors and stress (6.6%), thyroid swelling (6%), upper aerodigestive malignancy (2.6%), tongue base hypertrophy (2%), cervical osteophytes (2%), Eagle’s syndrome (2%), retroverted epiglottis (1.3%), and Vallecula cyst (1.3%). Conclusions: Based on our study, we conclude that globus pharyngeus predominantly affects females of age group 31-40 years, mostly married, illiterate farmer/labourer belonging to rural population and most common cause being gastroesophageal reflux disease.

118. Role of R.E.N.A.L Nephrometry Scoring System in Objectifying Treatment Decision
Alpana Pathak, A.N.D. Dwivedi, Pramod Kumar Singh, U.S. Dwivedi, Rupesh Kumar Sriwastawa
Background and Objective: Renal cell carcinomas are thought to be the 8th commonest adult malignancy, representing 2% of all cancers, and account for 80-90% of primary malignant adult renal neoplasms. Earlier small renal masses were seen mainly as incidental findings at autopsy or in nephrectomy specimens. To evaluate the utility of the RENAL scoring system in predicting operative approach  of renal masses. Methods: Nephrometry scoring was done in 50 patients in the tertiary care centre from 2018 to 2020 and the score sum along with its individual component scores was evaluated to assess its their relationship to surgical approach. Results: Increasing tumor complexity as given by total nephrometry score was associated increased incidence of both radical nephrectomy and open partial nephrectomy (P =0.0001). Patients who underwent radical nephrectomy had a significantly larger size, proximity to pelvicalyceal system, and location component as compared to those of partial nephrectomy. Comparatively those who underwent open partial nephrectomy had higher values of individual components (R, E and N mainly). Conclusion: The R.E.N.A.L nephrometry score has standardized, objectified decision making and made the assessment and reporting of renal masses very reproducible.

119. Randomized Clinical Trial of Diathermy Vs Scalpel Skin Incision in General Surgery
Birendra Kumar, Rajesh Kumar Ranjan
Background and Objectives: Although diathermy was regularly used for tissue dissection, cutting and haemostasis, its use for making skin incision not so popular in day to day practice. Scalpel skin incision produces a clean, incised wound with minimal tissue destruction. To compare the healing of incision in both procedures. To compare the operative time, To compare incidence of post operative wound infection. Material and Methods: Study area: Darbhanga Medical College and Hospital, Darbhanga, Bihar. Study Population: 14 – 65 years age group. Study period: January 2019 – June 2020. Sample size: A total 60 patients was studied. Among them 30 patients were randomly selected for diathermy skin incision and another 30 patients for scalpel skin incision. All even cases were selected for diathermy and odd for scalpel skin incision. Conclusion: Our study one and half year randomized clinical trial into two groups. Even cases were selected for diathermy and odd for scalpel skin incision in patients undergoing midline general surgery like intestinal obstruction. Blunt abdominal trauma and peptic ulcer diseases evaluation was doses in terms of incision time, amount of blood loss, post operative pain, post operative analgesic requirement and post operative wound infection. Results were analysed using mann whitney U test and chi square test.

120. Comparative Study on the Incidence of Gastric and Duodenal Perforation Presenting at DMCH Darbhanga Bihar
Rajesh Kumar Ranjan, Birendra Kumar
Background and Objectives: Peptic ulcer disease affects more than 4 million people around the world every year. Complications are encountered in 10%-20% of peptic ulcers of which 2%-10% perforate. To evaluate and compare the incidence of gastric and duodenal perforation. To evaluate and compare the causes of gastric and duodenal perforation. Material and Method: This was a retrospective comparative study which included 153 patients who were admitted and treated in the Upgraded Department of General Surgery at Darbhanga Medical College, Darbhanga for the management of peptic perforation peritonitis between July 2019 to December 2020. Conclusion: Gastric and duodenal perforations are common presentations of peptic ulcer disease but each one of them have their own individuality. The incidence of peptic ulcer perforation had decreased in the past decade but the burden of disease still remains in our society. The incidence of gastric ulcer perforation has increased in the past few years and much still is needed to evaluate the cause and management of the disease.

121. Factors Influencing Pre-Hospital Delay in Acute Myocardial Infarction Patients
Nikhil Shah, Kinjal Patel, Purvi Patel, Dipesh Patel
Introduction: Acute Myocardial Infarction (AMI), or a heart attack, remains a major global health concern. Timely medical care during an AMI is vital, as every moment can impact patient outcomes. Pre-hospital delay, the time from symptom onset to treatment initiation, is a critical period. Despite efforts to reduce delays, challenges persist. This study explores the multifaceted factors contributing to pre-hospital delay in our region, with a focus on socio-demographic, clinical, situational, and cognitive influences. Material and Methods: This 12-month prospective observational cross-sectional study, conducted from February 2022 to January 2023 in Silvassa tertiary care center, aimed to investigate pre-hospital delay factors in Acute Myocardial Infarction (AMI) patients. A total of 150 AMI patients aged 18 or older were included, with exclusion criteria for severe communicative impairments. The AMI diagnosis considered medical history, electrocardiographic criteria, and elevated cardiac biomarkers. Data collection employed a structured questionnaire covering sociodemographics, clinical details, situational factors, and cognitive factors. Interviews and medical record reviews were conducted, following informed consent. Descriptive statistics, normality checks, univariate comparisons, and logistic regression analysis were performed using SPSS 20.1.1 to assess factors contributing to pre-hospital delay. Results: In our study of 150 AMI patients, the mean age was 49.9 years. Most patients were ≤60 years old (60.6%) and male (74.7%). The majority was married (88%), belonged to the upper-middle class (52%), and resided in urban areas (59.3%). The median pre-hospital delay was 2.5 hours, with a mean delay of 6.5 hours (±14.54 hours). Gender significantly influenced delay, with males seeking medical attention sooner than females (p = 0.01). Marital status also played a notable role, with married individuals having shorter delays compared to unmarried counterparts (p = 0.04). Socioeconomic status and education levels showed significant associations, with higher classes and education linked to shorter delays (p = 0.03 and p = 0.04, respectively). Urban residents reached medical care more promptly than rural residents (p = 0.02). The origin and seriousness of symptoms, as well as the mode of transport, showed significant associations with delay (p = 0.03, p = 0.02, and p = 0.001, respectively). Conclusion: In conclusion, our study identifies several critical factors that significantly influence pre-hospital delay in acute myocardial infarction (AMI) patients. The delay is significantly influenced by demographic and psychosocial factors that emphasize the need for targeted interventions to expedite access to medical care for AMI patients, ultimately enhancing their outcomes.

122. Obesity and Long-Term Survival in Acute Myocardial Infarction Patients with and without Diabetes Mellitus
Anand Shankar
Background: Ironically, patients who have experienced cardiovascular events like acute myocardial infarction (AMI) have been found to benefit from being overweight or obese in terms of survival. Regardless of the fact that AMI individuals with diabetes had more deaths from cardiovascular disease than their counterparts without diabetes, this obesity paradox has not been examined in this population. Thus, examining the relationship among BMI and death from all causes in AMI individuals who have or do not have diabetes mellitus was the aim of this long-term study. Methods: 12 individuals with diabetes and 28 patients without it, ages 28 to 75, were enrolled in the study. They were drawn from a population-based AMI registry in India. Individuals with their first AMI were monitored until December 2022. Structured interviews and review of charts were used in the data collection process. The relationship between BMI and mortality over the long-term from all causes was also analyzed. Results: Patients with AMI who were of average weight had the greatest long-term mortality rates (5 deaths per 100 person years) in both the diabetes and non-diabetic groups. Following covariate adjustments, patients with AMI who did not have diabetes showed a substantial protective impact from overweight and obesity on all-cause mortality (overweight: hazard ratio (HR) 0.74, obesity: HR 0.65). On the other hand, individuals with diabetes who had AMI did not exhibit an obese paradox. Nevertheless, stratified studies revealed survival advantages in diabetic over-weight AMI individuals who had been taken statins before developing AMI (HR 0.50) or four evidence-based drugs when they were discharged from the hospital (HR 0.53). Conclusion: Unlike AMI patients with no diabetes, AMI individuals who have diabetes have no advantage from an increased BMI in terms of survival. More research that stratifies its samples according to diabetes status is required to look into the underlying causes of these findings.

123. Proteinuria Changes and Myocardial Infarction Risk in Individuals with Diabetes or Pre-Diabetes: Insights from a Prospective Cohort Study
Anand Shankar
Background: It is yet unknown how variations in proteinuria relate to myocardial infarction (MI) in individuals suffering from diabetes or pre-diabetes. Our goal was to assess the independent and predictive significance of variations in proteinuria during a period of two years in relation to the prevalence of MI in individuals with pre-diabetes or diabetes. Methods: This prospective cohort study’s baseline and two-year dip-stick screening findings were used to categorize people into 4 groups: no proteinuria, incident proteinuria, persistent proteinuria, and remittent proteinuria. The effects of various confounding factors were taken into account by developing four multi-variable Cox proportional hazard models. Results: Over a median follow-up of 6.69 yrs, there were 3 MI occurrences from the 176 individuals in this study. The correlation between the incidence of MI and persistent proteinuria persisted even after accounting for laboratory indicators and demographic variables (hazard ratio [HR] 1.90). A 24% reduction in the incidence of MI was found to be caused by each decrease in proteinuria between 2020 and 2022 (HR 0.65). Diabetes and alterations in proteinuria were found to interact, however MI was unaffected. Conclusions: In the population of pre-diabetics and diabetics, chronic proteinuria is a distinct risk component for the occurrence of MI. These results should aid medical professionals in interpreting changes in proteinuria in the outpatient context and in suggesting potential preventive measures for individuals with pre-diabetes or diabetes.

124. Autonomous Mortality Risk Linked to Anemia Post Myocardial Infarction in Patients with and Without Diabetes
Anand Shankar
Introduction: Anemia and diabetes mellitus are recognized as significant risk characteristics contributing to increased short-term mortality rates subsequent to an acute myocardial infarction (AMI). The prevalence of anemia is higher among individuals diagnosed with diabetes mellitus. A retrospective study was conducted to evaluate the effects of the coexistence of diabetes along with anemia on outcomes following myocardial infarction. Methods: Data from a comprehensive registry covering the entire population were obtained for a cohort of consecutive AMI hospital admissions. The study categorized patients into four categories based on diabetes and anemia presence: Category 1 (8 patients with both), Category 2 (17 patients with diabetes but no anemia), Category 3 (9 patients with anemia but no diabetes), and Category 4 (40 patients with neither). The study focused on two primary outcome measures: mortality rates at 30 days and from 31 days to 36 months. Results: At 30 days, mortality rates were: Category 1 (31.3%), Category 2 (15.1%), Category 3 (20.5%), and Category 4 (5.6%). From 31 days to 36 months, mortality rates were: Category 1 (46.6%), Category 2 (21.8%), Category 3 (33.3%), and Category 4 (11.4%). Diabetes as well as anemia continued separate risk characteristics for 36-month mortality, with odds ratios of 1.51 and 1.49, respectively. Cardiovascular deaths from 31 days to 36 months accounted for 42.7% in Category 1, 53.1% in Category 2, 46.0% in Category 3, and 49.8% in Category 4. Conclusion: The coexistence of diabetes and anemia in patients is related with a markedly elevated mortality rate when compared to individuals with either diabetes as well as anemia in isolation. Cardiovascular mortality continued to be the predominant cause of death across all cohorts.

