International Journal of

Pharmaceutical and Clinical Research

e-ISSN: 0975 1556

p-ISSN 2820-2643

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1. A Comparative Study of the Correction of Serum Urea and Creatinine in Type-1 and Type-2 Diabetes Mellitus
Chhatray Marndi, Ashok Kumar Behera, Gopabandhu Patra
Background: End stage renal disease (ESRD) and deterioration of the kidney are the associated risk factors of diabetes and may lead to kidney failure with reduced levels of glomerular function which in turn causes the levels of serum creatinine and urea to increase rapidly. The aim of this study is to correlate the levels of urea and creatinine with glycemic index and diabetes duration in type-1 and type-2 DM. Materials and Methods: The analysis of the levels of serum urea and creatinine was done by collecting the blood samples in patients with diabetes (type-1 and type-2) and non-diabetes in a tertiary care center. A total of 144 males in each group with the age of 35-55 years affected with diabetes and non-diabetic patients were included in this study. Pre and post meal sugar levels, Hemoglobin A1C levels of all the patients were also analyzed. The resulting values were concluded by a one-way variance test. Pearson’s correlation coefficient was used to analyze the levels of serum urea and creatinine with Hemoglobin A1C and the period of illness in all the diabetic patients. Results: A total of 144 participants in each group were selected. The levels of the serum urea and creatinine were found to increase notably in both the types of diabetes patients when compared to patients with no diabetes. The mean ± Standard deviation value of blood sugar level (fasting) of the control group was found to be 83.89±7.50 and the mean ± Standard deviation value of blood sugar level (post meal) of the type 1 DM patients was found to be 97.64±12.50. A significant association of the levels of serum urea and creatinine with Hemoglobin A1C and the period of illness were noted in type-1 diabetes patients only. Conclusion: The levels of serum urea and creatinine stands as valuable biological markers to predict the proper function of the kidney in patients with diabetes.

2. To Assess the Diagnostic Accuracy of Wet Mount and Concentration Methods of Stool Examination for Detecting Intestinal Parasite Infections at a Hospital with Tertiary Care in India
Uppal Rashmi Kunkal, Abhay S Tirkey, Pushpendra Singh Sengar, Hindeshwari Rai
Background and Objectives: To assess the diagnostic accuracy of wet mount and concentration methods in detecting intestinal parasite infections during stool testing. Methodology: A total of 260 patients provided stool specimens, which were collected and evaluated in the Laboratory of the Department of Microbiology at RIMS, Ranchi during a period of 1 year.  The study participants were chosen by the utilisation of a systematic random selection methodology. The stool sample was analysed using the Wet Mount (WM) method and various Concentration Techniques. The data was inputted into Microsoft Excel spreadsheet 2007 and analysed using SPSS version 20.0. The sensitivity, specificity, positive predictive value, as well as negative predictive value were assessed using the combined result as the gold standard. The Kappa value was calculated to assess the concordance of the diagnostic procedures. Results: The prevalence of females was higher than that of males in both techniques. Through the routine technique, the prevalence was determined to be 17.07% in females and 15.16% in males. Through the Concentration Method, the percentage was determined to be 30.00% in females and 28.85% in males. The age group with the greatest occurrence rate was 6-10 years, namely 66.03%. Conclusion: The wet mount approach resulted in an underestimation of the frequency of intestinal parasites. Based on these results, we see that the supplementation of concentration method along with the routine wet mount method is more sensitive than the routine wet method alone. Therefore, the WM and various concentration techniques should be used as a routine diagnostic technique for the diagnosis of intestinal parasites identification.

3. Assessment of Healthcare Personnel’s Knowledge, Attitudes, and Practices in Biomedical Waste Management: A Cross-Sectional Study
Ajay Krishna, Aishwarya Krishna, Shalini, Ankit Krishna
Background: The waste generated during healthcare endeavors possesses a heightened propensity for infection and harm in comparison to all other forms of waste. Insufficient and unsuitable understanding of the proper management of healthcare waste can potentially result in severe health implications and exert a notable influence on the surrounding ecosystem. The primary objective of this study was to estimate the level of knowledge, attitude, and adherence to proper practices among healthcare professionals, including nurses, doctors, sanitary staff, and laboratory technicians, in relation to the management of biomedical waste. Materials and Methods: The investigation was conducted as a cross-sectional study. The present study was conducted within the healthcare facilities of Patna city, specifically focusing on hospitals with a bed capacity exceeding 50. The medical personnel comprised of 70 physicians, 50 registered nurses, 68 laboratory technicians, and 60 members of the sanitary staff. Results: The level of experience that healthcare professionals, such as nurses, laboratory technicians, and physicians, possess in the field of biomedical waste management is far higher than that of sanitary workers. The nurses and laboratory staff exhibited a higher level of understanding with regards to the color coding and waste segregation at the source, in comparison to the doctors. In relation to the practices concerning the management of biomedical waste, it was observed that the sanitary personnel exhibited a lack of knowledge and awareness across all aspects. Nevertheless, there was a notable paucity in injury reporting among all cohorts of healthcare practitioners. Conclusion: The significance of training pertaining to biomedical waste management necessitates emphasis, as insufficiency in comprehensive understanding of biomedical waste management adversely affects the implementation of suitable waste disposal procedures.

4. Assessment of the Socio-Demographic Profile, Knowledge, and Training Status of Healthcare Personnel Associated with RNTCP in Relation to Loss to Follow-Up
Ajay Krishna, Aishwarya Krishna, Shalini, Ankit Krishna
Introduction: The pivotal role in the management of tuberculosis is undertaken by health workers affiliated with the NTEP or RNTCP. The efficacy or inefficacy of treatment is contingent upon the comprehension, disposition, and conduct pertaining to tuberculosis among healthcare practitioners. Consequently, the current investigation was designed to evaluate the socio-demographic characteristics, level of knowledge, and training status of Health Care Workers affiliated with the NTEP/RNTCP in relation to instances of loss to follow-up. Methodology: A total of four hospitals, consisting of two urban and two rural facilities, were selected using a random sampling method. All healthcare professionals associated with the RNTCP, including STS, STLS, LT, TBHV, and DOTS providers from the designated T.U.s, DMCs, and DOTS centers, were interviewed using a pre-tested semi-structured interview schedule. Results: Healthcare workers were mostly 30-41-year-old men with graduate degrees. These people understood TB’ genesis and transmission processes well. The majority of people have received occupational-specific training. Most participants (71.41%) said pharmacological side effects contributed to TB treatment follow-up loss. A considerable majority (57.62%) stated that a feeling of wellbeing had a role, and a smaller percentage (33.48%) ascribed the loss to follow-up to an alcoholic habit. Conclusions: 26% of healthcare workers didn’t know what “loss to follow-up” meant. The majority of people believed that treatment side effects, improved health, and alcohol usage were the main causes of tuberculosis follow-up loss. Thus, educational measures to reduce follow-up loss and increase female healthcare professional participation are needed.

5. Ultrasonic Indicators for Good Ovarian Response in Patients with Infertile Poly Cystic Ovarian Disease
Samira Mistri
Background and Aim: Polycystic ovaries are a prevalent hormonal disorder affecting ovulation. The study introduced an ultrasonographic scoring system that can predict the likelihood of pregnancy in individuals with PCO. Various strategies have been employed to improve ovulation in individuals with polycystic ovary syndrome (PCOS), including the use of ovulation induction and/or intracytoplasmic sperm injection (ICSI) as a viable treatment.   Ultrasound plays a crucial role in the assessment and surveillance of patients with infertility. Material and Methods: This study was a prospective observational study that compared two distinct scores of ovulation tracked by ultrasound in women with polycystic ovary syndrome (PCOS). A total of 160 cases of PCO were separated into two groups of similar size.   This study was carried out at the Department of Obstetrics and Gynaecology in a prestigious teaching institute in India for a period of one year.   A total of 160 participants were divided into two groups and induced for ovulation using a minimal stimulation protocol. After the induction of ovulation in patients with known polycystic ovary syndrome (PCOS), six different ultrasonic parameters were calculated. Group one had a collective ultrasound score greater than 6, while group two had an ultrasound marker score of less than 6. Results:  The demographic statistics of both groups were similar and there was no statistically significant difference. The p-value is greater than 0.05.   In relation to chemical pregnancy, there were 65 out of 80 individuals who had an HCG level greater than 25, compared to 40 out of 80 individuals in the second group with a score less than 6. This difference was statistically significant. Conclusion: The development of a novel composite ovarian and endometrial score for individuals with polycystic ovarian disease demonstrates a favourable prognostic and predictive capacity for determining the clinical pregnancy rate and ovulation rate.   The sonographic score comprises measurements of cortical/stromal length, stromal resistive index, presence of a perifollicular ring of fire, tri-laminar endometrium, endometrial thickness, and applebaum grade 3 endometrial flow.

6. High Serum Interlukin-6 in Acute on Chronic Liver Failure (ACLF) is a Early Mortality Predictor
Shravan Kumar Jannu, Suresh Arya, Amit Mathur, Shobna Bhatia
Background and objectives: Acute-on-chronic liver failure (ACLF) is characterised by a poor prognosis. Interleukin-6 (IL-6) is a pro-inflammatory cytokine associated with both severe liver damage and the liver regeneration, suggesting that systemic inflammation plays a substantial role in its aetiology. There is no research on how serum IL-6 affects ACLF prognosis. To examine serum IL 6 levels as a separate predictor of early mortality in ACLF patients. Method: A retrospective analysis was conducted at NIMS Jaipur from December 2021 to June 2023.   In this study 150 patients participated and IL 6 serum levels were measured. The results were examined in relation to mortality, baseline serum IL-6 levels, and dynamic changes in IL-6 levels over the course.  Results: Mortality was linked to the level of IL-6 in the serum. In contrast to living patients, higher mortality rates within 4 weeks were seen in patients with high IL-6 levels > 19.8 pg /mL (7.3 -57.6 ) compared to low IL-6 levels 12.5 (4.7- 22.3) p=0.018 pg/mL Odds ratios were estimated using univariate and multivariate logistic regression, and the results were 2.20 (95% confidence interval [CI] and 2.12 (95%CI) respectively. In comparison to patients with high IL-6 levels at 4 weeks, those with high IL-6 levels between weeks 5 and 8 had a mortality rate of 15.0%, which was considerably greater than 6.6% in low IL6. The dynamic change of increasing trend of IL-6 significantly high mortality rate. Conclusion: In patients with ACLF, the sustained high serum IL-6 level is a stand-alone risk factor for high mortality.

7. Association between Knowledge and Practicing Behaviour of HCWs
Rijul Ranjan, Varsha Chaudhary, Pawan Parashar
Background: The term “biomedical waste” has been defined as “any waste which is generated during diagnosis, treatment or immunization of human beings or animals, or in the research activities pertaining to or in the production or testing of biologicals and includes categories as mentioned in schedule I of the Government of India’s Biomedical Waste (Management and Handling) Rules 1998”. Objectives: To assess the practices related to Bio-Medical Waste Management Material & Methods: The present cross-sectional study was conducted from march 2016 to February 2017among healthcare workers of tertiary care hospitals of Meerut city. Simple random sampling was used. The written consent was taken. Data was analysed using SPSS version 19 and Pearson’s Chi square test was applied. Results: The healthcare workers segregate BMW according to different categories and they were doing this at the point of generation (87.6% and 88.5% respectively). 88.5% HCWs did not dispose all kind of waste into garbage waste. Majority (89.2%) were following color coding for disposal of BMW. Correct practice related to disposal of Normal Waste was observed in 89.2% of HCWs. Most of the HCWs were correctly disposing category 1,6,7 and 8 of BMW (97.1%, 89.2%, 88.5% and 97.1% respectively) whereas Category 2,3,4,9 and 10 were disposed correctly by nearly three-fourth of the HCWs (72.3%, 73.9%, 72.3%, 78.0% and 78.0% respectively). Conclusion:  Practices regarding Bio-Medical Waste was also found to be satisfactory in all the Health Care Workers but lower for IV class workers.

8. Effect of Intrathecal Bupivacaine versus Ropivacaine in Caesarean Section: A Systematic Review.
Dinesh Kumar Sahu, Prashant Sachan, Manoj Kumar Upadhyay, Rituraj Singh
Background: This systematic review investigates the comparative impact of intrathecal bupivacaine and ropivacaine on maternal and foetal outcomes during caesarean sections. Focusing on the onset of motor and sensory blockade and neonatal well-being assessed through APGAR scores, the study aims to inform clinical decision-making in obstetric anaesthesia. Materials and Methods: A thorough search of relevant databases identified studies assessing intrathecal bupivacaine and ropivacaine in caesarean sections. Studies were selected based on predefined criteria, and data extraction included onset times and APGAR scores. The systematic review adhered to PRISMA guidelines, ensuring a rigorous and comprehensive approach. Results: Analysis of the selected studies revealed variations in the onset of motor and sensory blockade between bupivacaine and ropivacaine. While some studies showed comparable onset times, others demonstrated statistically significant differences, emphasizing the need for individualized anaesthesia regimens. Notably, APGAR scores at 1 and 5 minutes consistently indicated favourable neonatal outcomes with both agents, highlighting their safety in the intrathecal setting. Conclusion: This systematic review provides valuable insights into the comparative effects of intrathecal bupivacaine and ropivacaine in caesarean sections. The observed variations in onset times underscore the importance of tailoring anaesthesia regimens based on individual patient characteristics and clinical context. Importantly, the consistently favourable APGAR scores affirm the overall safety of both agents. Clinicians can use these findings to make informed decisions, recognizing the nuanced differences between bupivacaine and ropivacaine in the obstetric anaesthesia landscape.

9. Analysis of the Prevalence and Pattern of Polypharmacy among Elderly Patients in General Medicine and Orthopaedic Department of a Tertiary Care Hospital in Pondicherry
Nikita Rao Nalla, Narayanasamy S, B.R.Asokan, Kamali A
Introduction: Global population aging continues to be a significant phenomenon. Due to their various chronic illnesses, which necessitate the use of multiple medications, elderly persons are more likely to be prescribed multiple medications, a practice known as polypharmacy (PP) or potentially inappropriate medication (PIM). Aims and Objectives: This study set out to: (1) To access the prevalence and incidence of polypharmacy among the elderly patients in general medicine and orthopaedic department. (2)Assess the prescription pattern and which medications were most commonly administered to this group of people. Methods: This Hospital-based Prospective and observational study will be conducted in AVMCH a tertiary care teaching hospital was carried out on senior patients who visited the out-patients departments (OPD) of General medicine and orthopaedics. The Institutional Ethical Committee granted approval for the trial, which ran for a full year from May 2023 to April 2024. Data on the demographic data, prescribing pattern of drugs (polypharmacy), total number of prescribed drugs, and main and adjuvant drugs prescribed to patients during treatment given to patients were gathered and entered on excel sheet. Results: Of the 600 patients, 315 men and 285 Women were involved in the research. Minor polypharmacy (two to four drugs) accounted for 86.5% of the prevalence, major polypharmacy (five or more drugs) for 13.0%, and hyper polypharmacy (ten or more drugs) for 0.5%. Most often recommended medications in department of medicine included NSAIDs, multivitamins, PPI, leukotriene receptor antagonists, H2 blockers and antihistamines, which accounted for 99.3%, 41.7%, 41.0%, 14.0%, 12.0% and 10.0% respectively. In orthopaedics department NSAIDs, vitamins, proton-pump inhibitors, H2 receptor blockers, pregabalin, agents, antacids, antispasmodics and opioids analgesics, they accounted for 145.3%, 68.7%, 47.7%, 25.0%, 13.7%, 13.7%, 7.0% and 3.0%.respectively. Conclusion: polypharmacy is no doubt a global issue however it is avoidable and treatable with the right prescription. Future medication usage strategies for senior patients will employ a multidisciplinary team comprising physicians, nurses, and pharmacists. This study can further be extended with more number of cases and for a longer duration to get a broad idea on the potential DDIs in various other departments with respect to the wide range of diseases encountered.

10. Comparative Study of Ultrasonography (USG) and Computed Tomography (CT) in the Evaluation of Suspicious Ovarian Masses
G.Rakesh Sharma, K.Raghunatha Reddy, D. Edwin Moses, Jerin Paul Jacob
Introduction: Ovarian tumours continue to be a major source of concern for Gynaecologists and radiologists. Ovarian Carcinoma is the second most prevalent type of gynaecological cancer. The purpose of this study was to compare ultrasound and computed tomography diagnostic modalities in the evaluation of suspicious ovarian masses. Materials and Methods:  The present study was conducted in Department of Radio- Diagnosis, Viswabharathi Medical College, Kurnool, Andhra Padesh, India. In the present study 50 females were enrolled having Suspicious Ovarian Masses. Computed tomography (CT) and USG characteristics of ovarian lesions were noted and recorded. The histopathological diagnosis was followed up and recorded.  CT scan and Ultrasonography are excellent noninvasive modality to differentiate ovarian masses from benign and malignant lesions and both imaging techniques seem to be comparable in differentiation of malignant from benign ovarian tumors Result: 50 patients were evaluated. USG had sensitivity of 87.6%, specificity 64.4%, positive predictive value (PPV) of 88.4% and negative predictive value (NPV) of 65.7% for benign tumors whereas for malignant tumors the sensitivity was 62.4, specificity 87.6, PPV 65.3% and NPV 85.3%. CT scan showed sensitivity of 98%, specificity of 96%, and PPV of 98% and NPV of 96% for benign tumours whereas for malignant tumors the sensitivity was 88.6, specificity 93.1%, PPV 78.6% and NPV 95.8%. Conclusion: The evaluation of ovarian masses by Computed tomography scan was superior to the evaluation by Ultrasonography.

11. Knowledge of Hiv/Aids and Attitude toward Voluntary Counselling and Testing among Antenatal Clinic Attendees at a Tertiary Care Center
Shagufta Fatema, Varsha Deshmukh, Pallavi W Tidke, Sanjaykumar Pagare,  Pratima Gaikwad
Introduction: Human Immunodeficiency Virus is a retrovirus that causes Acquired immunodeficiency Syndrome (AIDS). In India of estimated 1.8-2.9 million people living with HIV, 39% are women with a national antenatal prevalence of 0.48%. Mother to child transmission (MTCT) is responsible for 90% of childhood HIV infections. The transmission of HIV from infected mother to babies can occur during antenatal period (in utero by transplacental spread), intrapartum period (during delivery through an infected birth canal),a postpartum period(through breast feeding.Methods: This cross sectional descriptive study was carried out at tertiary care hospital in Department of Obstetrics and Gynecology, Government Medical College Aurangabad. The study protocol was cleared by the institute research and ethics committee of the college. Results: Out of 500 cases in this study, 300 cases(60%) belonged to 21-25 age group, followed by 130(26%) belonged to age group <20 yrs. Amongst the study group 270(54%)  were second gravida, 178(35.6%) were primigravida and 52(10.4%) were third gravid. Majority of cases were educated up to primary level 305(61%), 142(28.4%)  were uneducated,20(4%) were up to  higher secondary. In our study the knowledge regarding sexual intercourse with infected partner was there in 156(31.2%) women. The role of sharp object and blood transfusion in the transmission was not known to majority of women i.e. 331(66.2%) and 323(64.6%) respectively. Most important, the MTCT was not known to 364(70.4%) of cases. Conclusion: Antenatal care attending pregnant women’s awareness on MTCT and their knowledge on its timing is still low in our country.  The lack of adequate knowledge regarding HIV and preventive practices against MTCT may be one of the reasons for HIV transmission from mother to fetus. In absence of an effective vaccine and cure, voluntary counseling and testing appears to be essential in the prevention of MTCT of HIV.

12. Assessment of Psycho-Social Effects of Vitiligo in a Tertiary Health Care Centre of Central India
Farah Khan, Saurabh Sarda, Prasanjeet Dash, Ransingh Tanwar
Background and Objectives: To study the socio-demographic profile and the effect of Vitiligo on of quality of life of these patients. Screening of psychiatric Morbidity in patients with vitiligo. Material and Methods: A hospital based, single observer, cross-sectional study was conducted over a period of three months involving 115 patients of vitiligo attending the dermatology OPD of a tertiary health care centre of Madhya Pradesh, India. All the patients between 18 to 65 years of age group, of both the gender with at least 3 months of duration of illness and willing to informed consent were included in the study. Results: Highest DLQI score, lowest RSES and highest BRPS was observed amongst 18 to 30 years of age group. Patients with vitiligo had significant reduction in quality of life, self-esteem and psychiatric stress/burden and severity of affliction varied based on various demographic, patient and disease factors. Conclusion: Vitiligo although non-life threatening, still continues to be a common cosmetically disfiguring disease. All genders, age groups, races are equally effected with the severity of infliction being significantly more if BSA involved is more or if exposed sites are involved and also the stress and quality of life become worse as the duration of disease increases.

13. Analgesic Efficacy of Bilateral Superficial Cervical Plexus Block Administered Before Thyroid Surgery: A Systematic Review
Dinesh Kumar Sahu, Ashish Puri, Manoj Kumar Upadhyay
Background: Thyroid surgery, while essential for various thyroid conditions, often poses challenges in postoperative pain management. The bilateral superficial cervical plexus block (BSCPB) has emerged as a potential analgesic intervention, but evidence remains diverse. This systematic review explores the analgesic efficacy of BSCPB by examining variations in timing, techniques, and perioperative strategies. Materials and Methods: A systematic search of electronic databases identified 14 studies meeting inclusion criteria. Data on sample size, timing of block, block details, types of surgery, premedication, intraoperative, and postoperative analgesia were extracted. Methodological quality was assessed, and a narrative synthesis was performed. Results: Studies demonstrated heterogeneity in sample size, timing of BSCPB, and surgical types. Premedication varied with agents like hydroxyzine and midazolam. Intraoperative analgesia predominantly involved opioids (sufentanil, fentanyl), while postoperative regimens included intravenous paracetamol and morphine. Conclusion: The analgesic efficacy of BSCPB in thyroid surgery shows promise but warrants cautious interpretation due to methodological variations. Tailoring interventions based on patient and surgical factors is crucial. Standardization and larger studies are imperative for conclusive insights into optimizing pain control in thyroid surgery.

14. Study on the HIV Status of the Children Born to HIV Positive Mothers
Subhash Singh Slathia, Sanjeev K Digra
Introduction: HIV 1 and HIV 2 are members of the Retroviridae family and belong to the lentivirus genus. HIV infection affects the immune system and disrupts its homeostasis. In 2015, WHO estimated that 1.8 million children younger than 15 yrs. of age worldwide were living with HIV 1 infection. Children contribute to one-sixth of HIV deaths and more than 95% of HIV infections in children are due to vertical transmission. Aim: To analyze the efficacy of nevirapine prophylactic therapy in the prevention transmission of HIV infection from mother to child. Method: This retrospective cohort study was conducted at a Pediatric Centre of Excellence in HIV Care in northern India. It focused on infants born to HIV-positive mothers enrolled in the Prevention of Mother-to-Child Transmission (PMTCT) program. This study assessed HIV status using DNA-PCR and serological tests in infants before and after national guideline changes. Maternal and infant data was obtained, including nutritional status and ethical approval. Results: In a study involving 47 children born to HIV-positive mothers (25 male, 22 female), significant findings emerged. Of the mothers, 36% were identified as HIV-positive before pregnancy, 51% during antenatal testing, and 10% during labor. Notably, more mothers were identified during antenatal than prenatal and natal periods (P=0.047). Additionally, 6% of children tested positive for HIV after Nevirapine prophylaxis, with a significant number having negative results (P=0.041). Rural areas had more affected children (27) than urban areas (20). ELISA testing was conducted on 28% of children, revealing a 4% positive rate. Conclusion: The implementation of Nevirapine prophylaxis therapy showed promising results, with a low proportion of HIV infection among the children born to HIV-positive mothers.

15. Can Retrograde Intra Renal Surgery Replace Mini Percutaneous Nephrolithotomy in Renal Stone of Size Upto 25 mm a Retrospective Analysis: RIRS Vs MiniPCNL
Abhilekh Tripathi, Sabyasachi Panda, Sachin Sharma, Tilala Yash Manharlal, Jateen Anshuman, Kishore Kumar Behera, Samir Swain
Background: Renal tone diseases are common in Indian population, prevalence is about 13%, but it constitutes major cause of chronic renal diseases in unattended patients. Methods: In this study we have compared mini PCNL with RIRS for the management of stone diseases in renal stone size up to 25 mm. it’s a retrospective study to assess which one is better. In this study we took 150 cases of mini PCNL and 142 cases of RIRS Results: The RIRS group had a similar operative time, but less hemoglobin drop, shorter hospital stays than that in MPCNL group. In the MPCNL group, total complication occurred 24/150 while in the RIRS group vs  11/142. However, the differences was statistically significant (16% in PCNL vs. 7.7% in RIRS, p=0.315). The stone-free rate after a single procedure was similar in both groups. Conclusion: (1) RIRS showed higher SFR compared to MPCNL after a single session can get a satisfactory stone-free rate. (2) MPCNL can achieve a similar stone-free rate, but still with potential severe bleeding complication, which can occur by chance or technical problems. (3) Patients with much more number of risk predictors (lower pole location, severe hydronephrosis, and multiple calyces) will get lower stone-free rate after RIRS, and this model has good preoperative predictive accuracy for SFR. (4) the RIRS may be the first option to treat these group of patients with 2–3 cm stones.

16. Factors Contributing to Foot Amputation Risk in Patients with Diabetic Foot Infection
Chhatray Marndi, Gopabandhu Patra, Rakesh Ranjan Swain, Saubhagya Chhotaray
Introduction: Diabetic foot complications pose a significant health burden globally, particularly among specific ethnic populations. Understanding the contributing elements of diabetic foot ulcers and amputations is critical for tailored preventive strategies. The goal of the research is to understand the risks involved in foot amputation in the cases of Diabetic foot ulcers. Methods: The study was conducted at Balangir Medical College and Hospital Bhima Bhoi Medical College. The entire investigation and research followed the medical procedure and ethics of the Helsinki Declaration. Medical records of 150 participants were reviewed, evaluating variables such as foot ulcer location, size, chronic kidney disease, eGFR, and sarcopenia index. Statistical analysis was conducted for each variable. Results: While comparing both the categories it was observed that the ankle-brachial index (ABI) showed a substantial difference, with the amputation group displaying a lower mean ABI (1.0 ± 0.1 vs. 1.9 ± 0.6, p = 0.028). Previous amputation history, ABI < 0.9 prevalence, and chronic kidney disease were notably higher in the amputation group. Moreover, the amputation category had a significantly lower eGFR (66.2 ± 26.0 vs. 64.1 ± 29.8, p = 0.039). These findings suggest ABI, past amputation, kidney health, and eGFR as crucial amputation risk factors in diabetic patients. Conclusion: Analysis revealed forefoot ulcers as higher risk factors for amputation due to compromised blood supply in the distal foot area. Larger ulcer sizes and lower eGFR significantly increased amputation risk, emphasizing the role of chronic kidney disease. The study underlines the necessity for early identification and targets prevention strategies for diabetic foot complications among the Indian population.

17. An Epidemiological Analysis of Delayed Presentation of Orthopaedic Polytrauma Patients to the ED
Saubhagya Chhotaray, Chhatray Marndi, Rakesh Ranjan Swain, Gopabandhu Patra
Objectives: This study aims to investigate the epidemiology of trauma and reasons for delays in reaching Emergency Departments (ED) in developing countries. Additionally, it focuses specifically on understanding the characteristics and causes associated with polytrauma patients. Methods: This prospective observational study conducted at Bhima Bhoi Medical College and Hospital in Odisha, India from December 2022 to September 2023 aimed to investigate polytrauma cases in the Emergency Medicine department. Criteria for inclusion involved individuals aged 20 to 60 with workplace or road traffic injuries, while exclusion criteria comprised specific skeletal injuries. Data, including patient demographics, injury details, and emergency response factors, were collected and analyzed statistically using SPSS version 21. Results: In the ten-month period, the Emergency Department received 265 polytrauma patients, with 60 meeting inclusion criteria. Among them, 70.67% were male, averaging 34.2 years. Road traffic accidents accounted for 64% of cases, occupational injuries for 35%, and 37.67% of patients were under alcohol influence. Only 32% reached the hospital within the golden hour, and significant correlations were found between alcohol intake and the mode of injury and the time of injury and the arrival time of government-run ambulances. Conclusion: This study highlights challenges in polytrauma care in low and medium-income countries, emphasizing the imperative for improved pre-hospital systems, including addressing road traffic concerns and transportation difficulties. Urgent measures, such as encouraging public involvement and increasing patrolling on accident-prone highways with ambulances can enhance timely trauma care within the critical golden hour.

18. A Study on the Evaluation of Adverse Drug Reactions Associated with Antiretroviral Therapy in Tertiary Care Hospital
Kaushal Kumar Mishra, Ashoka Kumar Chowdhury2 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.

19. A Comparative Analysis of Serum Creatinine and Urea in Diabetic and Non-Diabetic Individuals
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra
Introduction: Diabetes mellitus is a serious worldwide health concern because of its effects on many organ systems, notably kidney function. The purpose of this research was to examine the interrelationships and consequences of serum urea, serum creatinine, and blood sugar levels in persons (diabetic and non-diabetic). Materials and Procedure: Fifty diabetic and twenty non-diabetic individuals were evaluated during a three-month period at the SCB Medical college and Hospital, Cuttack, Odisha, India. Urea, creatinine, and blood sugar levels were measured using blood samples. Statistical calculations were used to examine the relationships and associations between these biomarkers. Results: In diabetic individuals, there was a strong positive association between blood sugar and serum urea levels, indicating a relationship between glycemic management and renal function. Serum urea and creatinine have emerged as viable indicators for monitoring diabetic kidney impairment. Notably, gender disparities in serum creatinine levels were discovered, necessitating additional research. Conclusion: Effective blood sugar control is critical in avoiding diabetic nephropathy. In diabetes, serum urea and creatinine are useful indices for evaluating kidney function. The study emphasises the importance of monitoring kidney health and functioning tests in the management of type 2 diabetes and urges for more research to improve diabetes treatment practises.

20. Comparative Study between Same-Day Discharge vs Overnight Stay in Laparoscopic Acute Non-Perforated Appendectomy in a Single Institution
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra
Laparoscopic appendectomy has become one of the most frequent laparoscopic surgeries done by surgeons on a daily basis. When compared to open appendectomy, the advantages are significantly greater, and so the change from open to limited access surgery has gained relevance, primarily in terms of perioperative duration. Small trials conducted over the last decade have shown that same-day discharge following appendectomy may be used for non-perforated appendicitis. We looked at a research group to see whether same-day release in acute non-perforated appendicitis is a safe alternative. All patients over the age of 18 who had acute, non-perforated appendicitis and had a laparoscopic appendectomy were included in the study. individuals released on the day of surgery were compared to individuals hospitalised for one night and followed up on sequentially. The research included 100 patients, 70 of whom were discharged on the same day and 30 of whom were hospitalised. When compared to the hospitalised group, patients in the same-day discharge group had a reduced risk of readmission within 30 days (2.2% vs 3.1%; p 0.005). The hospitalised group had somewhat more postoperative general surgery department visits (85% vs 81%; p 0.001).

21. An Overview of Surgically Treated Benign Breast Disease in Odisha: A Hospital Based Retrospective Clinico-Pathological
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra
Background: Benign breast illness is a pretty frequent occurrence in women. A thorough knowledge of benign breast disease is essential because successive steps are required to identify lesions that provide a high risk of eventual breast cancer from those that do not. Purpose: To know the characteristics of benign breast diseases which were treated surgically. Materials and Methods: This retrospective study included 111 patients with benign breast disease who were treated surgically from June 2021 to May 2023. Patients who did not required surgery were excluded. Histopathopathological reports were collected from pathology. Result: Most individuals with benign breast disease who had surgical treatment had fibro adenoma. The condition was more frequent in those aged 20 to 29. The most frequent location was the top outside quadrant, while the most common side was the right. Conclusion: Most patients with benign breast illness who had surgical treatment had fibro adenoma, according to this research.

22. A Clinical Study on Port Site Complications in Laparoscopic Surgery
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra
Background: Laparoscopic procedures have enhanced the surgical profession and are more favourable than lapa-rotomies in terms of decreasing patient morbidity, minimising hospital stays, and allowing patients to return to regular activities. Complications are determined by the extent of the portal site incision, the number of ports, obesity, and umbilical ports. Complications include abdominal access by laparoscopic trocars, vascular injuries, visceral injuries, air embolisms, subcutaneous emphysema, port site infections, portal site incisional hernias, and portal site metastases. Aims of the Study: To study and identify the port site related complications in laparoscopic procedures and to determine the risk factors, foresee difficulties, and recommend prompt preventative actions. Materials & Methods: A Prospective Observational study done in 50 patients undergoing Laparoscopic Sur-gery in the Department of Surgery, SCB Medical college and Hospital, Cuttack for a period of 12 months from May 2022 to April 2023. Results and Conclusion: A prospective research was conducted to examine the morbidity at the port sites of laparoscopic surgeries (both basic and advanced), including elective and emergency procedures, as well as the risk factors for complications and their management. This research population consisted of 100 people and was conducted over a three-year period. The most prevalent LPSCs were discharge and infection, followed by bleed-ing, PSH, and metastases. These problems are more common in people who have the following factors: Has-son’s approach of access or open, larger port size, older age group, higher BMI, specimen retrieval bag not uti-lised.

23. Hollow Viscus Injuries in Abdominal Trauma: A Clinical Study
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra
Background and goals:  To investigate the incidence of abdominal trauma. The incidence of blunt and penetrating abdominal trauma-induced hollow viscus lesions is investigated in this study. Demographics such as age and gender will also assist us understand stomach injury symptoms. Determine the duration between injury and surgery, as well as the effectiveness of treatment approaches. Methods: Between October 2021 and September 2022, 65 patients sought emergency care at the Department of General Surgery, SCB Medical college, cuttack for blunt or penetrating abdominal trauma caused by automobile accidents, attacks with various objects, acts of interpersonal violence, or unintentional falls. Those who had significant abdominal pain but exhibited no evidence of hollow viscus injury on imaging or after surgery were eliminated. Results: The starting factor declined with age, with 18 individuals aged 31 to 40 and 12 aged 41 to 50. 56 of the 65 patients were males, showing that men are more likely to be injured as a result of violence. 78 percent of the 65 patients with hollow viscus injuries had blunt trauma, whereas 13 had penetration. 25 of 42 patients had blunt hollow viscus injuries in car accidents, 9 from falls, and 8 from assaults. Of the 55 patients, 27 had primary perforation closure. Resection and anastomosis were necessary in 12 instances. Seven serosal tears mended without surgery. Conclusion: This research demonstrates that blunt abdominal trauma induces hollow viscus damage. As a result, patients with acute abdominal trauma should be assessed for hollow viscus damage. In dubious cases, extensive clinical testing, close observation, and further imaging are required to confirm the diagnosis and expedite surgery. The best restoration procedure is determined by age, intestinal pollution, underlying illnesses, and health. The most essential factors are surgeon skill and trauma center facilities.

24. A Comparative Study of Anesthetic and Analgesic Effect of Clonidine with Bupivacaine and Fentanyl with Bupivacaine Combinations for Infra Umbilical and Lower Limb Surgeries
Mohamed Shakeel Mohaideen N., Pramod Parthasarathy, Triveni M.R.
Background: A comparative study between spinal adjuvants, clonidine 30µg or Fentanyl 25µg along with 0.5% hyperbaric bupivacaine 15 mg for their anesthetic and analgesic properties in patients undergoing infraumbilical & lower limb surgeries. Objectives of the study: Primary objective: To compare the onset time of sensory block, onset time of motor block, duration of sensory blockade, duration of motor blockade and duration of analgesia of clonidine bupivacaine combination and fentanyl bupivacaine combination intrathecally. Secondary Objective: To compare hemodynamic change by clonidine bupivacaine combination and fentanyl bupivacaine combination intrathecally. Materials and Methods: This study comprised of 60 patients, of ASA grades I– II, between the age group 18 and 60 years belonging to ASA Grade I and II. Standard procedure for sub arachnoid block with a fixed dose of 0.5% hyperbaric bupivacaine 15mg with either clonidine 30µg or fentanyl 25 µg as per randomization. All vital and study parameters were recorded and monitored till 180 min. Any intra operative complications were managed.  The time until patient requested for pain relief or when VAS score was more than 3 was taken as the duration of analgesia. Results: Time in seconds for onset of sensory blockade with clonidine 102.06±16.1, with fentanyl 100.733±10.46 (p=0.027); time in seconds to onset of motor blockade with clonidine 123.13±13, with fentanyl 126.3±14.77(p=0.946); Time in minutes for peak of sensory blockade  with clonidine 8.5±0.75, with fentanyl 7.015±0.41(p=0.031);Two segment regression time in minutes for sensory blockade with clonidine 125.9±17.04, with fentanyl 111.06±8.87 (p=0.651): duration of analgesia in minutes with clonidine 248.17±29.93, with fentanyl 201.0±34.09 (p< 0.001). Conclusion: Hence clonidine 30µg as an adjuvant has more advantages in terms of duration of analgesia and fentanyl 25 µg as an adjuvant has faster sensory onset based on our study.

25. Trichoscopy in the Evaluation of Non-cicatricial Alopecia: A Cross- Sectional Study from South Kerala
Pamela Teresa Joseph, Rajiv Sridharan, Anoop Thyvalappil
Background: Clinical diagnosis of hair and scalp disorders is not always straightforward. The standard methods used to diagnose hair loss disorders vary in sensitivity, reproducibility, and invasiveness. Trichoscopy holds great promise as a noninvasive tool for the evaluation of alopecia but it is greatly underutilized. Aims: To find the trichoscopic features in each type of non-cicatricial alopecia, to compare the trichoscopic characteristics of different types of non-cicatricial alopecia, and to identify features of diagnostic value. Methods: This cross-sectional study included 200 patients with non-cicatricial alopecia.  After obtaining consent, a detailed history was taken and clinical examination was done. Hair and scalp were evaluated using a Dermlite DL3 dermoscope with 20 x magnification and optimal trichoscopic images were captured with an attached digital camera and findings were noted. Results: The most frequent type of non-scarring alopecia in the study sample was androgenetic alopecia (46%) followed by telogen effluvium(23%) and alopecia areata (22%). Various trichoscopic findings with diagnostic value identified in the study include hair shaft thickness heterogeneity, vellus hair, brown peripilar sign in androgenetic alopecia and female pattern hair loss and exclamation mark hair, black dots, comma hairs, broken hair in Alopecia areata. The absence of hair shaft heterogeneity and vellus hair are the important characteristics that help differentiate Telogen effluvium from Female Pattern hair loss. Conclusion: The trichoscopic findings with diagnostic value in different alopecia were identified. Trichoscopy helped to reach a definite diagnosis in patients in whom clinical diagnosis was doubtful and hence is a useful noninvasive tool in evaluating alopecia.

26. Otomycosis: According to the Seasons Fungal Species Distribution in a Tertiary Care Hospital
Arjunsing Vijaysing Samorekar
Aims:  (1)To study seasonal variation of otomycosis cases. (2) To study fungal species distribution of otomycosis. Methodology:  This is a tertiary Hospital based study which is carried out in the patients attending outpatient Department of ENT, Rajarajeswari Medical college and Hospital, Bengaluru. This study is conducted during the period between September 2019 and March 2021.103 patients of otomycosis are considered in this study. Clinical diagnosis of otomycosis is done and then two ear swabs are taken and sent to the microbiology lab. Swabs were first subjected to 10% KOH slide preparation and then cultured over sabourauds dextrose agar (SDA) media for 48 to 72 hours at 37°C and 2500C. Sampling Method: Purposive sampling. Results: Otomycosis is more common during post monsoon (Oct-Dec) 60(58.25%), followed by Winter 32(31.06%) and South-west monsoon 11(10.67%). Aspergillus niger 62(60.18%) is the most common fungus isolated followed by Aspergillus flavus 14(13.58%) in our study. Conclusion: This study showed that otomycosis is more common during post monsoon period and Aspergillus niger is the most common fungal species isolated.