125. Surgico-Clinical Significance of Accessory Foramina Transversaria in Cervical Vertebrae
I Dinesh, T Neeraja, S Ravindrakishore, S Suneetha
Introduction: The cervical vertebrae, located in the neck region of the spinal column, is recognized by the presence of the Foramen Transversarium (FT) on their horizontal processes. This anatomical feature allows for the passage of vertebral artery. Variations in the size, shape, and number of FT may lead to clinical symptoms, emphasizing the need to understand these anomalies for safe and effective medical interventions. The study’s primary objective was to investigate the significance of foramina transversaria in the cervical spine. Methodology: In this study, 150 cervical vertebrae were macroscopically examined to identify the presence of accessory FT. The investigation was conducted over a 16-month period and excluded vertebrae with congenital defects or pathological issues. The data collected was analyzed and presented in a tabular format. Results: Out of the 150 cervical vertebrae investigated, 50 exhibited accessory foramen transversarium, resulting in an incidence of 33%. Among these, 15 featured Unilateral Accessory Foramen Transversarium, primarily on the left side. Bilateral Accessory Foramen Transversarium was more common, with the foramina often found in the lower spinal vertebrae (C5 and C7). Conclusion: Observations of this research shed light on the occurrence and characteristics of accessory foramina transversaria in cervical vertebrae. This knowledge is valuable for spine surgeons and radiologists, especially when performing computed tomography and magnetic resonance imaging scans. Additionally, it underscores the importance of precise anatomical understanding in surgical procedures involving the cervical spine, as even minor lesions to the vertebral artery can result in life-threatening hemorrhage. The research serves as a foundation for future investigations aimed at enhancing surgical methodologies and improving patient safety in cervical spine surgeries.

126. A Cross-Sectional Study For Evaluation of Platelet Indices in Patients With Type 2 Diabetes Mellitus
Amoghasiddha S Jyoti, Arun. K, Anjali Shankar
Background: Diabetes mellitus has become a major global health problem. It’s a state of hyperglycemia which causes spectrum of long term systemic complications having considerable impact on individuals in their most productive years. Altered platelets have been reported in such patients and has been considered as a ‘prothrombotic state’. Identification of such patients can be easily made by simple routine haematological analysis which is a cost-effective tool that could possibly benefit the diabetic patients by preventive actions. Methods: A cross sectional hospital based study of platelet parameters MPV, PDW, PCT and P-LCR was carried out on 110 diabetic patients from December 2019 to May 2021. Complete blood count with platelet parameters PC, MPV, PDW, PCT, P-LCR, FBS and PPBS, HbA1c, ECG, FLP, RFT and microalbuminuria was done . Statistical evaluation was performed by using Student’s t test and Pearson correlation test. Results: In the present study, maximum proportion of patients were in the age group of 61-70 years accounting for 37.27%.With regards to MPV, 49% of them had the values between 8.9 -11.8 fl, and about a quarter of them had MPV above 11.8fl. Majority (88%) of them had their PDW above 15.3 fl. Majority (66%) of diabetics had the plateletcrit value above 0.24%. total of 53.63% patients had the LCR above 35%. Thus it was seen that a quarter of the population had higher MPV, 88% of them had a higher PDW, 66% of them had a higher PCT value and just above 50% of them had LCR above 35%. It was also seen that more the duration of diabetes, higher the MPV and LCR. Pearson’s correlation showed that there was a positive relationship between MPV and HbA1c suggesting that as the HbA1c increases, MPV value also increases. A Student T test was done to assess the relationship between presence of microvascular complications and platelet indices. MPV and LCR were higher among those with microvascular complications when compared to those without complications. This relationship was also found to be statistically significant with p value <0.05. Conclusion: Longer the duration of diabetes, higher the MPV and P-LCR. There was a positive relationship between MPV and HbA1c suggesting that as the HbA1c increases, MPV value also increases. MPV and P-LCR were higher among those with microvascular complications compared to without complications.

127. A Comparative Study of 2D Echo and Treadmill Test in Identifying Ischemic Heart Disease in Asymptomatic Type 2 Diabetes Mellitus
Anjali Shankar, Amoghasiddha S Jyoti, Arun. K
Background and Objectives: Diabetes mellitus (DM) is a modern-day disease with micro and macrovascular problems that have an impact on a person’s quality of life. The condition stays undiscovered due to its asymptomatic nature. A screening method for identifying CAD in asymptomatic type 2 diabetes mellitus patients is required. This study aims to assess the accuracy of two-dimensional echocardiography and treadmill tests in diagnosing asymptomatic coronary artery disease in type 2 diabetes mellitus patients. Materials and Methods: The present cross-sectional study was conducted at a Tertiary care centre of Davangere. After receiving ethical committee approval, 101 consecutive individuals with type 2 diabetes mellitus who were either hospitalised or attending amount patient department who were asymptomatic for coronary artery disease were recruited and data was collected from JULY 2020 to AUGUST 2021. All study participants underwent thorough clinical examination and necessary laboratory tests. All individuals with normal resting ECG were followed up with a 2D echocardiography and treadmill test. Results: TMT was positive in 32 (31.8 percent) of the 101 individuals in this study, and negative in 69. (68.31 percent). LVDD was found in 14 of the participants. TMT was positive in 11 (34.4%), 17 (53.1%), and 4 (12.5%) patients with diabetes for less than five years, five to ten years, and more than ten years. Conclusions: Silent myocardial ischemia prevalence in current study was 31.8 percent of asymptomatic type 2 diabetes mellitus patients. Longer duration of diabetes, socioeconomic characteristics, delay in diagnosis, presence of autonomic neuropathy, peripheral neuropathy, dyslipidemia, and HbA1C levels are all strong clinical predictors of silent myocardial ischemia inasymptomatic type 2 diabetes mellitus.

128. Site Complications in Patients Undergoing Laparoscopic Surgeries in AIIMS, Bhopal
Merlyn S Henriques, Pradeep Saxena, Puneet K Agarwal, Ashwathi Prakash
Objective: To study the various port site complications associated with laparoscopic surgeries. Methods: Single centre observational retrospective and prospective study conducted at AIIMS, Bhopal between Jan 2018 to Jan 2020 (MRD), February 2020 to January 2021(Department of General Surgery). Sample size was based on convenience sampling and included all the files retrieved from MD of patients who have undergone laparoscopic surgery and the patients who underwent laparoscopic surgeries. Data such as patient demographics, diagnosis, procedure details and complications were noted. Patients were contacted telephonically and asked about any discharge from surgical site or any swelling at surgical site. Results: The mean duration of surgery for all procedures was 112.48 minutes with a standard deviation of 45.28. the mean post-operative stay was 4.36 days with a standard deviation of 2.73. the frequency distribution of ports >10mm. 5 patients of the 133 had surgical site infection, with a frequency of 3.75%. 1 Patient reported port site hernia. 95.48% of the study population did not reports any port site complication. The association of port site complication with diagnosis. 3 of the 5 patients who had surgical site infection had cholelithiasis. One had appendicitis and one had hernia. One patient reported port site hernia at umbilical site also had cholelithiasis. Conclusion: The incidence of port site complications is higher in laparoscopic cholecystectomies. There is a higher chance of surgical site infections in patients who have diabetes. The incidence of port site infections is higher at umbilical sites as compared to other port sites. No association was found between technique of closure and port site infections.

129. Comparison of Conservative and Surgical Approaches to Mallet Fractures Treatment
Anand Shankar, Rishabh Kumar, Ashutosh Kumar, Rakesh Kumar
Objectives: The objective of the study is to compare the radiological and functional outcomes of patients who have sustained mallet finger fractures. Methods: The study involved patients admitted to Indira Gandhi Institute of Medical Sciences Patna, India within a week of their injury for two years, provided they were aged 18 to 55, fit for anaesthesia, and without concurrent fractures in the same finger. Exclusions comprised individuals with open injuries, head injuries, or severe medical conditions. Results: The majority of patients achieved positive outcomes in terms of both function and radiological union. However, six patients experienced extensor lag due to premature splint removal or inconsistent splint usage, and no other significant complications were observed. Furthermore, all patients demonstrated radiographic union within 10 to 12 weeks, with minimal articular misalignment (<1mm) in 34 individuals and slightly greater misalignment (1-2mm) in 2 individuals, and notably, no signs of joint degeneration were observed during this timeframe. Conclusion: Although the mallet finger fixation method is technically challenging, it shows favorable outcomes in the short term. Surgical precision, particularly in the one-shot drill and screw insertion, demands a high level of accuracy and patience.

130. Prevalence, Risk Factors and Microbial Profile of Orthopedic Implants Associated Infections in a Tertiary Care Hospital
Vepada Ravi Kiran, Gaurav Akhand, Ali Akbar Malik, Niket Raj Garg
Objectives: Orthopaedic implants associated infections are the major problem of surgical site infection, lead to high morbidity and mortality. They are preventable if its risk factors, causative organisms and antimicrobial susceptibility patterns in the regional area are timely recognized. Aim: This study is aimed at determining prevalence, risk factors and bacterial profile of orthopedic implants associated infection. Methods: This was a cross sectional study. The study group comprised of 90 patients who had undergone orthopaedic prosthetic implant surgeries and presented with signs and symptoms of infections. The demographic data were recorded and all related risk factors were noted. Samples are taken from the infection site and processed in the laboratory for identification on microorganism as per the standard protocol. Results: The prevalence of implants associated infection was 25.7% (90/350). Majority of the patients were 45-60 years predominantly male. Interlocking nails and dynamic compression plates were the most common used implants. Obesity, smoking, duration of the surgery, pre-operative blood transfusion and prolonged duration of hospital stay were the significant risk factors associated with the infections. Among overall isolated organism 60.1% was Gram negative bacilli and 39.9% were Gram-positive cocci Staphylococcus aureus (25.5%) was the predominant isolate followed by pseudomonas (15.5%), Klebsiella (12.3%) and Coagulase Negative staphylococci (11.1%). Conclusion: obesity, smoking, duration of surgery and post-operative hospital stay were the significantly associated risk factors and Staphylococcus aureus was the most frequent isolates in orthopedic implants associated infections.

131. A Comparison of Open Hernia Repair and Laparoscopic (TAPP Mesh Repair) Outcomes
Abrar Ahmed Aazam, Sonal Vaishnav, Vivin Thomas Varghese
Objectives: The aim of the current study is to assess laparoscopic and open hernia repair outcomes, including pain, surgical duration, recurrence, post-surgery complications, and hospital stay duration. Methods: The study took place at Govt. Medical College in Chittorgarh, Rajasthan, India, for one year (2022-2023) and involved 100 patients equally bifurcated into group A (open surgery) and group B (TAPP repair). The exclusion criteria were patients with complex hernias needing urgent medical intervention, individuals with psychological disorders, and those unfit for general anaesthesia. Results: The patients in Group A (open-repair) patients experienced significantly higher postoperative pain levels compared to Group B (laparoscopic group) on the pain rating scale. The average surgical time for patients treated by open surgery was 43.5 minutes, significantly shorter than those treated by laparoscopic (TAPP) procedure which was estimated to be 59.07 minutes (p=0.0001). Superficial wound infections, hematoma, and seroma occurred exclusively in the open hernioplasty cohort, rather than the TAPP hernioplasty cohort. The TAPP surgery treated patients presented no serious complications, with only 2 cases of recurrence (rare), and orchitis (3 cases). In contrast, the cohort that underwent open surgical procedure exhibited 2 cases of orchitis, 3 hematoma cases, and 2 wound infections. Group B patients resumed routine activities faster, and pain disappeared within 14 days of surgery. Conclusion: The study’s findings support the safety and preference for laparoscopic TAPP repair over open hernioplasty in patients belonging to diverse age groups. In this study, the TAPP approach for hernia treatment proved to be an effective alternative to traditional open surgery, with benefits like reduced post-surgery pain, shorter hospital stays, and quicker return to daily activities. However, it was also associated with some potential drawbacks, including a higher recurrence rate, longer surgery times, increased costs, and the risk of complications like intestinal obstruction due to abdominal cavity entry.

132. Impact of Diet and Exercise on Fasting, Postprandial Blood Glucose Levels, and Hba1c in Patients with Uncontrolled Type 2 Diabetes Mellitus
Shubhi Tamrakar, Sai Shanmukh Vemparala, Prashanth A
Background: According to estimates, the prevalence of diabetes among the Indian population reached around 77 million individuals in the year 2019. The projected estimate for this numerical value is anticipated to surpass 134 million by the year 2045. The implementation of dietary and physical activity modifications is crucial for the management of Type 2 Diabetes Mellitus (T2DM). Engaging in regular physical activity (PA) can delay the onset of diabetes-related chronic conditions such as neuropathy, retinopathy, and nephropathy, while also mitigating their advancement.  Methodology: In this 12-week prospective trial, 100 uncontrolled T2DM patients were randomly assigned to the Lifestyle Modification Group and Control. The LMG received supervised and guidance on lifestyle modification. Whereas the other group received Standard treatment and medication changes. HbA1c, FBS, and PPBS were measured at baseline and 12 weeks. Result: The difference in the changes found in both the groups were statistically significant, as indicated by p-values less than 0.0001 for both blood sugar that is fasting and postprandial, p-value less than 0.001 for glycated hemoglobin (HbA1c). Conclusion: A lifestyle modification program involving dietary changes and exercise demonstrated an improvement in blood glucose levels Keywords: lifestyle modification, type 2 diabetes mellitus, sugar levels

133. Assessment of the Surgical Profile among Patients of Gastro-Intestinal Tract Perforation
Abhishek Jain, Trilok Jain, Dinesh Kumar Badaya, Vinita Jain
Background: Gastrointestinal tract perforation occurs when pathology of any specific disease involves the entire depth of the gastrointestinal tract. Gastrointestinal tract perforation leads to the contamination of peritoneal cavity with intestinal contents. According to previous researches it was reported that perforations can be occurred anywhere in full length of gastrointestinal tract. Material & Methods: Patients who were diagnosed as perforation and peritonitis on the basis of laboratory diagnosis and clinical examination were enrolled by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: In the present study, out of total study participants abdominal pain was the most common presenting symptom present in patients which was followed by fever, abdominal distension and vomiting. On the basis of time of perforation, 10% cases presented within12 hour, between 12 and 24 hour was reported among in 50% cases, in the rage of 24 and 48 hour seen in 20% patients, in the range of 48 and 72 hour reported in 10% cases, in range of 72 and 96 hour reported in10% cases. Near about all patients were operated in the range of 12 hours of hospitalization. We found that majority of cases had circular perforation of typhoid at antimesenteric border which was followed by tubercular elliptical perforation on the antimesenteric border and traumatic type perforation. Conclusion: The most common presenting symptoms present among patients were abdominal pain, abdominal distension, vomiting, fever and obstipation. We found that majority of cases had circular perforation of typhoid at an times enteric border which was followed by tubercular elliptical perforation on the antimesenteric border and traumatic type perforation. Keywords: Gastro-intestinal tract perforation, signs and symptoms, presentation.

134. Association of CRP (C-Reactive Protein) Level with Body Mass Index in Overweight and Obese Persons
Neha, Nisha Jangir, U. S. Solanki, A. K. Bhargava
Background: Obesity affect people in both developed and developing countries. According to reports, there are about 250 million adults suffering from obesity. In particular, obesity is considered a strong factor in controlling the concentration of circulating CRP concentrations because adipose tissue is involved in the regulation of cytokines. Inspite of being healthy, increased adipose tissue depots in overweight and obese persons are associated with subclinical inflammation that leads to slightly increased serum CRP level. Objectives: This study was conducted to evaluate the association of serum CRP level with BMI in overweight and obese healthy persons as compare to persons having normal BMI. Methods: Determination & comparison of serum CRP was done between 50 Cases & 50 healthy controls aged from 18 to 45 years.  Along with BMI, biochemical parameter CRP analysis was done using immunoassay techniques. Statistical comparison was done, results were expressed as Mean ± SD, p < 0.05 was considered to be statistically significant. Results: All groups were statistically matched in age and sex, means there was no significant difference in age and sex distribution in all groups. Serum CRP concentrations in cases & controls were (2.77 ± 1.36mg/L) & (1.07± 0.59 mg/L) respectively, showing p-value <0.0001. Mean CRP concentration in males and females was found to be (2.01±1.30mg/L) and (1.85±1.39mg/L) respectively, showing  p value=0.566, i.e. (p >0.05). Interpretation and conclusion: Although CRP level of both groups was within the normal reference range but significant increases in overweight and obese individuals as compare to controls. A comparatively elevated CRP level in overweight and obese persons as compare to normal persons is an indication of low grade systemic inflammation. Keywords: Obesity, cytokines, inflammation, CRP (C-reactive protein).

135. The Association between Gallstone Disease & Metabolic Syndrome – A Prospective Observational Study
Raj Kumar Paliwal, M.M. Mangal
Background – Gall stone disease a common clinical condition ,mostly affecting the females. Its incidence is increasing in the recent times , owing to various risk factors.Previous literature have reported metabolic syndrome to be present in patients diagnosed with gall stone disease. Aims & Objectives- To assess the association between the presence of gallstone disease and metabolic Syndrome. Material & Methods- This prospective, observational study recruited patients (n=60, age range 20-65 yrs) having cholelithiasis who were admitted in the Department of Surgery , of our tertiary care Hospital from January 2023 to September 2023. Normal healthy persons (n=60, age range 20-65 yrs) with no evidence of cholelithiasis on ultrasonography were taken as controls.CBC, fasting blood sugar, serum lipid profile,ultrasonography was conducted. Metabolic syndrome was defined by adult treatment panel III (ATP III) criteria.  Results – Both the groups were comparable with respect to age and gender & with no statistically significant difference. In the Case group, 24 (40%), while in control group 11(17% ) of the study participants fulfilled the criteria for metabolic syndrome which showed statistically significant difference (p<0.05). Waist circumference , diabetes mellitus , low serum high density lipoprotein were statistically significantly higher in Case group as compared to control group . Hypertension & serum triglycerides levels were also elevated in case group with no statistically significant difference. A positive association was found between waist circumference , DM & low serum high density lipoprotein & gall stone disease which was statistically significant(p<0.05). Conclusion – Metabolic syndrome was statistically significantly associated with gall stone disease & can be used to predict the risk . Increased waist circumference , diabetes & low serum high density lipoprotein are the noted findings in Gall stone disease & should be management to prevent any complications.  Key words – Metabolic syndrome ,Gall stone disease, dyslipidemia, insulin resistance ,diabetes mellitus

136. Prevalence of Dengue in Sickle Cell Disease in Pre-School Children
Nikhil A Gavhane, Sachin Shah,Ishant S Mahajan, Pawan D Bahekar
Introduction: Millions of people are affected with dengue fever every year, which drives up healthcare expenses in many low-income countries. Organ failure and other serious symptoms may result. Another worldwide public health problem is sickle cell anaemia, which is most prevalent in Africa, the Caribbean, and Europe. Dengue epidemics have reportedly occurred in locations with a high frequency of sickle cell disease, compounding the health problems in these areas. Aims and objectives: This study examines dengue infection in sickle cell disease-afflicted pre-schoolers. Method:This Retrospective cohort study examined paediatric patients. Young people with sickle cell disease (SCD), dengue infection, and a control group without SCD or dengue were studied. Data on demographics, SCD consequences, medical treatments, and laboratory findings were gathered to analyse the influence of SCD on dengue severity and clinical outcomes, classified as severe or non-severe by the 2009 WHO classification. Using fever or admission symptoms, the research estimated acute illness duration. Result: Table 1 compares haemoglobin genotype-based dengue episode features in SS, SC, and controls. Table 2 shows that severe dengue cases are older, have longer admission delays, and have particular symptoms.  Table 3’s multivariate analysis indicates SS genotype’s high connection with severe dengue, multiorgan failure, and acute pulmonary problems. Table 4 relates severe dengue to greater white blood cell counts, anaemia, liver enzymes, and reduced lactate dehydrogenase. Conclusion: This study is valuable but confined to hospitalised dengue patients with sickle cell illness. Small cohorts limit comparisons. Further study is needed since findings contradict predictions. Keywords: Dengue, chills, headache, severe myalgia, vomiting, nausea, and prostration

137. To Identify Specific Age Group and Distribution of Carcinoma Breast in Females
Meha Ghodawat, Manoj Kela, Priyal Jain
Background & Methods: The aim of the study is to identify specific age group and distribution of carcinoma breast in females. All biopsy / FNAC proven cases of Ca breast in females.Results: In our study we found maximum no. of of cases in age group of 41-50 i.e. 29.5%, followed by 25.5% in age group of 31-40. Maximum cases in stage II (45%) followed by 38% in stage III. We found Postmenopausal (67%), Perimenopausal (18%) & Menstruating (15%) Conclusion: Carcinoma of Breast is the most commonly site-specific cancer in women & is the leading cause of death from cancer for female 35-50 years of age. Breast Cancer accounts for 32% of all female cancer and is responsible for 19% of the cancer related deaths is women. In our study most common presenting complaint is lump in breast (98%). In our study most common presenting complaint is lump in breast (98%). Keywords: age, carcinoma, breast & females. Study Design: Observational Study

138. Progression of Pregnancy Outcomes with Respect to the Location of Placenta Previa
Priyanka Kumari, Rahul Ranjan, Krishna Sinha
Background: Placenta Previa (PP) is linked to substantial use of healthcare resources due to its significant contribution to both foetal and maternal morbidity and death rates, particularly in poor nations. Complications include a range of possible adverse outcomes, such as the occurrence of excessive haemorrhaging and premature delivery, alongside the need for caesarean section. The objective of this research was to ascertain the prevalence, identify the risk factors, and examine the poor feto-maternal outcomes associated with placenta previa. The present study employs various methodologies. Methods: A retrospective cohort analysis was undertaken using the maternal medical data obtained from Jawaharlal Nehru Medical College and Hospital, Bhagalpur, in India covering the period from August 2021 to July 2023. Results: The study comprised 128 individuals, ranging in age from 20 to 38 years, with an average age of 28.6 ± 4.5 years. 66 (51.6%) of the pregnant women in the research were multipara, while 62 (48.4%) were primigravida. A 1% PP rate was detected. Approximately 60.2% of patients, or 77, experienced substantial postoperative problems, whereas 39.8%, or 51, had moderate postoperative problems. About 61% of moderate placenta previa (PP) cases- 31 of 51- are nulliparous. About half of placenta previa patients had a previous caesarean. 34 of 51 patients (66.6%) with minor postpartum haemorrhage (pph) and 59 of 77 (76.6%) with severe pp had antepartum haemorrhage. Conclusion: The positioning of the placenta may have a significant role in influencing the outcome of a pregnancy. This research emphasises the need of comprehensive obstetrics care and timely identification of women who are at risk of developing placenta previa, since these measures have the potential to mitigate the occurrence of such issues. Keywords: placenta positioning, maternal and fetal outcomes