27. Assessment of Level of Serum Urea and Creatinine in Non-Diabetics and Diabetics in Odisha, India
Chhatray Marndi, Saubhgya Chhotaray, Ashok Kumar Behera, Sabitri Beshra, Gopabandhu Patra
Objectives: The study aims to assess the correlation between blood glucose, serum urea, and serum creatinine levels in non-diabetic and diabetic patients. Additionally, the study also investigated the variations in these biomarkers concerning the duration and severity of diabetes. Methods: The present study took place at Bhima Bhoi medical college and Hospital, Balangir for a period of 1 year and involved 100 participants, consisting of 50 diabetics and 50 controls, with blood samples collected to measure blood glucose, serum urea, and serum creatinine levels. These biomarkers were analyzed using the GOD-POD method for blood sugar and the Cobas Integra fully automated analyzer for urea and creatinine. Results: The study involved 100 participants, divided into two groups: 50 diabetics, and 50 control. The diabetic patients with a duration > 6 years exhibited heightened levels of serum creatinine and urea compared to those with a shorter diabetic history. The average fasting and postprandial blood sugar levels were notably elevated in patients with diabetic in contrast to other non-diabetic individuals with fasting glucose at 132.5 and postprandial glucose at 167.07. Conclusion: The study compares the levels of serum creatinine and urea in diabetic and non-diabetic patients and indicates that vigilant monitoring of serum creatinine and urea levels is essential for assessing kidney function in poorly controlled diabetic individuals. Effective blood glucose control is crucial in preventing diabetic nephropathy, a significant cause of chronic renal failure. Regular evaluation of these biomarkers provides a practical approach to assess renal health in diabetics.

28. A Comparative Evaluation of Surgical vs Conservative Modalities in Treatment of Condylar Fractures
Deepak Sharma, Shromi Roy Choudhury, Keerat Preet Kour, Punit Singh Dikhit
Background: The present study was conducted for comparatively evaluating surgical and conservative modalities in treatment of condylar fractures. Materials & methods: The current research included evaluation of 40 subjects which reported with condylar fractures. All the patients were randomly allocated into two study groups as follows: Group A: Patients undergoing surgical treatment, and Group B: Patients undergoing conservative treatment. Subjects of group A underwent surgery under general anesthesia with endotracheal intubation using retromandibular approach. Among patients of group B, Arch bar splinting of the maxilla and mandible and intermaxillary fixation was done with teeth in occlusion with the help of guiding elastics. Patients were systematically followed up. Clinical and radiological parameters were evaluated during the follow-up visits. The pain was measured using the visual analog scale (VAS). All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results: Significantly better improvement was seen among patients of group A in comparison to patients of group B in terms of interincisal opening. Occlusion was significantly better stable among patients of group A at 2 weeks post-treatment. While comparing the height of ascending ramus at different time intervals, non-significant results were obtained. Also, no significant difference was observed while comparing the VAS at different time intervals in between the two study groups. Conclusion: Although conservative procedures can be considered for the management of condylar fractures, our study demonstrated better results with surgical treatment.

29. Effect of Propofol Infusion and Dexmedetomidine Fentanyl on Serum Biochemical Indices in ICU Patients
Sourabh Shrivastava, Ashwin Sharma, Divya Sinha, Swati Shrivastava
Background: Sedation plays a pivotal role in the care of the critically ill intensive care unit patient. It is equally important to assess depth of sedation. Anesthetic agents can alter the hemodynamic variables, hematological and biochemical laboratory parameters. Objectives: The purpose of this study was to compare the effect of propofol and dexmedetomidine on hemodynamic and biochemical parameters on ICU patients. Methods: This was a cross sectional study conducted in the department of Anaesthesia. Hundred ICU admitted patients who required sedation were included in this study. The patients were randomly assigned into two equal groups of propofol and dexmedetomidine group. Hemodynamic parameters (heart rate and mean atrial pressure) were measured. Lipid profile, liver function test, renal function test and blood sugar were investigated in both groups of patients after sedation infusion. Results: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.05). Also, the lipid profile and other biochemical parameters were significantly higher in propofol group as compared to dexmedetomidine group (p<0.05). Conclusion: Propofol showed significant difference in hemodynamic and biochemical parameters in comparison with dexmedetomidine. Dexmedetomidine is a safe and effective sedative agent as compared to propofol.

30. Maternal and Fetal Dynamics in Referral Obstetric Cases: A Tertiary Care Center Study
Sagar R Kacha, Vishal Prajapati, Mitul Patel, Paras Majithia
Introduction: Exploring the outcomes of obstetric referrals offers insights into the complexities faced by expectant mothers and healthcare systems. Understanding maternal and fetal dynamics in referred cases is essential for tailoring interventions, optimizing care, and enhancing overall maternal and neonatal health. Material and Methods: This cross-sectional observational study conducted at a prominent Tertiary Care Center in Gujarat delves into the complexities of antenatal and intra-natal cases among obstetric referrals. The research, spanning from January 2022 to April 2022, focuses on patients with a gestational age surpassing 24 weeks and excludes gynecological referrals and postpartum cases for specificity. With a sample size of 120 patients selected through systematic random sampling, the study meticulously examines various parameters, including sociodemographic intricacies, reasons for referral, and maternal and neonatal outcomes. The data were analyzed utilizing the SPSS version 22.1 statistical software to interpret categorical variables such as age-category, maternal outcomes, and neonatal outcomes as proportions. Results: In our study of 120 referred obstetric cases, diverse outcomes unfolded. The majority (30.83%) underwent Vaginal Delivery, while 47.67% opted for Lower Segment Cesarean Section (LSCS). Notably, 3.33% experienced Vaginal Birth After Cesarean (VBAC), and 2.50% underwent Hysterectomy. Maternal complications included 5% with Postpartum Hemorrhage, 9.17% with Puerperal Pyrexia, and 1.67% each for Sepsis, maternal death, Wound Gaping, and Pelvic Abscess. Concerning neonatal outcomes, 3.33% required Neonatal Intensive Care Unit (NICU) stays, 2.50% had Intrauterine Death (IUD), and 59.67% experienced maternal-side stays. Conclusion: In conclusion, our study unravels the intricate tapestry of referred obstetric cases, emphasizing diverse delivery modes, maternal complications, and neonatal outcomes. The findings shed light on the multifaceted challenges within tertiary care, guiding targeted interventions for improved maternal and neonatal health.

31. Risk Factors for Clinically Significant Weight Gain in Psychiatric Patients on Treatment: A Case Control Study
Jumi Jacob, Rakhesh LR, Sanitha Kuriachan, Mahesh Kumar D
Background: This study focuses on the various risk factors for weight gain in psychiatric patients receiving treatment. It helps the clinician to treat accordingly to prevent comorbidities associated with weight gain in psychiatric patients. This in turn can prolong the lifespan of these patients and can also improve their quality of life. Aims and Objectives: To evaluate the risk factors of clinically significant weight gain, defined as more than 7% of initial weight over 3 months in psychiatric patients of age group between 18 to 45 years receiving treatment in a tertiary care setting. Materials and Methods: 145 psychiatric patients who gained weight more than 7% during treatment were selected as cases and 145 psychiatric patients without weight gain were selected as controls. Data collected from patients by direct interviews were recorded in a proforma and the various risk factors studied were socio-demographic factors, family history of overweight, psychiatric diagnosis and psychotropic medications.  Data was analyzed by SSPS 17 statistical software. Chi Square Test was used for comparison of proportions. Odds ratios and their confidence intervals were calculated to determine the strength of association.  Binary logistic regression was then used to find the adjusted odds ratios and their confidence intervals and thereby its statistical significance. Results: Psychiatric   patients   treated   with Clozapine and Olanzapine were associated with clinically significant weight gain on univariate analysis.  Multivariate  analysis  showed that patient’s  age (adjusted  odds ratio i.e. AOR=0.964,  95% confidence interval(CI): 0.937-0.992), and the use of  atypical anti-psychotic agents like Clozapine (AOR=2.290, 95% CI:1.422-5.996), Olanzapine (AOR=3.474, 95% CI:1.805-6.685), Quetiapine (AOR=4.060,  95% CI:1.193-13.821), and Risperidone (AOR=2.224, 95% CI:1.189-4.233) were associated with clinically significant weight gain. Conclusion: Patient’s age and the use of psychotropic drugs like Clozapine, Olanzapine, Risperidone and Quetiapine were associated with clinically significant weight gain in psychiatric patients.

32. A Comparison of Effect of Oral Premedication with Clonidine and Metoprolol on Intraoperative Haemodynamics and Surgical Condition during Functional Endoscopic Sinus Surgery
Devendran P, L. Uma Pradeepa, Kiruthika Rathinasabapathy, K Uma
Background: Achieving an optimal surgical field in functional endoscopic sinus surgery (FESS) is crucial, as even minor bleeding can significantly impair an already limited visual perspective. Therefore, if controlled hypotension can be safely facilitated through a relatively straightforward method without compromising patient safety, it has the potential to significantly enhance the surgical field. The present study was conducted to assess the impact of oral clonidine and oral metoprolol as premedication in reducing blood loss and enhancing the surgical field during FESS. Methods: The patients were selected form those undergoing functional Endoscopic sinus surgery (FESS) based on the inclusion and exclusion criteria. All the patients were instructed to remain nil per oral, 8 hours for solids and 2 hours for clear liquids. In group I, patients received oral Tab. clonidine 300 µg, and in group II Tab. metoprolol 50 mg orally 2 hours before induction of anesthesia with sips of water. Intraoperative PR, SBP, DBP, and SPO2 were recorded at 0, 2, 5, 10, 15, 30, 45, and 60 minutes from the start of surgery. Results: A total of 80 cases divided equally between two groups. Although the clonidine group exhibited a greater mean heart rate decrease than the Metoprolol group, statistical significance was only observed at 30 minutes (p=0.08). A significant drop in systolic and diastolic blood pressure was noted in the Clonidine group at 15 minutes compared to Metoprolol (p < 0.05). Differences in mean arterial pressure (MAP) were significant at 30, 45, and 60 minutes, favoring Clonidine. Conclusion: Both clonidine and metoprolol demonstrated effectiveness and safety in establishing a stable hemodynamic profile and reducing intraoperative bleeding when administered orally as premedication to patients undergoing functional endoscopic sinus surgery. However, when comparing the two drugs, clonidine exhibited superior performance in terms of reducing blood loss and enhancing the overall quality of the surgical field compared to metoprolol.

33. TRAP vs. Olecranon Osteotomy in Intra-Articular Distal Humerus Fractures: A Comparative Study
Jyotirmaya Nayak, Sridhar Panda, Nagendra Kumar Rajsamant, Gopabandhu Patra
Background and objectives: There are many techniques to managing intra-articular distal humeral fractures. The purpose of this research is to evaluate and compare the functional results associated with two separate techniques for treating intra-articular distal humeral fractures: one requiring olecranon osteotomy and the other utilizing the triceps-lifting approach (TRAP). Materials and Procedures: In Group A, 17 patients were paired with an equal number in Group B. Age, gender distribution, length of injury, and amount of fracture comminution were all comparable in both groups. Surgical length, hospital stay, union rates, range of motion, and complications were all compared. The Mayos’ elbow performance score (MEPS) was used to evaluate functional results. Results: Patient follow-up was prolonged for a minimum of 12 months as a result of the findings. All patients in both groups had fracture union at or before 4 months, with the exception of one instance in Group A, when union was noted at 8 months. The average time to union was comparable in the two groups. In both groups, the total range of motion was comparable. There were no statistically significant variations in mean MEPS between the two groups. The cumulative complication rate in the TRAP group was 38%, whereas it was 28% in the olecranon osteotomy group. Conclusion: In intra-articular distal humerus fractures, surgical intervention is required for good functional results. Despite its technical complexity, TRAP exposure appears as a feasible option to olecranon osteotomy. In the treatment of intra-articular distal humerus fractures, both approaches provide equivalent clinical and functional results.

34. On Pump Beating Heart CABG: an  Acceptable Trade Off?
Chittaranjan Thatei, Sarada Prasanna Sahoo, Manoj Kumar Pattnaik, Soubhagya Kumar Das
Introduction: On-pump beating heart coronary surgery is a combination of normal on-pump surgery and the OPCAB approach. The lack of cardioplegic arrest, together with the hemodynamic stability provided by substantial cardiac manipulation, are thought to be the most significant advantages of this approach. The purpose of this research is to investigate CABG procedures, their respective benefits and drawbacks, and their impact on the end result, with a focus on the on pump beating heart operation Aims and Objectives: (1) To assess the relative merits and demerits of different techniques of myocardial revascularization, with reference to in- hospital mortality and morbidity associated with either procedure. (2) To find out whether on pump beating heart CABG is to be considered an acceptable tradeoff between cardioplegic and OPCAB procedures Results: The 91 patients included in this study, were chosen in a manner as to allow equitable distribution among the three groups as per mortality risk using the additive EUROSCORE. The choice of procedure was at the discretion of the operating surgeon based on severity of disease, co-morbidities and peroperative  findings. A total of 4 cases required conversion to the on pump beating heart procedure due to intraoperative haemodynamic instability so that complete revascularization could be performed. None of the cases required that grafting be abandoned due to intraoperative haemodynamic instability in the OPCAB group. A LIMA to LAD or D1 was routinely attempted in all cases. Cases with poor flow in LAD received RSVG. Three cases received a LIMA- radial Y-graft to D1. No significant difference in operating time was found in the three groups i.e OPCAB, On pump/beating, On pump/Arrest. Conclusion: Both OPCAB and on-pump CABG with cardioplegic arrest have great short-term outcomes in terms of mortality/morbidity. There was no significant difference in the number of grafts obtained between the three groups. The on-pump group required considerably more transfusions. The on pump groups showed greater post-operative drainage and lower mean hemoglobin levels in the immediate post-operative time. During the post-operative period, the on pump groups needed considerably more ionotropes.

35. Evaluation of Extra Pulmonary Tuberculosis (EPTB) Cases with CBNAAT in Comparison with Cytology
Jyotirmaya Nayak, Sridhar Panda, Nagendra Kumar Rajsamant, Gopabandhu Patra
Introduction: EPTB causes a large burden of mortality and morbidity because of its complicated and subclinical presentations, which cause a delay in diagnosis. EPTB has little infectious potential and so has never been prioritized in National TB Control Program efforts. EPTB may be detected using a variety of approaches, including microscopy, culture, and identification of the organism’s DNA. CBNAAT is a newer approach. The current research was designed to compare the efficacy of CBNAAT in diagnosing EPTB to that of cytology. Materials and Procedures: The investigation comprised 120 lymph node, pus, pleural fluid, ascitic fluid, and C.S.F. samples. Samples were collected and tested for AFB smear, FNAC, and CBNAAT all at the same time. Result: EPTB was diagnosed by CBNAAT, FNAC, and AFB stain in 40, 71, and 18 of the 120 patients, respectively. Conclusion: CBNAAT is a modern confirmatory test that adds the advantage of concurrent drug resistance. Even in remote locations, combining CBNAAT with other tests yields a higher diagnostic result.

36. The Functional Outcome of Medial Compartment Osteoarthritis of the Knee Treated with Proximal Fibular Osteotomy: A Prospective Cohort Study
Jyotirmaya Nayak, Sridhar Panda, Nagendra Kumar Rajsamant, Gopabandhu Patra
Background: Osteoarthritis (OA) is a polyarticular chronic degenerative disease with multiple aetiology, with the knee being the most often affected joint. Objective: The purpose of this study was to assess the clinical and functional results of medial compartment OA of the knee treated with PFO in terms of pain, disability, and range of motion. Materials and Methods: The current prospective cohort research included 60 patients with medial compartment knee OA treated with PFO who visited the orthopaedic department’s OPD and emergency department. The research was authorized by the institutional ethics committee, and all subjects provided signed informed permission. Results: With a M: F ratio of 1:1.5, there were 36 (60%) females and 24 (40%) men. The average age of the patients was found to be 58.728,29 years (P = 0.26). Patients were evaluated for range of motion at three and six months. At the 3-month follow-up, 9 (15%) of the patients had a range of motion of 80, whereas 21 (35%) had a range of motion between 80 and 90. There were 19 (31.67%) individuals with ROM between 90 and 100. There were 11 (18.33%) patients with ROM higher than 100. At the 6-month follow-up, 05 (8.33%) patients had a range of motion of 80, while 21 (35%) had a range of motion between 80 and 90. 23 patients (38.33%) had ROM between 90 and 100. There were 11 (18.33%) patients with ROM higher than 100. Conclusion: PFO is a simple, safe, quick, and successful surgery for treating medial joint OA of the knee. It does not react to conservative treatment and produces better functional and clinical outcomes, less knee joint discomfort, and a higher ML ratio.

37. Histopathological Spectrum of Various Prostatic Lesions in TURP Specimens: A Retrospective Study
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra, Madhab Madhi
Background: In adult men, benign prostatic hyperplasia (BPH) and prostate cancer are major causes of morbidity and death. Other prostatic lesions include inflammatory conditions and lesions in situ. TURP is required to detect these abnormalities, particularly prostatic cancer. The purpose of this study was to assess the histomorphological spectrum of distinct prostatic lesions in TURP tissues. Materials and Procedures: A total of 85 TURP specimens were investigated during a two-year period, from April 2018 to March 2020. The cases were examined in terms of their entire history, clinical examination, and histological results. The diagnostic criteria were modified from World Health Organization (WHO) recommendations. Result: Over a 2-year period, 85 prostate TURP tissues were analyzed, with 81 instances of benign lesions (95.2%) and 4 cases of malignant lesions (4.8%). Among the benign lesions were 54 instances of benign prostatic hyperplasia (BPH), 24 cases of BPH with prostatitis, and 2 cases of granulomatous prostatitis. Conclusion: TURP is important in the diagnosis of prostatic abnormalities. The benign lesions outnumber the malignant ones. The modified Gleason score is used to grade prostate cancer because it is straightforward and accurate.

38. Current Cancer Trends and the Need for Palliative Care at a Cancer Care Centre in Eastern India
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra, Sai Priyadarsini Das
Cancer as a disease has emerged as a leading source of morbidity and death in low and middle-income nations, where patients are more likely to be diagnosed with advanced disease than in high-income countries. According to the WHO Global Report, India lacks coordinated palliative care and has uneven activity. A lack of government priority for palliative care impedes proper policy solutions, resulting in limited regulation. Understanding current patterns of illness, treatment, and outcomes in LMICs is required for optimal development and implementation of cancer control programs. Between January 2021 and December 2022, a retrospective study was conducted at the Department of surgery, to study the current trends of carcinoma in patients presenting with advanced cancer and their need for palliative care services at a tertiary care cancer hospital. More over half of the participants (51.6%) are between the ages of 41 and 60, with the remainder older than 60. The female to male ratio was 2.2:1.65.83% of patients had stage III and stage IV malignancies, as well as physical, psychological, and emotional issues. In light of the presentation of advanced tumors at the Medical College associated cancer hospital, palliative care services at Medical College cancer departments are needed, in accordance with the National Cancer Control Program (NCCP) and WHO recommendations.

39. Comparative Study of Irrigation with Povidone-Iodine versus Normal Saline on Wound Infection after Open Appendectomy for Prevention of Surgical Site Infection
Jyotirmaya Nayak, Nagendra Kumar Rajsamant, Sridhar Panda, Gopabandhu Patra, Suvensu Das
Introduction: Surgical site infections (SSIs) are a persistent issue for operating surgeons. It raises healthcare costs, increases morbidity and death, and sometimes results in re-explorations. The incidence of SSIs may be reduced by eliminating damaged or non-viable tissue, metabolic waste, and wound exudates; this can be accomplished via intraoperative irrigation of surgical wounds. Postoperative surgical wound irrigation is also possible. Even with preventive antibiotics and strict aseptic procedures, post-appendectomy wound infection persists. Although the efficiency of povidone-iodine on non-incised skin is widely documented, its use as an intraoperative irrigation solution in open surgical wounds is not common. Similarly, prophylactic irrigation using normal saline solution to prevent wound infection has been shown in certain trials to be helpful. The goal of this research is to examine the percentage of superficial SSI after appendectomy with 1% povidone-iodine solution intraoperative irrigation of subcutaneous plane against normal saline. Methods: At Medical College, 100 patients of open appendectomy for acute appendicitis were randomly assigned to one of two arms. In group A, 0.9% Normal Saline was used to irrigate subcutaneous tissue prior to skin closure, while in group B, 1% diluted povidone-iodine solution was used. For five days following surgery, the patients were evaluated for infection in surgical wounds using the Southampton wound grading system, and they were monitored for thirty days. Results: The participants in this research had an average age of 18.65 years. There were 50 patients in each group, and there were no significant differences in terms of age, gender, or operation results. Out of 100 patients, 19 (19%) had Southampton grade 2 or above, indicating wound infection. 15 (29%) were from Group A, and 5 (9%) were from Group B (p=0.001). Conclusion: When compared to normal saline irrigation, 1% diluted povidone-iodine irrigation of the subcutaneous plane following appendectomy significantly reduces the risk of SSI.

40. A Study on a Comparative Analysis on Serum Uric Acid Levels in the Spectra of Hypertension
Jyotirmaya Nayak, Sridhar Panda, Nagendra Kumar Rajsamant, Gopabandhu Patra, Samikshya Kar
Introduction: Hyperuricemia in prehypertension and hypertension may be either a cause or a result. Hyperuricemia has been reported to excite smooth muscles in the artery wall and promote endothelial dysfunction, both of which are important in the etiology of hypertension. In turn, hypertension may cause renal dysfunction, resulting in a decrease in GFR and renal urate excretion. Though studies demonstrate higher uric acid levels in both the prehypertensive and hypertension groups, there are few research that examine the association of uric acid levels in the prehypertensive and hypertensive groups. Aim of the study: (1) To assess the existence of asymptomatic hyperuricemia in normotensive, prehypertensive, and hypertensive individuals. (2) To compare the serum Uric Acid levels in different Hypertensive categorization groups, both subjectively and quantitatively. Materials and Methods: A prospective observational research was conducted at SCB Medical college and Hospital, cuttack on 300 patients chosen at random from outpatient clinics in the Department of Medicine and Surgery at SCB Medical college and Hospital, cuttack. The participants were tested for hypertension and categorized according to the JNC VII Recommendation (Normotensive, Pre-hypertensive, Hypertensive-stage I & II). Other information were documented, such as the occurrence of hypertension and diabetes mellitus. They had their anthropometric measures taken and their BMI computed. In these individuals, serum Uric Acid, fasting blood glucose, and serum cholesterol were all measured. All data was gathered and analyzed using a proforma created specifically for this project. S. Uric Acid 6.8mg/dl is used to treat hyperuricemia. Conclusion: The results of my investigation support previous research on the relationship between uric acid and hypertension. Uric acid levels are increased in all hypertension populations. Stage II hypertension has the highest association among hypertensive categories. It has also been shown that as the stage of hypertension advances, so do the mean uric acid levels. The mean values grow sharply from stage I to stage II. This shows that uric acid may play an important part in the pathophysiology of hypertension problems, since it is well known that higher grades of hypertension are linked with a larger degree of end organ damage. Asymptomatic hyperuricemia (S. Uric acid 6.8 mg/dl) is substantially related with all of the components of metabolic syndrome, consistent with previous research. Conclusion: The relationship between serum uric acid levels and hypertension is a key paradigm in identifying many variables implicated in hypertension pathogenesis. The necessity for this stems from the fact that hypertension is a significant cause of illness and death in our nation, and it is getting more frequent. As further research is conducted, it is possible that medications that decrease uric acid will have a role in the primary prevention of hypertension or the secondary prevention of consequences.

41. Study of Maternal and Perinatal Outcomes in Pregnant Women with First trimester Vaginal Bleeding in North Karnataka Population
Shailaja Dabshetty, Aisha Humera, Niveditadongapure, E.Tejaswini
Background: Although first trimester vaginal bleeding had normal pregnancy in 50% of cases, vaginal bleeding during the first trimester was associated with spontaneous abortion, miscarriage or ectopic pregnancy, and low birth weight foetuses; hence, it had to be managed meticulously to prevent mortality of the foetus and morbidities in pregnant women. Method: 100 (one hundred) pregnant women with first-trimester vaginal bleeding were studied. Detailed history, Physical and obstetrical examinations were carried out. Blood investigations —CBC, ABO, “Rhtyping,” BT, CT, HIV, HBsAg, VDRL, HCV, FBS, TSH, and beta-HCG, and urine analysis was carried out in every patient. USG was performed to determine the period of gestation, cardiac status, the size of the sub-chorionic hemomatoma, the adnexal mass, and the free fluid. Results: The bleeding volume was 22% spotting, 74% had moderate bleeding, and 4% of patients had heavy bleeding. Nulliparity was observed in 56%, 1 in 28%, 2 in 10%,>2 in 6% of the patients. History of bleeding was in 34% and history of abortion was 14% patients, 24% premature labour, 6% PROM, 14% placental abruption, 4% was IU death, 4% was IU growth retardation, 48% patients had no complication, 14% had abortion, 8% had termination of pregnancy, 26% had normal vaginal delivery, 30% had caesarean delivery, 10 had poor minute 5 APGAR score, 12% had NICU admission. Conclusion: It is concluded that vaginal bleeding during the first trimester has diagnostic value for maternal and foetal complications, and it is a challenge for obstetricians and gynaecologist to evaluate and treat efficiently to prevent morbidity and fetal mortality.

42. Relationship between Hemoglobin and Platelet Count
Ritika Kansal, Kiran, Sachi Gupta, Amit Joon
Background: The relationship between haemoglobin level and platelet count was carried among 212 patients with respect to differences between platelet counts within haemoglobin (gm%) level within platelet count. Methods: Blood samples were collected into EDTA anticoagulant vials for both platelet count and haemoglobin level of patients. Results: Statistical analysis showed significant differences (p<0.0001) between haemoglobin level that fall within platelet count 1.5 to 2.5 lacs/mm3 as (11.79±1.20) and haemoglobin level that fall within platelet count 2.51-4.0 lacs/mm3 as (10.74.1±1.20). statistical analysis also show a significant difference (p<0.0001) between platelet count that fall within the haemoglobin level less than 11 gm% as (2.50±0.50) and platelet count that fall within haemoglobin level of 11-14 gm% as (1.94±0.38). Conclusions: The above results indicate that there is a relationship between low and high level of haemoglobin on platelet count and vice versa.

43. Autologous Bone Marrow Cell Therapy in Complex Fistula in Ano
Prangya Lochan Chand, Biswajeet Pusty, Jyoti Ranjan Behera, Rupashree Behera
Introduction: Fistula-in-ano, a highly frequent anorectal problem, is nearly as prevalent as perianal-perirectal suppuration. Because of the disease’s private location, which raises morbidity, the shy, timid patient avoids the surgeon. Due to the chronic nature of the illness and its annoying symptoms, which include soiling, itching, and recurrent suppuration, a normally healthy and energetic individual becomes an economic burden, retreats from social engagements, and loses confidence. The majority of patients are shy, and it is difficult to assess the sickness because they refuse to undergo proctologic and rectal tests. Over the previous few decades, a great deal of progress has been made in our understanding of the anatomy of the rectum and anal canal, as well as the mechanics of continence. Material and Method: The study comprised all patients who were Hospitalised to VIMSAR, Burla’s general surgery department between October 2016 and September 2018 and who satisfied the inclusion and exclusion criteria. Result: Compared to the control group, the research group’s post-operative pain was less severe. Patients in the control group did not need an analgesic for wound pain after post-operative day 7, but patients in the study group did not need one after post-operative day 3. Of the 25 patients in the trial, 2 (8%) had post-operative bleeding, while 6 (24%) had control (P value 0.02). Recurrence was seen in 6 (24%) of the 25 patients in the control group, but not in the research group, with a P value (P value 0.004) <0.05. Conclusion: In order to reduce complications such as bleeding, incontinence, recurrence, and post-operative discomfort at the wound site, as well as to improve traditional wound healing, bone marrow cell treatment is being used for difficult fistula-in-ano. This is demonstrated by the grade of granulation tissue observed following biopsy using an HPE investigation.

44. Comparative Analysis of Palmer’s and Sub-Umbilical Point for Veress Insertion to Create Pneumoperitoneum in Laparoscopic Cholecystectomy
Santhosh Kumar Elaveree E, Himani Sandhu, Rakshit Agnihotri, Rohit Singh
Introduction: Laparoscopic cholecystectomy has emerged as a gold standard technique for the treatment of gall stones. The first step of a laparoscopic procedure is to create pneumoperitoneum through veress needle insertion in a selected point. The Palmer and sub-umbilical points are debated insertion sites. Compare the insertion sites of creating pneumoperitoneum for doing laparoscopic cholecystectomy in terms of safety, time taken and complications are the aim and objectives of the study. Materials and Methods: A randomized controlled trial enrolled 50 patients undergoing laparoscopic cholecystectomy. Palmer Point Group (n=25) and Sub-umbilical Point Group (n=25) were formed. Veress needle insertion points were compared in terms of procedural time, complications, and conversion procedure. Results: The baseline characteristics, including age, gender, and body mass index (BMI), were comparable between the two groups, ensuring a balanced distribution of demographic factors.  In this study the Mean age was 41.73±7.61 years in group A and 40.8±9.08 years in group B; maximum number of females were presented i.e. 76% in Gr.-A and 80% in Gr. B; Mean weight was 65.20±6.66kg in group A and 64.82±7.34kg in group B; patients in group A, 11 (44%) were having calculus cholecystitis and 14 (56%) were presented with cholelithiasis, whereas, 13 (52%) were having calculus cholecystitis and 12 (48%) were presented with cholelithiasis; BMI was presented with  25-29.9 (9), 36% in Gr.A and 25-29.9 (8)32% in Gr.B. In the present study minimum assess time taken was 5.5 min and maximum was 8.5min. Mean procedure time was 70.3±2.19 min in group A and 72.15±1.56 min in group B. It was also observed the Palmer Point Group showed lower complications compared to Sub-umbilical Point Group (p=0.022). Whereas conversion procedure, hospital stay lengths, etc., did not show any significant difference. Conclusion: This study supports the Palmer point technique’s superiority for veress needle insertion than the sub umbilical point in patients undergoing laparoscopic cholecystectomy.

45. Association of Diabetic Cheiroarthropathy with Duration of DM and Hba1c
Harpreet Singh, Inderpal Singh, Jasleen Kaur, Sunil Suman
Background: Diabetic mellitus can lead to a myriad of complications (both microvascular and macrovascular). The wide spectrum of rheumatic affections related to DM are Diabetic Hand Syndrome (Diabetic Cheiroarthropathy), Adhesive Capsulitis, Trigger Finger, Dupuytren’s Contracture, Diffuse Idiopathic Skeletal Hyperostosis (DISH), Diabetic muscle infarction etc. Diabetic cheiroarthropathy is characterized by limited movement of the joints of the hands along with thickening of the skin on the palmar and dorsal surfaces. Studies have found association between Diabetic Cheiroarthropathy, Duration of diabetes and Glycation end products of Diabetes. The present study was conducted to study the prevalence of Diabetic Cheiroarthropathy in patients of DM and its association with duration of DM and Glycation end products. Materials and Methods: This was conducted on 200 patients in the department of Medicine, Government Medical College, Amritsar. The study protocol was approved by the institutional ethics committee. The patients were enrolled in the study after obtaining written informed consent. All the patients were interviewed and examined for peripheral neuropathy, retinopathy by ophthalmoscopy, presence of albuminuria and Diabetic Cheiroarthropathy by Prayer Sign and Table Top Sign. The results were then analyzed. Results: Out of 200 patients, 104 patients had cheiroarthropathy. Majority of the patients with cheiroarthropathy (33) were in the age group 61-70 years. The mean age of patients with and without cheiroarthropathy were 61.3±13.6 years and 45.8±9.8 years, respectively (p value= 0.000). The mean diabetes’ duration in absence of cheiroarthropathy was 4.3±2.5 years, while in presence of cheiroarthropathy it was 12.6±5.7 years (p value= 0.000). With increasing duration of diabetes, incidence of Cheiroarthropathy also increased and this showed statistical significance (p value=0.000). Cheiroarthropathy showed positive association with HbA1c as with increasing HbA1c levels, there was increased incidence of Cheiroarthropathy (p value=0.000). Conclusion: Advancing age plays in the determination of the severity of diabetic cheiroarthropathy along with the duration of Diabetes Mellitus. Apart from the already established association of Cheiroarthropathy with microvascular complications, there is also association of Cheiroarthropathy with the status of HbA1c levels of the patient.

46. Evaluation of Addition of Nintedanib to Corticosteroids for Treatment of Radiation Pneumonitis in Patients Undergoing Treatment for Lung Cancers in India
Atiya Parveen, Mohammed Abdullah Saleem, Mohd. Ghouse Mohiuddin, Fazeel Zubair Ahmed, Subin V
Introduction: Radiation pneumonitis (RP) is a significant complication of chest cancer radiotherapy, often leading to severe respiratory distress and reduced survival rates. Current treatment guidelines primarily recommend corticosteroids, although their efficacy in preventing RP-induced pulmonary fibrosis is inconclusive. Nintedanib, a tyrosine kinase inhibitor, has shown promise in treating pulmonary fibrosis by targeting key inflammatory mediators. However, its application in RP management remains unexplored, particularly in the Indian population. Methods: A prospective, randomized, open-label study was conducted on lung cancer patients with RP, involving two groups: one receiving nintedanib in combination with prednisone, and the other receiving prednisone monotherapy. The primary endpoint was the proportion of patients free from acute pulmonary exacerbations within one year. Secondary endpoints included the total number of exacerbations and quality of life measures. Results: Among 39 enrolled patients, 34 completed the study. Significantly more patients in the nintedanib group (80%) remained free from exacerbations compared to the prednisone group (50%). The mean number of exacerbations was significantly lower in the nintedanib group (0.77) compared to the prednisone group (1.28). Adverse events were minimal, with diarrhoea and nausea reported as the most common side effects in the nintedanib group. Discussion: This study demonstrates a statistically significant reduction in acute pulmonary exacerbations within one year by adding nintedanib to prednisone for RP treatment. Nintedanib’s potential in targeting shared fibrosis mechanisms across various interstitial lung diseases, as evidenced in previous trials, suggests its efficacy in RP management. While diarrhea and nausea were common side effects, nintedanib was generally well-tolerated. Conclusion: This study provides crucial insights into the effectiveness of nintedanib as an adjunct to corticosteroids in managing RP. The significant reduction in exacerbations and favorable safety profile suggest a potential paradigm shift in RP treatment. Further, larger-scale confirmatory studies are warranted to validate these findings and potentially integrate nintedanib into routine clinical practice for RP in lung cancer patients.

47. Anatomical Variations of Recurrent Laryngeal Nerve (RLN) in Relation with Inferior Thyroid Artery (ITA) in the Patients Undergoing Thyroid Surgeries: A Descriptive Study
Arjunsing Vijaysing Samorekar
Aim: Injury to recurrent laryngeal nerve (RLN) is the complication of thyroid surgery. Hoarseness, aspiration and even respiratory difficulty due to vocal cord palsy are major sufferings of thyroid surgery to the patients. Anatomical knowledge about relevant important structures in vicinity is important that is RLN pathway, its relationship to inferior thyroid artery and its extra laryngeal branching pattern is important for the delivery of thyroid lobe. Morbidity after thyroidectomy is also related to the injuries to the parathyroids and external branch of superior laryngeal nerves (EBSLN), these are due to variations in the surgical anatomy. To analyse the intraoperative anatomical relation of recurrent laryngeal nerve and its variations with respect to inferior thyroid artery in patients undergoing open thyroid surgeries. Methodology: This Study was conducted between November 2020 to June 2021 with 50 patients who underwent thyroid surgeries in Department of ENT, Head and Neck Surgery at Medical College and Hospital, Bengaluru, and intraoperatively anatomical variations of recurrent laryngeal nerve with respect to inferior thyroid artery was analyzed. Results: In our study incidence of thyroid diseases is more common in females than in males. Third decade is the peak age group in which patients presented to the hospital. Solitary nodular Goitre is the commonest clinical diagnosis in patients with goitre in Euthyroid status. Multinodular Goitre is the commonest histopathological diagnosis in the specimens. Total of 69 recurrent laryngeal nerves were identified with 37(53.6%) on right side, which showed 14(37.8%) RLN anterior to artery, 22(59.5%) posterior to artery, and 1(2.7%) between the branches of artery. On left side of 32(46.4%) nerves identified, 9(28.1%) RLN was anterior to artery, 21(65.6%) posterior to artery and 2(6.3%) were between the branches of artery. Conclusion: By searching, identifying, and following the course of recurrent laryngeal nerve with care iatrogenic injury to recurrent laryngeal nerve or its branches is best avoided. The deep knowledge on surgical anatomy of varying course of recurrent laryngeal and inferior thyroid artery and their relation decreases the morbidity after thyroid surgery.

48. Socio-Demographics Features of Obesity and Blood Pressure and Correlation with Their Dietary Pattern
Asheesh Kumar Gupta, Bhagyashree Thakur, Manish Rathore, Jeetendra Kumar Singh, Naresh Bajaj
Background: Socio- demographic and dietary patterns are considered as a modifiable risk factor for obesity and hypertension. Marked increase intake of junk food associated with the higher risks for hypertension and obesity. Aim: The purpose of this study was to determine the socio-demographic characteristics and dietary pattern in adolescent and their relationship with hypertension and obesity. Methods: This was a cross sectional study conducted in a tertiary care medical college, central India, using a predesigned questionnaire-based interview. Adolescent subjects were randomly. Selected from various higher secondary schools Parameters Weight, height, waist circumference, Waist / hip ratio, body mass index (BMI), blood pressure and random blood sugar were noted. Results: A total of 350 schools going adolescent were enrolled in this study. Prevalence of hypertension was 20.8% and obesity was 4.5%. The dietary habits (vegetarian, Fast food/week, and food choice), gender and mother occupation was found no significant association with obesity, whereas father’s occupation and weight   of adolescents was found to be significantly associated with the overweight or obesity. Fast food consumption and choice of fast Food over Healthy Food was significantly associated with hypertension. Conclusion: Socio-demographic and dietary modification should help in implications for the prevention and management of obesity and hypertension in adolescent population.

49. Pelvic Exenteration in Elderly Individuals with Advanced Cancer
Sujit Kumar Mohanty, Gupteswar Mishra, Sankarsan Das, Nagendra Kumar Rajsamant
Background: An invasive surgical operation, pelvic exenteration is only appropriate for a very restricted group of patients. Elderly patients who have surgery frequently have higher rates of morbidity and mortality. Examining the results of exenteration for advanced pelvic cancer in this patient subgroup was the goal of this investigation. Methods: The study included all patients who underwent pelvic exenteration between ‘January 2018 to January 2019’ and were at least 70 years old. This included all primary tumors of the bladder, gynaecological system, and rectal area. The 5-year overall survival was the main outcome measure. Post-operative morbidity and 30-day death were the secondary objectives. Results: There were 80 patients in all, ranging in age from 70 to 90 years old, with a median age of 75. Eight bladder tumors, 30 gynaecological, and 42 rectal tumors were found. The way that neoadjuvant therapy was administered varied significantly depending on the type of tumor. Within 30 days following surgery, five patients (5%) died and 30 patients (33%) experienced postoperative problems. Patients with rectal cancer had a median survival of 64 months, gynaecological tumor patients had a median survival of 30 months, and bladder cancer patients had a median survival of 15 months. The five-year survival rates for each of these groups were, respectively, 46, 30, and 21%.