139. A Retrospective Study on the Anaesthetic Management of Awake Craniotomy
Bhaarat S Maheshwari, Meet Mordiya, Nency S Patel, Mayurkumar Sorathiya, Jithin Sankar. P.S
Background: Awake craniotomy includes awake brain surgery. Awake Craniotomies started in the 1800s. This procedure requires a comprehensive preoperative analysis and patient counselling. For tumor excision and brain mapping in Alzheimer’s and Parkinson’s, awake craniotomies are recommended. This therapy often lowers post-operative morbidity. This study aims to evaluate the success of awake craniotomy in the cases included in it. Method: This is a retrospective study conducted on the cases for which awake craniotomies were performed at BJ Medical College in Gujarat, India. The anaesthetic management procedure was carried out, the procedure conducted was evaluated for various parameters, and an analysis of the outcomes was performed. Results: The awake craniotomy conducted on 8 patients was successful, with certain complications during the procedure that were later managed. The average stay of the patients post-operatively was reduced to 3 days. The surgeon’s satisfaction score ranged from fair to excellent. Conclusion: Awake craniotomy reduces the number of days of hospital stay, decreases the risk of postoperative morbidity, and decreases the chances of complications. The evolution of the awake craniotomy can result in a successful operative procedure with increased patient satisfaction. Recommendation: Awake craniotomy can give successful outcomes if the patients are cooperative during the procedure. So patient counseling before the procedure is mandatory for an awake craniotomy. Keywords: awake craniotomy, tumor removal, scalp block

140. Impact of Anticoagulant Medication on Chronic Subdural Hematoma Incidence
Rahul Ranjan, Rajendra Kumar, Priyanka Kumari
Introduction: Chronic subdural hematomas (CSH) often manifest as a consequence of mild trauma in the elderly population. Nevertheless, it has been observed that there has been a rise in the population of individuals diagnosed with chronic subdural hematoma who were undergoing consistent anticoagulant treatment. The present study aims to demonstrate the correlation between the use of earlier generation anticoagulant medications and the increased incidence of hemorrhagic subdural cranial hematoma (HSCH). This association is mostly attributed to challenges in effectively managing the international normalised ratio (INR) and the potential risk of drug overdose. Method: The study was done in the Jawaharlal Nehru Medical College and Hospital, Bhagalpur, in India over the period spanning from September 2021 to September 2022. Results: The findings indicate that the highest proportion of patients, accounting for 24.71%, were on anticoagulant treatment and fell within the age range of 51 to 60 years. In 37.07% of instances, individuals who had anticoagulant medication exhibited INR values within the normal range, while 35.95% of these patients displayed INR levels beyond the threshold. Nineteen individuals in our study had deaths, all of whom were on anticoagulant treatment with earlier generation medications. Conclusion: The broad use of anticoagulant medication, both for preventive and therapeutic objectives, is a significant strategy in addressing the high incidence of hemorrhagic stroke and cerebral haemorrhage. The improper and excessive use of anticoagulant medication, along with the excessive reliance on complex terminology and the development of newer generations of anticoagulant pharmaceuticals, contributes to a heightened occurrence of hemorrhagic subarachnoid cerebral haemorrhage (HSCH). The use of novel anticoagulant medication is favoured due to its reduced reliance on regular laboratory testing. The monitoring of International Normalised Ratio (INR) is a crucial aspect in clinical practise. Keywords: Chronic subdural hematoma; Anticoagulants; Prothrombin time; INR

141. Study of Etiology of Pleural Effusion in Andhra Pradesh Population
Yasar Arafath Shaik, Dadeboyina suryakala
Background:  Pleural effusion is an excessive accumulation of fluid in the pleural space. It can be a diagnostic dilemma for clinicians because of the multiple etiologies of lung, pleura or systemic disorders.
Material and Methods: 95 patients with newly diagnosed pleural effusion based on Chest – x-ray PA view we’re studied . 20 ml of pleural fluid was aspirated and sent for biochemical, microbiological, and pathological analysis. Echocardiography, USG abdomen, and biopsy of the pleura were carried out in the same patients whose etiology or diagnosis was not clear.
Results: Clinical manifestations were: 65 (68.4%) had fever, 75 (78.9%) had cough, 44 (46.3%) had breathlessness, 22 (23.1%) had pedal oedema, 46 (48.4%) had chest pain, and 5 (5.26%) had abdominal distention. 57 (60%) patients had tubercular pleural effusion, and 38 (40%) had non-tubercular pleural effusion. In non-tubercular pleural effusion  9 had (23.6%) synpnemonic effusion, 6 (15.7%) had CCF, and 13 (34.2%) had malignancy, 2 (2.1%) had rheumatoid arthritis, 2 (2.1%) had dengue fever, 2 (2.1%) had pancreatitis, and 4 (4.20%) had nephrotic syndrome.
Conclusion: In the present study, it was concluded that most of the pleural effusions are tubercular, but the etiological evaluation of plural effusions is very important to diagnose and treat accordingly.
Key words: tubercular, non-tubercular, malignant, cell cytology, CCF, cirrhosis

142. Comparative Study of Alvarado and RIPASA Scoring System in Diagnosing Acute Appendicitis: A Retrospective Study
Abhishek Tiwari, Swati Mishra, Ramesh Kumar Ajai
Background: Rapid and accurate diagnosis is crucial in the treatment of acute appendicitis, a common surgical emergency. The clinical community has developed tools like the Alvarado (ASS) and RIPASA scoring systems to facilitate this diagnosis. However, research into how successful each method is as a diagnostic tool is on-going. The purpose of this retrospective study is to evaluate the performance of these two scoring systems in a defined group of patients.
Method: Five hundred patients who met the study’s inclusion criteria were analysed retrospectively. Clinical parameters, test results, and measurements on a variety of scales were all included. We compared the sensitivity, specificity, positive and negative predictive values, and Diagnostic Odds Ratios (DORs) of the Alvarado and RIPASA scoring systems to evaluate their diagnostic efficacy.
Result: The sensitivity of the RIPASA system was found to be 0.91, compared to 0.85 for the ASS; the specificity was found to be 0.78, compared to 0.72; the positive predictive value was found to be 0.80, compared to 0.74; the negative predictive value was found to be 0.89, compared to 0.83; and the diagnostic odds ratio was found to be 10.25, compared to 7.00. Statistically substantial differences (p < 0.05) favoured the RIPASA scoring system in this study population, highlighting its potential clinical advantage in identifying acute appendicitis.
Conclusion: This study demonstrates that the RIPASA scoring system for acute appendicitis has superior diagnostic accuracy in the context of our study population. More study is required to confirm these results in larger patient populations and to develop improved diagnostic tools further.
Keywords: Acute Appendicitis, ASS, Diagnostic Accuracy, RIPASA Score, Scoring Systems.

143. Results of Minimally Invasive Plate Osteosynthesis (MIPO) for Distal Tibia Fractures
K. Mankima, Joseph C. Vanlalsanga, J. Laldinpuia
Introduction: The presence of a subcutaneous distal tibial fracture is a surgical difficulty and might potentially lead to complications such as delayed union, non-union, wound infection, and wound dehiscence. Minimally Invasive Plate Osteosynthesis (MIPO) is a recommended surgical procedure for the treatment of distal fractures that are displaced or unstable. This approach is favoured because to its technical benefits and favourable clinical results.
Methods: The present study used a prospective design to investigate a cohort of adult patients who had sustained distal tibia fractures and were subsequently treated using locking plates using the minimally invasive plate osteosynthesis (MIPO) approach. Consecutive patients diagnosed with Gustillo type 1 open fracture, with or without articular extension, were included in our study. The evaluation of clinical outcome was conducted with the Olerud and Molander Score (OAMS). A radiographic evaluation was conducted in order to determine the presence of radiological union.
Results: Out of the total sample size of 30 patients, the right side was affected in 53% of the cases. The most prevalent form of fracture seen was the 43.A1 type, accounting for 47% of the cases. The post-operative assessment using the OAMS revealed that 67% of patients had an exceptional result, 27% had a good outcome, 6% had a fair outcome, and none of the patients experienced a poor clinical outcome. The attainment of radiological union occurred within a span of 12 weeks for 20% of the cases, between 12 and 16 weeks for 23% of the cases, between 16 and 20 weeks for 50% of the cases, and within a range of 20 to 24 weeks and 24 to 28 weeks for one patient each. A total of five patients exhibited superficial wound infections, while four patients had ankle stiffness, and two cases showed delayed union.
Conclusion: The results of our investigation indicate that the use of the minimally invasive plate osteosynthesis (MIPO) approach with a locking compression plate does not have a detrimental effect on the blood supply to the periosteum. Furthermore, the success of this technique does not only depend on the compression exerted between the plate and the bone. Therefore, it can be concluded that minimally invasive plate osteosynthesis (MIPO) is a very efficient therapeutic approach for managing fractures of the distal tibia.
Keywords: Distal tibial fractures, locking plate, Minimally invasive plate osteosynthesis

144. Comparative Analysis of Different Approaches to Labour Induction: A Retrospective Study
Sunita Singh, Smita Kumari
Background: Obstetric labour induction is crucial for various maternal or foetal health reasons. It is still a therapeutic decision with possible effects on mother and newborn outcomes and how labour is induced.
Methods: In a group of 200 women giving birth at the Hospital, researchers evaluated the efficacy and safety of several induction techniques. Statistics, such as chi-square testing and multivariate regression, were used to examine the data culled from the EMRs.
Results: Our study of 200 women indicated that the use of prostaglandins was linked to a 72.0% success rate for vaginal births, while membrane stripping was linked to a 61.5% success rate. Furthermore, the rate of postpartum haemorrhage was lowest (9.0%) in cases where a Foley catheter was used to induce labour and most significant (15.0%) in situations where synthetic oxytocin was used. Foley catheter induction was associated with a significantly lower incidence of postpartum haemorrhage compared to membrane stripping (p <0.05), and prostaglandins were considerably more effective than synthetic oxytocin at achieving successful vaginal deliveries. These findings highlight the significance of labour induction techniques on birth outcomes and maternal problems.
Conclusion: These findings provide critical information for obstetricians to consider when making decisions in the clinic. However, the potential biases introduced by the study’s retrospective nature must be considered. More research is needed to understand labour induction techniques’ impact and long-term implications on mothers and infants.
Keywords: Cesarean Section, Labor Induction, Maternal Complications, Neonatal Outcomes, Obstetrics.

145. Correlation between Cytological and Histological Diagnoses in Thyroid Nodules: A Cross-Sectional Assessment
Varsha Somabhai Khant, Hiren Nanjibhai Judal, Akash Suryakant Prajapati, Nuthi Vamsi Krishna
Introduction: This cross-sectional study aims to examine the correlation between cytological and histological diagnoses in thyroid nodules, shedding light on the reliability of these diagnostic methods.
Methods: A total of 200 thyroid nodules were included in this study. A cross-sectional design was employed, and the sample was selected based on predefined criteria. Cytological diagnoses were obtained through fine-needle aspiration (FNA), while histological diagnoses were derived using surgical biopsy.
Results: The examination of 200 thyroid nodules revealed a correlation between cytological and histological diagnoses in the majority of cases. Nevertheless, noteworthy disparities were detected in 15% of the nodules. These findings carry substantial implications for the accuracy and consistency of thyroid nodule diagnoses. Conclusion: This study contributes valuable insights into the correlation between cytological and histological diagnoses in thyroid nodules. The observed discrepancies underscore the need for further research and refinement of diagnostic approaches in clinical practice.
Keywords: Thyroid Nodules, Cytological Diagnosis, Histological Correlation.

146. A Study of Risk Factors for Acute Lower Respiratory Tract Infection in Under Five Children
Lakshmi L, Vidyasagar S, Poornachand V, Suguna S, Mahesh V
Background : Pneumonia remains an important cause of morbidity and mortality in both industrialized and developing countries. Indeed, it is one of the leading causes of under-five child death in the world. Pneumonia is the single largest infectious cause of death in worldwide. It accounts for 15% of death worldwide. In addition, socioeconomic and environmental factors like overcrowding, air pollution, passive smoking, practice of bottle feeding etc., contribute to the significant rise in incidence of pneumonia during recent years . Delay in seeking tertiary care facility is another contributing factor for increased mortality in severe pneumonia.
Objective : To study the clinical profile and Risk factors of ALRI in children aged 2 months to 5 years.
Materials and Methods: The present Case Control study was carried out by the department of Pediatrics at Chamarajanagara Institute of Medical Sciences, Chamarajanagara from March 2022 to September 2022. A Total 100 study subjects with LRTI and 100 controls were enrolled for the purpose of the study . Details of potential risk factors in cases and controls were recorded in pre-designed proforma.
Results : In the present study nearly 15% of the subjects were classified to be having Pneumonia only , 60% of them as Severe Pneumonia and 25% of them has very severe Pneumonia. On Analysing various common risk factors associated with lower respiratory tract infection in the present study it was found that immunization Status , type of house  Birth weight and Malnutrition status of the children were found to be statistically significant and other risk factors were found to be statistically insignificant .
Conclusion : This study has shown that the risk factors for ARI that have been identified—such as low birth weight, inadequate immunisation, hunger, and type of housing—had statistically significant associations that may be changed. Simple tactics like proper diet, immunisation, avoiding pollutants, parent education, and environmental cleanliness can change these risk factors
Keywords: LRTI, WHO, Pneumonia, Risk Factors, Malnutrition

147. Comparison of Steristrips and Subcuticle Suture for Wound Closure after Thyroid Surgery in Telangana Population
Pradeep Kumar N, Prasanna P L, Manepalli Uma Mounica
Background: The main aspect of wound repair is the long-term aesthetic or cosmetic appearance of the scar, as the thyroid gland is located on the anterior aspect of the neck and is easily visible. Postoperative wound closure is preferred after surgery.
Method: Out of 50 (fifty), 25 patients were closed by the sub-cuticular suture technique, and 25 were closed by steristrips followed by thyroidectomy. Verbal analogue scales and visual analogue scales were compared. Moreover, a cosmetic visual analogue was also compared after the 6th week of the surgery.
Results: Comparison of verbal analogue scale for neck mobility and visual analogue of neck mobility after certain intervals and significant p value (p<0.001). After six weeks of surgery, the steri-strip technique had 23 (92%) excellent and 2 (8%) good results, and sub-cuticular had 20 (80%) excellent results and 5 (20%) good cosmetic appearance.
Conclusion: In the present pragmatic study, it was concluded that steri-strip sutures were better in visual, verbal, and cosmetic analogue and reduced the stay in hospital as compared to sub-cuticular suture technique.
Keywords: stri-strips, sub-cuticular, visual analogue, verbal analogue, Telangana

148. A Study of Clinical Profile of Neonates Admitted in Sick New Born Care Unit with Dehydration and the Effect of Intervention on Duration of Admission Due to Dehydration in Neonates and Rate of IV Fluid Use for Treatment
Vidyasagar S, Lakshmi L, Suguna S, Vishma B K, Mahesh V
Background: Dehydration in new-born infants may be due to various reasons like inadequate breast feeding, primigravida mothers, poor support to mother and early discharge from hospital. Dehydration in neonates cause fever, increased jaundice, electrolyte disturbances like hypernatremia, acute renal failure. Dehydration may also lead to serious illnesses like convulsions, coma, cerebral venous thrombosis, aortic thrombosis and peripheral gangrene. Many studies in the literature have focused on hypernatremic dehydration in neonates. Limited studies have been done regarding overall profile of dehydration.
Objective: To study the clinical profile of neonates admitted to SNCU (Sick New born care unit) with dehydration. To determine the effects of interventions on the admission due to dehydration in neonates and use of IV fluids.
Materials and Methods: Hospital based observational study was conducted among 102 Neonates admitted to SNCU, Department of Paediatrics, CIMS Hospital, Chamarajanagara for a period of 24 months from March 2020 to February 2022. Neonates aged <28 days, Birth weight more than 2 kg, Gestational age >34 weeks and Weight loss >10% were included in the study. Neonates with Congenital anomalies, Birth asphyxia were excluded from the study. Institutional ethical clearance was obtained prior to start of study and informed consent from Parents or Guardian was taken prior to recruitment, data was collected from neonates admitted in SNCU with dehydration. Data was entered in MS excel and analyzed using SPSS 22 version software. ANOVA Test was the test of significance for quantitative data and chi-square test was the test of significance for qualitative data. p value <0.05 was considered as statistically significant.
Results: In the present study majority were in the age group <7 days (94.1%), females were in majority (52.9%). Most common primary diagnosis was Jaundice in 37.2%, AKI in 29.4% and neonatal sepsis in 24.5%. 87.3% were discharged, 2.9% had mortality and 9.8% were referred to higher centre. Majority of neonates were managed with IV Fluids + Breast feeding (78.4%), 15.7% were only breast fed or used expressed breast milk and 5.9% received artificial feeds. Among neonates managed with IV fluids, mean days of admission was 3.86 ± 1.466 days, among breast fed neonates 5.44 ± 0.814 days, among neonates who received feeds 6.50 ± 1.049 days.
Conclusion: Neonates admitted with dehydration in SNCU had varied clinical features and diagnosis. IV fluids with Breast feeding reduced the duration of admission in SNCU and mortality rate was reduced. Neonates receiving other interventions such as Exclusive breast milk or artificial feeds needs to be carefully monitored for early discharge.
Keywords: Neonates, Dehydration, Intervention, Sick Newborn Care unit (SNCU)

149. Prospective Study of Benign Breast Disease in South Karnataka Population
Prashanth C
Background: Benign breast diseases (BBD) can occur at any age during the life span of a female. The breast is a dynamic organ that undergoes cyclic changes throughout a woman’s reproductive life.
Method: 50 (fifty) female adults aged between 20 to 60 years with BBD were studied. Routine blood examinations, radiological investigations (USG/mammography), and pathological investigations (FNAC/HPE discharges) were also carried out if necessary.
Results: 44 (88%) breast abscesses were observed from menarche to menopause, 4 (8%) in lactating mothers, 2 (4%) in post-menopausal women, 5 (10%) breast abscesses, 1 (2%) cold abscesses, and 2 (4%) cystic mastalgia. 16 (32%) fibro-adenomas, 3 (6%) fibro-adenosis, 12 (24%) mastaliga, and 1 (2%) tubercular lesion were observed.
Conclusion: It is concluded that BBD can be managed with medication, and in resistant cases, surgery intervention is required. In certain cases, the clinician has to wait and watch the prognosis of BBD.
Key words: benign breast diseases (BBD), menopause, non-malignant, lactation, HPE (histopathological evaluation)

150. Post-COVID-19 Mucormycosis: A Retrospective Study to Analyze Risk Factors and Surgical Outcomes
Abhishek Rajagopal , Yashveer J. K., Badal Gondane , Meenakshi Ambulker4*

Background: The increasing incidence of post-coronavirus disease 2019 (COVID-19) mucormycosis has prompted a critical examination of its surgical management. This retrospective study investigates the outcomes and complications of various surgical procedures, aiming to provide insights into optimal treatment strategies for this complex condition. Aim and objectives: To analyze mucormycosis in patients with preceding or coexisting COVID-19 to explore risk factors, clinical presentation, and surgical outcomes. Materials and Methods: This single-center retrospective analysis included 288 patients diagnosed with post-COVID-19 mucormycosis. The cohort, with a mean age of 53.8 years, underwent diverse surgical procedures, including endoscopic sinus surgery (ESS), functional endoscopic sinus surgery, debridement, orbital exenteration, antrostomy, palatal resection, alveolectomy, middle and inferior turbinectomy, orbital decompression, septoplasty, septectomy, and partial maxillectomy. Data on demographics, comorbidities, surgical outcomes, and complications were systematically extracted from medical records. Result: Complication rates varied across procedures, with ESS demonstrating a rate of 25%, consistent with previous studies. Debridement, a cornerstone procedure, showcased a complication rate of 21%. Middle and inferior turbinectomy was performed in 90% of cases, emphasizing its frequent involvement in disease progression. Recurrence occurred in 21% of cases, with notable variations in timing and characteristics. Overall, patient survival was 88%, with mortality primarily linked to severe systemic involvement and delayed presentation. Conclusion: This comprehensive analysis of 288 cases contributes significantly to understanding the surgical management of post-COVID-19 mucormycosis. The varied outcomes across procedures underscore the need for a personalized approach to patient care. Continued research efforts are crucial for optimizing strategies tailored to the complexities of Mucormycosis management in the post-COVID-19 era. Keywords: post-covid-19 mucormycosis, surgical management, complications, middle and inferior turbinectomy, antrostomy, glycemic control.

151. A Retrospective Study of Cervical Cancer Screening using Pap Smear and the Bethesda System 2014
Fozia Jeelani Wani, Meka Krishna Kumari, Harshita Sirandas
Background: Cancer of the uterine cervix is the second most common malignancy among Indian females with very high mortality rates. Cervical cancer evolves through well understood progression model from pre-cancerous lesion to cervical intraepithelial neoplasia (CIN) with progression to invasive cancer. The identification of these pre-cancerous lesions of the cervix by cervical cytological screening will enhance cure rate by timely management and thereby reduce mortality rates. The aim of the study is to determine incidence of the various pre-cancerous and cancerous lesions of cervix using pap smear as a screening test and their incidence among different age groups. Materials and Methods: It is a retrospective study of pap smears conducted on the 2,450 cases for two years from January 2021 to December 2022. This study was conducted by the department of Obstetrics and Gynaecology with the help of department of Pathology using The Bethesda system 2014. Results: Pap smear was done on a total of 2450 patients on outpatient basis. Out 2450 smears, 150 (6.1%) were reported as having epithelial cell abnormalities. The most frequent epithelial cell abnormality reported in our study group was Low grade squamous intraepithelial lesions (LSIL) seen in 65 cases (2.65%), followed by high grade Squamous intraepithelial lesions seen in 40 cases (1.63%) and atypical squamous cell of undetermined Significance seen in 22 cases (0.89%). Atypical Glandular cells (AGC) were seen in 3 cases, while squamous cell carcinoma was seen in 20 cases (0.81%) on cytology. Mean age of women with abnormal pap smear was 43.4 years. LSIL was more common in age group of 41-50 years, while HSIL was more frequently noted between 31-40 years. Conclusion: Our study highlights the importance of routine pap smear screening for detection of precancerous lesions of cervix.

152. Portal Hypertensive Gastropathy and Colopathy in Cirrhotics with Anaemia
Athish Shetty, Avinash Balekuduru
Background: This study was to document portal hypertensive gastropathy (PHG)  and portal hypertensive colopathy (PHC) in a given cirrhotic with anaemia.Methods: 87 patients participated in this hospital-based prospective cross-sectional study, which was carried out from January 2016 to July 2017 at the Department of Gastroenterology, M.S. Ramaiah Medical College, MSRIT, Bengaluru. The patients underwent a thorough clinical evaluation, history, and physical examination, Biochemical investigations like CBC, LFT, PT-INR,Peripheral smear, Serum iron studies, Vitamin B12 levels,Viral markers-HBsAG and Anti-HCV, etiological workup for the underlying cirrhosis was done, USG abdomen was performed to confirm liver cirrhosis, all patients underwent Upper GI endoscopy and colonoscopy. CTP and MELD score were calculated in all patients. The study was approved by the institutional ethics committee and the participants provided written informed consent.Results: There were 68 males and 19 female patients, the mean age was 53.6 years. Mild anaemia was present in 29.9% of cases, moderate anaemia in 49.4%, and severe anaemia in 20.7% of cases. On upper GI endoscopy, mild PHG was present in 67.8%, severe PHG in 31% and GAVE was present in 2.3%. On colonoscopic examination, portal hypertensive colopathy was present in 26.4% and rectal varices in 10.3%. Mild PHG and severe PHG were statistically significantly correlated with the CTP score (p = 0.006/0.003). The correlation between PHC and severity of underlying liver disease (CTP status/MELD score) was not statistically significant (p = 0.062/0.431). The correlation between Hb and PHC was statistically significant (p = 0.001). There was a difference in the Hb values between the patients with or without PHC (8.4±1.6 gm/dl vs. 9.9±1.8 gm/dl, p = 0.001). There was a difference in the Hb values between the patients with or without severe PHG (8.3±1.6 gm/dl vs. 10±1.7 gm/dl, p < 0.001). The correlation between PHG and PHC was statistically significant (p < 0.001). PHC was present in 73.9% of patients with severe PHG, only 26.1% of patients with mild PHG had PHC.Conclusion: Mild PHG and severe PHG were statistically significantly correlated with the CTP score. The presence of severe PHG on upper gi endoscopy was associated with severe anaemia (Hb < 8gm/dl) and the presence of PHC on colonoscopy was associated with lower Hb (PHC absent Hb-9.9±1.8 gm/dl, PHC present Hb-8.4±1.6 gm/dl). The correlation between the increasing severity of PHG and the presence of PHC was statistically significant.