50. The Reproductive Outcome Following Hysteroscopic Septal Resection in Patients with Primary Infertility or Recurring Miscarriages
Gupteswar Mishra, Nagendra Kumar Rajsamant, Sujit Kumar Mohanty, Sankarsan Das
Aim: The purpose of this study was to assess the reproductive outcomes for women who were experiencing recurrent miscarriages or infertility after hysteroscopic septal excision. Methods: At “Hi-Tech medical college and hospital, Bhubaneswar” a prospective clinical experiment was carried out. Twenty patients with primary infertility and twenty with recurrent miscarriages were among the forty patients who were enrolled; all patients had uterine septums. Every individual had a hysteroscopic septal resection. Pregnancy rates and related outcomes like live births, preterm births, term births, and miscarriages were the main outcome measures. Results: The results showed that after hysteroscopic metroplasty, patients with uterine septum and primary infertility had significantly improved reproductive outcomes. Twelve pregnancies out of twenty patients represented a significant rise in the pregnancy rate to 54%. While term delivery and live birth rates were much higher at 30% and 44%, respectively, abortion and premature labor rates were relatively low at 4% and 9%, respectively. Additionally, it was noted that patients experiencing repeated pregnancy loss had significantly improved reproductive outcomes. While the percentage of preterm births decreased non-significantly from 10.1% to 7.3%, the rate of term deliveries increased significantly from 3.7% to 50.9%, and the rate of live births increased significantly from 7.3% to 54.6%. Conclusion: For patients who experienced repeated miscarriages, hysteroscopic metroplasty resulted in considerable improvements in reproductive outcomes, such as a decrease in the number of abortions and an increase in the rates of term deliveries and live births. Furthermore, a noteworthy improvement in the rates of conception was noted in patients whose main infertility could not be explained.

51. Anal Acoustic Reflectometry Forecasts the Results of Faecal Incontinence Examination using Percutaneous Nerve Stimulation
Gupteswar Mishra, Sujit Kumar Mohanty, Nagendra Kumar Rajsamant, Sankarsan Das
Background: Some faecal incontinence patients respond favorably to sacral nerve stimulation (SNS). Before a costly implant is placed, a procedure called percutaneous nerve evaluation (PNE) is carried out to determine which individuals are most likely to experience success with SNS. The purpose of this study was to determine whether the results of a pee nephrogram (PNE) for faecal incontinence could be predicted based on anal sphincter function parameters as determined by anal acoustic reflectometry (AAR). Methods: Women with faecal incontinence undergoing PNE were recurited. AAR was completed on the day of the procedure immediately before PNE, followed by anal manometry. The course of PNE was predicted using the findings from the bowel diary and the incontinence severity score. Logistic regression analysis was used to compare individuals who have successful PNE results to those with poor results in an effort to identify any independent drivers of success. Results: Eighteen (37%) of the fifty patients that were enrolled had an unsuccessful PNE result, and 31 (61%) had a successful one. Patients who went on to have a successful PNE result had an AAR variable opening pressure that was considerably higher than that of patients who did not. The maximal resting pressure, which is the manometric equivalent, did not change. Opening pressure had an odds ratio of 1.07, making it an independent predictor of success. Conclusion: Sphincter function can be sensitively assessed by AAR, which can distinguish between individuals who respond to PNE and those that do not. Opening pressure can help choose whether individuals are candidates for this costly treatment option because it is an independent predictor of PNE effectiveness.

52. Evolution of Ovarian Neoplasms in a Semi-Urban Population: A 3-Year Study at a Teaching Hospital in Odisha, India
Sankarsan Das, Gupteswar Mishra, Nagendra Kumar Rajsamant, Sujit Kumar Mohanty
Background: Due to its complex histology, embryology, and steroidogenesis, the female gonad known as “OVARY” has the potential to develop into cancer. Ovarian neoplasms therefore vary greatly in their biological behavior and structure. The study’s primary goals are to determine the prevalence and distribution of different mass lesions in the ovary among the people that are followed, as well as their histological and clinical characteristics. Methods: This three-year retrospective and descriptive study was conducted at the Obstetrics and Gynaecology Department of Hi-Tech medical college and hospital, Bhubaneswar, India, between ‘time period’. The study included all cases of ovarian tumors that were determined to be neoplastic (benign, malignant, and metastatic). Results: 134 (4%) of the 728 gynaecological hospitalizations had ovarian tumors. Out of these, 23.36% had non-neoplastic lesions and 74.64% had neoplastic lesions. The most prevalent histological pattern seen in 77 neoplasms was epithelial tumors (72.45%). Mucinous tumors (52.07%) were more common among them than serous tumors (45.92%). The most prevalent benign ovarian tumor was mucinous cystadenoma (61.31%), while serous cystadenocarcinoma (59.65%) was the most common malignant tumor. Of the non-epithelial ovarian tumors, germ cell tumors accounted for the majority (59%) of cases. Conclusion: There were more ovarian neoplasms among the admissions than non-neoplastic ones. Germ cell tumors were the second most prevalent histological type found, with surface epithelial type being the most common. The most common benign kind was mucinous cystadenoma, while the most common malignant type was serous cystadenocarcinoma. The age at which malignant ovarian tumors originate has dramatically decreased, and the most common symptom has been identified as an abdominal mass.

53. Optimizing Preoperative Antibiotic Prophylaxis Timing to Reduce Surgical Site Infection
Nagendra Kumar Rajsamant, Gupteswar Mishra, Sankarsan Das, Sujit Kumar Mohanty
Background: Whether the risk of surgical site infections (SSIs) changes with the application of surgical antibiotic prophylaxis (SAP) during 60–30 or 30–0 minutes before to incision is the hypothesis to be tested. The significance of properly scheduling SAP prior to surgery has long been understood. The best timing for an incision should ideally occur 60–0 minutes beforehand, although the evidence that is now available is inconsistent. Here, we use a carefully crafted observational cohort to assess prior discrepancies. Methods: A tertiary referral facility located in  Odisha underwent an observational cohort study. Patients with SAP indications undergoing orthopedic, gynaecologic, or general surgery were tracked after two years to check for the occurrence of superficial and deep surgical site infections (SSI), as defined by the Centers for Disease Control and Prevention. Multivariable logistic regression was used to evaluate the relationship between the time of SAP and SSI. Results: Following 300 surgical operations, 150 SSIs were found. Within 60 minutes following the incision, SAP was delivered in 86% of the surgeries. The only antibiotics utilized were those with short infusion times. SSI risk was not shown to change significantly after SAP was administered 60–30 minutes or 30–0 minutes before to incision, according to multivariable logistic regression. Conclusions: In this cohort, there was no discernible improved timing interval for SAP with short infusion times within the 60-minute window before to incision. The variations in SSI risk shown in previous research could not be replicated by us.

54. Spectrum of Breast Lesions: A Three-Year Retrospective Study
Jyotirmaya Nayak, Sridhar Panda, Nilamadhaba Prusty, Nagendra Kumar Rajsamant
Introduction: Breast lesions are one of the most common surgical diseases seen in daily clinical practice. Both benign and malignant illnesses might provide diagnostic difficulties or be difficult to treat. The high death rate associated with breast cancer is connected to tumor aggressiveness, which is heavily influenced by histopathological kinds and stages. Aim: The purpose of this study is to assess the prevalence of various breast lesions and to highlight the uncommon breast lesions observed in our research. Materials and Methods: Our institution’s Surgery department did a three-year retrospective analysis. A total of 348 breast specimens are being investigated. The sample size was determined by the study’s convenience. The results showed that 342 (98.28%) of the 348 specimens belonged to female patients, whereas 6 (1.72%) belonged to male patients. There were 254 non-malignant lesions, 92 malignant lesions (26.44%), and 2 borderline lesions (0.57%). Medullary carcinoma (3 instances), Paget’s disease of the nipple (1 case), Metaplastic carcinoma (1 case), Clear cell carcinoma (1 case), and Mucinous carcinoma (1 case) were the subtypes observed. Conclusion: The study of uncommon and underappreciated lesions, in addition to the normal lesions, is significant in today’s period because it plays an important role in reducing morbidity and death related with breast lesions.

55. Outcomes and Complications of Thyroid Surgeries: An Eight Year Experience
Jyotirmaya Nayak, Nagendra kumar Rajsamant, Nilamadhaba Prusty, Sridhar Panda
Background: Understanding the difficulties and outcomes of thyroidectomies in rural settings is critical for improving patient care, addressing any inequities, and identifying opportunities for improvement. Method: The investigation was conducted as a retrospective observational study at tertiary care teaching hospital. The data of patients receiving thyroidectomy surgery at the institution during the previous eight years has been evaluated and presented. The research comprised a total of 100 cases. Results: Right hemi thyroidectomy was performed in 57 instances, left hemi thyroidectomy was performed in 26, complete thyroidectomy was performed in 5, total thyroidectomy with neck dissection was performed in 9, and isthmectomy was performed in three cases. A total of 38 cases of colloid goitre, 35 cases of nodular goitre, 4 cases of multi nodular goitre, 9 cases of follicular neoplasm, 9 cases of papillary thyroid carcinoma, 3 cases of isthmus solitary nodule, 1 case of lymphocytic thyroiditis, and 1 case of Hurthle cell tumor were found in the diagnostic profile. Six individuals had temporary recurring nerve palsy, and two experienced transitory hypocalcaemia. Conclusion: The study’s results indicate the necessity for resource allocation, healthcare planning, and quality improvement measures in this sector. More research with a bigger sample size is needed to address the study’s shortcomings and broaden our knowledge of thyroid surgery techniques in rural locations.

56. Clinical Profiling of Cholelithiasis Patients at a Tertiary Care Facility: A Cross-Sectional Study
Jyotirmaya Nayak, Nilamadhaba Prusty, Nagendra kumar Rajsamant, Sridhar Panda, Bibhas Kumar Sahu
Background and Goals: Cholelithiasis is a chronic, recurring illness affecting the hepatobiliary system. Gallstones are a leading cause of illness and death worldwide. Gallstones affect around 10% of individuals, a prevalence that has been increased by recent dietary changes. This study aims to evaluate demographic characteristics, various presentation modes, treatment techniques, and following results. Methodology: A one-year prospective study comprising 123 individuals with cholelithiasis was carried out. Epidemiological variables, clinical profiles, diagnostic tests, treatment approaches, and results were all thoroughly examined. Results: The cohort’s average age was 36.95 years, with a female-to-male ratio of 1.41:1. Pain in the abdomen was shown to be the most common symptom. All patients had gallbladder stones detected by ultrasonography, with 30.89% getting open cholecystectomy and 65.04% undergoing laparoscopic cholecystectomy. There was a 5% conversion rate from laparoscopic to open cholecystectomy. The typical postoperative stay for laparoscopic cholecystectomy was three days, but open cholecystectomy required a seven-day stay. Conclusion: Laparoscopic cholecystectomy is a better surgical technique, with less postoperative discomfort, a shorter hospital stay, and improved cosmetic results.

57. Antibiotic Susceptibility Pattern of Uropathogens in Urinary Tract Infection in a Tertiary Care Hospital
Jyotirmaya Nayak, Nilamadhaba Prusty, Nagendra Kumar Rajsamant, Sridhar Panda, Saubhagya Sahoo
Background: Urinary tract infection (UTI) is one of the most frequent infectious illnesses in the population, especially in underdeveloped countries where healthcare and economic resources are limited. The infection of the urinary system is also known as pyelonephritis (kidney infection) or cystitis (bladder infection). Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Citrobacter species, Enterobacter species, Pseudomonas aeruginosa (P. aeruginosa), and Staphylococcus species are examples of UTI bacteria. Aims & Objectives: (1) To describe the bacteriological. (2) To identify the antimicrobial resistance (AMR). (3) To find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility. Method of study: This was a hospital-based, cross-sectional research that used normal laboratory information. From 2020 to 2023, the antibiotic sensitivity and resistance pattern of bacteria responsible for UTI at a Tertiary care facility, MGM Hospital Warangal, Telangana, India, were studied to assess the efficacy of empirical treatment. Three years of urine culture findings, biochemical test results, and antibiotic susceptibility test results of isolates were obtained from the medical microbiology laboratory registry using a checklist. Infection reports from persons of all ages and genders were taken into account. To evaluate, enter, and analyze data, SPSS version 23 was utilized. Our results were presented in the form of descriptive tables and graphs. Results: The most frequent uropathogen was Escherichia coli, with a prevalence rate of 72%, followed by Klebsiella spp. (20%) and Pseudomonas spp. (8%). Penicillin was the least effective against UTI-causing E. coli, with fourth generation cephalosporins being the most vulnerable. Klebsiella spp., another prevalent uropathogen, was most resistant to broad-spectrum penicillin, followed by aminoglycosides and third generation cephalosporins. The infection rate was almost the same in both sexes, but was highest in individuals over the age of 60. Conclusion: The antibiotic resistance trend of two primary UTI pathogens, E. coli and Klebsiella spp., in our hospital seems to be equivalent to that reported in other parts of the nation. The prevalence of broad-spectrum penicillin resistance was determined to be more than 50%. Fourth generation cephalosporins and macrolides seem to be the medications of choice for treating UTIs in South India. Furthermore, improved infection incidence record keeping in hospitals is essential to allow for regular surveillance of the occurrence of antibiotic resistance patterns, since such levels change.

58. Etiology, Clinical Picture and Diagnosis of Lower Gastrointestinal Bleeding at a Tertiary Care Institute in Eastern Odisha: A Retroprospective Study
Jyotirmaya Nayak, Nilamadhaba Prusty, Nagendra Kumar Rajsamant, Sridhar Panda, Omm Swayam Prakash Routray
Aim of the Study: To evaluate the various etiologies, clinical assessment, and requirement for blood transfusion in patients with lower gastrointestinal bleeding admitted to an eastern Odisha tertiary care center. Materials and Procedures: The research comprised 988 patients, 824 retrospective cases and 164 prospective cases from Department of Surgery in S.C.B. Medical College and Hospital in Cuttack, Odisha. Analyzing case sheets from retrospective cases yielded information. Prospective patients were handled in accordance with departmental practice, and all investigations and treatments were recorded. Results: Patients over the age of 40 were the most often afflicted, accounting for 56% (533/988) of the study group. Males made up 70.5% (697/988) of the population, while females made up 29.5% (291/988).Males had a mean age of 43.2310.65 years, while females had a mean age of 42.7916.53 years. Hemorrhoids were shown to be the most prevalent pathology in colonoscopy, affecting 30.8% (n =305) of individuals. Anorectal growth was identified in 15.3% of the patients; while colonic growth was found in 9.7%.14% (139/988) of patients had inflammatory lesions. Colonic polyps were discovered in 4.8% of patients, whereas rectal polyps were found in 3.9%. Males had a higher mean hemoglobin level of 10.643.79 g/dl than females (10.833.69 g/dl). Only 7.8% (77/988) of patients needed a blood transfusion if their hemoglobin level fell below 7gm/dl. Conclusion: Hemorrhoids were the most common cause of lower gastrointestinal hemorrhage, followed by anorectal growth. Colonoscopy was the first and most common diagnostic performed to evaluate lower gastrointestinal bleeding. Only a small number of patients needed blood transfusions.

59. Assessment of Health Related Quality of Life in Children with Epilepsy With Regard to Various Domains of Life
Santosh Shimpiger, Sushma Save, Nishigandha Joshi
Background: Epilepsy is unpredictable, usually chronic and debilitating disorder that impacts not only those bearing with it but also their caregivers. Epilepsy is thought to affect more than 100 million individuals and their families worldwide at some point of their lives, and thus constitutes a major universal public health issue. Objectives: Emphasis on various factors which can affect the quality of life in children with epilepsy. Certain factors such as seizure frequency and time since last seizure which are not studied extensively in India or abroad are included in this study to establish their effects on different domains of life in children with epilepsy. Results: Majority of the study participants were in the age group of 8-10 years (42%), followed by 5-7 years (29%) and 11-12 years (29%). Also illustrates the distribution of study participants according to gender. Majority of study participants were males (60%). Also illustrates the distribution of study participants according to maternal education. Majority of the mothers were graduates (41%), followed by 12th standard (30%) and primary education (24%). Only 5% of mothers were illiterate. The mean score was highest for time of more than 365 days. No statistically significant difference was found. In our study we found that children with time since last seizure of more than 1 year (i.e. more than 365 days) had a better quality of life with a mean score of 89.19 compared to those with time since last seizure of less than 7 days with a mean score of 60.77. Conclusion: The overall quality of life was compromised in children with epilepsy. The quality of life was better in participants of older age group, higher maternal education level, less seizure frequency and more time since last seizure. Sex of the participant did not have a significant impact on the quality of life.

60. Clinicopathological Study of Multiple Myeloma in a Tertiary Care Hospital of North-East India
Gabyanjali Devi, Jilimili Devi
Introduction: Multiple myeloma is a plasma cell malignancy. The present study aims to investigate the spectrum of clinical, haematological and biochemical features and histopathological findings of bone marrow (BM) biopsy in patients with multiple myeloma attending a tertiary care hospital of North-east India. Methods: The present hospital based cross-sectional study was carried out in the Department of Pathology, Gauhati Medical College and Hospital, Guwahati (GMCH)along with Department of Clinical Haematology, GMCH during July 2019 to June 2020 including 34 newly diagnosed multiple myeloma patients. Complete clinical examination along with bone marrow aspiration and bone marrow biopsy samples were collected and reviewed. The diagnosis was established according to International Myeloma Working Group (IMWG) 2014 criteria. The study approval was obtained from the Institutional ethics committee of GMCH, Guwahati. Data analysis was done using SPSS v21. Results: Multiple myeloma is more frequent among patients in sixth decade (35.3%) and male gender (58.8%). Low backache and bone pain was the most common presenting symptom (67.6%). Heamoglobin level, erythrocyte sedimentation rate (ESR) and Beta-2 microglobulin levels differed significantly between genders (p-value<0.05). Monoclonal protein (M-protein) was detected 33 (97%) patients. In comparison to the BM aspirate, the mean plasma cell percentage on the BM biopsy (65.4%) was greater. In addition, substantially more instances had > 50% plasma cells on the BM biopsy than the BM aspiration (p-value 0.05). Conclusion: Multiple myeloma is more common among adult and male patients. Clinical manifestations are not necessarily gender free. Discrepancies exist between bone marrow biopsy and bone marrow aspiration.

61. Comparative Evaluation of Alvarado Score and Pediatric Appendicitis Score for the Diagnosis of Acute Appendicitis in Children Undergoing Appendicectomy in AGMC & GBP Hospital
Damodar Chatterjee, Bijit Lodh, Subhrendu Bhattacharya
Introduction: The abdomen is a crucial diagnostic tool for many stomach-related illnesses, and acute appendicitis, a common cause of acute abdomen in surgical practice, has been a subject of ongoing study since its initial report in 1886. The vermiform appendix, a tubular structure from the postero medial portion of the caecum, is located inferior to the ileco caecal junction and is suspended by a fold of peritoneum. It contains the appendicular artery, a branch of the ileocolic artery. Acute appendicitis initially presents with vague symptoms like nausea, anorexia, and indigestion, which may cause vomiting and body temperature rise. Pain migration occurs when pain is overrun by local peritoneal nociception, and histopathologic characteristics include mucosal ulceration, neutrophilic leukocyte invasion, and in some cases, perforation and serositis. Men have an 8.6% lifetime risk of developing acute appendicitis, compared to 6.7% for females. The appendicitis organ has five layers: mucosa, lamina propria, sub mucosa, muscularis, and adventitia. It plays a role in immunity, with lymphoid aggregations in the sub mucosal layer causing an inflammatory response in acute appendicitis. Appendicitis is caused by obstruction of the appendicular lumen, which can be caused by foreign body, crohn’s disease, parasite infection, gastroenteritis, upper respiratory tract infection, fecolith, and lymphoid hyperplasia. Appendicitis diagnosis is a complex process involving various investigations, including laboratory and radiological tests, to find the most sensitive test for detecting acute appendicitis. Advancements in modern radiographic imaging and diagnostic laboratory tests have improved diagnostic accuracy and reduced misdiagnosis. Methodology: This research aims to compare PAS and Alvarado scoring systems for diagnosing acute appendicitis in children. The study involved 70 patients aged 4-14, divided into two groups using either system. Intraoperative findings included inflammation-characterized appendixes and normal ones, with histopathological analysis conducted on all appendicectomy specimens. Discussion: Clinical scoring systems have been developed to identify the most sensitive, specific, and accurate clinical scores for diagnosing acute appendicitis. The Alvarado score, developed by Samuel, is a well-known and researched method for pediatric appendicitis. A study involving 305 patients found that a score of less than five indicates no appendicitis, while a score of five or six requires observation. The Alvarado method has a sensitivity of 72%, specificity of 81%, and a sensitivity of 92.8%. A PAS score of 6 or higher was highly associated with appendicitis, while a score of 5 or less did not. A study comparing the Alvarado score and PAS for diagnosing acute appendicitis found no significant differences between the two. The study also found no significant differences in PAS scores for diagnosing AA among the 35 participants. Conclusion:  Diagnosing acute appendicitis in pediatric patients remains a challenge, with PAS having better predictive values, sensitivity, and specificity than Alvarado. Further research is needed to determine the best scoring system for pediatric patients.

62. A Study of Aerobic Bacteriological Profile & Antibiotic Susceptibility Pattern in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Mahesh Yadav, RK Maheshwari, Akriti Aggarwal, Jairam Choudhary, Mamta Lamba
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is characterized by airflow obstruction that is not completely reversible. COPD is usually progressive in nature, associated with an abnormal inflammatory response of the lungs to chronic inhalational exposure to smoke, dust and other air pollutants. It encompasses two broad categories which include Chronic Bronchitis and Emphysema. Over three million people died as a result of COPD in 2005 corresponding to 5% of deaths worldwide. So it would be the third leading cause of death by 2030.Thus that being the aim of this study to identify the aerobic and facultative anaerobic bacteria from the sputum culture of patients admitted with Acute Exacerbation of COPD and to determine the antimicrobial susceptibility pattern of the bacterial isolates. Material and Method: A total of 100 sputum samples were collected from patients with acute exacerbation of COPD & were processed at Bacteriology lab of the Department of Microbiology, SMS Medical College, Jaipur. Results: Among 100 clinically diagnosed AECOPD cases, 51 (51%) had growth of pathogenic flora. Among all the positive cases, the majority of the pathogens were gram-negative bacilli 45(76.3%) followed by gram-positive cocci 14 (23.7%). Conclusion: Empirical treatment should be based on the presumptive etiologic diagnosis developed from all existing epidemiologic, clinical and laboratory records. Once the culture report is accessible, the treatment should be based on the drug to which the organism is most susceptible. If this approach is followed it will definitely help us in curbing the dearth of Antimicrobial resistance.

63. A Cross Sectional Study of Spirometric Evaluation of Lung Functions and Respiratory Symptoms in Rice Mill Workers in Rural Region of Western Part of Maharashtra
Rupali Sudhir Baburdikar, Manasi Mukund Joshi, Yuvraj Khema Badhe
Introduction: Rice millworkers have an increased exposure to dust and chemicals which can have adverse effect on respiratory health of the workers. Spirometry is very important and widely used diagnostic tool for measuring obstructive or restrictive patterns of lung functions which can aid in early detection of airborne occupational health hazards. Aim: The primary objective of the study was to determine Forced expiratory volume in 1st second (FEV 1), Forced vital capacity (FVC), and FEV1/FVC and Peak expiratory flow rate (PEFR) in the rice mill workers and to compare these parameters with the healthy individuals. The Secondary objective was to find the prevalence of respiratory symptoms among the rice mill workers. Materials and Methods: A community-based observational cross-sectional study was conducted in Maval region of Western part of rural Maharashtra. Spirometry test was done in 36 rice mill workers and spirometry parameters were compared with healthy age and sex matched controls. Unpaired t-test was used to compare mean values of FVC, FEV1 & FEV1/FVC ratio between the study groups. Results: There was decrease in all spirometry parameters in rice mill workers when compared to healthy volunteers. The mean FVC in subject group was 2.7±1 while that in controls and control group was 3.6±0.6. The mean FEV1 in subject group was 1.7±0.7 while that in controls was 3±0.5. The mean FEV1/FVC in subject group was 64.1±5.6, while that in controls was 83.1±4.8. There was highly significant difference seen above mentioned spirometry parameters between the two groups with p value (< 0.0001). Conclusion: Rice mill dust exposure affects the lungs functions as seen by decrease in spirometry parameters as compared to control group. Also, chest tightness was one of respiratory symptom experienced in majority (63.9%) of the rice mill workers.

64. Vitamin D3 Deficiency in Women Experiencing Infertility: A Comparative Study
Satyajit Jena, Manamohan Biswal, Sujit Kumar Mohanty, Tapas Kumar Panda, Tushar Kar, Soubhagya Kumar Das
Background: There can be multiple reasons for infertility, making it a complex disease to cure. Infertility leads to emotional trauma among the patients. Low levels of vitamin D3 during childbearing age of a women can lead to infertility. This condition is common among undernourished women. Objective: To conduct a comparative study and analyze the serum vitamin D3 level among women of childbearing age, divided into two groups: fertile and infertile. Methods: A case-control observational study was conducted in the Department of Obstetrics and Gynecology, SCB Medical College, Cuttack, Odisha, India from July 2021 to July 2022. 122 women participated in the study; they were divided into two groups. 61 women were in the control group and 61 in the infertile group under study. The infertile group was thoroughly examined to rule out other factors of infertility. The blood was collected to measure the serum D3 levels. The data obtained was subjected to statistical analysis. Results: There was a substantial difference in the serum D3 levels of both groups. The average serum D3 level for the control group was 26.87 ng/mL, and for the infertile group, it was 7.86 ng/mL. The p-value was less than 0.05. Also, the serum level of vitamin D3 decreases with advancing age. Conclusion: Serum vitamin D3 levels decreased significantly in infertile women. The level decreased with advancing age, and so the infertility increased with age. The correlation between body weight and vitamin D3 levels was not significant. Similarly, the sociodemographic factors did not affect the serum vitamin D3 level.

65. Assessment of Degenerative Disc Diseases in the Cervical Spine through Magnetic Resonance Imaging: Insights into Age-Related Patterns and Severity
Akshaykumar Dhoriyani, Aditya Dhoriyani, Jitendra Parmar, Jalpa Bhadja Dhoriyani
Introduction: The assessment of degenerative disc diseases (DDD) in the cervical spine through magnetic resonance imaging (MRI) is pivotal for understanding age-related patterns and severity. As individuals age, the cervical spine undergoes changes leading to intervertebral disc degeneration, causing pain and reduced functionality. MRI, with its detailed soft tissue imaging, offers a non-invasive means to evaluate structural alterations associated with DDD. This study explores the relationship between age and severity of cervical spine degeneration, providing insights into diagnostics and potential interventions. Material and Methods: This descriptive study conducted at a tertiary care center aimed to evaluate and grade degenerative disc diseases in the cervical spine using Magnetic Resonance Imaging (MRI). From December 2021 to November 2022, 100 patients aged 16 years and above, presenting with neck pain and stiffness, were included. The study utilized a 1.5 Tesla MRI scanner and focused on six cervical disc levels (C1-2 to C7-D1). Exclusion criteria ensured a specific cohort, excluding those with cervical spine surgeries, spondylolisthesis, fractures, spinal cord lesions, or contraindications for MRI. Statistical analyses, including descriptive and inferential statistics, were performed using SPSS version 21.1 to assess the severity of degenerative disc diseases and explore associations with demographic factors. Results: In our study evaluating 100 participants for degenerative disc disease in the cervical spine through MRI, we found the highest prevalence in the age groups of 21-30 years (21.0%) and 61-70 years (22.0%), with females exhibiting a higher occurrence (56%) compared to males (44%). Disc degeneration was observed at 27.0%, posterior disc protrusion at 21.0%, anterior disc protrusion at 12.0%, narrowing of disc space at 23.0%, and foraminal stenosis at 17.0%. The grading of disc degeneration across different age groups revealed a trend of increased degeneration with advancing age, with the majority observed in older age categories. Notably, Grade C2-3 posterior disc protrusions were prominent in the 21-40 and 31-40 age groups, while Grade C5-6 cases were distributed across 21-30, 41-50, and >70 years. Conclusion: that disc degeneration was the most common degenerative disc disease, followed by posterior disc protrusion, narrowing of disc space, anterior disc protrusion, and foraminal stenosis. The C5-6 level exhibited the highest frequency of degenerative changes, with notable occurrences in the age group of 61-70 years for disc degeneration and over 70 years for posterior disc protrusion.

66. Comparison Between the Clinical Utility of Serum Albumin as a Diagnostic Marker with Serum Pro-BNP in Patients Presenting with Acute Heart Failure Admitted to the Cardiology Department: A Retrospective Study
Sandeep Singh Soam, Sonali Chaturvedi
Introduction: Ability of biomarkers to accurately diagnose a patient’s disease in emergency settings in cardiology department can predict the aggressiveness of the treatment given in due course of time. Heart failure is a clinical syndrome characterized by systemic perfusion inadequate to meet the body’s metabolic demands as a result of a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/ or elevated intracardiac pressure at rest or during stress.[1-3] Several studies have demonstrated the significant role of NT‑proBNP, in heart failure management from diagnosis to monitoring and recommended its use in clinical practice and the same has been approved by major international guidelines. Acute systemic response reflects increased capillary permeability and redistribution of albumin to extrcellular fluids. Aim: To compare the clinical utility of serum albumin as a diagnostic marker with serum Pro-BNP in patients presenting with Acute heart failure admitted to the cardiology department. Materials and Methods: This retrospective evaluation of data was done on patients admitted in cardiology department with acute presentation of symptoms in a government-run Tertiary Care Centre in Western Uttar Pradesh over a period of three months. This study was performed to observe any relationship between serum albumin levels and serum Pro-BNP levels in these patients. The analysis was performed on the data of 95 patients after considering the exclusion criteria and availability of their serum albumin and serum Pro-BNP reports. Based on the Serum NT‑proBNP values, < 125 pg/mL and > 125 pg/mL, the two groups were formed. The comparison between the mean value of serum albumin in these two groups was done was done by unpaired t-test. Value of Serum NT‑proBNP was not distributed normally, hence Spearman rank correlation coefficient was calculated to establish the correlation between serum albumin and Serum NT‑pro BNP levels. Results: About 45 of patients had Serum NT‑pro BNP values < 125 pg/mL and 50 patients had Serum NT‑pro BNP values > 125 pg/mL.The mean value of serum albumin was lower in the group with higher serum NT‑pro BNP (>125pg/mL) as compared to those with Serum NT‑pro BNP less than 125pg/mL, which was statistically significant (p value < 0.05).  The correlation coefficient between serum NT‑pro BNP and serum albumin levels was -0.460 which shows that both the parameters are negatively correlated and statistically significant. Conclusion: The significant difference was observed between mean serum albumin values in the two groups based on whether the serum value was less than 125 pg/mL and more than 125 pg/mL. The serum albumin levels of the patients were negatively correlated with their serum NT‑pro BNP levels and found to be statistically significant. So this study concluded that the low serum albumin levels can also predict the acute heart failure in patient admitted in emergency of cardiology department.

67. Maternal and Fetal Outcome in Pregnancy Complicated by Jaundice
Neelam Rajput, Priyanka Paliwal, Manisha Chauhan, Vaishali Singh
Introduction: Jaundice is a clinical manifestation of increased serum bilirubin levels, either direct or indirect. The incidence of jaundice in India ranges from 0.4/1000- 0.9/1000 deliveries [1]. Pregnancy complicated by jaundice carries a grave prognosis for both the mother and the fetus, and is responsible for high maternal and perinatal mortality rates. Liver disease in pregnancy is an important medical disorder seen more in the developing countries than in the developed ones. This study analyzes the causes and the feto-maternal outcome in the pregnancy which is complicated by jaundice. Liver function tests are deranged in 3% to 5% of pregnancies because of many potential causes and the clinical outcomes ranges from self-limiting to rapidly fatal. Objective: To determine the maternal outcome in terms of mode of termination of pregnancy, maternal morbidity and mortality in pregnancy complicated by jaundice and to identify the relation of maternal morbidity and mortality in relation to on- admission serum bilirubin level and to assess the fetal outcome in terms perinatal morbidity. Materials and Methods: A prospective observational study conducted in the Department of Obstetrics and Gynaecolgy, Kamla raja hospital, Gwalior, M.P for a period of 2 yrs. The study included 100 antenatal women admitted with total serum bilirubin levels >1.2 mg/dl. Detailed history taking and examination followed by required investigations were done and maternal and fetal outcome was analyzed. Results: HELLP remains the commonest cause of jaundice, either HELLP only, or associated with viral hepatitis or pre-eclampsia or eclampsia. Second most cause is the viral hepatitis. The incidence of post-partum hemorrhage was found 12%, 4% had hepatic encephalopathy, 6% had multi organ dysfunction syndrome. Amongst the total maternal deaths, the percentage of deaths in women with pregnancy complicated by jaundice was found to be 9.3% .In the total Maternal deaths of women having pregnancy complicated by jaundice, MODS i.e multi organ dysfunction syndrome was found the leading cause of death (35 %) .The initial level of bilirubin at the time of admission if >10mg/dl is associated with poor maternal outcome and high maternal mortality rate (80%).Majority of the babies were born preterm. Incidence of low birth weight was found to be 59%. Incidence of Intrauterine fetal death was found to be9.0% .29.6% of the babies got admitted in NICU in view of preterm, prematurity(75% of total NICU admission), low birth weight and fetal distress due to meconium stained liquor aspiration (25% of total NICU admission).

68. To Study the Socio-Demographic Profile of Cases of Fatal Head Injury in Road Traffic Accidents (RTA)
S N Hussaini, Priyal Jain, Saagar Singh, Meha Ghodawat
Background & Methods: To study the socio-demographic profile of cases of fatal head injury in road traffic accidents (RTA). The post-mortem centre conducting medicolegal post-mortems. All known cases of fatal RTA victims, who were brought for medico legal post mortem during study period. All cases fulfilling the inclusion criteria were studied. Preliminary data related to name, age, sex, address, brought by whom, date and time of incidence, date and time of admission, date and time of death were noted. The inquest report was carefully read, before starting post-mortem examination, detailed history regarding the mode of head injury was obtained from inquest report, hospital papers, from the concerned Investigating officer and also from relatives. Results: The distribution of RTA cases according to their demographic characteristics: Religion: reflects that majority of cases was Hindu (81.06%) followed by to Muslim (13.5%) and Sikh (5.3%). Marital status: It shows that death in road traffic accidents were more among married persons (72.5%) then unmarried cases (27.5%). Type of Habitat: Majority of the victims were belonged to rural areas 61.3% whereas 38.6% were belonged to urban area. Conclusion: From the present study it can be opined that injuries to the skull and brain are the main contributory factors in causation of fatalities due to vehicular accidents and prevention of these can reduce the mortality and morbidity to a great extent. The rate of incidence is higher in India because of its traffic patterns and their demographic profile. Possibly, the lack of preventive measures such as helmets in motor cyclists, seatbelts in automobiles, poorly controlled traffic conditions and poor road conditions are other factors responsible for injuries.

69. Mucosal Melanoma – A Retrospective Study in a Tertiary Cancer Centre
Arava Anu, S. Brindha, Suma Mn, Geeta V Patil, Usha Amritam
Introduction: Primary mucosal melanomas arise from melanocytes located in mucosal membranes lining respiratory, gastrointestinal and urogenital tract. Mucosal melanomas are rare, they are known to behave more aggressive and have less favorable prognosis compare to other melanoma subtypes. Most of the mucosal melanomas occur in the occult sites, which together with the lack of early and specific signs contribute to late diagnosis and poor prognosis. This study aimed to analyse the anatomical distribution of primary mucosal melanomas and their epidemiology. Materials and Methods: This is a descriptive, observational study conducted at KMIO. All cases with primary mucosal melanomas that underwent biopsy between 2019 to 2021 are included. Archived histopathology and immunohistochemistry slides along with data from medical records department were reviewed. Result: We present 24 cases of mucosal melanoma, identified over a period of 3 years. In our study the mean age of presentation was 58 years and male: female ratio is 1:2. Twelve, three, nine out of twenty four cases are from GIT, FGT, Head and neck respectively. We give a short comparison of few characteristics of cutaneous and mucosal melanomas. Conclusion: The purpose of the study is to analyse the anatomical distribution, epidemiology of mucosal melanomas along with literature review. Because of their rarity and aggressiveness along with varied clinical and morphological features melanoma has to be included in the differential diagnosis, especially in non-cutaneous sites and poorly differentiated neoplasms.

70. Dermoscopic and Clinico-Epidemiological Profile in Patients with Facial Dermatosis using Fairness Creams: A Cross Sectional Study
Haibatti SS, Solanki Y, Miranda TL
Background: Over-the-counter creams are misused to improve skin tone and for skin lightening. Some of these are steroid based which are not meant to be applied as fairness creams while the others are non-steroid based creams. These can both aid and incite facial dermatoses. Objectives: To study the clinico-epidemiological profile of patients with facial dermatoses induced by application of fairness creams, clinical effect of fairness creams and the dermoscopic findings associated with its use. Methodology: A single-center, observational, cross-sectional study was conducted on 88 patients with facial dermatoses that developed after using fairness creams. Mucocutaneous and dermoscopic examination was done to study the association of fairness creams with facial dermatosis. Results: Average age of our patients was 35.8±5.7 years with female predominance. Majority, 59.1% used steroid-based cream alone, 25% used creams with both steroidal and non-steroidal components and 15.9% used only non-steroidal creams. Photosensitivity (15.9%) and burning sensation (13.6%) were the commonest symptoms. Globular structure (84%) and telangiectasias (55.7%) were the commonest dermoscopic findings. The commonest cutaneous adverse effects were uneven patchy pigmentation (58%), followed by acneiform eruptions (17%) and facial erythema (11.4%). There was a significant association between patients using steroidal creams and the incidence of dermatosis (p-value=0.031). Conclusions: Females are more prone to developing fairness creams-induced dermatoses. Minute changes following its use like telangiectasias which may not be seen by the naked eye are better visualised by dermoscopy. Steroid-containing creams are commonly exploited for attaining fairness due to their relative inexpensiveness and familiarity as compared to other commercially available fairness creams.

71. Anti-Depressants & Sexual Dysfunction – Is Vilazodone A Better Choice Than SSRIS?
Shweta Chauhan, Swati Singh
Context: To compare the efficacy of new anti-depressant Vilazodone with SSRIs and associated sexual dysfunction. Aims: To assess and compare the Sexual Dysfunction of escitalopram, fluoxetine, sertraline and paroxetine with vilazodone. Methods and Material: One hundred and fifty patients diagnosed with Depression according to the DSM 5 criteria, seen in the Out-patient department of psychiatry at a tertiary care hospital, participated in the study after obtaining written and informed consent. Thirty patients were randomly assigned for treatment with either of the following drugs: escitalopram, fluoxetine, sertraline, paroxetine and vilazodone. Changes in Sexual Functioning Questionnaire (CSFQ) was applied on Day 1 to assess the baseline sexual functioning and again at week 1, week 2 and week 8 following initiation of treatment, to assess the extent of improvement, if any.  Statistical analysis used: SPSS v20 and independent sample t tests were used to tabulate and calculate the results. Results: Vilazodone was associated with the fastest improvement in sexual functioning as compared to other drugs; however, the difference in Sexual Dysfunction associated with all five drugs was not statistically significant at the end of the 8 week follow up study. Conclusions: Further studies are needed to verify or contradict the findings of this study.

72. Antinuclear Antibody Detection by Immunofluorescence Test: Insight from a Tertiary Care Hospital, North Western India
Jain Ruchi, Bithu Rameshwari, Yadav Manju, Aggarwal Akriti, Lamba Anita, Khandelwal Sonam
Introduction & Objectives: Anti-nuclear Antibodies (ANA) are said to be linked with various autoimmune diseases. ANA detection by Indirect Immunofluorescence Assay (IIFA) using Hep 2000 cells is considered as gold standard method for diagnosis. ANA screening is a reliable and a quick way to detect immunofluorescent patterns linked to autoimmune disorders. Thus that being the aim of our study to identify the prevalence of ANA patterns amongst the various patients presenting in a tertiary care hospital in Jaipur, Rajasthan. Material and Method: This is a retrospective study which included 3016 patients with either clinical suspicion of or suffering from autoimmune diseases attending a tertiary health care hospital in Jaipur, Rajasthan. ANA IFA test was performed with 1:80 dilutions of patient serum. Results: Out of 3016 samples processed 596 samples (20%) were positive. Out of various ANA patterns observed, most common pattern seen was nuclear speckled (81.54%) pattern. Conclusion: Autoimmune disorders are showing an increasing trend and ANA IFA is a promising tool for detection of antinuclear antibodies giving a clue for diagnosis of autoimmune diseases based on different ANA patterns.