153. Use of E-Cigarettes and its Effects on Lung Functions
Mukunth Kirubasankar, Sabarinath Ravichandar2, Kavyasri J.
Background: Electronic cigarettes are the most common form of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems. E-cigarette emissions typically contain nicotine and other toxic substances that are harmful to both users, and non-users who are exposed to the aerosols second-hand. These devices have various names, including e-cigarettes, e-hookahs, vaporizer cigarettes, vapes, and vape pens. [1] The heating conditions, especially on humectants, flavourings and the low-quality materials used, have been associated with over-all effects on the lung, airway physiology (hyperreactivity, increased airway resistance, mucus hypersecretion), host defence and alveolar compartment.[2] Lung volume measures the amount of air present for a living being to inhale or exhale. On the other hand, lung capacity is the volume of air in the lungs upon the maximum effort of inspiration. [3] It is known that vape smokers are prone to lung obstructions and scarring. It is characterized by a spectrum of clinicopathological conditions mimicking pulmonary disease. In the US –2,807 cases of E-cigarette associated lung injury (EVALI) were documented in 2019, out of which 68 were fatal. Moreover, it has been reported that the heating process itself can lead to the formation of new decomposition compounds of questionable toxicity. [4] Nicotine e-cigarettes can cause dependence or addiction in non-smokers. Young non-smokers who use e-cigarettes are more likely than non-users to initiate smoking and become regular smokers. [5]Methods: An offline survey was conducted with a self-prepared questionnaire among the sample size of 105 e-cigarette users of age group 18 and above coming to respiratory medicine OPD of Sree balaji medical college and hospital. The questionnaire included questions to analyze their knowledge, attitude and practice about e cigarette smoking habits. The descriptive statistics analysis was carried out including frequency and percentage. The results of the study were tabulated. Data entry and analysis-: Data entry was done is MS-EXCEL sheet, 2010 graph was presented in MS EXCEL, 2010.Results: 78% of the study population was male, where 39% of them had 2 years and 13% of them had 4yrs of smoking history. Among the study population 30% of them smoked 1 to 100 puffs per day and 9% of them were symptomatic.The mean age among the study population was 24 years and mean FEV1 is 108.2 whereas FEV1/FVC IS 81.6. 4% of asymptomatic and 5% of symptomatic patients show decreased FEV1/FVC values and 5% of asymptomatic and 7% of symptomatic patients show decreased FEV1 values, thus in broad spectrum there are 9% of symptomatic and 91% of asymptomatic study participants.

Conclusions: The present study revealed that the Smoking Index of the individual has direct correlation with various medical Comorbidities and there is significant association between patients’s FEV1/FVC values. The number of puffs was an important risk factor. There is a mild decrease in the FEV1, FVC, FEV25/75 and FEV1/FVC values of the e-cigarette users. Thus the erroneous belief that E-cigarettes are less harmful to health than tobacco-containing cigarettes must be addressed with urgency. Counseling on the cessation of vaping and offering them the needed support can make a difference in the patient’s lives.

154. Comparative Study of Perioperative Infusion of Dexmedetomidine Versus Labetalol for Controlled Hypotension in Functional Endoscopic Sinus  Surgeries
Deepa Kattishettar, Lakshmi Priya, Shambhavi A Prakash, Vinayaka C S, Vijayalakshmi B C, Manjunath H G
Background and objectives: A prospective, randomized study was undertaken to compare perioperative infusion of dexmedetomidine versus labetalol for controlled hypotension in functional endoscopic sinus surgeries under general anaesthesia. Methods: Sixty adult patients undergoing FESS were randomly allotted to two groups. Group Dexmedetomidine (n=30) received a bolus dose of 1mcg/kg over 10 minutes followed by infusion at 0.4-0.8mcg/kg/hr and group Labetalol (n=30) received a bolus dose of 0.25 mg/kg/hr infused over 10 mins followed by 1-2 mg/min/IV infusion dose titrated during maintenance to achieve target MAP of 70-75mmHg. Haemodynamic parameters were recorded at regular intervals. Surgical site assessment was done by surgeons using Fromme’s scale. Awakening time before extubation, recovery time (by Aldrete score), sedation score (using RSS scale) and surgeon satisfaction score were recorded. Statistical analysis was done with Chi-square test for qualitative data and Independent t test to identifythe mean difference between two quantitative variables. Results: Both drug regimens were able to produce and maintain controlled hypotension and thus optimal surgical conditions. Early recovery times were seen in Labetalol group whereas higher surgeonsatisfaction and higher sedation scores noted in the Dexmedetomidine group. Conclusion: Both dexmedetomidine and labetalol provide controlled hypotension and oligemic surgical fieldduring FESS under general anaesthesia. However, surgeon satisfaction and postoperative sedation were better with dexmedetomidine although early recovery was seen with labetalol.

155. Role of Lactobacillus in Vaginal Discharge and Bacterial Vaginosis
Smriti Sinha, Pritee Kumari, Shashi Bala Prasad
Background: In the field of women’s health, medical professionals frequently have to make a diagnosis and treat individuals who exhibit excessive vaginal discharge without much other information. A correct diagnosis cannot be made until the lab work is finished and the patient’s medical history is examined. Only then can the two common causes of vaginal discharge with identical symptoms lactobacillosis and other factors be distinguished. This study aims to explore the function of lactobacillus in bacterial vaginosis and vaginal discharge.

Methods: After selecting all patients who presented with vaginal discharge, only those with physiological normal vaginal discharge and those with bacterial vaginosis were isolated, and only in these two groups was lactobacillus counting performed.

Results: Recruitment was done for 270 patients with vaginal discharge. Among them, 140 patients had normal vaginal discharge and 60 had bacterial vaginosis. Research was conducted to determine the function of lactobacillus in both normal vaginal discharge and bacterial vaginosis. 85.72% of patients with normal vaginal discharge had a lactobacillus count >106 (CFU/mL), compared to 85% of patients with bacterial vaginosis who had a lactobacillus count <106 (CFU/mL). Fischer’s exact test revealed a statistically significant correlation (p value of 0.001) between the number of lactobacilli in normal vaginal discharge and the number in bacterial vaginosis.Conclusion: Reduced lactobacillus count in bacterial vaginosis and increased count in normal vaginal discharge were statistically significantly correlated.

156. Prevalence and its Antibacterial Susceptibility Pattern of Asymptomatic Bacteriuria in Pregnancy
Smriti Sinha, Pritee Kumari, Shashi Bala Prasad
Background: Pregnant women often have asymptomatic and symptomatic bacteriuria (ASB). The transition from asymptomatic to symptomatic bacteriuria is accelerated during pregnancy. If managed, this can result in acute pyelonephritis as well as other unfavorable consequences such preterm, postpartum, hypertensive disease, anemia, urinary tract infections, and increased chances of fetal mortality. The purpose of this study was to determine the most frequent bacteria and their susceptibility to antibiotics in pregnant women, as well as to assess the prevalence and risk factors of asymptomatic bacteriuria.Methods: From February 2023 to September 2023, 230 pregnant women in good health who made their first appointment at the antenatal outpatient department at MMCH, Madhubani, Bihar, had their bacteriuria assessed.Results: Ten percent of pregnant women had asymptomatic bacteriuria. Except for those living in rural areas, demographic and obstetric factors had no discernible impact on the frequency of asymptomatic bacteriuria (χ2=4.454, p=0.0348). 52.17% of the microorganisms were Escherichia coli. Amoxicillin, cotrimoxazole, ampicillin, nalidixic acid, and aminoglycosides all cause less sensitivity in uropathogens than imipenem and aminoglycosides. Conclusion: In the study, pregnant women had a significant rate of asymptomatic bacteriuria. Demographic and obstetric characteristics did not significantly affect the risk of ASB, with the exception of living in a rural area. Thus, in our setting, routine asymptomatic bacteriuria screening for expectant mothers is advised.

157. A Prospective Study of the Significance of Audio-Vestibular Assessment in Patients with Diabetes Mellitus
Khushbu Rani, Ajit Kumar
Background: It is estimated that by 2035, the number of Indians affected by diabetes mellitus (DM) will have nearly doubled. Divergent views exist on the audio-vestibular system’s involvement due to ongoing study on the microvascular issues associated with it. Thus, this study was carried out to assess the audio-vestibular capabilities in patients with diabetes mellitus and ascertain their association with the course and management of the condition.Methods: This prospective, cross-sectional study comprised 97 DM patients who underwent clinical evaluation, the Dix-Hallpike maneuver, and investigations such as videonystagmography (VNG) and pure tone audiometry (PTA). Results: Of the 97 patients, 64 reported sensorineural hearing loss in varied degrees on PTA, and 16 had vestibular hypofunction on the VNG caloric test. When 5 years of DM was used as the cutoff, it was found that the occurrence of bilateral hearing loss and vestibular hypo-functioning were statistically significant (p value 0.028 and <0.001, respectively). After analyzing the symptoms with PTA and VNG, it was shown that there was a strong link between tinnitus and hearing loss (p values of 0.03 and <0.001, respectively) and aberrant findings in both examinations. This suggests that the vestibular dysfunction is subclinical. But no meaningful associations were discovered with DM’s glycaemic control. Conclusion: Larger studies in other populations are required to further confirm the correlation, but it is recommended to consider audio-vestibular evaluation with PTA and VNG as screening tests for long-term DM patients with or without symptoms of giddiness and hearing loss as a step towards early identification of microvascular complications of the inner ear.

158. Study on Effect of Intra Lesional Steroid Infilteration in Oral Sub-Mucous Fibrosis in a Tertiary Care Hospital
Ajit Kumar, Khushbu Rani
Background: All age groups are affected by the common condition known as oral submucous fibrosis. The disease has spread to be a modern-day epidemic due to the widespread usage of tobacco, gutka, and betel chewing. A variety of treatment modalities, with differing degrees of success, have been tried to lessen the effects of the condition, such as antioxidants, systemic and local steroids, and physiotherapy. Methods: From August 2023 to October 2023, the ENT Department at Radha Devi Jageshwari Memorial Medical College and Hospital in Turki, Muzaffarpur, Bihar, conducted this study to gather information regarding the effectiveness of intralesional steroid injection in instances of oral submucous fibrosis.  There were forty individuals in total who had oral submucous fibrosis at presentation.Results: The study revealed that the greatest age incidence for both sexes was between 26 and 35 years old. There may be regional variations in the absorption of gutka and areca nut, among other factors. In terms of sex incidence, this study revealed a 9: 1 male preponderance. This could be as a result of men using gutka and betel more frequently than women do. All of the patients in this study had fibrous bands, mucosal blanching, and trismus. The most important haematological finding in this series was anemia.Conclusion: An efficient way to manage it and get rid of the morbidity is to inject hyaluronidase with dexamethasone. It relieves symptoms as well.

159. A Study to Assess the Association of Vitamin D (Serum 25 Hydroxy Vitamin D3) and Vitiligo
Barunesh Kishore, Saket Kumar
Background: An acquired pigmentary abnormality of the skin is vitiligo. Depigmentary white areas on the skin with normal border or surrounding hyperpigmentation are how it presents itself. Vitamin D, or vitD, has been linked to a number of different medical disorders in recent years. Similar to a hormone, it is produced in the skin and plays a significant role in skin pigmentation by increasing the activity of the tyrosinase enzyme, which in turn influences the formation of melanin. It also exhibits a range of immunoregulatory characteristics. In autoimmune disorders such as multiple sclerosis, alopecia areata, DM, RA, and SLE, vitamin D levels have been reported to be lower. The purpose of this study was to look for any connections between vitiligo and serum vitamin D levels. Methods: Serum 25 hydroxy vitamin D levels were measured in all subjects involved in this case control study (21 patients and 21 age and sex matched healthy individuals) once they met the inclusion and exclusion criteria. The relationship between vitamin D level and the vitiligo disease activity index (VIDA), affected body surface area (BSA), lesion site, patient age, and length of vitiligo was assessed.Results: In all, 42 people were included in our study: 21 vitiligo sufferers and 21 control subjects. In comparison to the control group, the mean serum level of vitamin D was considerably lower in the patient group (17.3 ng/ml ± 5.3 vs. 25.8 ng/ml ±7.9, P = 0.006). Age, the length of vitiligo, and the affected body surface area did not significantly correlate with vitamin D level (P>0.05), although there was a significant variation in 25(OH)D levels between the different grades of VIDA.Conclusion: This study findings that patients with vitiligo had a significant 25(OH) D shortage raise the possibility that vitamin D deficiency contributes to the pathophysiology of vitiligo.

160. A Case Control Study of Vitamin D Deficiencyin Psoriatic Patients
Saket Kumar, Barunesh Kishore
Background: A systemic, inflammatory, chronic autoimmune disease with silvery scales covering the body, psoriasis is linked to obesity, diabetes mellitus, hypertension, hyperlipidemia, and cardiovascular problems. There has also been recent news of a link between vitamin D levels and psoriasis. This study’s primary goal was to compare the vitamin D status of psoriasis patients to that of healthy controls. Methods: This study is a case-control, observational epidemiology study. From June to August of 2023, it was held at the outpatient department of dermatology and venereology at the Radha Devi Jageshwari Memorial Medical College and Hospital, Turki, Muzaffarpur, Bihar. In this study, 140 individuals were recruited and divided into two groups: 50 patients with psoriasis and 90 healthy controls. The level of vitamin D3 in both groups was measured. Results: When comparing males and females, the vitamin D levels in the control group were similar (P value = 0.263). Winter had the lowest vitamin D levels, while autumn had the greatest (P value < 0.001). Vitamin D3 levels were lower in underweight individuals and greater in those with a normal body mass index (P value=0.002). There was a significant difference in vitamin D levels between males and females in the psoriatic group (P value = 0.007). When comparing variable age groups (P value = 0.142), seasonal variation (P value = 0.387), and body weight (P value = 0.676), no significant differences were found. When comparing the vitamin D3 levels of the psoriatic group and the control group, there was a significant difference (P value < 0.001). Conclusion: Comparing the psoriatic group to the control group, vitamin D3 levels were considerably lower.

161. Significance of Hematological Parameters in Uncomplicated Diabetes Mellitus
Shashi Kant Kumar, Alok Himanshu, Poonam Kumari
Background: Globally, diabetes mellitus is the leading cause of chronic metabolic disorders. The hematological values on a complete blood count show the physiochemical alterations in the blood caused by continuous hyperglycemia. This study aims to assess the usefulness of hematological markers in the management of uncomplicated diabetes mellitus.Method: During the 12-month period from July 2022 to June 2023, a case control study was conducted at the Department of Pathology, Darbhanga Medical College & Hospital, Laheriasarai, Bihar, a tertiary care facility. A combination of clinical findings, case records, hematological findings, and a questionnaire were used to assess the 50 patients in the study group who had diabetes and the 50 patients in the control group who did not. Using a Beckman Coulter five part cell counter, the hemogram was analyzed. Peripheral smears stained with Leishman were examined. The significance test was used to analyze the gathered data in order to determine the significance of alterations in hematological markers in patients with diabetes.Results: The diabetic group exhibited anemia as well as elevated leucocyte and platelet counts.Conclusion: An effective method for improving the care of diabetes patients is the monitoring of changes in hematological markers.

162.Comparative Study of Post Operative Outcome with Reference to Pain in Unilateral Versus Bilateral Open Inguinal Hernioplasty by Lichenstien  Repair
Pankaj Babubhai Patel
Inguinal Hernia is most common General Surgical Problem. Males are more affected than Female. Almost 15 to 20% population develop Inguinal Hernia in lifetime. Among the Inguinal Hernia Patients 90% are Male and 10% are Female. Around 80% are Unilateral and 20 % are Bilateral Inguinal Hernia. Aims and Objective: To study the Early and Late Complication in terms of Pain in Unilateral and Bilateral Inguinal Hernioplasty in Same sitting by Open lichenstien Repair. To Compare Severity of Pain, Mesh Discomfort, Pain at Rest and Analgesics Required duration of treatment In Post Operative Period.Materials and Methods: During period From January 2023 to June 2023, Retrospective Study done on 30 (thirty) Patients Operated for Unilateral and Bilateral Inguinal lichenstien Repair, at Nootan General Hospital and Medical College Visnagar. Visual Assessment Scale was Not used, but direct interview of Post Operative patients done up to 6 months follow up Post operatively, by asking Patients Regarding (1) Mil (2) Moderate and (3) Severe pain Category depends on Activity and Analgesics Requirement.Results and Conclusion: Bilateral Inguinal Hernioplasty in Same Sitting Gives Almost Comparable Outcome to Unilateral Inguinal Hernioplasty by lichenstien Repair, in terms of Severity of Pain and Mesh Discomfort and Time to Early Return to Work.

163. Onco Reconstruction of Hemifacial Defects – Post Oncological Excision of Advanced Oral Cancer
Shailendra B Singh, Deepanjali Kalra, Rahul Kaushik, Manisha Singh
Aim: To study various ways of reconstructing hemifacial defects following supramajor Onco surgery in advanced oral cancer cases.Introduction: Head and neck cancer is the sixth most common type of cancer. It is a big challenge for oncoplastic surgeons to reconstruct these huge defects, as wide local excision of these tumors creates significant defects in functionally critical tissue. Reconstructive surgery requires close attention to both form and function.Patient and Methods: In our retrospective case series of 12 patients, we performed supramajor surgery for the reconstruction of hemifacial defects on 12 patients by our chief surgeon, out of which 10 were male (83.4%) and 2 patients were female (16.6%). Almost all of them were advanced malignancies and T4 tumors with N0 to N2 nodes and no distant metastasis. TNM cancer staging was all of stage IV, an advanced stage of tumor with histopathological diagnosis of either well differentiated, moderately differentiated, or poorly differentiated squamous cell carcinoma.After oncological resection, hemifacial defects were created, which were covered using a combination of two or more flaps, one microvascular and one pedicled flap, or two pedicled flaps or two free flaps. Pedicled flaps such as DP, PMMC, forehead, nasolabial, etc. were used in various combinations with microvascular-free flaps like Fibula, RAFF, ALT, LD, etc.Results: In our retrospective case series of 12 patients presenting with T4-staged head and neck cancer, they underwent resection, resulting in hemifacial defects. Four cases were reconstructed using a bilateral PMMC flap, and in three cases, a bipaddle ALT flap. In three cases, hemifacial defects were reconstructed using a PMMC flap in combination with a forehead or DP flap; one case was reconstructed using bilateral RAFF; and one case was reconstructed using contralateral PMMC with an ALT flap. All the flaps healed well, with functionally and aesthetically acceptable results and no further complications. The patient underwent radiotherapy or chemotherapy postoperatively. Conclusion: Post-palliative oncological resections lead to huge hemifacial defects. It is a complex task for the oncorconstructive surgeon. Using a combination of free flaps, pedicled flaps, or regional flaps, defects as huge as hemifacial defects are reconstructed. Hemifacial defect reconstruction requires supra-major oncoconstruction, keeping in mind functional and aesthetically acceptable results.

164. Efficacy of Preoperative Audiovisual Counselling on Perioperative Anxiety, Satisfaction and Stability on Patients Undergoing LSCS with AV Counselling versus Patient Undergoing LSCS Without AV Counselling
Bagya Lakshmi P M, JP Tiwari, Sarvjeet Varma, Alisha Singh
Background: The study objective involves the evaluation of the preoperative audiovisual information on the operation theatre environment as a tool to relieve anxiety in patient posted for LSCS under spinal anaesthesia. perioperative anxiety is detrimental to both intraoperative hemodynamic instability and postoperative recovery Methods: In this randomized control trial 100 parturient in the age group 18-40 years, American Society of Anaesthesiology (ASA) II, and admitted for Caesarean section under spinal anaesthesia. Patients were randomized into two groups: those who were not exposed to an audiovisual tour (NA) (n=50) and those exposed to audiovisual tour (A) (n=50). The measurements were based on demographic details; visual analogue score (VAS); and Amsterdam Preoperative Anxiety and Information Scale (APAIS) for anxiety, hemodynamic parameters, and patient satisfaction score (PSS) on five-point Likert scale.Results: The main results depicted significant decrease in VAS score and APAIS for anxiety, hemodynamic parameters, and satisfaction level (p<0.05) during intra-operative and post-operative periods in cases of group-A (with audiovisual counselling) than group NA (without audiovisual counselling).Conclusion: A preoperative audiovisual virtual tour of the operation theatre effectively reduces perioperative anxiety and stabilizes Heart rate; it also improves the satisfaction of patients undergoing elective surgery under spinal anaesthesia.

165. Fetomaternal Outcome in Pregnancies Complicated with Intrahepatic Cholestasis of Pregnancy (IHCP)
Kaushik Mahajan, Leimapokpam Roshan Singh
Background: The effects of Intrahepatic cholestasis of pregnancy (IHCP) on the foetus are significant. Preterm birth, meconium staining of the amniotic fluid, respiratory difficulties, foetal distress, and death are among the adverse foetal outcomes that are more likely to occur.Methods: This research recruited 101 women who were diagnosed with ICP at Regional Institute of Medical Sciences, Imphal in India between January 2019 and March 2023. To evaluate the relationships between foetal problems and maternal clinical and biochemical indicators, single predictor logistic regression models were used. Age, race/ethnicity, gravidity, parity, history of liver or biliary illness, history of ICP in prior pregnancies, and induction were among the clinical variables examined. Serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, albumin, total protein, and total bile acids (TBA) were among the biochemical predictors examined.Results: 1.9% of cases were ICP cases. Most were born by spontaneous vaginal birth (84%), and most had labour induced (87%). In 33% of the births, there were difficulties related to the foetus, most often respiratory distress. Clinical or biochemical variables that were statistically significant were not linked to a higher incidence of foetal problems. Until elevated TBA exceeded 100 mmoL/L, there was no correlation between elevated TBA and foetal difficulties, with 3 out of 5 cases reporting problems. Reduced risk of foetal problems was linked to ICP in prior pregnancies (OR 0.21, p = 0.046). No instances of late-term foetal death were reported.Conclusions: Elevated TBA and other maternal clinical and laboratory characteristics did not seem to be significant predictors of foetal problems in ICP.