73. A Study of Knowledge, Attitude and Practice of New Competencies in Pharmacology in Second MBBS Students of Tertiary Care Hospital, Vadodara, Gujarat
Nikita Panchal, Sneh Dudhia, Rahul Damor, Haresh Desai
Introduction: One of the significant transformations in recent years has been the adoption of Competency-Based Medical Education (CBME) curricula, designed to produce physicians equipped with the skills and knowledge necessary for contemporary healthcare delivery. Understanding current perceptions in both research and clinical practice may be helpful for improving teaching. AIM: The prospective study aimed to gather feedback and suggestions for improving teaching methods, exploring learning approaches, and assessing student attitudes toward clinical applications of pharmacology. Material & Method: The study included the current batch of 2nd professional MBBS students, totaling 166 subjects, who had been exposed to the new competencies in clinical pharmacology. A 20-question questionnaire, developed based on a literature review with necessary modifications, was administered to these selected medical students to evaluate various aspects of pharmacology education, learning methodologies and their attitudes. Participants received a brief explanation and their participation was voluntary, with informed consent obtained from all participants. Data collection occurred over a three-month period at Tertiary care hospital in Vadodara, Gujarat, India, following ethical guidelines to ensure participant confidentiality and anonymity. Result: A significant 93.4% demonstrated awareness of the Essential Medicines concept, while 84.9% emphasized the need for additional resources in p-drug selection. Additionally, 72.3% were well-informed about the Pharmacovigilance Program of India (PVPI), and 81.9% recognized the influence of effective doctor-medical representative communication on prescribing practices. In our study, case-based teaching preference was notably high. The usefulness of Multiple Choice Questions (MCQs) in internal assessment tests garnered strong support. Parallel integration of topics for better understanding and learning was well-received. Views on the usefulness of role-play/videos for improved patient communication varied. Conclusion: Study highlights the importance of effective communication with patient pharmacovigilance program. Furthermore, our findings support the growing preference for case-based teaching, referring standard textbooks new teaching methods like Multiple Choice Questions (MCQs), parallel integration of specific system, making videos/ role play for communication skill in medical education. These insights reflect the dynamic nature of medical education and the continuous pursuit of preparing healthcare professionals with the requisite knowledge and skills for responsible practice.

74. Feto-Maternal Outcome in Patients with Premature Rupture of Membranes, a Study of 250 Cases at a Tertiary Health Centre in Western India
Akash J. Patel, Ashish J. Varma, Jayneel V. Shah, Vihar R. Parikh, Richa B. Chaudhary
Background: Premature rupture of membranes is defined as spontaneous rupture of fetal membranes beyond 28 weeks of pregnancy but before the onset of uterine contractions. If PROM occurs before 37 completed weeks, it is referred to as preterm premature rupture of membranes (PPROM). PROM is associated with adverse outcomes in both; hence its management becomes crucial. It complicates 8% of pregnancies and is the cause of approximately one-third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapses, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate. The objective of the present study was to investigate the labor, maternal, and perinatal outcomes. Methods: The present prospective study was conducted in the Department of Obstetrics and Gynecology and associated Sheth L.G. Hospital, Narendra Modi Medical College, India from January 2023 to October 2023 among the patients diagnosed as premature rupture of the membrane with women complain of leaking attending antenatal OPD and antenatal ward. On admission, a detailed history was taken. General and Systemic examinations were done including Per Abdomen, Per Speculum and per vaginum carried out and investigations were done as per protocol. Diagnosis of PROM was confirmed by any of these methods. Continuous monitoring of maternal and fetal condition done antibiotics was given intra/ post-natal period. P/ V exam was done when necessary. Investigations done and maternal and fetal outcome were noted. Results: More number of booked cases was found in study group. Maximum women were in the age group of 20-24 years. Majority of cases of PROM were idiopathic. PROM results in oligohydramnios due to drainage of liquor amnii. Majorities of the babies were underweighted in mothers with PROM. Thus, the better fetal outcome was associated with term gestational age. Higher chances of maternal complication were found among mothers with PROM. Conclusions: From the above study, it can be concluded that PROM is associated with poor fetomaternal outcome. Early diagnosis and prompt management is required for better outcome of mother and baby.

75. Comparative Analysis of Sterilization Methods for Basic Surgical Instruments: A Retrospective Study
Sudhir Kumar, Rakhi Rani, Ramesh Kumar Ajai
Background: Sterilisation of surgical instruments is essential for minimising the risk of infection during surgery and keeping patients safe. This research evaluates the efficacy of three approaches to sterilising basic surgical instruments such as autoclaving, chemical sterilisation, and low-temperature sterilisation. Methods: The study used a retrospective design with 300 hospitals as subjects. We looked at how well it worked, how much it cost, and how safe it was. Institutional and electronic health records were mined for data, and analyses were run. Results: Compared to chemical sterilisation (₹1514) and low-temperature sterilisation (₹1810), autoclaving was the most cost-effective approach, with an average cost per cycle of ₹1040. The most reported adverse events (12) and highest grade for environmental effects (4.1) were associated with chemical sterilisation. Seven adverse events were observed during autoclaving, earning a score of 3.2 for ecological Impact, whereas others were reported with low-temperature sterilisation, achieving a score of 3.7. Conclusion: The results provide recommendations on how healthcare facilities allocate their resources to ensure patient safety. Potential data incompletion and variability in healthcare settings in the real world are limitations. This research lays the foundation for further investigations into sterilisation technologies, sustainability, and long-term patient outcomes.

76. Assessing the Effectiveness of Various Training Methods for Developing Basic Surgical Skills in Medical Students: A Retrospective Study
Sudhir Kumar, Rakhi Rani, Ramesh Kumar Ajai
Background: Training in surgical skills is an important component of medical education, as it affects the future competency and safety of those working in the healthcare industry. The purpose of this retrospective study is to evaluate the efficacy of various training techniques for establishing basic surgical skills in medical students and their consequences for patient outcomes. Methods: Three types of surgical skills education were compared using data from 300 medical students who had finished training: traditional classroom instruction, computer-based simulation, and on-the-job mentoring. Patient outcomes were analysed, including things like surgical complication rates, hospital lengths of stay, and rates of hospital readmission. Possible confounding factors were accounted for in the multivariate regression analysis. Results: Compared to simulation-based (10.8%), apprenticeship-based (7.5%), and apprenticeship-based training (8.1%), the rate of surgical complications (16.5%), hospital stays (4.9 days), and readmission rates (9.4%) were all higher in the didactic lecture group. These results were corroborated by a multivariate regression analysis, which showed that classroom instruction was independently associated with an increased risk of complications (p=0.03), longer hospital stays (p=0.02), and higher readmission rates (p=0.03). Hospital stays were shorter with simulation-based training, although more serious problems occurred less frequently with apprenticeship-based instruction. Conclusion: The results advise rethinking medical education’s didactic approach. Experience-based instruction can improve medical students’ surgical skills and patient safety. This study enhances medical education and patient care discussions. More study is needed to adapt training and courses to healthcare demands.

77. Management of Femur and Tibia with Antibiotic-Impregnated Polymer or Cement Coated Interlocking Nails
Upendra Kumar, Anand Shankar
Background: Infected fractured bones are exasperating issue faced by orthopedics. Through cleaning of the in-fected wound and then placing od the antibiotic releasing medullary nails id recommended in such cases. The aim of this study is to evaluate the efficacy of cement coat nails and polymer nails with impregnated antibiotics for treating infected fractured bones of tibia and femur. Methods: 20 patients who had infected fractured bones were included in the study. Before the treatment the level of infection and the extent of fracture was determined. Patients were then implanted with either cement coated antibiotic impregnated nails or polymer coated antibiotic impregnated nail which was done in single stage procedure or two stage procedure. Culture test and radiological test were repeated to calculate the dose of antibiotics to be given for 6 weeks. Regular follow-ups were conducted to check the healing process. Results: Four cases had sustained infection out of 20, in 5 cases the fracture did not heal. However excellent to good recovery were observed in the fracture healing for 60 % of the total cases. Similarly, 65% of the cases showed excellent to good restoration of the functional ability. Conclusions: In this comparative study there was no significant difference reported in the management of in-fected fractured bones considering cement coated and polymer coated medullary nails.

78. A Morphometric Study of Various Shapes of Scapular Glenoid Cavity at Jhalawar Rajasthan
Varsha Porwal, Ishrat Khan, Himanshu Sharma, Khushboo Mogra
Background: The variations in the morphology of gleaned fossa are influenced by genetic and environmental factors. Thorough knowledge on the morphometry and morphology of the glenoid cavity is essential in the understanding, investigation and management of demographic diseases pertaining to shoulder such as glenohumeral arthritis, rotator cuff disorders, shoulder dislocations, and fractures. Aim: To determine and analyse the morphological types and diameters of the glenoid cavity in adult scapulae. Method: A cross sectional study was done on 60 dry scapulae obtained from the Bone Bank of Department of Anatomy, Jhalawar Medical College, Jhalawar. Shapes of glenoid cavity were classified into three groups (Oval shape, Pear shape, Inverted comma shape) on the basis of presence or absence of notch on the anterior margin of cavity. All morphometric parameters were measured by using digital Vernier caliper in millimeter with accuracy of 0.1mm. Results: Among 60 scapulae, Most common shape of glenoid cavity was pear shape that is 58.33%) followed by oval shape in 25.0% and inverted comma shape in 16.67%. Mean values of measured parameters shows, SI diameter 31.38 ± 2.50 mm, AP- diameter 21.87 ± 2.23 mm and glenoid cavity index 69.69% ± 4.39 in total scapulae. All measurement values of right and left scapulae shows no statistically significant differences as p values is greater than 0.05. Conclusion: In the present study most common shape of glenoid cavity observed was pear shaped which followed by inverted comma shaped and oval shape. No significant differences was observed in measurement of right and left scapula.

79. Deciphering Macrocytic Anemia: Insights into Etiology and Hematology from South Rajasthan
Atul Tiwari, Nidhi Soni, Mayank Dosi, Savita Soni
Introduction: Macrocytosis characterized by abnormally large erythrocytes with an increase mean corpuscular volume (MCV), is a hematological condition indicative of various underlying pathologies. It is clinically significant and can range from nutritional deficiencies to bone marrow disorders. The prevalence in India varies significantly, making a complete workup essential for determining its etiology. Material and Method: This retrospective study from May to October 2023 in South Rajasthan, India, included 142 cases. It utilized clinical history, peripheral blood film examination, and biochemical tests for diagnosis. Result: Vitamin B12 deficiency was the most common (55.63%) cause of megaloblastic macrocytic anemia and alcohol was the most common (14.79%) cause of nonmegaloblastic macrocytic anemia in this study. Conclusion: The present study suggests that vitamin B12 deficiency, alcoholism, liver disease, and drugs were the main causes of macrocytic anemia in South Rajasthan, India. The study suggests that haematological parameters along with clinical history, peripheral smear examination and biochemical analysis is useful tools for detecting and managing macrocytosis.

80. Comparative Evaluation of Hemodynamic Response to Induction and Endotracheal Intubation in Normatensive and Controlled Hypertensive Patients
Shivraj N Chilwant, Pankaj Gorakh Shiledar
Background: The hemodynamic responses associated with laryngoscopy and racheal intubation may be harmful to patients with hypertension. myocardial ischemia, or cerebrovascular disease. Hence, anti-hypertensive medication is mandatory to control hypertension. Method: Out of 100 (one hundred) patients, 50 were classified as normatensive and so were controlled hypertensive. Blood pressure, heart rate, and SPO2 were recorded in both groups of patients, and significant parameters were noted. Results: 42 (84%) patients had no co-morbidity, 4 (8%) had type II DM, and 1 (2%) had DM with hypothyroidism. In comparison, heart rate (HR) after intubation at 4 minutes, 6 minutes, and 8 minutes had a significant p value (p<0.001). After medication, after intubation, 0 minutes, 2nd minutes, 4th minutes, 15 minutes, and 30 minutes had a significant p value (p<0.001). In comparison of DBP (diastolic blood pressure) pre-operatively on the day of surgery before medication after intubation at zero mediation, the 2nd and 4th minutes had a significant p value (p<0.001). In the comparison of SPO2 before medications, both parameters had a significant p value (p<0.001). Conclusion: In the present pregnant study, it was concluded that controlled hypertensive patients can be safely inducted and endotracheal intubation can be carried out for general anesthesia, and no cardio-vascular risk was observed.

81. To Study the Histomorphological Diversity of Various Non-Neoplastic and Neoplastic Lesions of Gall Bladder
Neelam Kumar Soni, Meha Ghodawat, Pratima Verma, Dhiraj Kumar Soni, Manoj Kela
Background & Methods: The aim of the study is to study the histomorphological diversity of various non-neoplastic and neoplastic lesions of gall bladder. Due importance was paid to record a brief clinical history with age, Inpatient number, presenting signs & symptoms, drug history and relevant radiological and other investigations. Thorough gross examination was carried out and salient features were noted down. The gross specimens received were fixed in 10 percent formalin for 24 hours and multiple sections from each specimen were taken to include the representative area for histological examination. Results: A total of about 106 cholecystectomies were found in two year study duration. In this study the age of patients ranged from 18 years to 80 years. Cases were studied for relevant clinical information regarding age, sex, sign and symptoms if any. We observed 106 cases of cholecystectomy specimen of which 99(93.3 %) were inflammatory lesions, 05(4.7%) were malignant lesions and 01 case (0.9 %) were benign lesion. Conclusion: Majority of the patients (33.9%), 36 cases were in the age group of 41-50 years. It shows that gall bladder diseases most frequently occurs in middle aged population. Out of 106cases, 90(84.9%) cases were chronic cholecystitis, of which, 66(62.2%) cases are associated with gall stones and 24(22.6%) cases are without gall stones. The commonest histological observation found was chronic cholecystitis with cholelithiasis.

82. Depression and Attitude towards Life of Elderly Population Living in Old Age Homes and Selected Communities of Bhopal City: A Comparative Study
Neeraj Khare, Nandini Shukla, Richa Nigam, Sanjay Gupta, Arvind Athavale, Sanjay Agarwal
The population of the elderly age group is increasing rapidly in India. Thia has been attributed to the increased life expectancy.  Projection by United Nation say that by 2050 more than 20%of the population in India will be above 60 years. Lack of social security and inadequate facilities for health care, rehabilitation and recreation has imposed many problems in our society. Present study has been conducted with the objective to determine and compare the psychosocial health status of elderly persons living in Old Age Homes of   Bhopal city with those living in field practice area under Urban Health and Training Centre of   Peoples College of Medical Science and Research Centre, Bhopal. Material Methods: A cross-sectional comparative study was done in Old Age Homes in Bhopal city & field practice area under Urban Health & Training Centre (UHTC) of Peoples College of Medical Science and Research Centre, Bhopal. A Total of 224 elderly subjects were included from the Old Age Homes of Bhopal city. Another group of the 200 study participants were taken from the adopted community at Urban Health & Training Centre (UHTC) Peoples college of Medical Science and Research Centre as a comparison group.  All the elderly (60 years of age and above) included in present study were subjected to personal interview with the help of a predesigned and pretested Performa. Assessment of functional status like Activity of Daily Living (ADL) was done with use of Barthel Index (BI).  An Abbreviated short version a self-report scale of the Geriatric Depression Scale (GDS) was used to assess the psychological status. Results: 90 (45.0%) of the subjects in the community were having happy attitude towards life than old age homes 65(32.5%), statistically significant difference (p<0.05) was obtained between attitude toward life residence of old age homes and community. No significant association found between depression status and age of elderly in old age homes and in the community was not significant statistically( p>0.05)

83. Navigating Obstetric Challenges: Insights from Tertiary Care ICU Admissions
Soubhagya Kumar Das, Satyajit Jena, Sumanta Kumar Dansana, Pramoda Kumar Sahoo
Background: The number of pregnant women admitted to the intensive care unit (ICU) is growing due to variables such as increased maternal age, rising rates and levels of obesity, and other comorbidities. The current research was conducted to examine the admission rate, outcome, and trends in women needing peripartum ICU care. Methods: This 6-month retrospective analysis looked at peripartum hospitalizations to the obstetric ICU. Demographics, comorbidities, diagnosis, intensive care unit treatment, duration of stay, and outcome were all examined. Result: Out of 7489 births throughout the research period, 112 patients were hospitalized to the intensive care unit. Thus, in our research, the rate of ICU admission was 1.49%. The majority of the patients (37.5%) were between the ages of 31 and 35 and were multigravida (83.9%). Severe pre-eclampsia and eclampsia (77.7%) were the most prevalent diagnoses at the time of ICU admission.47.5% of patients needed mechanical ventilation. The majority of patients (51.8%) were admitted for a brief (3-day) stay. During the study period, mortality was 4.5%. Conclusions: In obstetric critical care units, a multidisciplinary team approach including an obstetrician and an intensivist is suitable. The establishment of obstetric intermediate care units may help to alleviate the stress. In addition to appropriate prenatal care, prompt referral, health education, and health professional training may enhance clinical outcomes and obstetric practice, particularly in low-income countries like India.

84. An Observational Study of Patients Undergoing Below Knee Surgeries under Popliteal Fossa Block and Saphenous Nerve Block
Viralkumar Ashokbhai Vaghela, Kinjal Ashokbhai Vaghela, Hetal Chaudhari, Dharmesh Galiya
Background and Objectives: Most of the below knee surgeries are done under spinal anaesthesia. Due to more haemodynamic stability, better postoperative analgesia, early mobilization and less hospital stay, popliteal-sciatic nerve block more preferable over conventional methods. Popliteal-sciatic nerve block at branching point of tibial and common peroneal component prevents nerve sparing effects and saphenous nerve block along with it provide better analgesia over medial aspect of leg. There are various methods to perform block. In this prospective observational study, we used dual technique (USG & PNS guided technique) for popliteal-sciatic-saphenous nerve block to observe technical difficulty, ease of insertion, onset, duration and complications of block. Methods: Thirty patients were included in this study. Under all aseptic precautions, we performed popliteal-sciatic nerve block with posterior approach in prone position and saphenous nerve block in supine position by using dual technique with local anesthetic agent inj. Bupivacaine 0.5% 30ml and 10ml respectively. Data were analyzed by using STATA 14.2 version. Results: The average mean time for performing block was 33.4min while, in in-plane and out of plane techniques were 33.2min and 34min respectively. The mean onset time of sensory and motor blockade were 16.1min and 19.03min respectively. The average total mean duration of sensory blockade, motor blockade and analgesia were 8.16hours, 6.83hours and 9hours. Conclusion: We observed that dual technique for popliteal-sciatic-saphenous nerve block is very helpful for achieving analgesia and anesthesia in below knee surgeries.

85. Study of Anxiety and Depression in Chronic Obstructive Pulmonary Disorder (COPD) Patients in North Karnataka Population
Viralkumar Ashokbhai Vaghela, Kinjal Ashokbhai Vaghela, Hetal Chaudhari, Dharmesh Galiya
Background: Depression, anxiety, and COPD are bi-direction disorders in air pollution, smokers, due to a hurry and worry lifestyle. Hence, it is a challenge for psychiatrists to manage both depressive illnesses. Method: 65 adult patients aged between 40-70 years with COPD, anxiety, and depression was studied. They were subjected to a detailed clinical examination, and COPD was diagnosed as per GOLD guidelines with a post-bronchodilator fEv1/FEV<70n MRC score. The spirometric study, psychological assessment was carried out by the HAM-D, and anxiety assessment was carried out by the MADRS method. Results: 32 (49.2%) had no depression, and 33 (50.7%) had depression. Respiratory and psychiatric parameters had a significant p value (p<0.001). Conclusion: The prevalence of depression and anxiety in COPD should be evaluated with respiratory parameters, and psychiatric counselling and early treatment will improve the quality of life.

86. To Evaluate the Acute and Chronic Effect of a Nicotine Administration, Effect of Its Abstinence Alone and Its Combination with Mecamylamine on Thermal Pain Perception and Body Weight of Albino Mice
Rout Anima, Elisha Paikray, Amrit Prakash, Jigyansa Mohapatra, Chaitali Pattanayak
Introduction: Nicotine is a plant alkaloid and when given systemically, acts as an exogenous ligand of nicotinic acetylcholine receptor (nAChR). It is a tertiary amine that readily crosses the blood-brain barrier to bind to the central nAChR and nicotinic receptors on the ganglions. Aim: we aimed to evaluate the acute and chronic effects of nicotine administration, the effect of abstinence alone, and its combination with mecamylamine on thermal pain perception and body weight in albino mice. Materials & Methods: Animals were divided into four groups, each containing six mice. Group 1: treated with saline (subcutaneous). Group 2: nicotine 4 mg/kg/day administered in two daily subcutaneous injections for 7 and 14 days to analyze the acute and chronic effects on thermal pain sensation. Group 3: nicotine 4 mg/kg/day 2 daily subcutaneous injections for up to 7 days, then withdrawn. Group 4: nicotine 4 mg/kg/day 2 daily subcutaneous injections up to 7 days, then mecamylamine hydrochloride (2 mg/kg/day) in two doses on day 8. For the remaining 6 days (day 9 to14), the animals will receive only saline injections. All animals were fed a regular diet or high-fat diet. The amount of food consumed per mouse was recorded daily. The cumulative caloric intake was calculated based on the kcal/g of each diet. Each mouse was weighed at the start of the study (day 0) and subsequently every 3 days. Any weight change from baseline was noted. Results & Conclusion: In addition to boosting reward- and antinociception-related brain systems, nicotine causes discomfort, paw withdrawal, and other unpleasant side effects. This study showed nicotine’s unpleasant and antinociceptive effects, withdrawal, and neurobiology. Understanding the relationship between nicotine and tobacco usage may inspire new ways to quit.

87. Estimation of Supine Length from Percutaneous Measurement of Arm Length
Vishwajeet Singh, Ashok Sagar, Shilpa Singh, Kalayan Kumar Banerjee
Identification of the deceased is important at the time of medicolegal autopsy in case of mutilated dead bodies. Stature is one of the parameters which could help in identification of the deceased especially in cases of mass disasters wherein mutilated or amputated body fragments are brought to the mortuary for the purpose of examination. The aim of the present study was to estimate supine length from percutaneous measurement of arm length in 200 dead bodies (100 male and 100 female) brought to the mortuary of University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi. The results showed significant positive correlation between arm length and supine length (right arm length r = 0.812 and left arm length r = 0.829).

88. Association of Vitamin D Deficiency in Febrile Seizures
Harjot, Harshindar Kaur, Sukhmani Kaur, Rajesh Ranjan
Background: A febrile seizure is “an event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause.”.Although the etiology of febrile seizures is multifactorial, there is increasingly raised concern that vitamin D deficiency might also play a causal role. The present study was conducted to establish the association of vitamin D deficiency in febrile seizures. Materials & Methods: This prospective study (duration:1 year) was conducted on 120 patients in the department of paediatrics of GMC, Patiala. Informed consent was taken and then, patients were divided in two groups of 60 patients each- Case group included diagnosed cases of febrile seizures and control group includedfebrile patients without any seizures. The relevant biochemical tests of patients were done. The results were then analyzed. Results: In the present study, the mean age in case and group were 28.60 ± 15.02 months and 29.75 ± 16.27 months, respectively (p-value 0.654). In both the groups, there was a male preponderance (case group- male 63.3%; control group- male 53.3%; p-value 0.266). Malnourishment was observed in 16.7% patients of case group and 20.0% patients of control group (p-value 0.637). In case vs control groups, various lab investigations were- Serum Vitamin D [23.99 ± 14.34 ng/ml vs 30.55 ± 14.60 ng/ml;p-value 0.014 (S)]; Serum calcium [6.55 ± 0.64 mg/dl vs 8.78 ± 0.97 mg/dl;p-value <0.0001 (S)]; Hemoglobin [9.67 ± 0.60 g/dl vs 9.80 ± 0.65 g/dl;p-value 0.257 (NS)]; Serum phosphorous [5.30 ± 0.67 mg/dl vs 5.35 ± 0.64 mg/dl;p-value 0.676 (NS)]. Conclusion: Vitamin D deficiency can be a risk factor for febrile seizures in children. Significantly lower level of vitamin D was observed in febrile seizure group. Vitamin D supplementation should be considered for epileptic children and children with epilepsy should follow a well-balanced diet and good nutritional habits to optimize seizure control along with proper control of seizures and a proper follow up.

89. Profile of Blood Sugar Estimation in Adult Individuals Seeking Services in Health Camps and Hospital at ESICMCH, Bihta: An Observational Study
Neelam Kumari, Abha Kumari, Lovely Kumari, Ambika Saraswat, C. Selvakumar
Introduction: Diabetes is the global health problem. It is a one of the most common endocrinal disorder. Its prevalence has been increased maximum since last one to two decades. Diabetes mellitus is one of the leading causes of mortality among non-communicable disease together with cardiovascular disease, respiratory disease and cancer. Aims & Objective: To study the level of blood sugar among adult population coming to ESICMCH and attending in different Health camps organised by ESICMCH, Bihta Patna. Study design: This study was a observational study, conducted in a the Department of Biochemistry, ESICMCH, Bihta, and health camps of ESICMCH, Bihta, India. Study setting: A retrospective study on 11038 samples received for blood sugar has been done in Biochemistry central lab for a study period of 16 months (from April 2021 to July 2022). Inclusion criteria: (a) All adult who were above the age 18 yrs. (b) All samples received in biochemistry central lab for Blood sugar testing. (c) All samples of patients attending health camps of ESICMCH ,Bihta Exclusion criteria (a) Icteric and haemolysed sample were excluded. Study duration: The study period of 16 months (from April 2021 to July 2022) at ESICMCH, Bihta. Sample size: 9716 samples are taken. Results: Out of total 3059 fasting blood samples, only 903 persons are having FBS more than 126 mg/dl, Out of these 499 females & 404 persons were males. Out of total 2322 post prandial blood samples, 750 persons were having 200 mg/dl & above postprandial blood sugar in which 410 females and 310 were males. Total 5657 Random blood sugar were taken, out of which only 222 persons are having 200 mg/dl or more, in which 115 males and 117 were females. The relationship between age group & fasting blood sugar, the relationship between PPBS and age is found to be significant as p-value is <0.00001. Conclusion: Our study implies a need for physicians to focus on the education of diabetes-related knowledge in the clinical practice, which is of great importance to improve blood glucose monitoring adherence.

90. A Spectrum of Hematological Disorders in Children in a Tertiary Care Hospital
Charu Chandwani, Ritika Kansal, Amit Joon
Background: This study was conducted at the department of pediatrics and the department of Pathology of G S Medical Hospital Pilkhuwa. The study period was from January 2023 to August 2023. Methods: A retrospective analysis of those patients who underwent bone marrow examination (aspiration/trephine) was made. Charts were analyzed in detail regarding history, examination and investigations. Results: A total of 60 patient’s case histories including bone marrow examination results were analyzed. Nutritional anemias contributed 38(63.33%) cases amongst the non-hematological group. Out of nutritional anemias, megaloblastic anemia was the most common i.e. 30(50%) cases and Iron deficiency anemia was the least common i.e. 8(13.33%) cases amongst the non-malignant hematological disorder. Other non-malignant hematological disorders in descending order of frequency were aplastic anemia 7(11.66%) cases, hemolytic anemia 3(5%), idiopathic thrombocytopenic purpura ITP 2(3.33%) cases and visceral Leishmaniasis 1(1.66%) cases. Amongst the malignant hematological disorders, acute lymphoblastic leukemia accounted for 4(6.66%) cases and was found to be the most common disorder, followed by acute myeloid leukemia 2 (3.33%), lymphomas 2(3.33%) and 1(1.66%) chronic myeloid leukemia. Conclusion: Nutritional anemias as a group was the most common hematological disorder found on bone marrow examination in our patients. Megaloblastic anemia was the most common while iron deficiency anemia was the least common in the nutritional anemia group. Acute lymphoblastic leukemia was the most common amongst the malignant hematological disorders followed by acute myeloid leukemia.

91. An Observational Study Regarding Perinatal and Maternal Morbidity and Obstetrical behavior in Relation to Teen Age Pregnancy
Rekha Kumari, Sadhana Kumari, Usha Kumari
Background and Objectives: Teenage pregnancy which is detrimental to health of mother and child, is a common public health problem worldwide especially in third world. It is a problem that affects nearly every society-developed or developing alike. It is one of the key issues concerning reproductive health of women not only in developing but also in developed countries. The obstetrical behaviour of teenage pregnancies was observed in relation to presentation, mode of delivery duration of labour and foetal outcome and its complication and many other abnormality. Material and Methods: The present study was carried out in the Obstetrics and Gynaecology Department of Nalanda medical college and Hospital Patna Bihar. One hundred and twenty teenage pregnant women in the age group of 13 to 19  years were included in the series. The period of gestation was after the age of viability of foetus i.e. 28 weeks. Conclusion: Now on the basis of the above facts and figures it can very well be conclude that teenage pregnancy comes under high risk group. The importance of good prenatal care for the young primigravida cannot be overruled. The incidence of pre-eclampsia, eclampsia and prematurity was found to be higher in the teenagers.

92. Effect of Meditation on Heart Rate and Blood Pressure
Shaik Meera Sharief, Arjuman Parveen Shaik, Shaik Auliya Parveen
Meditation is a technique of achieving harmony between the physical, mental, intellectual and spiritual person alities of man. Meditation has a number of positive effects on the physiology of human body. It has shown to reduce diastolic blood pressure , systolic blood pressure, heart rate. The present study was done to know the effect of meditation on heart rate and blood pressure in healthy volunteers above the age of 30 years. The cardiovascular status of the subjects was assessed clinically in terms of resting heart rate and blood pressure before the start of meditation practice and again after 4 months of practice of meditation. The results were compared and analysed.. From the study it was observed that significant reduction in the heart rate occurs in the subjects practicing meditation (P < 0.001). The systolic blood pressure was lowered to a highly significant level (P < 0.001). The diastolic blood pressure was reduced significantly (P < 0.001). From our study, it can be concluded that regular meditation increases parasympathetic dominance in our body. This result in better cardiac reserve in meditators compared to non-meditators. Meditation provides significant improvements in physiological cardiovascular functions by tilting of autonomic balance from sympathetic in favour of parasympathetic.

93. Effectiveness of Conservative and Definitive Interventions to Enhance Outcomes of Diabetic Foot Ulcer
Prashik Meshram, Sanjay Kucheria, Satyendra Prasad Mukhiya, Mohini Kucheria
Background: Diabetic foot ulcer is one of the most commonly encountered complication seen in patients with uncontrolled diabetes. It is most commonly treated with combined approach of debridement with dressings or offloading techniques and use of sking grafts or flaps. We review the various conservative approaches like dressings, offloading, vaccum assisted dressings, use of growth factors, hyperbaric oxygen therapy and definitive modalities like grafting, flaps or the use of integra, to facilitate early wound healing and prevent undergoing amputation. Methods: 106 patients of age above 35 years with diabetes mellitus suffering from non-healing foot ulcers and infections were selected as per Wegger-Maggit Classification up to Grade 3. Outcomes were compared with patients improving with dressings/ offloading/ VAC dressing vs debridement with skin grafting, integra or flaps. Results: Surgical complications are more common in men due to their increased susceptibility to trauma, smoking, and tobacco. More than half of the patients had infection in addition to ischemia or neuropathy. This study indicates that all these three factors can be present in a patient with diabetic foot lesions. Conclusion: Conservative procedures include wound debridement followed by dressing with offloading / VAC dressing, use of PDGF resulted in healing of diabetic foot ulcers. Definitive procedures like Integra implant followed by SSG, or directly SSG or Flap Transfer resulting in healing of diabetic foot ulcers in patient with poor glycemic control or more complications. A multidisciplinary approach involving early intervention with conservative and definitive measures helped in preventing amputation in majority of the patients.

94. Evaluating the Long Term Impact of Adenotonsillectomy on the Standard of Living in the North Indian Children of 3-15 Year Age
Rajeev Kumar Nishad, Reetu Verma, Mohd Amir, Priyanka Das
Background: Children with tonsillar hypertrophy and recurrent tonsillitis undergo surgical operations to improve their quality of life and enable them to continue growing normally on the physical and mental levels. Aim: The goal of the current clinical experiment was to evaluate and compare the clinical symptoms that pediatric patients presented with following tonsillectomy, adenoidectomy, or adenotonsillectomy. The influence of these surgical treatments on the afflicted children’s quality of life was another goal of the study. Methods: A thorough examination of the head and neck area was conducted on 110 participants, ranging in age from 3 to 15 years. Parents of the participants were asked to complete a questionnaire that assessed the subjects’ feelings of wellbeing, frequency of sleep apnea, frequency of medical visits, frequency of tonsillitis episodes, frequency of absences from work or school, and frequency of sleep apnea three months before to and following the surgical operations. To formulate the results, the gathered data were statistically evaluated. Results: Out of 110 research participants, 16.36% (n=18) had adenoidectomy as a form of treatment. Tonsillectomy was performed in 47.27% (n=52) of the children, whereas adenotonsillectomy (a combination of tonsillectomy and adenoidectomy) was performed in 36.36% (n=40) of the subjects. The research individuals’ sleep apnea considerably decreased, going from 3.01±0.98 to 0.01±0.96 (p ~^0.001). Between three months prior to surgery and three months following surgery, there was a substantial decrease in the frequency of throat discomfort and absences from school (p ˂0.001). Moreover, there was a decline in doctor visits from 5.08±2.12 to 0.30±2.14, with a p-value of ˂0.001. Also, there was a noticeable improvement in the sense of wellbeing. Conclusion: Within the constraints of the study, the results indicate that tonsillectomy, adenoidectomy, or adenotonsillectomy done to treat recurrent tonsillitis or tonsillar hypertrophy considerably enhance the quality of life for the affected individuals.

95. Linezolid Induced Peripheral Neuropathy- How Do We Treat It?
Prakash R Deshmukh, Helee Khetan, Manjiri Ranade, Kailash Kothari, Shreyas Godbole
Background: Linezolid induced peripheral neuropathy (LIPN) is a relatively unexplored form of peripheral neuropathy which is commonly seen in the Indian population due to a higher incidence of treatment of multi-drug resistant tuberculosis. There have been a few cases described in literature, but the current guidelines for the treatment of peripheral neuropathies do not include LIPN as a subcategory while developing the treatment algorithms. As such, physicians who are the primary caregivers for these patients tend to undertreat the condition. This leads to a significant number of patients, who continue having chronic neuropathic pain that affects their day-to-day life. Methods: 50 patients with LIPN presented to the clinic. They were being treated with low dose Gabapin NT (400/10 1 tablet OD) and had not experienced any relief in their pain. They were placed on a high dose regimen comprising of Gabapin NT (400/10) 2 tablets TDS and were called for follow up after 3 days. Patients who experienced severe side effects such as tremors or dizziness were managed by dose adjustment. Patients lost to follow-up or with incomplete data were not included for analysis. Results: Patient data for 44 patients was available. 9 patients out of these were lost to follow up. Out of the remaining 35, 22 patients (62.85%) experienced pain relief, while 13 patients (37.14%) experienced no relief in their pain and were switched to another medication. We present the results of treating LIPN with high dose gabapentin-nortriptyline (Gabapin NT, 400mg/10mg), within the recommendations of the current guidelines for treatment of peripheral neuropathies. Conclusion: A high dose Gabapentin-Nortriptyline combination regimen can be used with good results in patients who experienced neuropathy following chronic Linezolid use and should be brought into clinical practice. Studies that examine the treatment guidelines for LIPN must be encouraged, as this is of direct benefit in the Indian population.

96. Clinicopathological Features of Gastric Cancer: A Retrospective Study from a Regional Cancer Center, Odisha
Niranjan Rout, MamitaNayak, Sashibhusan Dash, Sagarika Samantaray
Background: Gastric cancer (GC), is a common malignancy that poses a significant health burden in India. Although clinicopathological studies of GC helps to generate baseline data and guide future health care strategies and management but there is limited literature on this regard, particularly in this geographical part. In this study, we designed to evaluate the clinicopathological profile of gastric cancer with an aim to detect the cancer early for reducing the morbidity and mortality. Materials and Methods: During this hospital-based retrospective study, clinicopathological information was extracted from hospital records of GC patients who underwent subtotal or total gastrectomy between the years 2018 and 2020. Results: A total 279 cases of gastric carcinoma were included out of which male-to-female ratio was 2.4:1. The mean age of the study population was 54.47±12.2 years with range 18 to 82 years. The frequency of gastric cancer was highest in the antrum. Adenocarcinoma was the most frequent histologic subtype. The majority of our patients presented at an advanced stage locally. Conclusion: The present study confirms that the incidence of gastric cancer surges between the fourth and sixth decades. Males are disproportionately afflicted. The most prevalent symptom is abdominal pain, which is frequently vague and therefore disregarded. The majority of patients exhibited advanced disease. Raising public awareness can help us detect the disease earlier and develop a more effective treatment.

97. Case Control Study to Predict the Diagnostic Importance of Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a Biomarker for Chronic Kidney Diseases
Amita Gupta, Rajeev Lohokare, Purnima Dey Sarkar, Akshatha R
Introduction: The incidence of kidney disease is reaching to epidemic proportions. Early intervention can significantly improve the prognosis of kidney diseases. However, the paucity of early, predictive, non-invasive biomarkers has impaired the timely effective managements in these cases. In our study a new biomarker neutrophil gelatinase-associated lipocalin (NGAL), is investigated for its role in chronic kidney disease (CKD). Aim: To assess the role of Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a potential biomarker of Chronic Kidney Disease (CKD) in comparison to serum urea, serum creatinine and Creatinine Clearance Rate (CCR). Materials and Methods: This case-control study was conducted at MGM Medical College, Indore, MP, India, from October 2022 to March 2023. Total 50 known patients of kidney diseases and 50 healthy individuals above the age of 18 years were enrolled in the study. Blood samples were collected from all individuals and serum NGAL, serum urea level, serum creatinine level, fasting blood sugar were measured. Correlation of NGAL with serum urea level, serum creatinine level, CCR was calculated by Pearson Correlation test. Results: In present study, 50 patients in case groups (28 male and 22 females) and 50 healthy controls (26 males and 24 females) were included. Among controls, the mean age of patients was 53.14±5.62 years and among cases 52.74±8.56 years. NGAL level was increased two times (from 106.28±43.72 ng/mL to 296.17±62.65 ng/mL) in CKD patients than controls individuals. NGAL level was positively correlated with serum urea level, serum creatinine level while negatively correlated with CCR. Conclusion: The NGAL may be a useful and reliable serum marker for identifying the magnitude of renal dysfunction in patients with CKD and may have its place beside serum creatinine as an alternative endogenous GFR marker.

98. Assessment of Improvement in General Condition of Burn and Critically Ill Surgical Patients on Glutamine
Meha Ghodawat, Neelam Kumar Soni, Dhiraj Kumar Soni, Priyal Jain
Background & Methods: The aim of the study is to assess of improvement in general condition of burn and critically ill surgical patients on Glutamine. The patients were assigned randomly to study and control groups. Study group included 51 patients who were provided with parenteral glutamine along with the routinely prescribed parenteral nutrition regime. Oral intake was also started if not contraindicated. Results: Pus and Blood Cultures were assessed in Cellulitis and Burn patients, which included a total of 10 patients in the Glutamine group and a total of 14 in the control group.  7 out of 14 ( 50%) patients on Day 3 and 6 out of 14 ( 43%) on Day 7 showed positive Pus cultures in the Control group while corresponding figures in the Glutamine group were 4 out of 10 (40%) and again 4 out of 10  (40%) respectively ( p < 0.05). For blood culture, 5 of 14 (36%) patients on Day 3 and 2 (14%) on Day 7 were positive in the Control group while 3 of 10 (30%) on Day 3 and none (0%) on Day 7 were positive in the Glutamine group. (p > 0.05). Conclusion: The effects on infectious complications are again found to be beneficial in the form of decreased infection rates. This emphasizes the immunomodulatory role of glutamine. Hence the overall clinical and biochemical benefits of glutamine, observed in this study, provide enough evidence for suggesting parenteral Glutamine as an essential nutritional supplement for burn, critically ill and malnourished surgical patients.

99. A Comprehensive Analysis of CRP, D-Dimer, and CBC as Inflammatory Markers in Adult Patients with COVID-19
Asheesh Kumar Gupta, Sangeeta Dudve, Manish Rathore, Naresh Bajaj
Background and Objectives: Given the highly contagious nature of COVID-19, numerous healthcare systems worldwide are strained to their limits. It is imperative to establish straightforward and expeditious risk stratification methods for the identification of severe cases. This study endeavors to underscore the utility of readily accessible laboratory biomarkers with robust predictive value for assessing the severity of COVID-19. Methodology: A retrospective collection of data involved 118 individuals who tested positive for COVID-19. All fundamental laboratory biomarkers such as anemia, leukocytosis, lymphopenia, Neutrophil-to-Lymphocyte Ratio (NLR), in conjunction with C – reactive protein (CRP), and D-dimer at the time of admission were meticulously documented. Results: Parameters such as anemia, leukocytosis, lymphopenia, Neutrophil-to-Lymphocyte Ratio (NLR), in conjunction with C – reactive protein (CRP), and D-dimer were notably elevated. Nevertheless, through the application of multivariate logistic regression, solely anemia, elevated NLR, elevated PLR, and heightened D-dimer levels demonstrated a significant association with the risk of ICU admission. Conclusion: At the time of admission, anemia, a Neutrophil-to-Lymphocyte Ratio exceeding 8.5, a Platelet-to-Lymphocyte Ratio surpassing 193, and a D-dimer level exceeding 1 mg/L emerge as accessible and straightforward predictors for identifying severe COVID-19 cases necessitating ICU admission.

100. A Drug Utilization Study in Patients Suffering From Gastro-Intestinal (G.I.) Cancer at a Tertiary Care Teaching Hospital
Hardik Prajapati, Kamalesh Bhatt, Jatin Pathak, Vidhi Thacker, Minaxi Shah, Darshan J Dave
Objective: The objective of the study is to evaluate utilization patterns of drugs in patients suffering from Gastro-intestinal (G.I.) cancer at a tertiary care teaching hospital. Materials and Methods: This prospective, observational study was carried out at the Department of Pharmacology and Oncology, GCS Medical College, Hospital and Research Centre, Ahmedabad, to assess the drug utilization pattern in patients of cancer. The study was carried out over a period of 19 months from August 2019 to March 2021. A total of 43 patients were enrolled for the study. Patient’s demographic, clinical, and therapeutic data were collected from the files and in person ward visit and analyzed in Microsoft Excel version 2015. Results: Diagnosis of G.I carcinoma was highest in age group of >60 years (44.19 %). Colon (23.26%) was commonest organ affected followed by esophagus (16.28%) and stomach (11.63%) subsequently. Family history of cancer was seen in 25.6% patients, while 51.2% gave history of Tobacco consumption. Oxaliplatin and CAP: Capecitabine (OXA + CAP) was the most commonly used initial combination followed by CAR: Carboplatin and PAC: Paclitaxel (PAC + CAR).

101. Sleep Disturbances in Children with Autism – A Cross-Sectional Study
A. Geetha Jyothy, Vaidyanath Gottumukkula, Ravi Prakash Rangam, Anil Kumar. P
Background: Sleep is a fundamental component of human biology, and any disruption in sleep impacts an individual’s cognitive, emotional, and physical well-being. The prevalence of sleep-related diseases in children and adolescents was estimated to be between 25 and 40%. Furthermore, more than 40% of autistic children have sleep issues. The current study intends to investigate sleep impairment and disturbances in autistic children living in Anantapur District in Andhra Pradesh. Objectives: In this study, we aimed to explore sleep disturbances in children with autism.  Materials and Methods: It is a Cross-sectional study The study participants aged 3 -18 with autism who visit the District Early Intervention Centre (DEIC), Psychiatry Outpatient Department at Government Medical College, Anantapur in Andhra Pradesh. In this investigation, we evaluated 111 participants (children with autism). Children were diagnosed with Childhood Autism using ICD10 criteria. We measured the severity of autism using the Childhood Autism Rating Scale (CARS-2ST) and assessed sleep disturbances with the Sleep Disturbances Scale for Children (SDSC). The data were analysed using version 25.0 of SPSS. ANOVA and the Independent T-test were used to analyse the data.  Results: The results revealed a high prevalence of sleep impairment, affecting approximately 70% of the participants. Furthermore, nearly half of the children exhibited modest intellectual disability, and around 40% had mild to moderate autism severity. Notably, a significant correlation was observed between SDSC scores and intellectual disability, indicating that higher IQ scores were associated with improved sleep patterns. Conclusions: The prevalence of sleep problems in our study is 70%. The most common sleep disturbances reported were sleep-onset insomnia and nocturnal awakenings.

102. A Cross-Sectional Study to Evaluate Risk Factors of Chronic Kidney Disease among Diabetic Patients at Tertiary Care Hospitals in a District Of Gujarat
Bhaveshkumar R. Sureja, Kaushik K. Lodhiya, Nasrin A. Hala, Kapil J. Govani, Smit R. Kotadiya, Jeet B. Sureja
Background: Non-communicable diseases such as DM and kidney disease are the foremost cause of mortality and morbidity worldwide. Aims & Objectives: (1) To assess the different risk factors responsible for chronic kidney disease (CKD). (2) To assess the basic profile and stages of CKD among patients. Methods and Material: The study was a cross-sectional study. The study participants were confirmed diabetic patients of the general medicine department of tertiary care hospitals in a district of Gujarat. Sample size was calculated by fleiss with CC method. Based on predefined inclusion and exclusion criteria, a total 320 patients were selected. Based on eGFR value, patients were classified into two groups. Group-1 was normal to mild kidney dysfunction and Group2 was moderate to severe kidney disease. Various CKD risk factors were compared between two groups. Results: Among 320 patients, males were 61.6% and females were 38.4%. The mean age was 58.6±14.4. Around 19% of patients were illiterate. Half of the patients were tobacco users of ≥10 years (P<0.0007). The majority of patients (35%) belonged to CKD stage-1 followed by CKD stage-2 (30%). Significant difference was noted between the two groups for different risk factors e.g. Age (P<0.0001), prolong NSAIDs users (P: 0.01), history of UTI (P: 0.03), Labor occupation (P: 0.007) and chronic alcohol users (P: 0.0008). Conclusions: Half of the participants were aged (≥60years). The majority of them were males. The proportion of risk factors was significantly higher in the moderate to severe CKD stage (Group-2). Among them the majority of risk factors were non-communicable and lifestyle habits-based categories.

103. Psychological Distress in Infertility Patients Receiving Treatment at a Specialized Hospital: A Study in a Tertiary Care Setup
Jitendar Singh, Tarun Pal, Neelam Rathi
Background: Infertility is a common issue that causes physical, emotional, financial, and psychological strain on couples. Women are often blamed for infertility in developing countries, despite only one-third of infertility issues being caused by women. Little research exists on psychiatric morbidity in infertile patients in India and their coping mechanisms, making this study valuable. The study aims to investigate the prevalence of infertility and associated demographic factors in a tertiary care facility. Methods: This case control study was conducted in a LLRM medical college Meerut, including 280 females attending the obstetrics and gynaecology opd and infertility clinic opd. A questionnaire was used to collect data on infertility and associated factors, and standardized scales were used to assess depression, anxiety, and coping strategies. SPSS version 20 was used for data analysis. Conclusion: Infertile women are at high risk of psychological morbidity, and risk factors such as multiple abortions, Nuliparity, and lack of support can increase stress. Healthcare professionals should be aware of these factors and evaluate potential patients, using a quick screening tool to identify those in need of psychological support.

104. Epidemiology and Histomorphological Presentations of Salivary Gland Neoplasms
C. Aruna Mutharasi, L. Muthumani, N.S. Subbulakshmi
Background and Objective: Salivary gland tumors are relatively uncommon tumors and have diverse histopathological and clinical presentation. More than 70% of tumors occur in the parotid region. The second common site is submandibular salivary glands followed by sublingual and other minor salivary glands. About 70% salivary gland tumors are benign and arise from the major salivary glands. This study aims to evaluate relative frequency of various salivary gland tumors, its clinical presentation and histopathological morphology. Method: It is a retrospective study. 150 cases of salivary gland tumors were taken up for study. Clinical and epidemiological details were collected from old case records. Histopathological reports were collected from the department of pathology and analysed. The incidence of various tumors, male to female ratio, mean age at presentation, site and histological appearance were analyzed. Results: This is one among the few studies that concentrates predominantly on the epidemiology of salivary gland tumors. Among the 150 cases studied, 53.3% were females and 46.7% were males. 74% were benign tumors and 26% were malignant tumors.  108 tumors (72%) were from parotid, 16 (10.6%) from submandibular and 26 tumors (17.3) were from the other minor salivary glands. Pleomorphic adenoma was the commonest tumor. It constituted 91 cases (60.6%) out of the 150 cases studied. Mucoepidermoid carcinoma was the commonest malignant tumor of the study constituting 19.3% (29 cases) of the total tumors studied.  Age at presentation of these cases ranges from 15 to 72 years. Our data shows that the various characteristics of salivary gland tumors evaluatedin this study is similar to various available litreture worldwide. Conclusion: Salivary gland tumors have a wide range of presentation with regards to age, site and clinical features. Their histomorphological patterns too have different appearance. Even in the same type of tumor, individual components may vary in appearance and presentation. This study throws some light on thespectrum of salivary gland tumors and its different presentations.

105. To Evaluate the Diabetic Foot Using Diabetic Ulcer Severity Score in GMC Kadapa
R. Pushpalatha, B. Nageswara Rao, U. Harshini, M. Vijay Kumar
Background: In Diabetic foot ulcers early expert assessment and treatment are required to reduce the impact of the condition on the patient and to reduce the incidence of major amputation. The incidence of major amputation has been described as ‘a marker not just of disease, but also of disease management’. So a classification system that is easy to apply and robust enough to permit should be available in routine practice. The Aim of the study was undertaken to analyze the efficacy of DUSS scoring system in diabetic foot ulcers for prediction of clinical outcomes. Materials And Methods: Prospective Observational Study in GMC Kadapa over one year period in the Department of General surgery, in 100 cases that were randomly selected. Conclusion: DUSS scoring system provides an easy diagnostic tool for know the probability of healing and amputation. It combines four clinically assessable wound based parameters peripheral pulses, bone probing, number and site of ulcers giving 0 and 1 score for each parameter. DUSS score helps us to stratify patients based on score. It is a simple, streamlined approach in a clinical setting without any investigations. So this can be used in any setup to assess the diabetic ulcers. Lower DUSS score was strongly associated with healing and higher score with amputation.

106. Role of Serum Lactate in Predicting Strangulation in Intestinal Obstructon: A Prospective Study in Southern Part of Odisha
Nirod Kumar Sahoo, Nagendra Kumar Rajsamant, Sujit Kumar Mohanty, Suryasnata Sahoo
Background: Strangulation is one of the grave complications of intestinal obstruction that requires emergency laparotomy. Time is an essence, with an earlier diagnosis of strangulation favouring increased patient’s survival. Lactic acid is the normal endpoint of the anaerobic breakdown of glucose in the tissues. L-lactate and D-lactate are the two optical isomeric forms of lactate. D-lactate is not produced in mammalian tissue, but it is detected in a situation of an abnormal proliferation of enteral bacterial flora due to mucosal injury following mesenteric ischemia. Aim and Objective: The aim of this prospective observational study is to evaluate the role of Serum Lactate as an early marker of strangulation in bowel obstruction. Patients and Methods: 50 cases admitted in Emergency General Surgery Ward M K C G Medical college, Berhampur with clinical suspicion of intestinal obstruction for a period of one year (November 20222 to October 2023). Blood samples are taken at the time of presentation in the emergency within 20 minutes of their arrival and sent to the Dept of Biochemistry for estimation of serum lactate. Assessment and comparison of serum lactate levels in various outcomes of intestinal obstruction is done. Results: In this study a group of 50 cases of intestinal obstruction with no comorbidities had been taken for assessment of various outcomes of obstruction and their relation to levels of serum lactate. Out of 50 patients, 72% had strangulation and bowel gangrene as intra-op findings and the rest were simple obstruction. The mean serum lactate value in the patients was 5.16 mmol/L ranging between 1.70 to 8.60 mmol/L. The cut off values of strangulation, simple obstruction and those subacute cases managed conservatively were 4.3,3.4 and less than 2.3 respectively. Based on these values, 72% were classified strangulation, 22% with strong suspicion and 6% of them were normal. Conclusion: A positive correlation between elevated serum lactate and strangulation bowel obstruction had been established via this study. Further studies incorporating various biomarkers and their correlation with clinical presentation and radiological findings should be sought. Such studies would help in reducing the time interval to surgery in cases of acute intestinal obstruction with strangulation as well as decreasing unwarranted laparotomy in those cases of intestinal obstruction without strangulation that can be managed conservatively depending on other parameters and clinical findings. These biomarkers can be made readily available in the emergency setting after due consideration given to their clinical relevance at the institutional level. This study does add to the current literature regarding the need of decision-making policy for management of acute intestinal obstruction incorporating the role of biomarkers for predicting strangulation at the time of presentation.

107. A Comparative Study of Clinical Outcome in Early and Interval Cholecystectomy in Acute Calculous Cholecystitis
R. Pushpalatha, B. Nageswara Rao, G. Balakondrayudu, M. Vijay Kumar
Background: The optimal timing of laparoscopic cholecystectomy in the treatment of acute cholecystitis remains controversial. Two approaches are available for the treatment of acute cholecystitis – Early cholecystectomy – performed within 72 hours of the onset of disease. Delayed or interval cholecystectomy – performed 6 to 8 weeks after initial medical treatment with anti-microbial agents. The study aims: To compare both early and delayed or interval cholecystectomy in acute calculous cholecystitis. Methodology: Patients with Acute Cholecystitis admitted to the General Surgery department at GMC Kadapa were divided to two groups. Early laparoscopic cholecystectomy is performed in patients of group A and Delayed or interval cholecystectomy is planned in patients of group B who presented after 72 hours. Conclusion: There is no significant difference observed in overall clinical outcomes in patients managed by early and delayed cholecystectomy in acute calculous cholecystitis. Total overall hospital stay and overall medicine requirements are higher in the delayed cholecystectomy group when compared to the early cholecystectomy group.

108. Association of Thyroid Function Test and Heart Rate in Hypothyroid Patient Before and After Treatment
Kesubathula Venkateswarlu, Prasad Srirekha
Background: In terms of prevalence, hypothyroidism is second only to diabetes mellitus among endocrine disorders. The cardiovascular system is one of the key organs that hypothyroidism targets, and this system is extremely sensitive to even minute variations from normal levels. A decrease in cardiac contractility, a reduction in cardiac output, and an increase in peripheral vascular resistance are all examples of the cardiovascular manifestation of hypothyroidism. It has also been noted that administering L-thyroxine medication to these individuals will be useful in preventing the issues mentioned above. Aims and Objectives: Association of Thyroid function test and Heart Rate in Hypothyroid patient before and after treatment. Materials and Methods: Thirty newly diagnosed female hypothyroid patients with high serum TSH and age-matched healthy controls were studied. Heart rate variability analysis was performed before L-thyroxine therapy and after 3 months. Heart rate variability was examined after achieving euthyroid levels with serum TSH. Results: Hypothyroid females had autonomic imbalance with increased sympathetic activity and decreased parasympathetic activity before treatment, as shown by very highly significant (p<0.000) changes in frequency domain Heart rate variability. After treatment with L-thyroxine the changes were comparable with normal to normal individuals. The elevated serum TSH levels were also shows highly significant (p<0.001) after treatment. Conclusion: This study suggests that L Thyroxine replacement medication would help avoid hypothyroidism’s cardiovascular consequences including autonomic instability. Heart rate variability can check hypothyroidism patients for CVS problems and frequent follow-up following therapy because they are non-invasive.

109. Morphometric Anatomical Variations of Greater Palatine Canal and its Clinical Implications: A Dry Human Skull Study
Aravinth Mahesh M.S., Fasila. P Assis, Jesin Elsa Jose, Rajesh S
Context: Understanding the anatomical variations of the greater palatine foramen (GPF) is crucial for effectively administering regional anesthesia to areas innervated by the maxillary nerve during maxillofacial surgeries. Objective: To analyze the morphological characteristics of the GPF concerning nearby anatomical landmarks in the south Indian population. Materials and Methods: Thirty adult human skulls were examined to assess various GPF parameters on both sides of the hard palate, including location, angulation, and length of the greater palatine canal (GPC) for guiding a needle through the GPC to reach the pterygopalatine fossa (PPF). Findings: The average distance of the GPF from the mid-sagittal plane was 15.05mm on the left and 15.20mm on the right. Distances from the incisive fossa were 39.57mm on the left and 39.72mm on the right, while those from the distolateral margins of the hard palate’s greatest concavity were 4.47mm on the left and 4.77mm on the right. Distances from the tip of the hamular process were 14.12mm on the left and 14.30mm on the right. The angulation of the GPC with the hard palate was measured at 55.54° on the left and with the midline at 14.79° on the left and 16.83° on the right. The mean length of the GPC and PPF was 28.9mm on the left and 29.19mm on the right. Needle insertion showed a 3.34% chance of penetrating the orbit and a 1.67% chance of reaching the cranial cavity. Comparatively, these measurements aligned closely with those of North and West Indian populations, exceeded those of Caucasians, were similar to Negroids, but were less than Mongoloids. Conclusions: Our investigation emphasizes the significance of using anatomical parameters to accurately locate the GPF for successful maxillary nerve block while minimizing potential complications.

110. Molecular Identification of Dermatophytes by Sequencing ITS Region of Ribosomal RNA
Bagchi Anindita, Nath Reema, Barua Shyamanta, Roy Jashbeer Singh
Background: Dermatophytes are a group of fungi that cause tinea or dermatophytosis. In tropical and subtropical countries like India, prevalence of these infections is much more because of high heat and humidity for most part of the year, over population and poor hygienic living conditions. Materials and Methods: Skin, nail and hair samples of 150 patients with suspected tinea lesions were subjected to direct microscopy and culture for phenotypic identification, followed by genotypic confirmation   by PCR and strain identification by sequencing of ITS regions. Results: Tinea corporis was the most common clinical presentation (44.12%) followed by T. manuum and T. pedis (14.71% each) .A total of 44 (29.33%) cases showed fungal growths, 34(22.67%) isolates were pure dermatophytes and 10(6.67%) isolates were non-dermatophytic molds. Most common isolate was Trichophyton rubrum (50%) followed by T. interdigitale (32.35%). Phenotypic identification of the isolates in our study showed 5 different species viz T. mentagrophytes, T. rubrum, T. verrucosum, T. interdigitale and M. gypseum. However, molecular method identified only 4 different species viz. T. mentagrophytes, T. interdigitale, T. rubrum and M. gypseum. Conclusion: In the present study, some of the dermatophyte species misidentified by conventional methods were identified accurately by molecular method. Hence, to conclude, we can say that molecular method of species identification helps in accurate identification of species which helps to choose proper antifungal therapy for patient care.

111. Association of Gestational Age and Birth Weight with Retinopathy of Prematurity: A Prospective Clinical Study
Sini P S, Vijayamma N, Manjit P S
Background: Retinopathy of prematurity (ROP) is a condition that mostly affects premature newborns. It encompasses a range of symptoms, from modest and temporary alterations in the retina that resolve on their own, to severe and progressive growth of abnormal blood vessels, scarring, detachment of the retina, and eventual blindness. India accounts for 20% of global childhood blindness. In addition to congenital cataract, congenital glaucoma, and ocular traumas, Retinopathy of Prematurity (ROP) is becoming recognized as a significant contributor to childhood blindness in India. Aim and Objectives: The enhancement of neonatal care has led to an increase in the survival rates of preterm babies. However, as a consequence, there has been a rise in the number of infants affected with retinopathy of prematurity (ROP). This study quantified the incidence of retinopathy of prematurity (ROP) and examined the correlation between gestational age and birth weight with the development of ROP. Research Methodology: A prospective research conducted in a hospital setting. Setting: Study conducted at the Ophthalmology department of the Government Medical College and Hospital in Kottayam, Kerala, India, from March 2012 until August 2013. Material and Methods: Seventy-two premature newborns were screened for retinopathy of prematurity between March 2012 and August 2013. This was done after obtaining approval from the institutional ethics committee and obtaining consent in writing from the parents. Outcome measures: The primary outcome measure utilised was the cumulative incidence of ROP, whereas the secondary outcome measure focused on the association between gestational age and birth weight with ROP. Results: Out of the 72 newborns included in the study’s sample, 28 of them had Retinopathy of Prematurity (ROP) in either one or both of their eyes. The total incidence rate of ROP in the population under study was 38.88%. Significant differences were seen in the average gestational age (29.55±1.79 weeks) and average birth weight (1030.12±175.08 grams) between the ROP group and the control group (Without ROP) (32.31±1.83 weeks) and (1371.37±309.64 grams), respectively (P < 0.0001 and P=0.0005, respectively). Conclusion: In the population examined, researchers found a notable prevalence of ROP in this study (38.88%). Furthermore, an early gestational age and a low birth weight have a statistically significant influence on the advancement of ROP in its active state. Minimizing future postnatal risk factors relies on receiving excellent prenatal and postnatal care, along with following to stringent ROP screening criteria. Timely identification and treatment of ROP are crucial for optimizing visual outcomes. Collaboration between ophthalmologists and neonatologists is crucial for prompt screening and consistent monitoring in order to alleviate the prevalence of blindness caused by retinopathy of prematurity (ROP).

112. Correlative Study of Length of Upper Limb with Position of Bifurcation of Brachial Artery in Males of North Karnataka Population
Gazala Shaireen, Humaira Zainab, Mohd. Ibrahim Pasha
Background: Variations of the brachial artery are often observed in autopsies, which are probably due to their complex embryonic development. Hence, knowledge of variations in the brachial artery is mandatory for clinicians, especially orthopedicians, during amputation. Method: 30 (thirty) male, non-pathological cadavers were dissected. Tailor’s tape was used to measure the length of the upper limb (UL). (A)-UL was measured from the tip of the acromion process of the scapula to the tip of the middle finger. (B) The position of bifurcation of the brachial artery (BA) was measured from the epicondyle of the humerus to the bifurcation of the brachial artery, and variations were noted and correlated with the length of the respective upper limbs. Results: The mean value of the right upper limb was 71.66 (± 5.14) and the mean value of the position of bifurcation of BA was 4.11 (± 0.57) and the correlation coefficient was 0.77 and p<0.001. The mean value of the length of the left UL was 71.54 (± 5.13), the length of the position of the bifurcation BA was 4.10 (± 0.59), and the correlation coefficient was 0.78 and p<0.001. Conclusion: It is concluded that the present correlative study of the upper limb and position of bifurcation of BA has a great importance for appropriate invasive or surgical treatment of arm, forearm, and hand disorders.

113. The Development of Novel Drug Delivery Systems for Improved Therapeutic Efficacy: A Retrospective Study
Rakhi Rani, Sudhir Kumar, Keshav Kumar Sinha
Background: Novel drug delivery systems have sparked interest in pursuing better therapeutic efficacy in pharmacology. This retrospective study compared the effectiveness of liposomal formulations, systems based on nanoparticles, and conventional distribution methods, which included 200 participants. Methods: Treatment outcomes, safety profiles, and treatment durations were evaluated by thoroughly examining electronic medical information. All three medication distribution methods were compared using statistical tools, including logistic regression and t-tests. We gained IRB approval and adhered to all ethical considerations. Results: The clinical response rate of liposomal formulations (85%) was noticeably more significant than that of nanoparticle-based systems (75%), as well as traditional administration methods (60%), with a p-value of less than 0.001. When comparing liposomal formulations to nanoparticle-based systems (1.2 ± 0.6 events per patient) and traditional Delivery (1.5 ± 0.7 events per patient), the number of adverse events was lower (0.8 ± 0.4 occurrences per patient) (p = 0.014). Liposomal formulations resulted in shorter treatment duration (10.5 ± 2.3 weeks) when compared to nanoparticle-based systems (12.2 ± 3.1 weeks) and traditional Delivery (14.8 ± 4.2 weeks) (p < 0.001). Conclusion: Liposomal formulations show promise as an improved method of drug delivery, with better therapeutic efficacy and fewer adverse effects. These findings support the need for additional research into prospective randomised controlled trials to confirm the effectiveness of sophisticated drug delivery systems before they are widely used in clinical practice.

114. The Role of Personalized Medicine in Optimizing Drug Therapy: Opportunities and Challenges: A Retrospective Study
Rakhi Rani, Sudhir Kumar, Keshav Kumar Sinha
Background: Personalised medicine, tailoring medical interventions based on individual patient characteristics, has emerged as a transformative approach in healthcare. This retrospective study, comprising 700 participants, aims to assess the impact of personalised medicine on drug therapy outcomes and explore challenges and opportunities in its implementation. Methods: A retrospective cohort design was employed, utilising electronic health records to analyse the treatment outcomes of participants who received personalised medicine interventions. Descriptive statistics, subgroup analyses, and longitudinal trends were assessed, employing appropriate statistical tests. Results: In our retrospective study of 700 participants, personalised medicine substantially impacted treatment efficacy. Demographic analysis revealed a diverse cohort with a mean age of 54.2 years and a predominant cancer diagnosis (68%). Personalised medicine interventions were widespread, including 45% receiving pharmacogenomics-guided treatments and 30% undergoing targeted therapies. Treatment efficacy assessments showed significant improvement, particularly in oncology and cardiovascular diseases. Conclusion: Personalised medicine demonstrates substantial potential in optimising drug therapy outcomes. Integrating ethical frameworks, addressing cost concerns, and leveraging technological advancements are vital for successful implementation. Embracing personalised medicine is a crucial step toward more precise and effective healthcare.

115. Intramedullary Nail supplemented with Poller screws for proximal and Distal 1/3rd shaft tibial fracture
Tarun Solanki, Vivekanand Pal, Maneesh Kumar Maurya
Introduction: The most frequent fracture of a long bone is a tibial shaft fracture. The aim of therapy for a shaft tibial fracture is to maintain the length of the initial fracture, accomplish union, and restore both axial and rotational alignment. Fractures of the proximal and distal 1/3rd of the tibia’s shaft have higher rates of malunion. The preferred method of managing diaphyseal fractures of the lower limb, however, is intramedullary (IM) nailing. Aim: To evaluate the functional and radiological outcomes of IM nail supplemented with Poller screws for proximal and distal 1/3rd shaft tibial fractures. Materials and Methods: From May 2020 to November 2021, a prospective, interventional study was carried out at thecollege name. The study included a total of 30 fracture patients between the ages of 18 and 60. For the treatment of the proximal and distal 1/3rd shaft tibial fractures in all participants, IM nails were additionally combined with Poller screws. Ten instances had open fractures (grade I or II according to Gustilo Anderson’s complex tibia fracture classification), while twenty cases had closed fractures. Patients were checked on at three weeks, then every six weeks till union. KarlströmOlerud’s functional evaluation standards were used to assess patients.The IBM Statistical Package for the Social Sciences (SPSS) software version 23.0 was used to statistically evaluate the data. Results: In this study, there were 20 (33.3%) females and 40 (66.7%) males, indicating a male predominance. It was found that 40% of the patients were between the ages of 41 and 50. The patients’ median age was 34.12 ±5.9 years. According to KARLSTRMOLERUD’S FUNCTIONAL EVALUATION, 36 patients (n=60) in the current study had excellent outcomes, followed by 16 (26.7%) patients who had good outcomes, and 4 (6.7%) patients who had both satisfactory and moderate outcomes. Postoperative complications included shortening of the leg, of which two patients experienced a 0.5 cm shortening, four patients experienced a 10° loss in ankle dorsiflexion, three patients experienced a loss of knee flexion (two patients experienced a loss of 20° flexion and one patient experienced a loss of 15° flexion), six patients experienced a loss of subtalar movement (two patients experienced a 10° inversion loss, three patients experienced a 5° inversion loss, and one patient.

116. A Comparative Study between CRP/Albumin Ratio and Serum Procalcitonin as A Prognostic Marker in Sepsis
Udaybhanu Rout, Ashish Malla, S Dilip Kumar, Aswini Kumar Sahoo, Samir Sahu, Rishab Garg, Abhirup Bagchi, Kanishka Uthansingh, Girish Kumar Pati
Backgrounds: One of the most prevalent causes of death among hospitalized patients in the critical care unit is sepsis (ICU). Because of the various co-morbidities and underlying disorders that these people have, diagnosing them is very difficult. A combination of hematological, biochemical, and microbiological tests can be used to identify sepsis. PCT and CRP levels are commonly considered valid indicators of the degree of systemic inflammation. The ratio of CRP to albumin is increasingly used as a biomarker for both systemic inflammation and nutritional status. The current study aimed to see if the CRP/albumin ratio, combined with procalcitonin, could be used to predict sepsis. Methods: This was a prospective cross-sectional study carried out with 150 patients. Baseline characteristics, biochemical investigations, and serum CRP/albumin ratios were done. The quantitative variables were expressed as mean and standard deviation compared by ANOVA followed by Bonferroni’s correction. A p-value of <0.05 was considered significant. Results: Serum procalcitonin levels were significantly higher on day-1 in non-survivors compared to survivors (P<0.0001). CRP/albumin ratio was substantially higher on day-1, day-3, and the day of discharge in non-survivors compared to survivors (P<0.0001). Conclusion: Despite the use of optimal treatment and an improved approach, the death rate in sepsis has been proven to be high (56.2 percent). Patients with increased procalcitonin and CRP/albumin ratio at admission can be better classified and identified as having a higher risk of adverse outcomes.

117. An Association between Type 2 Diabetes and Osteoarthritis
Mahidhar Reddy, Sarfaraz Syed, Samhitha Reddy
Background: Type 2 Diabetes Mellitus (T2DM) and Osteoarthritis (OA) are known to frequently coincide, whether any causal relationship between the two disorders exists is a question of research interest. Aims and Objectives: To find an association between Type 2 Diabetes and Osteoarthritis. Material and Method: This is a cross-sectional study conducted on 100 patients at department of Orthopaedics in collaboration with department of General Medicine, at Govt. Gen Hospital, Kadapa for the duration of one year, between October 2022 to October 2023 on patients with diabetes and Osteoarthritis, after getting informed consent from patients, approved by institutional ethical committee and after following inclusion and exclusion criteria. Results: 100 patients divided into two group,  Osteoarthritis with T2DM and Osteoarthritis without T2DM, Correlation between the knee injury and osteoarthritis outcome score and duration of diabetes mellitus and level of HbA1c showed statistically significant correlation (P-value<0.001). Conclusion: T2DM can be considered as an independent predictor of severe OA also type 2 diabetes is independently associated with advanced OA of knee.

118. Estimation of Pre-Analytical Errors in Biochemical Analysis of Blood Specimen at Tertiary Care Center
Nadia Ali, Kailas Gadekar, Supriya Wagh, Abhijit Ninghot, Santosh G. Varma
Background & Objectives: In health care laboratories most errors occur in the pre-analytical phase which account for 70% of the total errors. This study was conducted to estimate the frequency and type of pre-analytical errors and to determine the frequency of blood specimen rejection and its reasons. Material and Methods: Current study was a prospective observational study. Total of 15,24,751 samples were collected. Out of these 1,80,952 samples were collected from OPD and 13,43,799 samples were collected from indoor patients. Following categories of pre-analytical data were collected for study period: 1. Quantity insufficient 2. Lipemic specimens 3.NDF: No data found 4. Fibrin clot 5. Hemolysed specimen 6. Autolysed specimen and others. Results: Out of 15,24,751 samples collected pre-analytical errors were observed in 29,033 samples, which is approximately 1.91%. A major cause of rejection was quantity insufficient. Conclusion: 1.In our study rejection rate of specimen due to pre-analytical error is around 2%. 2. Major causes of rejection in our laboratory in decreasing order are: a) Quantity Insufficient b) Fibrin Clot c) No Data Found d) Hemolysis and others. 3. Rejection rate of IPD specimen is 1.91% and that of OPD specimen is 1.83%. 4. It is seen that the rejection rate is greater in months of November, December, April, May and June which can be probably due to joining of new junior resident doctors and interns. Corrective actions based on the outcome of Pre Analytical Quality Indicators will be beneficial for patient care service.

119. Health Challenges amongst Post-Menopausal Women in Maharashtra’s Urban Slum Enclaves: A Comprehensive Morbidity Analysis
Shivcharan P Chavan, Vikas Tukaram Makar, Rupal D Girase, Sushant Shamrao Chavan, Yuvaraj B Chavan
Background: The study aims to investigate the morbidity profile among post-menopausal women residing in urban settings within Maharashtra, focusing on associations between morbid conditions and the menopause transition phase. Methodology: A cross-sectional study comprising n = 274 post-menopausal women in an urban metropolitan area was conducted. Participants’ demographic characteristics, morbid conditions, and current menstrual status were recorded. Statistical analyses including chi-square tests were employed to explore associations between participant characteristics, morbid conditions, and menopause transition. Results: The study revealed significant associations between the menopause transition and prevalent morbid conditions. Notably, women in the menopause transition phase exhibited a higher prevalence of poor memory (67.4%) and diabetes (66.7%) compared to post-menopausal women. However, associations between menopause transition and feelings of depression or vasomotor symptoms were non-significant. Conclusion: The findings underscore a distinct relationship between the menopause transition phase and increased prevalence of poor memory and diabetes among post-menopausal women in this urban cohort. These results emphasize the need for targeted healthcare interventions addressing memory-related issues and diabetes risk management during the menopause transition phase.

120. Characterizing Paediatric Urinary Tract Infections: Clinical and Laboratory Profiles in A Tertiary Care Setting
Mugdha D. Ketkar, Amol Ramrao Suryavanshi, Aniket Bhikaji Sarvade, Sachin Bapurao Bodhgire, Prabha Khaire, Pritam Kumar Bhagwan Chimane
Introduction: Paediatric urinary tract infections (UTIs) pose significant health risks, demanding a nuanced understanding of their clinical, demographic, and microbiological profiles. This study aimed to comprehensively analyse these facets among paediatric UTI cases in Chh. Sambhajinagar Tertiary Care Hospital. Methodology: A retrospective observational analysis was conducted on 178 paediatric UTI cases, focusing on demographic distributions, clinical presentations, imaging and laboratory findings, and microbial profiles. Data were collected from electronic records, and statistical analyses were performed to delineate patterns and associations. Results: The study revealed a higher prevalence of UTIs among females and uncircumcised males, with rural areas exhibiting a higher incidence. Socioeconomic disparities were evident, reflecting potential correlations with UTI occurrences. Clinical manifestations varied widely, and while imaging often presented as normal, urine cultures unveiled a diverse spectrum of pathogens, notably Acinetobacter baumannii and Escherichia coli. Conclusion: The findings highlight the multifaceted nature of paediatric UTIs, emphasizing demographic disparities, varied clinical presentations, and a diverse microbial profile. Tailored approaches, considering gender, circumcision status, residential settings, and socioeconomic factors, are imperative in formulating effective diagnostic and therapeutic strategies for paediatric UTIs.

121. Cytomorphological Spectrum of Palpable Breast Lesions – An Observational Study from a Tertiary Care Centre in Palakkad
Priya P Kartha, Aysha Ali, Salahudeen.M, Jayasree K A, Antony Peter, Magdalene K F, Feby T Francis, Amalkumar V
Background: Fine Needle Aspiration Cytology (FNAC) is a pivotal tool in the diagnosis of breast lesions, offering a minimally invasive, rapid, and accurate method for evaluation. Objective: This study aimed to analyze the cytomorphological patterns of palpable breast lesions using FNAC and to assess its diagnostic accuracy compared to histopathology. Methods: An analytical cross-sectional study was conducted on 100 consecutive female patients with palpable breast lumps. FNAC was performed, followed by cytomorphological analysis and comparison with histopathological findings. Results: The majority of lesions were benign (60%), followed by atypical (15%), malignant (15%), and suspicious (10%). FNAC demonstrated a sensitivity of 93.3% and a specificity of 96.7%. The PPV and NPV were 93.3% and 96.7%, respectively, with significant P-values (<0.001). Cytological features like high cellularity and prominent nucleoli were strongly associated with malignancy. Discrepancies between FNAC and histopathology were low, with 3% false positives and 2% false negatives. Conclusion: FNAC proves to be a highly accurate diagnostic tool for evaluating palpable breast lesions, with a significant correlation of specific cytomorphological features with malignancy. Despite its high efficacy, the integration of FNAC with other diagnostic modalities is recommended for comprehensive breast lesion evaluation.

122. Congenital Double Ureter and Its Clinical Significance
Revathy R, Sumathi S, Priya Ranganath
Introduction: Congenital ureter anomalies like double ureter and double pelvicalyceal system are uncommon variations and they remain asymptomatic in majority cases. These variations are encountered during an abdominal or incidentally in any other routine abdominal and pelvic investigations or during educational cadaveric dissection in medical colleges. Aims and Objectives: To study the congenital ureteric variations in cadaveric kidney and ureter specimens. Materials and Methods: In Department of Anatomy, Bangalore Medical College and Research Institute, Bangalore, 50 cadaveric specimens of kidney and ureter were noted and observed for congenital variations Results: Out of 50 specimens observed, a rare case of incomplete double ureters with double pelvicalyceal system was seen in left kidney of an adult 60 year old female cadaver. Conclusion: Duplication of ureter can be found alone or with any other congenital anomalies. Duplex ureteric system can lead to certain complications like recurrent urinary tract infections, renal calculi hydronephrosis, vesicoureteric reflux, ureterocoele, etc. Knowledge of anatomical variations of ureter is very important to the concerned urologists, operating surgeons and gynaecologists to avoid the accidental injury to this anomalous system. Radiologists should be aware of these variations for the correct interpretation of varied anatomy.

123. Imaging Spectrum of Toxic and Metabolic Encephalopathies
Nath A, Pegu BJ, Kutum T, Islam MI
The basal ganglia and thalami are paired deep grey matter structures with extensive metabolic activity that renders them susceptible to injury by various diseases. Most pathological processes lead to bilateral lesions, which may be symmetric or asymmetric, frequently showing characteristic patterns on imaging studies. Toxic and metabolic brain disorders manifest secondary to derangements of a well-balanced environment encompassing metabolic substrates, neurotransmitters, electrolytes, physiologic pH levels, and blood flow, either by endogenous malfunctions or exogenous toxic effects. Patients with these disorders often present to the emergency department and are diagnosed with global cerebral dysfunction presenting as acute confusional state and delirium. Imaging plays a key role in these cases, as imaging findings can be used to diagnose the condition or narrow the differential diagnosis.