166. Histomorphological Spectrum of Endoscopic Biopsies in Upper Gastrointestinal Lesions- A Study of 50 Cases in a Tertiary Care Centre
Roushan Kumar, Md. Zeeshan Haider, Anand Raj, Krishna Murari Prasad
Background: Lesions of the gastrointestinal tract along with symptoms represent a pathological condition that can be diagnosed with the help of endoscopy-assisted biopsies. In this study, the histomorphology of the biopsies obtained from endoscopy is used to diagnose the pathological stateMethods: The biopsies obtained were fixed with formalin and stained with hematoxylin and eosin. Further processing of the biopsies was done if the H.pylori and celiac disease were suspectedResults: The patients who were presented with the symptoms were mostly 60 years of age. Eight biopsies were from the oesophagus, 18 biopsies were from the gastric region, 13 biopsies were from the colon and rectal regions, and 11 biopsies were from the duodenum region. Most carcinomas in oesophagus region were squamous cell carcinoma; most biopsies in the gastric region were gastritis; and most biopsies in the colorectal region were benign neoplastic lesion.Conclusion: From this study, it can be concluded that a wide range of lesions can be analyzed to derive their pathological state. Endoscopy along with biopsy aids this process earlier and faster which helps physicians to develop an effective treatment plan.

167. Efficacy of Preoperative Audiovisual Counselling on Perioperative Anxiety, Satisfaction and Stability on Patients Undergoing LSCS with AV Counselling versus Patient Undergoing LSCS Without AV Counselling
Bagya Lakshmi P M, JP Tiwari, Sarvjeet Varma, Alisha Singh
Background: The study objective involves the evaluation of the preoperative audiovisual information on the operation theatre environment as a tool to relieve anxiety in patient posted for LSCS under spinal anaesthesia. perioperative anxiety is detrimental to both intraoperative hemodynamic instability and postoperative recovery Methods: In this randomized control trial 100 parturient in the age group 18-40 years, American Society of Anaesthesiology (ASA) II, and admitted for Caesarean section under spinal anaesthesia. Patients were randomized into two groups: those who were not exposed to an audiovisual tour (NA) (n=50) and those exposed to audiovisual tour (A) (n=50). The measurements were based on demographic details; visual analogue score (VAS); and Amsterdam Preoperative Anxiety and Information Scale (APAIS) for anxiety, hemodynamic parameters, and patient satisfaction score (PSS) on five-point Likert scale.Results: The main results depicted significant decrease in VAS score and APAIS for anxiety, hemodynamic parameters, and satisfaction level (p<0.05) during intra-operative and post-operative periods in cases of group-A (with audiovisual counselling) than group NA (without audiovisual counselling).Conclusion: A preoperative audiovisual virtual tour of the operation theatre effectively reduces perioperative anxiety and stabilizes Heart rate; it also improves the satisfaction of patients undergoing elective surgery under spinal anaesthesia.

168. Prevalence of Personality Traits in Patients with Generalized Anxiety Disorder
Palkin, S. K. Mattoo, Varun Arora, Arvind Sharma, Saurabh Yakhmi, Shubham Batra,Virpal Kaur
Background & Aim: Personality traits refer to the enduring patterns of perceiving, relating to, and thinking about environment and oneself. Generalized anxiety disorder (GAD) is characterized by persistent and significant tension and restlessness, accompanied by autonomic nervous function excitation and hypervigilance persisting for most of at least 6 months. The present study aimed to know the prevalence of personality traits in patients diagnosed with generalized anxiety disorder. Materials and Methods: The study was conducted at a tertiary care hospital in Shahabad, Haryana, to determine the prevalence of personality traits among patients diagnosed with generalized anxiety disorder (GAD). The study involved gathering reliable information through history taking and mental status examination, diagnosing GAD based on ICD-10 criteria, assessing patients’ socio-demographic profile using the Modified Kuppuswamy Scale (2022 version), and scoring the severity of GAD symptoms using the Hamilton Anxiety Rating Scale (HAM-A). Additionally, International Personality Disorder Examination for ICD-10 (IPDE) was used to assess personality traits. Result: On Modified Kuppuswamy Scale mostly patients belonged to lower middle SES (48%), 72% patients were of younger age group (19-28 years) and most patients were females (64%). On HAM-A scale, most patient’s scores ranged in the mild severity (64%), followed by mild to moderate severity (28%) and moderate to severe (8%). Using IPDE (ICD-10) module PD traits were detected in 72% GAD patients (n=8). PDs were present in 8% patients (n=2), no PD-traits or PDs in 20% patients (n=5). Cluster C and mixed cluster PD-traits were most prevalent, 28% each. Within Cluster-C, Anankastic PD-traits (16%) were of highest prevalence, followed by Anxious (8%) and Dependent (4%) PD-traits. Majority of patients (57.14%) with mild to moderate severity on HAM-A had mixed PD traits. Cluster-C PD traits with mild severity on HAM-A were statistically significant (p value=0.036), calculated using Pearson Chi-square. Conclusion: Personality impairments were seen in majority of the patients with generalized anxiety disorders having variable sociodemographic distribution. Cluster-C and mixed personality disorder traits were most prevalent while there was a significant association of milder severity of GAD with Cluster-C PD traits.

169. Assessment of Needs, Causes and Perception of Women after Stillbirth
Prabh Simranpal, Anju, Ashishjot Kaur, Satinder Pal Kaur, Tarvinderjit Khurana, Rajat Gupta, Parneet Kaur
Aim: We aim to evaluate the stillbirth rate, the main leading factors, its emotional impact on families, and the needs of mothers after the baby’s demise.Design: It is a prospective cohort study that was conducted in the Inpatient wards of the Obstetrics and Gynaecology department of Rajindra Hospital, Patiala (a tertiary healthcare institute).Materials and methods: A total of 100 mothers who had stillbirths willingly participated and were surveyed through a questionnaire, centered around World Health Organisation and EPDS standards, following informed consent. Appropriate percentages were calculated for the various categories of our study. Results: The stillbirth rate in our study came out to be 63.4/1000 births. Congenital abnormality and FGR were the most frequent fetal factors linked to stillbirth. Placental conditions like previa and abruption were found in 31% of the cases in our study. 97% of parents went through several stages of grief and bereavement following the loss of their baby. A large number of mothers denied to preserve memories like footprints, hand prints, and locks of hairs and were not interested in going for an autopsy (73%) or dried blood spot testing (89%) in our study. A big share of mothers of the deceased baby were worried about future pregnancy (87%) and future childbirth (93%).Conclusion: Interventions for inter-conception counseling should be undertaken to provide couples with crucial knowledge to enhance pregnancy outcomes, identify fears, assess genetic risk, ease bereavement, and examine attachment and parenting issues.

170. Acute Kidney Injury in Covid-19 Patients Hospitalised in Intensive Care Unit
Raghavendra BL, Varsha R Mokhasi, Ahmedi Fathima
Introduction: The incidence of AKI with COVID-19 has been reported varying from 3%–9%. A large prospective study has reported the overall incidence of 5.1%.17 In a study of 59 COVID-19 patients with 28 severe cases and 3 deaths, Li et al found that 34% of patients had proteinuria on the first day of admission, and 63% developed proteinuria during the hospital stay. Nineteen percent of people showed an elevated level of serum creatinine. Blood urea nitrogen (BUN) was elevated in 27% patients and in two-thirds of patients who died. The study also emphasized that renal impairment may be an independent factor of mortality. There is a dearth of data in India, especially among critically ill patients in the ICU. Little to date has been published on AKI in COVID-19 beyond rate; for example, wider descriptions of the timing, urine studies, relationship to respiratory failure, detailed analysis of renal replacement therapy (RRT) requirements, risk factors, and outcomes post-AKI are lacking.Settings and Design: We conducted a cross sectional observational study at a tertiary health care centre in Mysuru, India. Data for this study was obtained from the Intensive Care Unit (ICU) admitted patients who were confirmed positive by polymerase chain reaction testing of a nasopharyngeal sample for COVID-19 and those who were hospitalized from October 1, 2020 to December 31, 2020 were included.Methods and Material: Patients aged above 18 years; ICU admitted with COVID 19 infection patients. The definition of AKI was considered according to Kidney Disease – Improving Global Outcomes (KDIGO) criteria. The primary outcome was Acute Kidney Injury in ICU set-up. Secondary outcomes was requirement for discharge, death . The RRT facility provided to our patients were in the form of intermittent haemodialysis, sustained low efficacy dialysis or CRRT (Continuous Renal Replacement Therapy). Statistical analysis:The data was collected using a pre-tested structured questionnaire. The data was entered into Microsoft excel spread sheet. The qualitative variables were coded.The collected data was summarized and presented as frequencies, proportion, mean and standard deviation, depending on the quantitative or qualitative variables. Analysis was performed using SPSS 22 version.Results: Among patients hospitalized with COVID-19, we found that 33.8% developed AKI during their hospitalization. In addition, the respiratory disease severity appeared to be less, as only 13.4% of their patients required mechanical ventilation compared with 21.5% among our patients. We also found that the development of AKI among our patients was associated with  poor prognosis. Of 176 who developed AKI, 17 % of them died. Conclusions: In conclusion, we found that AKI was a relatively common finding among patients  hospitalized with COVID-19. It was strongly linked to the occurrence of respiratory failure and was rarely a severe disease among patients who did not require entilation. The development of AKI in patients hospitalized for COVID-19 conferred a poor prognosis.

171. Observation of Anatomical Mechanical Femoral Angle (AMFA) and Mechanical Femoro-Tibial Axis Angle (MFTA) on Ctscanogram Bilateral Lower Limbs in Those Undergoing CT Angiography in Adult Indian Population
Srinivas Pandurangaiah Sivaram, Ranganatha BT, Naveen Kumar N, Harish YS, Nishaa Prathap
Background: The angle formed between the mechanical axis of the femur and the anatomical axis of the femur is the anatomical mechanical femoral angle. The alignment of this angle has great importance in performing a proper distal femoral cut during total knee arthroplasty.ethod:100 knees CT scanogramswere selected for study. Anatomical mechanical femoral angle (aMFA) and mechanical femoro-tibial axis angle (mFTA) in adults were compared radiologically, and variations of these angles were noted.Results: The femoral mechanical femoral angle (aMFA) was 6.450 (± 1.240)- range 4 to 100, the mechanical femoro-tibial axis angle (mFTA) was 1.60 (± 0.6).Conclusion: The present correlative study of aMFA and mFTA will be quite useful to orthopedicianartists for distal femoral cuts during knee arthroplasty to maintain normal erect posture post-operatively.

172. MRI Study of Uterine Mass Lesions in Correlation with Trans-Abdominal, Trans-Vaginal Ultrasound using HPE as a Gold Standard
Girish Babu Swarna, Peruri Venkata Sri Ramachandra Murthy
Background: Although MRI is an expensive technique compared to USG, USG examination can’t encompass every lesion or mass of the uterus due to the obscuration of the pelvis by bowel gas; hence, both studies are mandatory to conclude the uterine mass apart from the histopathology of the uterine mass.Method: In 30 adult women with uterine masses, transabdominal ultrasound, transvaginal ultrasound, and MRI were performed in all patients. The observations were compared.Results: The clinical manifestations were: 21 (70%) had pain, 11 (36.6%) had bleeding PV, 9 (30%) had discharged PV, 2 (6.6%) had a mass abdomen, 2 (6.6%) had loss of weight and appetite pre-menopausal, and 10 (33.3%) were post-menopausal.According to their histopathological report, they were classified into five groups: adenomyosis was affected in 7 patients, fibroids were observed in 14 individuals, endometrial cancer was in 2 patients, and cervical cancer was polyp. Out of ten women, two had adnexal pathology.Conclusion: TVS is a good screening modality, but MRI is definitely better for proper characterization and localization of fibroid, enabling clinicians to select the most appropriate management in clinical practice today.

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