124. The Role of Power Doppler Imaging with Trans Rectal Ultrasonogram Guided Biopsy in the Detection of Prostate Cancer
P.V.S Abhishek, Katika Munna, B. Sachin Kumar
Background: The most common cancer in men is prostate cancer after skin cancers. Prostate cancer detection and treatment are still evolving. Various additional methods have been tested in an effort to increase the detection rate with TRUS biopsies. Aim and Objective: To assess the effectiveness of  trans rectal ultrasonography using Power Doppler imaging guided biopsy with extended sextant biopsy being the reference standard. Material and Method: In this observational study, total 65 patients, who present with  LUTS with abnormal digital rectal examination and/or PSA>=4 ng/ml were included over the duration of one year, in the Department of Radiodiagnosis, CAIMS, Karimnagar after following inclusion and exclusion criteria and getting approval from institutional ethical committee. Results: Mean age group of the patients was 65.63 years. 58% of the patients found with cancer and overall sensitivity of power Doppler in the detection of prostate cancer was 88.5% and specificity was 79.8%. Conclusion: Transrectal ultrasound with power Doppler imaging guided biopsy is more sensitive and specific compared to grey scale imaging. Power Doppler imaging guided hypervascular area directed biopsy is efficient in the detection of prostate cancer in comparison with hypoechoic nodule directed biopsy.

125. Onychomycosis: Prevalence and Its Etiology in a Tertiary Care Hospital, North-East India
Debajit Das, Shromona Kar, Shreeni Chatterjee
Background: Onychomycosis is the most common of all diseases of the nails in adults. It is a fungal infection of the finger and toe nails, usually caused by dermatophytes, yeast and non-dermatophytic moulds. It represents upto 20% of all nail disorders. Objective: This study was done to know the isolation rate and etiological agents of onychomycosis. Methods:  This study has been conducted in the Department of Dermatology, Venereology and Leprosy, Silchar Medical College and Hospital, Silchar, Assam over a period of one year extending from 1st June 2021 to 31st May 2022, on 120 patients, with clinically suspected fungal infection of the nail, from those attending the Dermatology OPD. Results: Out of 120 clinically suspected cases of onychomycoses, 50 (41.7%) cases showed fungal growth in culture and 70 (58.3%) cases showed no fungal element on culture. Among the isolates, dermatophytes were the commonest group of isolates accounting for 24(48%) cases, followed by yeasts 14(28%) cases, and lastly non-dermatophyte moulds, 9(18%) cases. Among 50 cases of isolated fungus, Trichophyton rubrum (DM) was the commonest isolate -11(22%) cases, followed Candida species (yeasts) 9(18%) cases, followed by Aspergillus niger (NDM) 8(16%) fungi. Thereafter we obtained Trichophyton mentagrophyte, 7 (14%) cases, other unidentifiable species of Trichophyton, 6 (12%) cases, 5 (10%) cases of Candida albicans and lastly 4 (8%) Aspergillus flavus isolates. Conclusion: This study demonstrated that dermatophytes were the main agents in causing onychomycosis and the importance of performing fungal culture.

126. Hollow Viscus Injuries in Abdominal Trauma: A Prospective Study
Deepak Jadhav Maloth, V Shyam, Bushigampala Anil Kumar, Kyasa Shiva Kumar
Introduction: Abdominal organ injuries are the third most common injuries encountered after head and chest injuries. Hollow viscus injuries are not less common and are equally or more life threatening than solid visceral injuries accounting to more blood loss and contaminating bowel injuries. Aim and Objectives: To study hollow viscus injury in the cases of abdominal trauma patients. Materials and Method: This study was a prospective observational study includes 68 patients admitted in the casualty ward, of Chalmeda Anand Rao institute of medical sciences, Karimnagar, with abdominal trauma both blunt and penetrating injuries following road traffic accidents, assault by various objects, interpersonal violence and accidental falls during the period of one year after following inclusion and exclusion criteria and after approved from institutional ethical committee. Results: In the study out of 68 patients, patients with age group between 12 to 70 years, majority of the patients were from the age group of 16 to 45 years. most frequent cause of blunt abdominal injuries was automobile accidents (61.8%), abdominal pain was the most prevalent symptom in the current study (61%). Jejunum, and Ileum was most commonly involved followed by gall bladder, urinary bladder and colon. wound infection is the most common complication seen in 10 patients (14%). Mortality is this study was 7.35%. Conclusion: Blunt or penetrating abdominal trauma causes hollow viscus injuries in the stomach, small intestine, colon, rectum, gall bladder, and urine bladder. Trauma can produce anything from a little bruise to a life-threatening loss of blood.

127. Breast Lesions: Histopathological and Cytopathological Correlation
Meeta J. Parikh, Jitendra H. Parikh
Background: In India cancer of Breast is second most common cancer in women following cervical carcinoma.  Most of the cases in breast lesions are benign.  Early diagnosis of Breast lesions can be done by FNA cytology.  The FNA was first introduced by Martin and Ellis in 1930. The aim of this study is to establish utility and accuracy of FNAC by correlating histological and cytological findings and whether accuracy depends on the age of the patient as well. The objective is to study the cytological findings of a clinically palpable tumor by fine needle aspiration cytology, find the incidence of breast cancer in a palpable lump in different age groups and to study the various histopathological features of breast lumps, benign and malignant and correlate with cytological findings. Methods: This study of 300 patients was carried out at B.J. Medical College, Ahmedabad from May 2011 to November 2013.  FNAC was done on that patients who had undergone histopathological diagnosis of palpable lump were included in this study. Results: Most of the patients were in age group of 16 to 35 years. Right sided breast lump (59.66%) was more common then left side lump (40.33%). Most common malignant lesion is invasive ductal carcinoma NOS followed by Medullary carcinoma in and lobular carcinoma. In our study FNAC has 96.05 sensitivity and 98.06% specificity and accuracy is 97% in all age group. Conclusion: Incidence of malignancy in the younger age group appears to be rise, through higher awareness and higher degree of detection at early stages due to rise, better availability of expertise may be the reason for the apparent rise in incidence.  FNAC is a very useful tool especially in our set up where resources are scarce.

128. A Cross Sectional Epidemiological Study to Find the Prevalence of Depression and Anxiety in Patients of Leprosy and It’s Correlation to Stigma Related with Leprosy
Sachin Kore, Anand Bhide, Vibha Bhide, Akshada Shinde
Background: Depression and anxiety are common mental health conditions that can significantly impact the quality of life and overall well-being of individuals affected by leprosy, a neglected tropical disease. This study aimed to assess the prevalence of depression and anxiety among subjects with leprosy in the tribal block of western Maharashtra and investigate its correlation with the stigma associated with leprosy. Materials and Methods: A cross-sectional study was conducted with a sample size of 145 subjects diagnosed with leprosy, over duration of three months, in the tribal block of western Maharashtra, India. Participants were selected using a systematic random sampling technique from local healthcare facilities and leprosy clinics. Data collection involved structured interviews using standardized tools, including the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and the Stigma Scale for Leprosy (SSFL) to measure stigma associated with leprosy. Results: The study found that 52.4% of subjects with leprosy exhibited symptoms of depression (PHQ-9 score ≥ 10) and 48.3% showed symptoms of anxiety (GAD-7 score ≥ 10). Furthermore, a significant positive correlation was observed between the severity of depression and anxiety symptoms (r = 0.654, p < 0.001), indicating a comorbid relationship. The stigma associated with leprosy, as measured by the SSFL, was found to be moderate, with an average score of 36.7 ± 7.2. There was a significant positive correlation between stigma and depression (r = 0.451, p < 0.001) as well as stigma and anxiety (r = 0.398, p < 0.001), indicating that higher levels of stigma were associated with more severe symptoms of depression and anxiety. Conclusion: This study highlights the high prevalence of depression and anxiety among subjects with leprosy in the tribal block of western Maharashtra. Additionally, it underscores the significant correlation between these mental health conditions and the stigma related to leprosy. Interventions aimed at improving mental health outcomes for individuals with leprosy should not only focus on symptom management but also address the stigma associated with the disease. Reducing stigma may help mitigate the psychological distress experienced by individuals with leprosy, ultimately improving their overall well-being.

129. A Study of Predictors in Outcome of Fever with Thrombocytopenia in Children upto 12 Years
R. Vanitha, T.R.R. Ananthy Shri, Rajkumar
Background: Fever with thrombocytopenia is one of the leading cause of mortality and morbidity in children <12 yrs. There are various infectious causes for fever with thrombocytopenia including deadly dengue fever and bacterial sepsis. Various studies have showed that there are many prognostic factors which are very useful in predicting the outcome. These factors also alert the treating paediatrician in taking many crucial decisions like whether to treat the case as opd or to admit and treat aggressively. Based on this aim of our study is to evaluate   the clinical and laboratory parameters in predicting the outcome of children with fever with thrombocytopenia below 12 years. Material and Methods: All the patients between 1month to 12 years presenting with the complaints of fever (>99.9degree F) with thrombocytopenia (less than 1,50,000/μL) were included in the study . Pre structured proforma was used to obtain information from the parents which includes general characteristics and blood parameters, after getting consent, detailed history, clinical details and investigations were collected and entered in the proforma. Blood investigations, Ultrasonogram abdomen and chest findings was recorded. Outcome was assessed as morbidity in the form of only fever, fever with bleeding and fever with shock. Results:  Among 100 cases taken in our study, 62% children had only fever. 15% children had fever with bleeding. 23% children had fever with shock. 31% of children admitted with respiratory distress. Among admissions 55% children admitted with platelet count less than 1lakh. 86% children had ascites. Conclusion: Late visit to hospital with prolonged fever and warning symptoms influence poor outcome in these children. Children presenting with altered sensorium, respiratory distress, abdominal distension, hepatomegaly and dehydration had poor outcome as bleeding and shock. Chest X-ray, Ultrasonagram chest and abdomen revealing pleural effusion and ascites at the time of admission showed more morbidity. Children with Positive C-Reactive protein at the time of admission and serology positive for Dengue had more morbidity as bleeding and shock.

130. Volar Barton’s Fractures: Comparison between Two Techniques
Om Prakash Khichi, Hoshiyar Sharma, Raju Lal Yadav
Background: One of the most frequent injuries that orthopaedic surgeons treat is a fracture of the distal radius.  A clear consensus regarding the best management strategy could not be achieved because there are numerous therapeutic options described in the literature. Since the invention of buttress plates, young adults prefer open plating as a treatment. Aims: The present study was conducted to compare the outcome between open reduction and plating or by Kirschner wire fixation with external JESS fixation in Volar Barton Fracture. Material and Methods: 40 patients of distal end radius fracture aged 18-60 years with Volar Barton pattern (AO type B3.2 and B3.3, intra-articular involvement with a volar fragment and volar subluxation of the carpus) were either treated by open reduction and plating (22 cases) or by Kirschner wire fixation with external JESS fixation (18 cases). Results: All 22 plating and 16 pinning patients had satisfactory results at the most recent follow-up, according to the functional outcome of the wrist. Conclusion: Both open reduction with stabilization by buttress plates and closed reduction with stabilisation by pinning and external fixation can achieve excellent success rates in the current investigation. Both methods have benefits and drawbacks, but the plating procedure appears to produce better outcomes.

131. A Cross- Sectional Study on the Association of Vitamin D and D Binding Protein Levels with Clinical Depression
Asha Shekar, Sushma Rayappa, Raveesh B N, Savitha Nageshappa, Srikanta B M
Introduction: The underlying pathophysiology of depression remains unknown despite multiple theories and several different mechanisms are probably involved. A number of studies have given conflicting results about the association of vitamin D deficiency with depression. Studies have identified the emergent role of D binding protein in the physiological effect of Vitamin D in most of the target tissues. Hence this study was taken up to measure DBP levels along with 25 hydroxy vitamin D levels to look for association with Clinical Depression. Material and Methods: Participants aged 18-60 years visiting the outpatient department of Psychiatry with clinical depression were assessed consecutively between 2018 and 2020. The blood samples were analyzed for 25 hydroxy vitamin D and DBP levels and were compared to the severity of anxiety and depression as determined by HAM-D and HAM-A scores. Results: Out of 108 subjects, 53(49.1%) were males and 55(50.9%) females. Half of the participants had vitamin D deficiency and significant had insufficient levels. There was no association between Vitamin D levels and the severity of Depression and anxiety. Vitamin DBP was found to be associated with HAM-A and not with HAM-D. There was no correlation between vitamin D, Vitamin DBP with depression and anxiety. Conclusion: Vitamin D deficiency can be seen in clinical depression. However, there is no association between vitamin D and the severity of depression. Vitamin DBP is found to be associated with anxiety symptoms of depression due to particular assessment method. The current study suggests RCT for a better understanding of vitamin DBP’s role in Clinical depression.

132. Efficacy of Powder-Free Surgical Glove Bag versus No Glove Bag for Retrieval of the Gallbladder during Laparoscopic Cholecystectomy
S. Sivamanthiraraj MS, R Suganesh M.S
Introduction: The one of the most commonly done laparoscopic surgeries was laparoscopic cholecystectomy. The specimen after surgery can be retrieved outside either directly or through retrieval bags. The present study was done mainly to identify the benefits of use of retrieval bags. Materials and Method: Patients those who underwent laparoscopic cholecystectomy are taken into the study. The study was conducted at Government Dharmapuri Medical College and Hospital, during the time period April 2021 – September 2022. They were separated into two groups based on glove bag usage for gall bladder retrieval. Results obtained were analyzed, tabulated and interpreted. Results: In the present study out of 40 patients, Overall 22 % developed port site infection. Out of the 9 patients who developed port site infection, glove bag was used in 1 patient and glove bag was not used in 8 patients. Out of 40 patients, 23 patients developed port site discharge, which accounts for about 57%, 17 patients doesn’t show any discharge, which accounts for about 43%, in which glove bag was used in 20 patients out of which only 6 patients developed port site discharge. The port site discharge in which no glove bag was present in 17 patients. Conclusion: Laparoscopic cholecystectomy done with retrieval of gallbladder using glove bag versus no glove bag was done. It is mainly to identify whether there benefit in decreasing the port site infection, discharge or metastasis.

133. A Study of Clinical Profile of Dengue Fever in Children at a Tertiary Care Centre in Kalol Town of Gandhinagar District in Gujarat, India
Nirav Parmar, Hiral Solanki, Ramesh Bajannia, Ashwin Dangi
Background and Aim: Dengue fever remains a significant public health concern, particularly in tropical regions. This prospective observational study aimed to comprehensively analyze the clinical manifestations, laboratory findings, and outcomes of dengue fever cases in a specified geographic area. Material and Methods: The study was conducted at the Department of Pediatrics, Ananya College of Medicine and Research, Kalol, Gandhinagar, India, from September 2022 to August 2023. A total of 53 cases were enrolled, with demographic distribution reflecting a prevalence of patients from nearby village areas. Results: The clinical presentation exhibited the hallmark symptom of fever in all cases, accompanied by symptoms such as body ache, headache, retroorbital pain, abdominal pain, and breathlessness. Laboratory investigations demonstrated hematological abnormalities, including leukocytopenia and thrombocytopenia. Serological analysis revealed positive IgM antibodies and NS1 antigen, aiding early diagnosis and confirming recent infection. Complications included abnormalities in prothrombin time and activated partial thromboplastin time, hemorrhagic manifestations, and raised hematocrit levels. Conclusion: This study provides a comprehensive understanding of dengue fever’s clinical manifestations, laboratory features, and outcomes in the studied region. The findings contribute to existing knowledge, facilitating improved clinical management and public health strategies. Further multi-center studies are recommended to validate these observations and enhance their applicability.

134. Comparative Study between Dexmedetomidine and Ondansetron for Prevention of Post-Spinal Shivering: A Randomized Controlled Trial
Santosh Kumar, Shivam Jaisawal, Prabhat Ranjan, Erum Ozair
Background: Post-spinal shivering is a common complication following spinal anesthesia, leading to patient discomfort and increased morbidity. Various pharmacological agents have been investigated for its prevention. This randomized controlled trial aimed to compare the efficacy of dexmedetomidine and ondansetron in preventing post-spinal shivering. Materials and Methods: In this prospective study, 200 adult patients undergoing elective surgery under spinal anesthesia were randomly allocated into two groups: Group D (dexmedetomidine) and Group O (ondansetron). Group D received dexmedetomidine 0.5 μg/kg intravenously, while Group O received ondansetron 4 mg intravenously, 15 minutes before the spinal anesthesia. The occurrence of post-spinal shivering was assessed using a standardized grading system. Hemodynamic parameters, adverse events, and patient satisfaction were also recorded. Results: The incidence of post-spinal shivering was significantly lower in Group D (12%) compared to Group O (26%) (p < 0.05). The severity of shivering was milder in Group D, with a higher proportion of patients experiencing only Grade 1 shivering compared to Group O (p < 0.05). Group D also showed better maintenance of hemodynamic stability with lower mean arterial pressure (MAP) and heart rate (HR) fluctuations. There were no significant adverse events in either group. Patient satisfaction scores were higher in Group D. Conclusion: Dexmedetomidine is more effective than ondansetron in preventing post-spinal shivering. It also provides better hemodynamic stability and patient satisfaction without significant adverse effects. Dexmedetomidine can be considered as a preferred option for the prevention of post-spinal shivering in patients undergoing elective surgery under spinal anesthesia.

135. Antibiotic Stewardship in Long-Term Care Facilities: Challenges and Strategies for Optimizing Antibiotic Use
T. Sankaranarayanan, R. Poornakala, M. Basheer Ahamed, S.Punitharanjitham
Antibiotic stewardship is an indispensable facet of modern healthcare, aimed at safeguarding the efficacy of antibiotics while optimizing patient care. In the context of long-term care facilities (LTCFs), a unique set of challenges arises, necessitating tailored strategies to ensure responsible antibiotic use. The burgeoning elderly population, often frail and with multiple comorbidities, makes up the majority of LTCF residents. Compounding the issue, diagnostic challenges in LTCFs can lead to delayed or inaccurate diagnoses, hampering the timely initiation of appropriate treatment. LTCFs frequently grapple with infection control issues, exacerbated by the lack of resources and expertise found in acute care settings. Inadequate infection control can result in outbreaks and drive the inappropriate use of antibiotics as a preventive measure. Moreover, high staff turnover and the absence of well-defined guidelines for antibiotic use in LTCFs pose further challenges to stewardship efforts. In response to these challenges, a multifaceted approach to antibiotic stewardship is crucial. The implementation of LTCF-specific antibiotic use protocols, involving physicians, pharmacists, and infection prevention specialists, is imperative. Regular audits and feedback mechanisms, coupled with educational initiatives, can foster a culture of responsible antibiotic use. This review paper provides a comprehensive analysis of the challenges faced by LTCFs in antibiotic stewardship and offers a thorough exploration of effective strategies to enhance the judicious use of antibiotics.

136. Comparative Evaluation of Antimicrobial Activity of Different Endodontic Sealers against Three Root Canal Pathogens-An in-Vitro Study
Manjula.C.G, Rosamma George, Gayathree.L
Introduction: Main objective of endodontic treatment is removal of micro-organisms from root canal and preventing them from re-infecting. Endodontic sealers exhibit antimicrobial activity thereby eliminate micro-organisms from root canals and facilitate success of endodontic treatment. AIM: To evaluate and compare antimicrobial activity of different endodontic sealers against three root canal pathogens. Material and Methods: Microbial suspension of Enterococcus faecalis, Escherichia coli, and Candida albicans was prepared. Petri-dish containing Mueller Hilton agar medium were streaked with sterile cotton swabs dipped in microbial suspensions. Four wells of equal dimension were prepared, and were immediately filled with equal volumes of freshly mixed selected four sealers i.e., Zinc Oxide Eugenol based, Epoxy Resin based, Mineral Trioxide Aggregate based, Bio Ceramic based sealers. After pre-diffusion plates were incubated at 370C and microbial growth inhibition zones were measured using digital callipers, after 24 hours, 48 hours and 72 hours. All the assays were conducted in triplicate under aseptic precautions and data was recorded in terms of average diameter of inhibition zone. Data was statistically analysed using Epi Info and Statistical Package for Social Sciences (SPSS) software. Results: Four sealers exhibited microbial growth inhibition. Epoxy Resin sealer showed the greatest microbial growth inhibition of 13.89±2.96 millimetres followed by MTA sealer (9.67 ±3.84 millimetres) and Bioceramics sealer (9.22±1.75 millimetres). ZOE sealer comparatively exhibited mild antimicrobial activity (8.89±1.91 millimetres). Conclusion: All sealers exhibited antimicrobial activity. Epoxy Resin sealer showed highest antimicrobial activity followed by MTA, Bioceramics sealer and ZOE sealer against tested organisms.

137. Investigate the Role of Parental Behaviors, Knowledge, and Attitudes in Shaping Children’s Oral Health Habits
Sandeep Kumar Swarnkar, Anuary Ering, Sonal Bansal, Utkarsh Gupta, Anupama Pradhan, Upma Dhakad
Background: Effective oral health habits in children are influenced by various factors, with parental behaviors, knowledge, and attitudes playing a pivotal role. This cross-sectional study explores these influences in the specific cultural and socio-economic context of India. Study Design: Cross-sectional. Participants: 300 parents of children aged 2 to 12 years. Data Collection: A structured questionnaire addressing parental behaviors, knowledge, and attitudes related to children’s oral health, encompassing tooth brushing practices, fluoride product use, and attitudes toward dental visits. Demographic information is also collected. Results: Demographic analysis reveals a diverse sample, reflecting different age groups, educational levels, and income brackets within the Indian population. Parental behaviors, as indicated by mean tooth brushing frequency and fluoride product use, demonstrate active engagement in promoting oral hygiene. The mean knowledge score suggests a high level of awareness, while positive attitudes toward dental visits underscore a favorable disposition to professional oral care. Conclusion: This study contributes essential insights into the complex dynamics of parental influences on children’s oral health habits in India. The positive parental behaviors, knowledge levels, and attitudes observed suggest a foundation for building effective public health strategies. Leveraging cultural strengths and addressing identified challenges can enhance the development of optimal oral health habits in the Indian pediatric population.

138. Investigate the Awareness and Utilization of Preventive Measures, Such As Fluoride Varnish and Dental Sealants, in Pediatric Dental Practices
Sandeep Kumar Swarnkar, Anuary Ering, Sonal Bansal, Utkarsh Gupta, Anupama Pradhan, Manishi Tiwari
Background: This cross-sectional study investigates the awareness and utilization of preventive measures, specifically fluoride varnish and dental sealants, among pediatric dental practitioners. Given the importance of preventive care in pediatric dentistry, understanding practitioner practices is essential for optimizing oral health outcomes in children. Methods: Study Design: Cross-sectional. Participants: 200 pediatric dental practitioners. Data Collection: A structured questionnaire assessing awareness, utilization patterns, and factors influencing the incorporation of fluoride varnish and dental sealants. Demographic information was also collected. Results: Demographic analysis revealed a diverse sample in terms of age, gender, and years of practice. The majority of practitioners demonstrated high awareness of fluoride varnish (60.0%) and dental sealants (55.0%). However, variations in utilization patterns were observed, with 42.5% and 37.5% routinely applying fluoride varnish and dental sealants, respectively. Conclusion: This research provides valuable insights into the awareness and utilization of preventive measures in pediatric dental practices. Addressing variations in practices could enhance the consistency and effectiveness of preventive care. Future research should focus on developing targeted interventions and exploring specific challenges faced by practitioners.

139. Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique with Locking Compression Plates for the Treatment of Distal Tibial Fractures
Akber Ikram Ahmed, Radhesh K.R., Nikil Das Bhat, Gowri L.Y
Background: Distal tibia fractures present a challenge in orthopedic surgery. This study evaluates the outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) using locking compression plates in these fractures. Methods: A prospective study was conducted on 20 patients with distal tibia fractures treated using MIPPO. Patients aged 22-52 years (mean 38.2, SD 9.7) were included, with a follow-up of 14.3 months on average. The surgical approach, operative time, union time, and complications were analyzed. Results: The majority of fractures were due to road traffic accidents (60%). The average operative time was predominantly between 60-90 minutes (50%). Bone union was achieved in less than 16 weeks in 40% of the cases. Complications included ankle stiffness (15%) and infection (10%), with a generally favorable prognosis (65% good to excellent outcomes). Conclusion: The MIPPO technique using locking compression plates for distal tibia fractures is effective, with a relatively quick operative time and a high rate of timely union. The low complication rate and favorable prognosis suggest its viability as a preferable treatment option in orthopedic trauma.

140. Etiological Study of Biliary Strictures in Northeast, India, Endoscopic Assessment and Predictors of Malignancy
Pallab Kumar Medhi, Bikash Narayan Choudhury, Bhaskar Jyoti Baruah, Mallika Bhattacharyya, Utpal Jyoti Deka
Background: Biliary strictures, whether benign or malignant, pose a significant diagnostic challenge. A detailed analysis of the potential factors affecting the differentiation between benign and malignant biliary strictures was undertaken to enhance the precision and efficiency of diagnostic procedures. Methods: This study examined multiple variables such as stricture length, levels of the biomarker CA 19-9, ALKP and bilirubin, alongside demographic factors such as age and gender. Through a comprehensive analysis, we sought to identify which parameters could most reliably indicate the nature of biliary strictures. Results: Our findings revealed that length of the stricture emerged as a notable factor, with an accuracy of 86.7% in distinguishing benign from malignant strictures. The biomarker CA 19- 9 demonstrated a remarkable efficiency with a predictive accuracy of 89.2%. Furthermore, the levels of serum alkaline phosphatase and serum bilirubin were found to be reliable indicators, with AUC values of 0.78 and 0.82 respectively. Gender appeared to be less significant in predicting malignancy, while age exhibited a strong statistically significant association with malignancy. Conclusion: Our study underscores the importance of a multifaceted approach in diagnosing biliary strictures. The identified markers and parameters can potentially enhance the current diagnostic protocols, facilitating more targeted and effective strategies for managing individuals with biliary strictures.

141. Avascular Necrosis of Femoral Head Secondary to Intramedullary Nailing of Femur
L Keerthi Krishna, K T Madhukar, Vineeth Varma
Background: Avascular necrosis (AVN) of the femoral head post intramedullary nailing of femur is a significant clinical concern, often resulting from multiple factors. This study aimed to determine the incidence of AVN and identify potential risk factors following intramedullary nailing. Methods: A retrospective cohort study was conducted with 60 patients who underwent intramedullary nailing of the femur over a period of two years. Data collected included demographics, fracture details, surgery duration, and post-operative complications. Multivariate analysis was utilized to pinpoint potential risk factors contributing to AVN. Results: The incidence of AVN in patients post-intramedullary nailing was 6.67%. A notable link was found between underlying comorbidities and AVN development, with comorbidities present in 50% of the AVN group compared to 14% in the non-AVN group (p=0.09). Fracture stability also emerged as a key factor; unstable fractures were more common in the AVN group (50% vs. 7%, p=0.06). The average time to AVN onset was found to be around 2 months. Additionally, surgeries lasting over 3 hours and post-operative complications were significantly associated with an increased risk of AVN. Conclusion: The study highlights the complexity of AVN following intramedullary nailing of the femur, emphasizing the importance of fracture stability, underlying comorbidities, surgery duration, and vigilant post-operative care. Routine radiographic follow-ups are essential for early detection and management of AVN.

142. Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique with Locking Compression Plates for the Treatment of Distal Tibial Fractures
Akber Ikram Ahmed, Radhesh K.R., Nikil Das Bhat, Gowri L.Y
Background: Distal tibia fractures present a challenge in orthopedic surgery. This study evaluates the outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) using locking compression plates in these fractures. Methods: A prospective study was conducted on 20 patients with distal tibia fractures treated using MIPPO. Patients aged 22-52 years (mean 38.2, SD 9.7) were included, with a follow-up of 14.3 months on average. The surgical approach, operative time, union time, and complications were analyzed. Results: The majority of fractures were due to road traffic accidents (60%). The average operative time was predominantly between 60-90 minutes (50%). Bone union was achieved in less than 16 weeks in 40% of the cases. Complications included ankle stiffness (15%) and infection (10%), with a generally favorable prognosis (65% good to excellent outcomes). Conclusion: The MIPPO technique using locking compression plates for distal tibia fractures is effective, with a relatively quick operative time and a high rate of timely union. The low complication rate and favorable prognosis suggest its viability as a preferable treatment option in orthopedic trauma.

143. Analysis of Clinical Presentation and Surgical Outcomes of Shunt Surgery of Congenital Hydrocephalus
Basanta Kumar Baishya, Angirash Bhattacharyya
Background: Congenital hydrocephalus, characterized by the abnormal accumulation of cerebrospinal fluid within the brain, presents a significant challenge in pediatric neurosurgery. Early intervention and proper management are vital for improving the clinical outcomes in affected infants. This study aimed to analyze the clinical presentations and surgical outcomes of shunt surgery in congenital hydrocephalus patients. Methods: A meticulous two-year analysis was conducted at the Department of Neurosurgery at Gauhati Medical College and Hospital, involving 50 patients who underwent shunt surgery. The parameters analyzed encompassed demographic details, clinical presentations, etiologies, and surgical outcomes. Results: The majority of the patients were aged between 2-4 months (50%) and had a male predominance (60%). Clinical presentations were marked by increased head circumference (90%), developmental delays (70%), and motor deficits (50%). Aqueductal stenosis (26%) and meningomyelocele (24%) emerged as the primary etiological factors. Ventriculoperitoneal shunt was the preferred surgical intervention, utilized in 70% of cases, with an 80% success rate involving the standard technique. The post-operative period witnessed a 52% complication rate, predominantly characterized by shunt obstruction (14%) and infection (12%). Encouragingly, 70% of the patients did not require revision surgeries, indicating initial surgical success. Conclusion: The study highlights the critical need for early detection and intervention in congenital hydrocephalus, emphasizing the significance of monitoring head circumference as a potential early indicator. The findings underscore the necessity for continued advancements in surgical techniques and post-operative care to further enhance the successful outcomes.

144. A Study on Aspartate Platelet Ratio Index (APRI) Versus Splenic Bipolar Diameter Ratio in Predicting Oesophageal Varices in Patients with Cirrhosis in a Rural Medical College Hospital
M. Venkatesh, R.Suresh, A. Karthikeyan, R. Gopinath, R. Jegatheesh
Cirrhosis presents a significant health burden globally, often leading to morbidity and premature mortality. Esophageal varices, a complication of cirrhosis, necessitate early identification to prevent potential bleeding complications. This prospective study, conducted at Government Medical College Hospital, Theni, aimed to evaluate non-invasive diagnostic markers for esophageal varices in cirrhotic patients. 75 patients diagnosed with liver cirrhosis were included after obtaining consent and meeting specific criteria. The study focused on assessing the utility of Aspartate Platelet Ratio Index (APRI) and Platelet Count to Splenic Diameter ratio in diagnosing esophageal varices. Statistical analyses were conducted using SPSS, employing descriptive statistics, Chi-square, student t-tests, and ROC curves. The majority of the patients (89%) were male, predominantly in the age group of 50 to 60 years. Alcoholism was a prevalent etiology (89.33%) among the study cohort. Parameters such as platelet count, splenic diameter, and their ratio exhibited significant associations with the presence of esophageal varices. Notably, the Platelet Count to Splenic Diameter ratio demonstrated higher sensitivity (96%) and specificity (90.48%) in predicting esophageal varices compared to APRI. A cut-off value of <909 for this ratio exhibited robust positive and negative predictive values (88.8% and 90.4% respectively), indicating its potential as a reliable non-invasive marker for identifying esophageal varices. The study underscores the promising utility of the Platelet Count to Splenic Diameter ratio as a non-invasive parameter for diagnosing esophageal varices in cirrhotic patients. Validation of these findings in larger, multi-center studies could potentially reduce the necessity for invasive endoscopic procedures and aid in early identification and management of at-risk patients.

145. Correlation of Clinical and Biochemical Parameters in Liver Abscess Patients at Tertiary Centre of North Bihar
Chiranjeevi B, Arohi Kumar
Background: 48 percent of all visceral abscesses are located in the liver. Due to inadequate nutrition, overcrowding, and poor sanitation, it is frequent in India, where it has the second highest prevalence. An estimated 40–50 million individuals worldwide contract amoebic abscesses each year. In order to provide a timely diagnosis and effective treatment, the purpose of this study is to monitor the clinical and biochemical characteristics of patients suffering from liver abscesses at the tertiary center set up in North Bihar. Methods: The study examined 50 liver abscess patients and was carried out over a 12-month period. A physical examination and history were taken. A full hemogram, a liver function test, a coagulation profile (PT/INR), and an abdominal USG were performed on each patient. HIV and Entamoeba histolytica serology were performed. Results: The patients were 41.8 years old on average, with a male preponderance. The majority of liver abscesses were amoebic (86%) as opposed to pyogenic (14%). Diabetes mellitus (20%) and alcoholism (52%) are the two main risk factors for hepatic abscess. In 80% of instances, hepatomegaly was detected. Low albumin, elevated PT INR, and elevated ALP all suggest a liver abscess. Right lobe abscesses accounted for 76% of all abscesses, and 66% of them were solitary. Pleural effusion (6%), and ascites (12%) were the observed complications. Conclusion: Patients who come with a protracted fever and right upper quadrant abdominal pain may have a liver abscess, especially if they have diabetes mellitus or are alcoholism. The use of ultrasonography is a simple and affordable method of diagnosing liver abscess. A strong foundation for preventing complications, morbidity, and death is early and aggressive treatment.

146. Study of Lipid Profile, Serum Magnesium and Blood Glucose in Hypertension
Md. Balal, Shahzad Khan, Farhan Usmani, Madhu Sinha
The aim was made to study the function of blood glucose, serum Mg+2, and lipid profile in individuals with hypertension. Furthermore, a biochemical analysis is performed on each parameter. About 80 samples (50 cases and 30 controls) show that hypertensive people with dyslipidemia had unchanged HDL concentrations. Serum magnesium levels in hypertension patients and controls do not correlate. Serum magnesium levels in hypertension subjects have been found to be somewhat higher than in normal persons. The hypertension subjects’ (101.62 mg/dl ±33.78) fasting blood glucose level is greater than the controls’ (82.46 mg/dl ±10.8). There has been a statistically significant rise (p<0.001). However, 12% of the cases may be diabetic situations which could explain this increase. Even yet, hypertensive individuals have a propensity to have reduced glucose tolerance. Systolic and diastolic blood pressure readings are recorded independently for each measurement of blood pressure. As age groups increased, the systolic blood pressure became more relevant than the diastolic blood pressure.

147. Analyze the Prevalence of Hyponatremia in Adult Patients with Pulmonary Tuberculosis
Prakash Sinha, Laxmi Niwas Tiwari, Ritesh Kamal
Background: One of the main causes of morbidity and death in developing and poor nations is pulmonary tuberculosis (PTB). The nation with the greatest PTB load is India. Hyponatremia is one of the most prevalent electrolyte imbalances, and it increases morbidity and mortality. The prevalence of hyponatremia in adult pulmonary tuberculosis patients was investigated in this study. Methods: Patients who presented to the pulmonary medicine department at Katihar Medical College and Hospital in Katihar, Bihar between September 2019 and August 2020 and who were above the age of 18 were included in this retrospective analysis. PTB was identified in accordance with the institutional protocol, which took into account the patient’s clinical presentation, microscopic investigation results suggesting the presence of acid-fast bacilli (AFB), and abnormal chest radiograph findings. During the study period, all patient case files with PTB were gathered, and pertinent laboratory results and demographic information were recorded and examined. Results: In all, 150 PTB patients between the ages of 18 and 86 were enrolled in this study. The patients’ average age was 50.92 ± 17.76. Thirty-six (26%) and eighty-four (74%) of the 150 patients who had hyponatremia—that is, serum sodium levels less than 135 mmol/l were female. A total of 150 patients were found to have mild hyponatremia in 59 (39%), moderate hyponatremia in 41 (27%) and severe hyponatremia in 14 (9%) of them. Males constituted the majority in all groups with hyponatremia. Sputum tested positive for AFB in 27 cases (46%) of mild hyponatremia, 34 cases (83%) of moderate hyponatremia, and 11 cases (79%) of severe hyponatremia. All patients but four had severe hyponatremia and needed vasopressor therapy due to hypotension; the other patients were asymptomatic. Conclusion: Hyponatremia should be assessed in patients with PTB as early detection and therapy may be able to lower morbidity and death.

148. A Study on Incidence of Lung Malignancy at KMCH, Katihar, Bihar
Prakash Sinha, Laxmi Niwas Tiwari, Ritesh Kamal
Background: The most common cancer in men and the main cause of death for people of all ages is lung cancer. It is linked to a 13.7% death rate and makes up 11.3% of all new cancer cases in India. It is imperative that lung cancer be diagnosed early due to this tragic death rate. The purpose of the study was to assess the frequency, distribution by age and gender, and relationship between smoking and lung cancer. Methods: From October 2020 to September 2021, this study was conducted in the pulmonary medicine department of Katihar Medical College and Hospital, Katihar, Bihar. 52 patients with radiological and clinical suspicions of lung cancer are included in the study. Every case suffered transthoracic needle aspiration guided by USG and was sent for cytology. Histopathological analysis was performed on cases that were malignant or inconclusive in order to provide confirmation. Results: Of the fifty-two patients, who were suspected of having cancer, thirty-two were ultimately found to have cancer, five had benign or inflammatory lesions, six had no evidence of cancer or non-specific inflammation, and eight were unable to receive an opinion. With an incidence rate of 71.8% and 15.7%, respectively, squamous cell carcinoma and adenocarcinoma are the two most common types. The fifth decade is when lung cancers are most common in both sexes. Conclusion: The occurrence of lung cancers in women is on the rise, shedding light on factors other than smoking, such as exposure to biomass fuel and secondhand smoke. Of them, adenocarcinomas are the most prevalent. Moreover, lung cancers can be detected with a high degree of sensitivity using USG-guided transthoracic needle aspiration.

149. Comparison of Induced Sputum and Bronchial Washings for CBNAAT in Diagnosing Sputum Smear Negative Pulmonary Tuberculosis
Prakash Sinha, Ritesh Kamal, Laxmi Niwas Tiwari
Background: One of the most contagious public health issues for many years, tuberculosis has also become more challenging to diagnose recently because of its link to immunocompromised individuals. Modern diagnostic methods, such as CBNAAT, can now provide positive results even when there are fewer tuberculosis bacilli in specimen samples. The purpose of the current study was to compare bronchial washings and induced sputum for the CBNAAT in the diagnosis of sputum smear-negative tuberculosis. Methods: From November 2021 to October 2022, a prospective, observational study was carried out in the pulmonary medicine department of Katihar Medical College and Hospital in Katihar, Bihar. In Katihar, Bihar, 43 patients with sputum-negative tuberculosis were recruited and given BAL fluid and sputum for CBNAAT analysis under RNTCP. Results: There were more male patients (67.45%) than female patients (32.55%). The majority of people are between the ages of 51 and 60, with a mean age of 49.18. Infiltration was the most frequent X-ray presentation, followed by consolidation. Compared to bronchial washings CBNAAT in 27 patients, induced sputum CBNAAT was positive in only 7 patients. Conclusion: All smear-negative and immunocompromised patients should undergo CBNAAT because it can diagnose pulmonary tuberculosis patients quickly, prevent transmission, and reduce mortality. In addition to helping with early diagnosis in less than two hours so that early therapy can be started, CBNAAT detects pulmonary TB in PLHIV more effectively than sputum microscopy. This decreases the incidence of MDR-TB and the mortality associated with it.

150. Estimate the Level of Lipid Peroxide and Lipid Profile in Diabetes Mellitus Patients at Patna Medical College and Hospital, Patna, Bihar
Rajani Sinha, Shubhangi Raj, Amit Kumar, Madhu Sinha
Background: Diabetes mellitus is a condition like a “iceberg.” An estimated 150 million people globally are expected to have diabetes. Twenty percent of the world’s diabetic population is thought to currently dwell in South-East Asia. The purpose of the study was to determine the relationship between lipoprotein levels and lipid peroxidation and the severity and complications of diabetes mellitus. Materials and Methods: This study was conducted at Department of Clinical Pathology and Biochemistry, Patna Medical College, Patna, Bihar from July 2022 to June 2023. In diabetes mellitus, the degree of lipid peroxidation was assessed using malondialdehyde (MDA), blood glucose, and the lipid profile. Diabetes mellitus (DM) is broadly classified into type 1 DM or insulin dependent diabetes mellitus (IDDM) and type 2 DM or non-insulin dependent diabetes mellitus (NIDDM). Results: There were 52 non-diabetic subjects who served as controls and a total of 112 known cases of diabetes were examined. These cases were divided into three groups: controlled, poorly controlled, and uncontrolled, based on the concentration of fasting blood glucose level. All groups showed a significant rise in lipid peroxide (MDA) and lipid profile as compared to controls, with the exception of HDL cholesterol, which was shown to be decreased. Lipid peroxidation was significantly higher in the NIDDM group compared to the IDDM group, and it was higher in the DM patients with complications. Another observation was that the amount of lipid peroxide rose in proportion to the rise in blood glucose levels. The increased lipid peroxidation associated with hyperglycemia may be explained by the antioxidant enzyme superoxide dismutase becoming dormant as a result of superoxide radical production inside the cell. In case of diabetes, maximum lipid peroxidation causes damage to the tissues and organs, which can lead to macro vascular and micro vascular complications. Increased cholesterol synthesis is the cause of high total cholesterol levels. The glycemic control affects the levels of triglycerides. The excess VLDL-TG produced could be the cause of the rise. Conclusion: It is concluded that maintaining adequate metabolic control over hyperglycemia can help to prevent changes in lipid metabolism and peroxidation, which may improve prognosis and delay the onset of vascular and secondary complications in diabetes mellitus.

151. Association between Level of HbA1c and Lipid Profile in T2DM Patients Attending Diabetic OPD at PMCH, Patna, Bihar
Shahzad Khan, Md. Balal, Madhu Sinha
Background: Insulin-induced hyperglycemia is the feature of diabetes mellitus (DM), a group of metabolic diseases. Those with type 2 diabetes (T2DM) are more likely to be obese, have high blood pressure, and have high cholesterol. Our study was to determine the usefulness of Hba1c as a dyslipidemia indicator in individuals with type 2 diabetes. Methods: After a minimum of eight hours of fasting, we obtained venous blood samples from 168 T2DM patients in both plain and EDTA vials. An entirely automated analyzer was used for the biochemical analysis. substantial negative correlations were seen between HbA1c and the HDL/LDL ratio and substantial positive correlations with total cholesterol, LDL-C, and triglycerides. Results: Compared to patients with poor glycemic control, those who had good glycemic control had reduced mean values for TC, LDL-C, and TG. However, compared to individuals with poor glycemic control, the mean value of HDL and HDL/LDL ratios was higher in the former group. At the p-value of less than 0.05, these differences were significant. Conclusion: Our study recommends using HbA1c as an additional dyslipidemia indication.

152. Status of Vitamin D in Polycystic Ovary Syndrome: A Case Control Study
Shubhangi Raj, Rajani Sinha, Farhan Usmani, Madhu Sinha
Background: Endocrine and metabolic abnormalities are clinical manifestations of PCOS, or polycystic ovarian syndrome. The lack of vitamin D in many people worldwide, regardless of age, has led to a significant increase in interest in the nutrient in recent years. This study compared and measured the vitamin D levels of healthy women and PCOS patients. Methods: It was a case-control study. In this study, 75 PCOS patients and 75 age-matched healthy controls were enrolled. Using the ELISA technique, an immunoassay method was used to estimate the serum level of Vitamin D. When appropriate, the independent t-test and chi square test were used to compare the data. Results: Compared to healthy controls (34.12±7.41 ng/ml), PCOS patients had a significantly (p<0.0001) lower total blood vitamin D level (21.91± 8.49 ng/ml). Conclusion: The observation of hypovitaminosis D in PCOS cases suggested a potential role for vitamin D in the pathophysiological alterations associated with the illness.

153. Correlation of Dual Energy X-Ray Absorptiometry with Markers of Bone Metabolism in Femur Fractures
Manish Raj, Alok Chandra Agrawal, Harshal Sakale, Bikram Keshari Kar, Amritava Ghosh
Background: Numerous functions have been made possible by notable advancements in dual-energy X-ray absorptiometry (DXA) in terms of quality, picture resolution, and acquisition time. By indirectly analyzing the micro- and macroarchitecture of the bone, DXA can assess bone quality and enhance fracture risk prediction. Additionally, without the need for additional radiologic imaging or radiation exposure, DXA can identify pre-existing fractures, such as atypical femur fractures or vertebral fractures. Furthermore, it can evaluate the metabolic state by the assessment of metrics related to body composition, such as visceral fat and muscle mass. DXA is obviously useful for more than simply bone mineral densitometry, even though additional research is needed to evaluate and apply these characteristics in a clinical setting. Aim of this study to correlate bone density DUAL ENERGY X-RAY ABSORPTIOMETRY in patient with femur fracture with markers of bone metabolism. Methods: This cross-sectional analytic study was conducted at Department of Orthopaedics, AIIMS, Raipur from 24 months after obtaining ethical clearance approval, sample collection – 12 months (April 2021 to March 2022), follow up – 6 months and article writing – 6 months. Total 99 patients were enrolled in this study. Results: This study by the Department of Orthopaedics, Raipur, correlated bone metabolism markers with dual energy X-ray absorptiometry in femur fracture patients (i.e. Serum calcium; Serum phosphorus; Alkaline phosphatase; Serum Vitamin D; and Serum protein – albumin). In this study of femur fractures, 99 cases met inclusion and exclusion criteria. The mean age of the population in our study was 51.44 ± 20.44 years with range (18-97 years). The majority of population the study group was male (65.7%) as compared to females (34.3%) in our study. Majority of the population had osteoporosis (47.3%) as compared to osteopenia in 31.3% of the population and normal bone mineral density in 21.2 % population. Mode of Injury reveals that Self fall (46.5%) and RTA (44.4%) were the most common mode of injury followed by fall from height (9.1%). Intertrochanteric femur fracture (42.4%) was the most common diagnosis followed by neck of femur fracture (28.3%) shaft of femur fracture (15.2%), distal femur fracture (9.1%) and subtrochanteric femur fracture (5.1%). ANOVA showed no significant association between bone mineral density and fracture groups (p value = 0.194) nor with the DXA parameters (T-score and Z-score; p value = 0.126, 0.092 respectively). Conclusion: We found a strong correlation between advanced age and low bone mineral density, even though blood calcium, serum vitamin D, and serum phosphorus have no effect on bone density. Bone mineral density is linked to blood alkaline phosphatase, serum albumin, and fracture prediction T- and Z-scores.

154. A Retrospective Study of Characterization of Various Pathological Isolates in Blood Culture Sample and its Antimicrobial Sensitivity Pattern at Tertiary Care Hospital
Swati Srivastava, Prachi Singh, Deepti Gangwar
Context: Blood stream infections are an important cause of mortality and morbidity and are among the most common health-care associated infections. Illness associated with blood stream infection ranges from self-limiting infections to life-threatening sepsis that require rapid and aggressive antimicrobial treatment. Aims: The aims and objectives of the study is to characterize the various pathological isolates in blood culture & its antimicrobial sensitivity pattern attended tertiary hospital. Study Design: This is a retrospective study in which 476 blood samples were collected over a period of one year. The clinically suspected cases were reviewed for bacteraemia. Material and Methods: The isolates were identified by laboratory Standard biochemical tests and the Antimicrobial Susceptibility testing was determined by Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Positive cultures were obtained in 207 (43.4%) cases out of 476 samples. Gram-positive bacteria were predominant and it accounted for 75.8% cases, Methicillin Sensitive Coagulase Negative Staphylococcus aureus (10.6%) was the predominant isolate followed by Methicillin resistant Staphylococcus aureus-MRSA (9.6%), followed by Methicillin resistant coagulase negative Staphylococcus aureus-MRCONS (8.2%), followed by Methicillin sensitive Staphylococcus aureus (4.8%), and followed by enterococcus (3.8%).  Among culture positive isolates, Gram-Negative Bacteria accounted for 18.8% cases; most common being Acinetobacter spp. (5.3%), followed by Klebsiella spp. (4.8%), and E. Coli (2.4%), followed by CDC No 1 (2.4%), followed by Pseudomonas (1.9%), followed by Salmonella typhi (0.9%), followed by Enterobacter (0.4%), followed by Citrobacter (0.4%).  Maximum Gram-negative isolates were sensitive to ceftazidime/clavulanic acid combination. Staph. aureus & CONS were 100%. sensitive to Vancomycin drug.

155. Comparative Study of Open Hernia Repair (Lichtenstein) versus Laparoscopic (TAPP) Mesh Repair for Inguinal Hernia
Rahul Ranjan, Rajendra Kumar, Priyanka Kumari
Aim: The study compares open hernia repair and laparoscopic surgery (TAPP) mesh repair in recovery time, discomfort, intra- and post-operative complications, recurrence, and time to resume regular activities. Methods: Lichtenstein’s open mesh repair and laparoscopic hernioplasty (TAPP) were compared in the general surgery department at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India for 1 year. 120 individuals with unilateral or bilateral inguinal hernias were randomized. The length of the procedure, intra- and post-operative issues, hospital stay, recurrence, discomfort, and time to return to regular activities were compared. Results: The 120 participants were 100 (84.71%) men and 20 (13.29%) women. The mean age for open mesh repair was 52.06 and laparoscopic surgery 49.45. Unilateral hernia was found in 95 patients and 25 patients had bilateral inguinal hernias. Among bilateral hernias Fifteen open mesh and ten laparoscopic bilateral hernia patients were treated. Among unilateral hernias, open mesh repair and laparoscopic hernioplasty were performed on 56 and 39 patients, respectively. The typical bilateral open hernioplasty took 87.26 minutes and unilateral 46.55. Unilateral laparoscopic hernioplasty took 120.45 and 62.48 minutes. The open hernioplasty group developed 16.9% seroma (12/71) and 14.08% (10/71) wound infection. 4.08% (2/49) of laparoscopic hernioplasty patients suffered wound infection, but 12.24% (6/49) developed seroma. Open hernioplasty had 14 urinary retention instances, laparoscopic 6.14%. Laparoscopic and open hernioplasty (LH and OH) exhibited mean pain scores of 5.1 and 6.6 on POD 0 and 4.2 and 5.1 on POD 3. LH pain was 1.7 and OH 3.0 on POD 7. Conclusion: Skilled laparoscopic hernia repair is safer and has less post-operative morbidity than open surgery. Less postoperative morbidity makes laparoscopic inguinal hernia repair the preferred procedure; long-term outcomes and affordability of laparoscopic versus open hernia surgery should be investigated to guide treatment choices.

156. Depression and Quality of Life in Parents of Intellectually Disabled Children: A Cross-Sectional Study
Sukanya S Kamble, AvinashV Gawande, BhagyashreeS Gawande, Uday W Narlawar
Background: Intellectual disability (ID) is characterized by significant impairment in cognitive and adaptive behavior. Delivery of a baby with intellectual retardation in one’s own family is generally an unanticipatory and unwelcome occasion. They have to make adjustments in their lifestyle, limit is imposed on their social existence, they’ve less time for themselves, and their recreational and leisure interest get compromised. So, this study was conducted to assess depression and quality of life in parents of intellectually disabled children. Methods: A cross-sectional study was conducted among 200 parents (100 mothers and 100 fathers) of intellectually disabled children at the district disability rehabilitation center (DDRC) and psychiatric OPD of a tertiary health care center in central India. Beck’s Depression Inventory (BDI) is used to document depression. Quality of life among parents of ID children assessed by WHOQOL-BREF scale by interview method. Results: The mean age of mothers was37.06 ±6.66 years and fathers were 41.79 ±7.75. The present study showed that 82 (82%) fathers & and 92 (92%) mothers had depression. Out of four domains of quality of life psychosocial, social, and environmental domains were found to be significant with depression in parents of ID children. (p<0.05). Conclusion: Since the proportion of depression in parents (mothers >fathers) of ID children is higher, it is recommended that the DDRC center and psychiatric department should have screened all those parents who came to register their ID children Through Psychological assessment.

157. Nerve Conduction Studyin Type 2 Diabetic Patients
Kunipuri Sarala, R. Pavani, Indla. Devasena, S. Lakshmi
Nerve conduction velocity (NCV) test measures the speed of conduction of an electrical impulse through a nerve. The NCV test can establish nerve damage and devastation. Nerve conduction studies (NCS) are regularly conducted to identify the neuropathy. This study will help to observe the difference in nerve conduction velocity between non diabetic and type II diabetic individuals. The present study was undertaken for a period of   subjects, both males and females aged between 40-50 years, informed written consent was taken from the subjects. The study group consisted of 25 diabetic patients, with history of diabetes for 1-10 years and controls (Non Diabetics) were 30 age and sex matched healthy individuals.  Comparison of sensory nerve parameters in Control Group (non diabetics) and diabetics shows  there is highly significant slowing of sensory nerves median & ulnar (p<0.001) and decrease in amplitude of Median nerve(p<0.05) in diabetics compared to controls. The study proved neuronal involvement in the diabetes mellitus which is accelerated by poor glycaemic control. Therefore nerve conduction studies should be carried out for the early detection and management of neuropathy in the diabetic patients.

158. Study of Caesarean Section using Robson’s Ten Group Classification System
Umesh Anil Sawarkar, Ashwini Rameshpant Raut
The aim of the present study was to calculate the overall cesarean section rate, to identify groups of women (distributed according to Robson’s Ten Group classification system) that contributed most to the overall cesarean section rate and to analyze cesarean section rates . This cross-sectional study was conducted at “The Department of Obstetrics and Gynaecology, The study population included a total of 200 women who underwent CS in the hospital . All pregnant women with gestational age of more than 28 weeks, delivered during the study period were classified according to Robson’s ten-group classification system. Cesarean section rate, group size, group cesarean section rate and absolute and relative contribution of each group to caesarian section (CS) rate were calculated and analysis was done. 54% cases were of 10 group of Robson’s  Classification (Singleton, cephalic, ≤36 weeks including previous cesarean section). 19% cases indication was Previous Cesarean Section. 17% cases indication s was Fetal Distress. “Robson’s ten group classification system” helps us to identify the main groups of subjects who contribute most to the overall CS rate. In present study as women with previous cesarean section constitute the most important determinant of overall cesarean section rates. We should judiciously make use of vaginal birth after cesarean section but not at the cost of maternal or fetal health.

159. A Comprehensive Assessment of Clinical and Radiographic Outcomes Proximal Fibular Osteotomy in Osteoarthritis Knee
Amit Kumar, Mahavir Prasad Goyal, Vinay Kumar Singh, Khushwant Singh Rathore
Introduction: Osteoarthritis, a common joint disease, causes discomfort and motion due to cartilage deterioration. Around the world, 22.9% of 40-year-olds have knee OA. Traditional treatments include non-pharmacological methods and drugs, although they have drawbacks. The surgery proximal fibular osteotomy (PFO) has shown promise in relieving knee OA pain and improving function. More study is required to compare its long-term efficacy to other surgeries. Aim and objectives: The efficacy of this study of proximal fibular osteotomy in treating osteoarthritis of the knee should be thoroughly investigated by analysing its radiographic and clinical results. Method: This prospective cohort study examines proximal fibular osteotomy for grades 1 and 2 medial knee osteoarthritis. Patients had thorough pre-operative evaluations approved by the Institutional Ethical Committee. Anaesthesia was used during surgery and recovery. Visual Analogue Scale, American Knee Society Score, and femorotibial axis examinations were performed up to 12 months post-surgery, utilising rigorous statistical analysis. The study’s methodological merits make it promising, although biases and the lack of a control group should be considered. Result: This research examines proximal fibular osteotomy for low-grade medial knee osteoarthritis. The findings show that there was a substantial decrease in pain (p < 0.05) and a persistent improvement in knee function (p < 0.05) up to six months after surgery, with a broad demographic (mean age 52.55, 55.2% males). A substantial increase (p < 0.05) was also seen in the Range of Motion. Restrictions guarantee consistent harshness, highlighting the procedure’s potential effectiveness.

Conclusion: Proximal fibular osteotomy improved medial compartment osteoarthritis discomfort, knee function, range of motion, and tibio-femoral angle.

160. Study of Sputum Cytology in COPD and Bronchial Asthma
Laxmi Niwas Tiwari, Prakash Sinha, Ritesh Kamal
Background: Globally, COPD is the leading cause of illness and mortality. Additionally, smoking is a major contributing factor to this condition. Airflow restriction is the cause of this type of issue, which affects the progressive and concomitant hyper responsiveness. The quality of life is lower, lung function declines more quickly, and mortality is higher in people with asthma and COPD overlap (ACO). They also use a disproportionate amount of resources for medical care. Furthermore, sputum cell counts are widely employed in the management of COPD and asthma. Sputum cell count has not yet been successfully applied clinically in COPD and asthma patients. The purpose of the study is to investigate the function of sputum cytology in COPD and bronchial asthma patients. Methods: From January 2021 to December 2021, a prospective study was conducted in the pulmonary medicine department of Katihar Medical College and Hospital in Katihar, Bihar. Twenty healthy participants, twenty asthmatic participants, and thirty COPD participants were enrolled in the current study. All patients’ lungs were measured for volume and capacity using body plethysmography and spirometry. Sputum cell and lung function variable counts were compared using the One-Way Analysis of Variance (ANOVA) technique. Results: The mean age of patients with COPD was 65.8±5.2 years, patients with asthma was 55.9±12.8, and patients in good health was 62.78±6.1 years. The analysis showed that the specific airway conductance for patients with aesthetic concerns was [0.60±0.04 kPa.Sec-1], for COPD patients it was [1.82±0.19 kPa.Sec-1], and for healthy individuals it was [1.19±0.12 kPa.Sec-1]. Conclusion: The neutrophil-macrophage ratio of COPD patients and sGaw had been found to be strongly correlated in the study. Eosinophils have a significant role in the pulmonary inflammatory infiltrates in both COPD and asthma patients, according to the interpretation of the study’s results.

161. Evaluation of Tobacco Smoking Effect on the Enzymatic Activity of Serum Gamma-Glutamyltransferase
Laxmi Niwas Tiwari, Prakash Sinha, Ritesh Kamal
Background: A cell-surface protein called gamma glutamyl transferase (GGT) aids in the extracellular breakdown of glutathione. Although the enzyme is produced in a variety of tissues, the liver produces the majority of the GGT in serum, making it the most sensitive enzymatic biomarker of liver disease at the moment. to measure the serum GGT enzyme activity in order to assess the impact of smoking on liver disorders. Methods: There were one hundred and twenty participants in the study. Every subject was divided into two groups. Group 1 is made up of sixty volunteers who smoke regularly. Group 2 is made up of sixty volunteers who do not smoke. Disposable syringes were used to reserve four to six milliliters of venous blood from each subject. The samples were immediately centrifuged at 3000 revolutions per minute for ten minutes, after which the obtained serum was immediately analyzed. Results: According to the data, the smoker group belongs to the moderate smoker group. According to the obtained data, the smokers’ group had a mean serum GGT activity of (23.49± 3.39 IU/L). This number was significantly higher than the 12.92 ±2.73 IU/L (p<0.003) obtained in the non-smokers group. Conclusion: Smokers tend to continue to suffer from the harmful consequences of smoking due to a significant increase in GGT activity. Additional research is required to elucidate the relationship between serum GGT activity and dietary and environmental variables.

162. A Study on Association of Obstructive Airway Disease in Previously Treated Pulmonary Tuberculosis Patients
Laxmi Niwas Tiwari, Prakash Sinha, Ritesh Kamal
Background: In a developing nation similar to India, pulmonary tuberculosis (PTB) and obstructive airway disease are becoming more and more prevalent. A significant proportion of tuberculosis patients get post-tubercular respiratory illness. The association between PTB antecedents and COPD antecedents has not been extensively studied in India. PTB significantly affects one’s quality of life. The purpose of this research is to determine the prevalence of obstructive airway disease in patients with pulmonary tuberculosis who have received prior treatment and to assess, using SGRQC, the effect of post-TB obstructive airway illness on quality of life. Methods: 116 research participants who satisfied the inclusion criteria were enrolled in a prospective, observational cross-sectional study from January 2023 to September 2023 at the Department of Pulmonary Medicine, KMCH, Katihar, Bihar, after obtaining informed consent. The main factor used to categorize study participants was their prior history of PTB. Consequently, PTB-associated COPD and COPD were the two study subject groups included in this investigation. The MIR Spirobank smart app was used to measure subjects’ PFT, and the SGRQ-C scale was used to measure their quality of life. Results: Out of 116 patients, PTB-associated COPD was diagnosed in 19 (22.6%) women, 65 (77.4%) men, and 5 (15.6%) women and 27 (84.4%) men, respectively. The most prevalent symptoms reported by 76 (94.04%) and 62 (71.42%) patients, respectively, were dyspnea and a cough with sputum. The study outcome shown a notable decrease in QOL of PTB related COPD patients (72%) compared to COPD patients (66.4%). The effect of airflow limitation (FEV1) was marginally enhanced in PTB associated COPD patients (25.65%) compared to COPD patients (26.4%). Conclusion: In a clinical setting, a sizable fraction of COPD cases are PTB-associated. It is a separate risk factor for OAD in nations with high tuberculosis rates. The findings suggested that in order to lower OAD, smoking cessation and early identification, treatment, and control of tuberculosis are equally important. Early detection of post-tubercular COPD and prompt treatment start increase quality of life and lower morbidity and death in these patients.

163. A Prospective and Clinical Study of Post-Partum Blood Loss in Induced Versus Spontaneous Vaginal Delivery
Pushpa Kumari, Amrita Roy
Background: The diagnosis and treatment of postpartum hemorrhage (PPH), a dangerous obstetric complication, depend heavily on real-time blood loss measurement. Predelivery and postdelivery blood hemoglobin and hematocrit measurements are used to evaluate postpartum blood loss in vaginal births. This study compares third stage blood loss in vaginal deliveries that are induced vs those that occur spontaneously and it looks at the relationship between blood loss and the drop in hemoglobin after delivery. Methods: From January 2023 to September 2023, the current prospective and clinical study was carried out in the obstetrics and gynecology department of the Madhubani Medical College and Hospital in Madhubani, Bihar. Using specialized collecting bags, blood loss after placental births was assessed in 150 pregnant women who delivered vaginally via labor induction, and the results were compared to those of another 50 women who delivered vaginally on their own. Prior to labor and following childbirth, each patient’s hemoglobin levels were documented. Results: The spontaneous group had a mean blood loss of 172 ± 114 mL, while the induced group had a mean blood loss of 30 mL less (p=0.12). However, this difference was not statistically significant. Comparing the oxytocin group’s blood loss (327 ± 140 mL) to other labor induction types and spontaneous deliveries, however, revealed a considerably greater blood loss due to the diverse induction techniques used. In comparison to spontaneous deliveries, prostaglandin-assisted labor induction did not result in increased blood loss. Post-delivery hemoglobin values in both the induced and spontaneous delivery groups showed statistically significant drops; however, the induced group’s drop was comparatively greater than the spontaneous vaginal delivery group’s (0.96gm/dL vs. 0.56gm/dL), which also appeared to be statistically significant (p=0.001). Conclusion: Using prostaglandins for labor induction is safer than using oxytocin. For all deliveries, it is crucial to accurately estimate blood loss in order to identify postpartum hemorrhage early and take the necessary action.

164. Relationship between Abnormal Cardiotocography and its Fetal Outcome – A Cross-Sectional Study
Pushpa Kumari, Amrita Roy
Background: Contextual details first, prenatal heart rate monitoring was used to detect situations such as foetal acidemia and hypoxia, which can both cause major issues for the developing infant. Data gathered from the medical literature indicates that there is a correlation between the circumstances of the newborn as determined by the Apgar score and hypoxic-ischaemic encephalopathy and pathological CTG. The frequency of aberrant cardiotocography during labor was to be ascertained, and the importance of these patterns in assessing fetal well-being was to be assessed. Methods: From May to September of 2023, a cross-sectional study was conducted at the Department of Obstetrics and Gynecology at Madhubani Medical College and Hospital in Madhubani, Bihar. For the study, one hundred admitted pregnant women were enrolled. After a 30-minute left lateral cardiotocography, the results were classified as normal, suspect, or abnormal. After hydration with 1000 ml of intravenous fluid and oxygen inhalation, suspicious pattern cardiotocography was repeated; if the results were still suspicious, delivery measures were implemented. The delivery method was determined by the labor stage. Results: 77 women had abnormal CTG traces, and 23 had questionable ones. With a p-value of 0.668, it was observed that the percentage of varied modes of administration did not significantly differ between the suspicious and abnormal CTG groups. With a p-value of 0.889, the Apgar score observed according to mode of delivery shows that there was no significant correlation between the score at one minute and the manner of delivery. With a p-value of 0.006, the relationship between low Apgar and the pathological and TG groups was significant. Out of all newborns, 81 (84.4%) did not require resuscitation, whereas 15 (15.6%) did. Conclusion: A low Apgar score at one minute and beyond, a higher rate of cesarean sections, and the need for neonatal resuscitation are all results of abnormal and TG fetal outcomes.

165. Comparative Study of the Standard Pritchard Regimen and Low Dose Dhaka Regimen of Magnesium Sulphate in the Management of Severe Pre-Eclampsia and Eclampsia
Bhavani Kamanchi, R. Sumathi, Jyothsna Sravanthi, Karuna Bhumireddy
Background: We wanted to evaluate the Standard Pritchard Regimen and Low Dose Dhaka Regimen of Magnesium Sulphate in the management of severe pre-eclampsia and eclampsia, assess the effects of magnesium sulphate regimens and investigate the efficacy of the Dhaka Regimen (a low dosage regimen), in eclampsia, compare Standard   regimen (PRITCHARD) with low dose regimen (DHAKA) with regard to the effectiveness in controlling of convulsions in eclampsia, and compare the magnesium related toxicity in both the regimens in this study. Methods: This was a hospital based prospective randomized clinical study conducted among 200 pregnant women with severe pre-eclampsia, imminent eclampsia & eclampsia attending the Government Maternity Hospital attached to SVMC, Tirupati, for 1 year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: In parity study, 135 cases were primigravida (67.5%) (Primigravidas >multigravidas). 65 cases (32%) were multigravida. Majority of the cases were primigravida in both the regimens. P- value was 0.004 which was statistically significant. In SBP, majority of the cases had SBP (>160) in DHAKA regimen i.e. 61% and in Pritchard regimen 48%. P-value was 0.02 which was statistically significant. In admission delivery interval in hours, it showed that mean duration of ADI for DHAKA regimen was 13.45 hours and Pritchard was 11.81 hours. Majority of the cases in DHAKA regimen had more delivery interval in hours. P-value was statistically insignificant. Conclusion: The current study offers more convincing evidence in favour of using magnesium sulphate frequently to treat eclampsia convulsions. Clinical surveillance seems suitable as long as there is enough urine output. There is no difference between the two magnesium sulphate regimens in terms of maternal mortality, perinatal death, maternal morbidity, or caesarean section rates. The research amply demonstrates that the Dhaka regimen is nearly similar to Pritchard protocol for the prevention and management of convulsions.

166. A Comparative Study to See Efficacy of Local Insulin Dressing Over Normal Saline Dressing in Diabetic Ulcer of Grade 1 and Grade 2 of Wagners Classification in Type 2  Diabetes Mellitus
Bipin Mishra, Vishakha Iyer, Sarojini Jadhav
Introduction: DFUs are one of the most common complications of diabetes and are a significant cause of morbidity and mortality, especially in older individuals. The prevalence of DFUs is estimated to be between 4% and 10% in patients with diabetes. The management of DFUs is complex, and several treatment modalities have been   developed to accelerate wound healing and prevent complications. Several studies have reported the effective- ness of local insulin dressings in accelerating wound healing in diabetic ulcers. However, the use of normal saline dressings is a conventional method of wound care and has been shown to be effective in promoting wound healing and preventing infections. This study is done to investigate whether topical insulin application has any role at all in the process of wound healing and if so to what degree it influences the outcome. This would provide a clinically beneficial and economically effective method to accelerate the process of wound healing. Methods: In the present study, 60 cases were studied comparing the wound dressings of the patient with Topical Insulin and the Normal saline dressing in Wagners grade 1 and 2 of type 2 diabetic wounds. Results: The Local Insulin Dressing group had a faster reduction in ulcer sizes with significant reduction in ulcer size in the second week and statistically significant higher difference in third week. The average number of days required for healing was significantly higher in the Normal Saline Dressing group. The percentage of granulation tissue increased significantly in the Local Insulin Dressing group at 2nd week (p=0.01), 3rd week (p<0.01). The average Pain Numerical scale decreased significantly in both groups from the baseline in each week. Conclusion: The use of topical insulin was studied in terms of duration required for healing, decrease in ulcers size, appearance and coverage of granulation tissues, pain scale, microflora study and systemic hypoglycaemic effects and it was found to be safe and effective in patients with diabetic Ulcers. The results showed that topically applied insulin promotes granulation tissue and accelerates wound healing without any systemic side effects.

167. A Study of Correlation between Body Mass Index, Blood Pressure and Lipid Profile Characteristics among Menopausal Women in Nanded, Maharashtra
Seema Takras, Mujtaba Nausheen, Sudha Karadkhedkar
Introduction: menopause is the time in women’s life when her menstruation stops. It occurs naturally or surgically induced. The average age at menopause in India is 47.5 years as compared to 51 years in other developing countries. Protective effect of estrogen decreases after menopause. There is increase in fat storage with simultaneous lipid deposition in central part of body. The body mass index (BMI) has a major influence on blood pressure and lipid profile and as such is a good predictor of hypertension and hyperlipidemia. Menopause predisposes the woman to the risk of ischemic heart disease. Aim: This study was carried out to correlate between BMI, blood pressure and blood triglyceride level and low-density lipoprotein (LDL) in postmenopausal women. Methods: The subjects were in two groups 60 premenopausal women and 60 postmenopausal women.  The Parameters studied were BMI, blood pressure and lipid profile (HDL, Total Cholesterol, LDL, VLDL). Results: we found significant increase in BMI, Blood pressure and total cholesterol, triglycerides, LDL, VLDL and decrease in HDL in postmenopausal women. We found positive correlation between BMI, blood pressure and lipid profile that shows increased risk of cardiovascular diseases in postmenopausal women. Discussion: Estrogen modulates energy intake by exerting an anabolic effect and exhibiting a lipolytic effect. Estrogen reduces collagen accumulation, elastin loss and reduces smooth muscle cell proliferation. It decreases vascular remodelling. Estrogen decreases vascular resistance by production of vasodilators like nitric oxide, cyclic AMP and prostacyclin. Lack of estrogen also causes deranged lipid profile. Conclusion: Since postmenopausal women lack cardioprotective action of estrogen. There is increased tendency of hypertension, obesity and atherogenic lipid profile in postmenopausal women.

168. Effect of Maternal Weight Gain during Pregnancy on Umbilical Cord Blood Lipid Profile
Shabana Andleeb Ansari, Azmat Kamal Ansari, Taukeer Ahmad, Suman Kumari Pandey, Seema Bisht, Harshita Mishra, Poonam Verma
Background: It is well established that fetal development is influenced by maternal factors and adverse intrauterine exposures. However, data regarding effect of these factors on fetal lipids is limited. As deranged fetal lipid profile is proposed to predispose to atherosclerotic Cardiovascular Diseases (CVDs) in later life, we planned to study effect of Maternal Weight Gain During Pregnancy (MWGDP) on Umbilical Cord Blood (UCB) Lipid Profile (LP). Material and Method: A hospital based cross sectional study including 200 neonates and their mothers satisfying inclusion criteria was performed. Both maternal and fetal data were collected from Out Patient Department (OPD)/In Patient Department (IPD) case files as well as Hospital Information System (HIS)/Laboratory Information system (LIS). We categorised mothers of neonates enrolled in our study according to Prepergnancy Body Mass Index (PPBMI) and respective MWGDP in three groups (low, normal and high MWGDP). The UCB samples were analysed for LP in order to compare Umbilical Cord Blood Lipid Profiles (UCBLP) among the groups of mothers based on MWGDP. Result:  As the participants with high MWGDP were few, we excluded them from further analysis. In our study, neonates whose mother had low MWGDP, had more atherogenic UCBLPs (statistically significant higher levels of TC and LDL-C (with P values of 0.045 and 0.001, respectively) while statistically significant lower levels of HDL-C (P value of 0.0001) as compared to neonates whose mother who had MWGDP. Conclusion: The results suggest that low MWGDP has deleterious effect on UCBLP resulting in more atherogenic lipid levels. Confirmation of this association with the help of further studies might provide in development of better screening protocols aiming at prevention of future life cardiovascular risks.

169. Efficacy and Feto-Maternal Outcome with Low Dose Dhaka Regimen Vs Conventional Dose Pritchard’s Regimen of Magnesium Sulphate in the Management of Eclampsia: A Comparative Study
Paul Gopa, Rakshit Asish Kumar, Paul Dhruba Prasad, Ray Debasish
Background & Objectives: Worldwide with the introduction of magnesium sulphate, the morbidity and mortality associated with eclampsia has been reduced significantly. Inspite of its excellent anticonvulsant property, it is still underutilized because of lack of proper training among the health staff as well as over the concern of potential adverse effects. In spite of having numerous regimens to administer Magnesium Sulphate, Pritchard regimen remains the most popular regimen till date. However, magnesium toxicity has limited its use especially in the low resource setting. The current study was undertaken to find out whether lowering the dose than conventional Pritchard regimen’s dose can produce desired effect. Methods: Observational comparative study conducted on 64 eclampsia patients from January 2019 to June 2020 at Agartala Government Medical College, Tripura, India. The patients under study were divided into two equal groups, each group comprising of 32 numbers of patients. One group received low dosage regimen and another Pritchard regimen. The analysis was done for ascertaining the optimum dose of MgSO4 required to control seizure’s as well as recurrence of seizure after the loading dose, magnesium toxicity and feto-maternal outcomes. Results: The mean dosage of MgSO4 to control seizures and its difference in both the groups was statistically significant (P value <0.05). After loading dose seizures were controlled in 96.88% of the cases receiving low dose regimen and 100% in Pritchard regimen. Only 3.13%cases of low dose regimen group had recurrence of seizure. The Feto-maternal outcome was comparable in both the groups. Interpretation and Conclusion: In this study, the dose required to control seizures was 40% lower than the standard Pritchard regimen. Low-dose MgSO4 therapy had similar efficacy as Pritchard therapy in controlling the convulsive episodes and in prevention of repeat convulsions, with minimal side effects, especially in rural women of lower socioeconomic status and lower bodyweight.

170. Evaluation of Functional Outcome of Supraspinatus Tear Repairdone by Open Procedure: A Clinical Study
Deepak Aher, RohanMunde, Prathamesh Bhad, Sanjay Jadhav
Background: Rotator cuff tears are a common cause of shoulder pain in the adult population and can be treated by one of the methods like arthroscopically, arthroscopically assisted (mini-open) or by an open procedure. Our present study is aimed to as­sess the functional outcome following rotator cuff repair by open approach. Materials and Methods: This prospective study includes30 patients with full thickness rotator cuff tears and were followed up for 1 years following repair byopen approach between May 2021 to May 2023 and functional scoring was done preoperatively and 6 months and 1 year postoperatively with the Constant and Murley scoring system. Statistical analysis of scores were done for significance. Results: Our study included 20 males and 10 females within the age group of 30 to 60 with most patients in the age group of 40 to 50 .The mean preoperative Constant and Murley score was 35 while the mean score at 6 months was 70 and 1 year follow up was 85 which is highly significant. Conclusion: Rotator cuff tears repair done by open method has good to excellent functional outcome.

171. Core Decompression with Autologous Bone Marrow Aspirate for Avascular Necrosis of Femoral Head at Pre Collapse Stage: A Clinical Study
Deepak Aher, Prithviraj Oswal, Shubham Ilhe, Sanjay Jadhav
Background: Avascular necrosis (AVN) is the bone death caused due to impaired blood supply and it leads to its collapse of femoral head, causing pain and compromised joint function. One of the treatment modalities of AVN, core decompression, reduces the Intra-osseous pressures and aids in halting the disease progression. Our study was conducted to study the outcome of Core decompression (CD) for the treatment in early stage osteonecrosis of the femoral (up to ficat arlet stage 2b). Materials and Methods: This study was conducted in our tertiary care centre from May 2021 to may 2023. 50 Patients with Avascular necrosis of the femoral head (up to grade 2B of Ficat and Arlet classification) were included in this study. Patients were treated with core decompression and autologous bone marrow aspirate. The Harris Hip Score (HHS) was used to assess the outcomes. Results: Out of 50 patients, majority (80%) of the patients in our study were in the 30 to 40 year age group, making it the most common age group with a male predominance (90 %).  The mean HHS was 69preoperatively and 95 at six months postoperatively. Conclusion: Core decompression is a good procedure in Ficat and arlet stages 1 and 2 AVN femoral head as it improves functional outcomes.

172. A Study to Access the Knowledge and Practices of Homeopathy Practitioners Regarding Intravenous Fluids in Tertiary Care Hospital
Sagar Phate, Mayur P. Pawar, Anita H. Yuwnate, Reena R. Giri
Introduction: Intravenous (IV) fluid therapy is pivotal in medical care, yet inadequacies in its administration have been linked to increased complications and adverse outcomes. Despite the significance of fluid management, there’s a notable lack of integrated practical guidelines for junior doctors, leading to common errors in prescribing and administering IV fluids. This deficiency extends to both adult and pediatric care, posing substantial risks to patients, especially in the context of electrolyte imbalances and inappropriate fluid choices. Recognizing these concerns, this study aimed to assess the knowledge, attitudes, and practices regarding IV fluid therapy among B.H.M.S practitioners practicing allopathy in the Pune region. Methodology: A prospective, cross-sectional survey employing a structured, validated questionnaire comprising 17 multiple-choice questions was conducted among 50 B.H.M.S practitioners practicing allopathy. Participants were enrolled through purposive sampling and were required to provide written informed consent. Statistical analysis of the collected data was performed using standard software. Results: Among the 50 participating practitioners (60% male, 40% female), most had extensive practice experience exceeding 30 years. However, when assessing knowledge about IV fluids, a considerable knowledge deficit was evident. For instance, only a small percentage correctly identified the most physiologically adaptable fluid and had clarity on drug dilution in specific solutions. While awareness about complications associated with IV site issues was relatively higher, understanding regarding conditions where certain IV fluids should be avoided was notably inadequate. Notably, all practitioners unanimously agreed on the need to emphasize clinical IV fluid knowledge during training. Discussion: The study highlighted significant knowledge gaps among B.H.M.S practitioners concerning IV fluid therapy, aligning with findings from similar studies involving different medical cohorts. Issues pertaining to drug dilution, appropriate fluid choices based on conditions, and understanding the most suitable IV fluids revealed substantial deficiencies. Addressing these gaps through enhanced teaching and training methodologies is imperative to improve clinical practice. Conclusion: The study underscores a pressing need for additional training modules addressing IV fluid therapy among B.H.M.S practitioners before their practice in allopathy. The observed knowledge deficits emphasize the necessity for comprehensive educational interventions to enhance competence and confidence in IV fluid prescription and administration.

173. Assessment of Nutritional Status among School-Aged Children in an Urban Slum Area: A Case Study of Malwani, Malad
Vikas Tukaram Makar, Shivcharan P Chavan, Swati Dattaramji Bhise, Rupal D Girase, Sushant Chavan
Background: Malnutrition among school-going children remains a significant public health concern, influenced by various socio-demographic factors and nutritional disparities across genders and age groups. Objective: To investigate nutritional status variations, specific nutritional disorders, and their associations with socio-demographic factors among 400 children aged 6 to 15 years in an urban setting. Methodology: The study, conducted in an urban slum area, assessed the nutritional status of children across four primary municipal schools. Information on socio-demographic variables, such as family structure, parental education, and breastfeeding, was collected. Nutritional statuses, specific disorders, and their prevalence were examined using odds ratios (ORs) and confidence intervals (CIs) to measure associations. Results: Analysis revealed nuanced variations in nutritional statuses across age groups and genders. While specific disorders like anemia showed gender-specific prevalence, associations between socio-demographic factors and malnourishment were observed. Notably, joint family setups demonstrated higher odds of malnourishment, while maternal education beyond the 6th standard significantly reduced malnutrition rates among children. Conclusion: The study highlights gender-specific vulnerabilities and substantial associations between family structure, maternal education, and malnourishment among school-going children. These findings underscore the need for targeted interventions addressing socio-demographic determinants to mitigate malnutrition’s prevalence and impact on children’s health outcomes.

174. Comparative Study of Effect of Topical Corticosteroid Vs Combination of Corticosteroid with Non-Steroidal Anti Inflammatory Agents on Post- Operative Inflammation after Cataract Surgery
Rishendra Singh Sisodiya, Bharti Badlani, Pankaj Kushwaha, Jaya Malviya
Background: In India, cataract-related blindness is a major social, economic, and medical burden as well as a major cause of human illness. According to a survey conducted by the WHO and NPCB (National Programme for Control of Blindness), India has a backlog of over 22 million blind eyes and 12 million blind persons, 80.1% of whom are blind as a result of cataract. Objective: To evaluate the comparative effectiveness of topical NSAIDs in combination with topical corticosteroids versus topical corticosteroids alone in controlling intraocular inflammation after uncomplicated phacoemulsification. Methodology: Totally, 100 patients undergoing phacoemulsification with posterior chamber intraocular lens implantation were randomly assigned to receive either nepafenac 0.1% 3 times daily plus 1% prednisolone eye drops for 1 month or 1% prednisolone eye drops only as their postoperative anti-inflammatory medication with 50 cases in each group. The patients were examined at the 1st day (baseline), 1st week, 2nd week, and 4th week after surgery. Postoperative inflammation was evaluated subjectively by intraocular pressure, slit-lamp assessment of signs of inflammation, including conjunctival hyperemia, ocular pain, and aqueous cells and flare. Result & Conclusion: We would want to draw the conclusion that there were no differences between groups randomly allocated to Corticosteroid monotherapy or combination treatment with NSAID & steroid in treating early inflammation following cataract surgery.

175. A Comprehensive Study on the Benign Lesions of Vocal Cords at Tertiary Care Hospital – SMC Vijayawada
T V S S N Leela Prasad, P Ramesh Chandra, P Ratna Babu, K Aditya, Peter Mummidivarapu
Objectives: Clinical study was conducted to analyse the age, sex distribution and symptomatology, and the prognosis of the common types of benign lesions of Vocal cords. Study Design: 1year study from September 2022 to August 2023 in a Tertiary care Hospital – Siddhartha medical college SMC-Vijayawada. Methods: Total of 50 patients with benign laryngeal lesion were included based on symptomatology such as hoarseness of voice, foreign body sensation, throat pain, neck swelling, cough with or without sputum. Lower and upper limit of the study age was 15-50 years, investigations include all haematological, clinical photographs, radiological investigations and therapeutic procedures are collected. All non-operative and malignant cases are excluded Results: Male to female ratio was observed to be 1:1.32, most common   age group was 30-40years, while vocal nodules are the most common presentation with throat pain being the earliest and hoarseness of voice being the common symptom.

176. Evaluation of Blood Donor Deferral Pattern in a Tertiary Hospital Based Blood Bank
Valina Brahma, Antariksha Sharma, Karishma Bhuyan, Mayurpankhi Saikia
Background: Selection of blood donor is an important procedure for a secure and healthy blood transfusion. Following a rigorous process of donor selection, disqualified donors are termed as deferred donors. Deferral causes range from temporary to permanent causes. The causes and rates of donor deferral differ from region to region. Present study was undertaken to identify the causes of donor deferral and deferral rates in our blood bank. Methods: This study was a retrospective study which was conducted in a tertiary care hospital based blood bank from North East India for a period of one year between September 2022 and October 2023. All the blood donors were screened following the guidelines of the National AIDS Control Organisation (NACO) provided in Standards for Blood Banks and Blood Transfusion Services under the Drugs and Cosmetic Act 1940. The relevant information and data of the deferred donors were collected and evaluated from the donor deferral register. Results: A total of 30,156 28,156 potential blood donors were undertaken in this study, out of which 2830 2,730 cases were deferred. Total donor deferral rate was 9.38 9.69%. The most common cause of deferral was anaemia (Hb<12.5 gm/dl) comprising of 54.58%. Conclusion: Awareness of donor deferral including causes and incidence in a specific region is essential in developing improved strategies to diminish the loss of valuable blood donors as it will ensure quality and safe blood and blood products for the recipients.

177. Comprehensive Evaluation of Efficacy and Safety Profile of Limb Recontruction System (LRS) in Patients with Non Unions of Long Bones
Prashant Singh Saharan, Rajesh Kumar Kanoji, Vinay Kumar Singh, Nitesh Meena
Introduction: Long bones like the tibia and femur have a weak blood supply and stabilisation, making nonunion fractures difficult. These issues affect people and healthcare systems. The Limb Reconstruction System (LRS) has promising results with firm fixation and rapid rehabilitation, although further study is required in non-union patients. More study is needed to determine LRS’s efficacy and safety in treating long bone non-unions. Aim and Objectives: The objective is to thoroughly evaluate the efficacy and safety of the Limb Reconstruction System (LRS) in the full treatment of long bone non-unions. Method: A single-site observational research ran from March 2022 to August 2023 at the National Institute of Medical Science and Research (NIMS) in Jaipur on Ilizarov ring fixation for infected non-union long bone fractures in 30 patients aged 18–60. The NIMS Jaipur institutional review board-approved study investigated functional outcomes and problems using standardised treatment regimens and ethical data gathering. Patients’ limb conditions were assessed pre- and post-surgery for Ilizarov ring fixation results and sequelae. Result: Infected non-union long bone fractures were treated with Ilizarov rings in 30 patients at NIMS Jaipur. Most were 20–40, mostly males (76.7%), and 90% were injured in road traffic incidents. Tibia suffered the most (66.7%). Pin tract infections, limb differences, and joint stiffness were complications. Overall, 83.3% had good functional results and 73.3% had good bone healing. The duration of non-union varied by bone type but not significantly. Conclusion: Indian Limb Reconstruction, with an 80% success rate, is a simple, successful treatment for diseased nonunion in long bones, rivalling Ilizarov fixation.

178. A Comparative Analysis of Fracture Risk in Type 2 Diabetes Mellitus with That of Healthy Adults
Harsh Galani, Mahavir Prasad Goyal, Vinay Kumar Singh, Nitesh Meena
Introduction: T2DM causes high blood glucose owing to insulin resistance or inadequate production. It now affects 9.3% of the world’s population and is projected to reach 10.9% by the year 2045. The risks of cardiovascular disease, neuropathy, retinopathy, and an increased vulnerability to fractures, even in those with adequate bone density, are sequelae of type 2 diabetes. Population comparisons inform personalised therapies and better healthcare policy. Aim and Objectives: The goal is to compare fracture risk between Type 2 Diabetes Mellitus patients and healthy persons to understand better how diabetes affects bone health. Method: The National Institute of Medical Sciences and Research in Jaipur compared trauma/fracture patients aged 40-80 with diabetes from July 2022 to December 2023. We gathered information on their demographics, way of life, and health, as well as their bone density and fracture risk, using individualised FRAX models. The study seeks to understand how diabetes affects bone health and identify fracture risk factors in diabetics. Result: People with Type 2 DM (Group A) and those without the disease (Group B) are compared in this research. Group A, consisting of individuals aged 40–50, had lower levels of BMD (P=0.022) and HbA1c (P=0.041) compared to Group B. Significant differences (P=0.011) exist in the history of parental fractures. Despite the lack of statistical significance in the FRAX scores (P=0.054), numerical differences indicate possible clinical consequences that need more exploration. Conclusion: Considering similar bone density and extensive osteoporosis therapy, diabetics, particularly those with comorbidities, have increased fracture risk.

179. Retrospective Study on Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis
C Dharma Kishore Raja, D. Shalini, J. Sudhakar
Background: Acute calculous cholecystitis is a common gastrointestinal condition associated with gallbladder inflammation. The traditional treatment has been open cholecystectomy, but laparoscopic cholecystectomy has emerged as a less invasive alternative. This retrospective study aims to assess the outcomes of laparoscopic cholecystectomy in patients diagnosed with acute calculous cholecystitis. Materials and Methods: We conducted a retrospective analysis of 250 patients diagnosed with acute calculous cholecystitis who underwent laparoscopic cholecystectomy at Andhra Medical College, King George Hospital, Visakhapatnam, Andhra Pradesh. Between June 2022 and July 2023. Demographic data, comorbidities, the severity of cholecystitis, intraoperative findings, and postoperative outcomes were meticulously collected. Statistical analysis was performed to evaluate the effectiveness of the procedure. Results: Among the study participants, the mean age was 56 years, with a slight female predominance (55%). Comorbidities included hypertension (30%) and diabetes mellitus (15%). The majority of patients presented with mild (grade I, 45%) or moderate (grade II, 40%) cholecystitis, following the Tokyo Guidelines. Intraoperatively, adhesions were encountered in 20% of cases, but no conversions to open cholecystectomy were necessary. Laparoscopic cholecystectomy successfully resolved acute calculous cholecystitis in 90% of cases, with a mean hospital stay of 3 days. However, 10% of patients required readmission within 30 days. Conclusion: Laparoscopic cholecystectomy is demonstrated to be an effective and safe treatment option for acute calculous cholecystitis, particularly in cases of mild to moderate severity. It offers advantages such as shorter hospital stays and reduced postoperative pain. However, the readmission rate warrants further investigation to enhance postoperative care.

180. Effects of Probiotic Lactobacillus Rhammnosus GG Supplementation on Outcome of Sepsis in Low Birth Weight Neonates
Kapil Thorat, Shalaka Prabhakar Patil
Background: Probiotics have been used to modulate gut microbiota which have effect on several immunological and metabolic disorders. Probiotics can be utilised to decrease incidence of diseases and promote health. Lactic acid bacteria and Bifidobacteria have been widely studied. Lactobacillus Rhammnosus GG is easily available, low cost medication, has ease of administration and storage compared to other strategies of infection control with favourable cost benefit ratio in resource poor settings. Methods: This was a prospective, interventional, single blind, case control study conducted at tertiary care center. Lactobacillus Rhammnosus GG was administered to LBW neonates from birth to discharge / death amongst cases while age, socio-economic status matched controls were not given any probiotic. Study period was from March 2020 to June 2021. Results: Amongst 30 cases and 30 controls enrolled in study there was no statistically significant difference in parameters between two groups with respect to gender, age, antenatal risk factors (leaking PV >18 hours, PROM, PIH), mode of delivery, birth weight, APGAR score, saturations and laboratory findings on first day of life. LBW neonates who received Lactobacillus R GG required significantly less doses of antibiotics and lesser need for change of antibiotics which was statistically significant (p=0.02) . Statistically significant (p=0.01) difference was found in association with duration of hospital stay. No significant difference was seen between two groups with respect to mortality (p=0.78). Conclusions: LBW neonates who were given Lactobacillus RGG had lesser requirement for antibiotics, lesser need for change / up gradation of antibiotics and shorter duration of hospital stay. Probiotics confer better cost- benefit ratio in management of LBWs with sepsis in resource poor settings. Larger population size is needed for further studies.

181. A Prospective Randomised Study Comparing the Analgesic Efficacy of Intraperitoneal Instillation of Ropivacaine with Dexmedetomidine and USG Guided Erector Spinae Plane Block with Same Drugs in Patients Undergoing Elective Laparoscopic Cholecystectomy
Dilip Kumar S.N., Shreyas Gomedic Ramachandra, Shashikala T.K., Deepa Kattishettar
Introduction: Laparoscopic cholecystectomy is a commonly performed surgery for cholelithiasis, associated with moderate to severe pain despite multimodal analgesics. The aim of our study is to compare the procedures like USG-guided ESPB versus IP instillation in prolonging the postoperative analgesia. Methodology: 60 ASA I and II patients were randomly assigned into two groups of 30 each. ESPB group: USG-guided ESPB was given bilaterally using Ropivacaine 0.375% plus Dexmedetomidine 50mcg (total 32mL), 16 mL each side. IP (Intraperitoneal instillation) group: same volume and concentration of study drug instilled at gallbladder bed and peri-hepatic region (16ml each site) just before removal of trocar, followed by Trendelenburg position for 5 minutes. Hemodynamic parameters like SBP, DBP, MAP, HR recorded. The total duration of analgesia, VAS score, the time of rescue analgesia and total analgesic consumption in first 24 hours after surgery were assessed. Results: The total duration of analgesia in ESPB group was 462.5±34.0 minutes when compared to 447.7±62.5 minutes in IP group which was not significant (p>0.05). Hemodynamic parameters were statistically significant in ESPB group when compared to IP group at various intervals of time (p<0.05). The total analgesic consumption in first 24 hours was significantly less in ESPB group when compared to IP group. Conclusion: To conclude the total duration of analgesia was not significantly changed in either group. Though there was significant increased consumption of analgesics in first 24 hours in IP group, either of the procedures can be used as multimodal analgesia in laparoscopic cholecystectomy.

182. Comparison of Dexamethasone and Dexmedetomidine as Adjuvants to 0.2% Ropivacaine for Post-Operative Analgesia in Ultrasound Guided Brachial Plexus Block
Ketan Modi, Shweta Narsingani, Gaurav Kumar Prajapati, Balraj B. Joshi
Background and Aim: An optimal adjunct to local anaesthetic in a nerve block would be one that accelerates the onset of sensory and motor blockade without inducing substantial adverse effects, while also extending the duration of analgesia. The purpose of this research was to compare the analgesic effects of Dexamethasone and Dexmedetomidine during an ultrasound-guided Brachial Plexus Block following surgery. Material and Methods: One hundred (50 patients each) ASA I and II patients, aged 18–60 years, who were undergoing orthopaedic operations on the upper limb under general anaesthesia with ultrasound-guided brachial plexus block for post-operative analgesia, participated in a prospective, double-blind clinical study. In Group A, 20ml of 0.2% Ropivacaine was combined with 8mg of Dexamethasone. 20ml of 0.2% Ropivacaine containing 50 µg of Dexmedetomidine was administered to Group B. The aims of this study were to compare the duration of sensory and motor block in the post-operative period, the time between the initial request for analgesia and its occurrence in both groups, and the cumulative requirement for analgesia in 24 hours. Results: The differences between the two groups in terms of age, gender, height, weight, and BMI were not statistically significant. A notable distinction in hemodynamic parameters was observed between the two groups after 10 hours, after which there was no significant difference. In both groups, the mean time to administer the first rescue analgesic was significantly different. The VAS scores deviated significantly (p <0.0001) at each of the following time points: 2 hours, 4 hours, 8 hours, 12 hours, 18 hours, and 24 hours. Conclusion: The adjuvants Dexamethasone and Dexmedetomidine demonstrate efficacy in extending the duration of analgesia following surgical procedures. Dexmedetomidine, on the other hand, prolongs the duration of analgesia and the overall analgesic requirement more effectively than dexamethasone.

183. Comparison of Efficacy of Infliximab and Adalimumab in Ankylosing Spondylitis and Its Impact on Inlammatory Markers
Gitanjali Kothiyal, Upender Kumar, Ravinder Kumar Yadav
Background: Ankylosing Spondylitis (AS) poses a substantial global health burden, necessitating targeted therapeutic approaches. Tumor Necrosis Factor-alpha (TNF-α) inhibitors, including Infliximab and Adalimumab, exhibit significant efficacy in AS management. However, regional variations in treatment response warrant focused investigations. This study, set in Moradabad, Uttar Pradesh, explores the comparative efficacy and impact on inflammatory markers of Infliximab and Adalimumab, addressing a critical gap in the literature. Materials and Methods: A prospective, randomized, open-label trial involving 240 AS patients compared Infliximab and Adalimumab efficacy. Approval was obtained from the Institutional Review Board, adhering to Helsinki Declaration principles. Participants were randomized, and outcomes measured over 24 weeks included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores, spinal mobility, patient-reported outcomes, and inflammatory markers (CRP, ESR). Adverse events were monitored, and statistical analyses employed appropriate tests. Results: Baseline characteristics (n=240) demonstrated well-matched cohorts. Both treatments significantly reduced BASDAI scores over 24 weeks (p<0.001). Spinal mobility improved remarkably (p<0.001), and patient-reported outcomes showed sustained enhancement (p<0.001). Both agents substantially reduced CRP and ESR levels (p<0.001), emphasizing their potent anti-inflammatory effects. Comparable safety profiles were observed, reinforcing the tolerability of both agents. Conclusion: Present study concluded that conclusion, both Infliximab and Adalimumab demonstrated significant and sustained efficacy in managing AS, improving clinical outcomes and modulating inflammatory markers. Their comparable safety profiles support their use, highlighting the importance of tailoring interventions based on regional factors for optimized AS management.

184. Detection of Carbapenem Resistance in Clinical Isolates in a Tertiary Care Hospital in Central India
Anita H. Yuwnate, Nirmal Channe, Ulhas Ghotkar, Mayur P. Pawar
Background: The increase in the rates of antibiotic resistance is a cause of concern worldwide. The aim of this study is to detect the prevalence of carbapenem resistance, production of carbapenemase and the various mechanisms of carbapenem resistance other than carbapenemase production. Methods: This descriptive laboratory based study was conducted over a period of 3 months, from December 2014 to February 2015. A total of 600 non-duplicate Gram Negative Bacterial (GNB) isolates from clinical samples from admitted patients were included. Antimicrobial susceptibility was performed by disc diffusion method. The isolates that showed resistance or intermediate sensitivity to carbapenems were considered as screening test positive. The minimum inhibitory concentration (MIC) of these isolates was determined by using E-test of Ertapenem and Meropenem. Modified Hodge Test (MHT) was performed for carbapenemase detection. MBL was detected by combined Disk Test (CDT) using meropenem with and without EDTA and by MBL E-Strip. AmpC detection was done by E-test. Statistics: P value was calculated by applying Pearson Chi- Square, and Fisher’s Exact Test. Results: A total of 35 out of 600 (6 %) GNB isolates were found to be carbapenem resistant. MHT detected carbapenemase production in 17 out of 35 (49 %) isolates. Remaining 18 (51 %) isolates were negative for carbapenemase production. Carbapenem resistance due to Amp C overproduction was seen in 4 isolates by AmpC E test. MBL production was detected by CDT in 21 isolates (60 %) and by E test in 25 isolates (71 %). Conclusions: MBL production is the most common mechanism of carbapenem resistance besides porin loss and AmpC over-production. Simple tests like CDT or E test can be used routinely to detect MBL in microbiology laboratories.

185. Estimation of Anti Mullerian Hormone in Sub fertile Group of Woman of Bihar and A Comparative Analysis
Arundhati, Ashok Kumar, Ranjeet Kumar Sinha
Introduction: Anti-Mullerian hormone (AMH) estimation has become amongst the first line of investigation in patients presenting with infertility be it primary or secondary to identify. It is a sensitive biological indicator of ovarian reserve. Its level helps to categorise the fertility potential. AMH measurement helps to identify premature ovarian failure, polycystic ovary syndrome and hypogonadotropic hypogonadism. Method: Our retrospective analysis study involves 60 females, in the age ranging from 17- 52 years, all being native of Bihar under investigation for infertility. Serum AMH estimation was done using fully automated immunoassay system Biomeurix VIDAS using Enzyme Linked Fluorescence Assay technology. Result: Serum AMH level is found to be peak in the age group of 17-25 years and the mean is 3.88 ng/ml. In the age group of 35 -43 years the mean AMH is significantly low and just 0.728 ng/ml so for this age group the fertility expectations seems to be low. Conclusion: Identifying with the pattern of fall of Serum AMH level in geographical regions and races could be of great help for the women and patients concerned with their fertility. Studies from different geographical areas could be considered for customisation of treatment and for preparation of reference range best suited to that particular population.

186. Clinical Study of Severe Cutaneous Adverse Reactions to Drugs
Debajit Das, Shahjubin Basir
Background: Adverse drug reaction is defined as ‘an undesirable clinical manifestation resulting from administration of a particular drug; this includes reaction due to overdose, predictable side effects and unanticipated adverse manifestations’. 1 of every 1000 hospitalized patients has a serious cutaneous drug reaction. SJS and TEN are associated with severe morbidity and mortality. The fatality rate in SJS is reported to be 5-10%, while in TEN it is reported to be 25-30%. So, the following study shall thus be a sincere effort to explore more about the adverse drug reactions. Objectives: To study the different clinical patterns of SCAR, and to identify the offending drugs causing different types of SCAR. Methods: The study has been conducted in the department of Dermatology, Silchar Medical College & Hospital, and Silchar, Assam over a period of one year extending from 1st June 2018 to 31st May 2019 after approval from the Institutional Ethics Committee (IEC) and after obtaining informed consent from the patients. Results: Out of the total 57,712 new patients attending the Department of Dermatology, Silchar Medical College & Hospital, and Silchar during the period from 1st June 2018 to 31st May 2019, 31 patients were diagnosed as having severe cutaneous adverse reactions due to drugs. Out of a total of 31 patients, 18 patients (58.06%) were male, while 13 patients (41.94%) were female with a male: female ratio of 1.38:1. In this study, the most common clinical pattern was the SJS-TEN part of the spectrum (64.52%) with SJS 35.48%, SJS/TEN overlap 6.45%, TEN 22.58%. In present study, Antimicrobials were the most common causative drugs (41.93%) followed by Anticonvulsants (35.48%) followed by Antipyretic analgesics (16.13%). The most common drug causing SCAR in this study was Carbamazepine (22.58%).The duration from the drug administration to cutaneous reactions (Reaction time) ranged from 12 hours to 60 days in this study. Shorter duration of 12 hours was seen in 1 case of TEN associated with re-exposure of the same drug Cotrimoxazole. Shorter duration of 12 hours was also seen in 2 cases of AGEP. Skin, oral and conjunctival mucosa were involved in 6 (54.54%) patients of SJS, 1 (50%) patients of SJS/TEN overlap, 2 (28.57%) patients of TEN and 2 (40%) patients of DRESS. Nikolsky’s sign was positive in all patients of TEN, SJS-TEN overlap and 2 cases of SJS which is per se Pseudo-Nikolsky’s sign. Conclusion: Severe cutaneous adverse reactions are highly troublesome and fatal conditions and are to be treated as an acute emergency, preferably in a Dermatology ICU. A sound knowledge of different clinical patterns and common causative drugs may lead to early suspicion and recognition so that the offending drug can be recognized early and stopped as soon as possible to limit the morbidity and mortality.

187. Lactate Dehydrogenase and Serum Ferritin as Predictors of Respiratory Failure in COVID-19 Patients
U. Sreelakshmi, Y. Krishna Mohan, R.S. Swaroopa Rani, Sabeeha Nasreen
Introduction: The pandemic COVID-19 infection with betacoronavirus-2 requires the identification of a reliable and inexpensive tool to quickly identify patients with a more unfavorable outcome. Many biochemical parameters like lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, creatine kinase, serum amyloid-A, and inflammatory markers like interleukin-6, C-reactive proteins, serum ferritin, and D-dimer are raised, which are predicting morbidity and mortality in COVID patients. Objectives: The aim and objectives of the present study are to evaluate serum ferritin and lactate dehydrogenase values, correlating them with oxygen saturation, and predict the cases that are going into respiratory failure. Materials &Methods: The present study includes 50 COVID-positive patients confirmed by RTPCR who were admitted to the government general hospital Kurnool during the period of September to November 2020. In these patients, 5 mL blood sample was collected, and serum ferritin and lactate dehydrogenase levels were estimated. Results: Lactate dehydrogenase and serum ferritin levels showed a negative correlation with oxygen saturation in COVID-19 cases during the study. Conclusion: Lactate dehydrogenase, a marker of tissue damage, and serum ferritin, an inflammatory marker that causes tissue damage by oxidative stress, may be related to respiratory distress as oxygen saturation is decreasing because of lung injury. Hence, lactate dehydrogenase and serum ferritin can be used as predictors of respiratory failure, and more supportive therapies might be given to avoid a poor prognosis.

188. Effect of Teaching on Depression Knowledge for Medical Undergraduate
Renu Pandey, Abdul Sajid Mansoori, Krishna Kumar Carpenter
Depression is a mood disorder characterized by pervasive sadness of mood, reduced concentration and attention, ideas of guilt and worthlessness, decreased interest in pleasurable activities and change in vegetative functions of the body i.e. sleep and appetite. The prevalence of Depression is 3.2 % to 8.9%, Suicide ideations is 21.1 and Suicidal attempt is7.1%. Causes of not seeking assistance include stigma associated with mental illness, less perceived assistance needed, lack of knowledge of the resources that are offered and privacy issues. Medical students are more susceptible to developing psychological distress and mental health disorders relative to other students in undergraduate training. Aim: To evaluate medical undergraduate students’  understanding of and attitudes toward depression. To assess the impact of a teaching intervention on depression knowledge and attitude. Materials and Methods: Three batches of Undergraduate students from AIIMS, Udaipur were select. These questionnaires are used assesses: (1) D-LIT Questionnaire, (2) Teaching Intervention, (3) DSS Questionnaire. Results: Only 10 out of the 22 questions in the pre-test study were answered correctly by fewer than 50% of the students. 92% of students were unaware of the function of CBT in treating depression. 85% of students thought that the first line of treatment for severe depression should not be medication. More than 80% of students regarded changes in eating and sleep patterns as significant signs of sadness. About 50% of students were aware that shame was present in depressed people and that it was connected to low confidence and poor performance. Conclusion: These therapies would be helpful to cater to a sizable community in the nation with the highest number of depressed patients. Interventions to combat stigma are desperately needed among those working in the health care industry.

189. Fornix versus Limbal Incision for Strabismus Surgery at Dr M K Shah Medical College and Research Center
Bhumika Shah, Romil Patel, Nishtha Patel, Saurabhkumar Hirani, Prerika Patel, Chandni Patel
Background and Aim: Over the past few decades, numerous minimally invasive procedures have been developed in the field of ophthalmology. These include phacoemulsification for cataracts, which utilises non-penetrating techniques and miniature drainage implants to treat glaucoma; vitreoretinal surgery employs transconjunctival approaches and minimal buckling; endoscopic techniques for the lacrimal system; and lids require small incisions. Strabismus surgeons’ utilisation of limbal versus fornix incisions is the objective of the current study. Material and Methods: A The current investigation was carried out over the course of three years on 50 patients at Dr. M.K.Shah Medical College & Research Centre, Chandkheda, Ahmedabad.  One English questionnaire was specifically designed and distributed to 50 Patients WhatsApp groups via a general link to the Google survey questionnaire that we had developed. Questionnaire contained questions regarding demographics and Reasons for the preferred approach in different settings. Results: The following 50 patients participated in our survey: In every setting, the limbal approach was favoured, including adult primary procedure. When questioned about the cause, the improvement in exposure across all contexts was cited. The participants who opted for the fornix approach stated that it caused them to experience reduced pain, distress and speedy recovery post-surgery. Conclusion: Every surgical technique for strabismus possesses its own set of benefits and drawbacks. An individual ought to incorporate every style into their arsenal and select the most suitable one for every patient. Two-muscle strabismus surgery based on the fornix was less difficult to perform and caused patients to experience less postoperative irritation and pain than two-muscle strabismus surgery based on the limbus.

189. Fornix versus Limbal Incision for Strabismus Surgery at Dr M K Shah Medical College and Research Center
Bhumika Shah, Romil Patel, Nishtha Patel, Saurabhkumar Hirani, Prerika Patel, Chandni Patel
Background and Aim: Over the past few decades, numerous minimally invasive procedures have been developed in the field of ophthalmology. These include phacoemulsification for cataracts, which utilises non-penetrating techniques and miniature drainage implants to treat glaucoma; vitreoretinal surgery employs transconjunctival approaches and minimal buckling; endoscopic techniques for the lacrimal system; and lids require small incisions. Strabismus surgeons’ utilisation of limbal versus fornix incisions is the objective of the current study. Material and Methods: A The current investigation was carried out over the course of three years on 50 patients at Dr. M.K.Shah Medical College & Research Centre, Chandkheda, Ahmedabad.  One English questionnaire was specifically designed and distributed to 50 Patients WhatsApp groups via a general link to the Google survey questionnaire that we had developed. Questionnaire contained questions regarding demographics and Reasons for the preferred approach in different settings. Results: The following 50 patients participated in our survey: In every setting, the limbal approach was favoured, including adult primary procedure. When questioned about the cause, the improvement in exposure across all contexts was cited. The participants who opted for the fornix approach stated that it caused them to experience reduced pain, distress and speedy recovery post-surgery. Conclusion: Every surgical technique for strabismus possesses its own set of benefits and drawbacks. An individual ought to incorporate every style into their arsenal and select the most suitable one for every patient. Two-muscle strabismus surgery based on the fornix was less difficult to perform and caused patients to experience less postoperative irritation and pain than two-muscle strabismus surgery based on the limbus.

190. A Cross-Sectional Study of Treatment-Seeking Behaviour of Patients Suffering from Neurological & Musculoskeletal Disorders in a Tertiary Care Hospital in Southern Rajasthan
Jatin Prajapati, Mahesh Upadhyay, Antima Galav, Vishnupratap Singh Chouhan, Shivani Vihan, Naveen Kumar
Context: The treatment seeking behaviour of patients suffering from Neurological Disorder and Musculoskeletal Disorder vary among nations. Delayed diagnosis and presentation at healthcare facilities are adding more Disability-adjusted life years to the sufferers. Aim: To study the treatment-seeking behaviour of patients suffering from Neurological Disorder & Musculoskeletal Disorder. Settings and Design: A hospital based cross-sectional study was conducted on 300 patients attending physiotherapist clinic a tertiary care hospital in southern Rajasthan in duration of 6 months. Materials and Methods: Diagnosed cases of Neurological Disorder & Musculoskeletal Disorder were interviewed for various variables, all relevant data is filled into per-designed Performa and outcomes were studied. Statistical Analysis Used: Data was analysed for percentages, Chi-square test and others as relevant. Results: The study identified that maximum patients presented after 2 days of onset of symptoms. Patients of Neurological Disorder presented early as compared to Musculoskeletal Disorder patients, additionally, there was a significant association of locality with the satisfaction level of patients, patients from Rural area were more satisfied from the treatment as compared to the Urban patients. Conclusions: There is a pressing need to advance and implement more effective strategies for primary prevention of Neurological Disorder and Musculoskeletal Disorder. Simultaneously, a substantial effort must be directed towards improving the quality of life for those already afflicted by these conditions and guiding individuals on how to best manage these often persistent disabilities.

191. Impact of Stress on Red Cell Indices and Serum Cortisol Levels in 1st Year Medical Students
Nadera Yasmeen, Shweta Patil, Imtiyaz Ali
Introduction: Academic stress in medical students is an important factor that leads to various health problems. The preclinical students are under constant stress since the time of admission as they have to follow a fixed schedule and stress exaggerates at the time of examination by producing changes in the blood indices and biochemical parameters like Serum Cortisol levels which need to be examined. Aims and Objectives:  (1) To demonstrate the effect of examination on blood indices and Serum Cortisol levels   in 1st year medical students. (2) To prove that stress alters blood indices and Cortisol levels. (3) To prove that Serum Cortisol level is a good indicator for determination of stress. Materials and Methods:  About 30 1st year medical students between the age group of 18-19 yrs were selected for the study carried out for 10 months at KBNIMS, Gulbarga, Karnataka. Ethical committee clearance was taken and consent obtained from all the study subjects. Blood indices and Serum Cortisol levels were estimated. 2 samples of blood were obtained. 1st sample of about 5ml was collected at the time of admission & 2nd  sample 6 months during their 2nd internal assessment viva-voce examination. Blood samples for blood indices were analysed using Celtac α Automated Hematology analyser from Nihon Kohden and for Serum Cortisol levels were analysed using Fully automated bidirectionally Interfaced Chemi Luminescent Immunoassay. Results: When blood samples were compared, it was found that those samples taken during the exams showed a significant increase in MCH and MCHC. A significant increase in Serum Cortisol levels was also noted. Conclusion: It is concluded that examination stress produce changes in Red cell indices and Serum Cortisol levels. A good social support and care from peers, parents and faculty minimizes the risk of stress. Healthy diet will improve their immune system and enable the students to cope up adequately with exam stress.

192. Role of Platelet Parameters in Denge Positive Case: An Observation Study
Shubhanshu Gupta, Parikshit Singh, Vineeta Singh
Introduction: With 50-100 million yearly infections, dengue fever is a worldwide health hazard. Dengue Hemorrhagic Fever (DHF) and DSS are dangerous. Platelets help diagnose several medical disorders by regulating vascular bleeding. Dengue often causes thrombocytopenia or a low platelet count; tracking platelet parameters helps doctors diagnose and treat the disease. In individuals with dengue fever, an early sign of platelet recovery is the Immature Platelet Fraction (IPF). Aims and Research: This observational study aims to gain comprehensive knowledge of the dynamics of dengue fever by investigating the effect of platelet parameters on infected patients. Method: This observational study in a tertiary care facility from August 2022 to July 2023 included 80 participants with confirmed dengue infections. The platelet characteristics were systematically recorded and correlated with disease severity (DF, DHF, DSS). The study aimed to offer diagnostic insights by examining the association between platelet indices and severity. Inclusion criteria comprised clinically and serologically positive dengue cases, while exclusion criteria included underlying conditions affecting platelet count and non-compliance with the diagnostic protocol. Result: The research examines individuals diagnosed with Dengue, classifying them based on their age, gender, and the severity of their condition. The frequency of biomarkers, platelet counts, and indicators are examined in connection to the disease. The findings demonstrate correlations between platelet properties and the severity of Dengue, offering useful insights for the diagnosis and treatment of this condition in a comprehensive dataset of 80 patients. Conclusion: The research suggests that platelet features, such as low MPV (< 9fl) and high PDW (> 13fl), may predict dengue severity despite limited sample size.

193. A Clinical Spectrum of Hepatitis a in Children
Asha Kumari, N P Gupta, Shilpi Kumari
Background: Hepatitis A is infectious through feco oral route and is a contagious disease caused by a hepatovirus. The primary cause of the disease is contaminated water or food, inadequate sanitation and improper personal hygiene standards. Despite the development of hepatitis vaccine this disease spreads easily through these primary causes. This disease can be of no symptoms to fulminant hepatitis. The main aim of this study is to analyze the profile of the children affected with Hepatitis A infection. Materials and Methods: This was a retrospective study which was conducted from a period of September 2022 to September 2023 on a total 100 children with the age group of 6 months to 12 years affected with Hepatitis A disease. This study took place in Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga, Bihar, India. Results: Totally 100 children with acute hepatitis A under 12 years of age were selected for this study. The average of the children’s age in this study was 6 years among the 100 cases and the most repeated symptoms were fever in about 92%, gastrointestinal complications in about 59% and dullness in about 38%. Conclusion: Hepatitis A is a self-restricting disease but because of its associated diseases, liver complications and usage of specific drugs makes this disease severe. And so thorough diagnosis is required for all the affected individuals until full recovery.

194. Difficult to Treat DRTB Cases: A Case Series
Sushree Swetapadma, Priyanka Das, Priyajit Jena, Parthiba Pramanik, Indira Priyadarshani, Ajay Kumar Das
Tuberculosis (TB) is one of the 10 leading causes of death worldwide. Although the global incidence of TB has been slowly declining, TB remains out of control in many parts of the world. Some of the early gains made in several parts of the world, including in Africa and Asia, are now being threatened by the emergence of drug-resistant TB [DR-TB]. As per the Global TB Report 2018, in 2017, there were approximately 558,000 estimated new cases of MDR-TB/ rifampicin resistant-TB (RR-TB) globally [3]. More than half the MDR-TB burden lies in India, China and Russia.

195. Case Series on Clinical and Radiological Findings in Pneumonia Due to Klebsiella Aerogenes
Abinash Dandasena, Priyanka Das, Priyajit Jena, N. Akshaya, Parthiba Pramanik, Indira Priyadarshani, Lalit Prakash Majhi, Seema Barik, H.K Sethy
Background: Pneumonia due to Klebsiella aerogenes is an increasing concern in healthcare settings. Therefore, early identification of the threatened riskfactors to initiate appropriate therapy for limiting the disease & progression of symptoms is urgently required. Hence, this study was designed to report 4 case series of pneumonia due to K. aerogenes. Methods: Gram staining of sputum was performed to identify the presence of Gram-negative bacilli. A sputum culture was conducted to confirm the presence of K. aerogenes bacteria. Radiological imaging, including chest X-ray and CT-scan, was used to assess lung manifestations, such as ground glass opacities, consolidation, and necrosis. Treatment options for pneumonia due to K. aerogenes were considered based on the susceptibility of the bacteria to specific antibiotics. Bronchoscopy and bronchoalveolar lavage (BAL) were performed in some cases to obtain samples for further analysis. Results: Clinical findings included fever, chest pain, cough with expectoration, chest auscultation encompassed a range of findings from harsh vesicular breath sounds to coarse crackles in the respective areas. Radiological imaging showed a spectrum of lesions from ground glass opacities, multilobar consolidation, cavitation, necrosis and multiple fibrotic strands in respective lung fields. Treatment options for pneumonia depend on factors such as the severity of the infection, the patient’s medical history and the presence of any drug allergies. Conclusion: K. aerogenes, a gram-negative opportunistic anaerobe, causes aggressive pneumonia with high fatality rates. Early active sputum culture and selective antibiotic use are crucial for effective management.

196. Role of IHC on Cell Blocks from FNAC of Neoplastic Breast Lesions
Kishore Kumar T, Shamili M, Naveen Kumar, Chandralekha J, Vijaya Bharathi I
Introduction: Breast cancer is one of the emerging cancers of women. Most of the women in India present with breast lumps. FNAC is usually done in palpable breast lumps; it is a rapid, cheap, and less invasive procedure. Cell block can be prepared from aspirated material, fixed and processed as histopathology specimens. Cell blocks are also called micro biopsies provides large battery of sections for IHC. Aims and Objectives: The present study was undertaken to evaluate the efficacy of cell block in comparison of FNAC in various breast neoplasm. Materials and Methods: A prospective study over a period of 18 months from July 2021 to January 2023. 168 patients were referred to cytopathology unit and FNAC was done, remaining material in the aspirating syringe was kept for cell block. The findings of cell blocks were studied in detail to arrive at diagnosis and correlated with FNAC findings. Cell blocks of malignant breast lumps were processed for IHC status. Results: Out of total 168 cases, most of cases were benign lesions (76.78%), with fibroadenoma being most common. Among malignant tumours, invasive carcinoma of no other special type was the most common type. Cell blocks are more accurate (96%) compared to FNAC (88%) in diagnosis of both benign and malignant lesions. Conclusion: FNAC smears and cell block combined the diagnostic accuracy can be around 90%. The principal advantage of cell block is that of large battery stains can be easily done. Cell blocks are useful assessor hormone expression markers ER, PR and HER 2 neu to know the prognosis of tumour for target therapy.

197. Epilepsy and Psychiatric Comorbidity: A Study of Treated Patients
Jitendar Singh, Tarun Pal, Neelam Rathi
Background: Epilepsy affects a significant proportion of the population and is typically treated with antiepileptic drugs or surgery. There is a well-established link between epilepsy and psychiatric disorders, which has been overlooked in modern times. The purpose of this study is to document the prevalence and types of comorbid psychiatric disorders in patients with epilepsy, which have a significant impact on the quality of life and well-being of patients. Objective: The study aims to determine the prevalence and types of psychiatric disorders in patients with epilepsy, and to explore the association between sociodemographic factors and comorbid psychiatric disorders. Material & Method: The study was conducted at the Department of Psychiatry, L.L.R.M Medical College, Meerut, Uttar Pradesh, between February 2020 and June 2021. It followed an open, longitudinal, and follow-up design and enrolled all consecutive epilepsy patients referred for psychiatric evaluation who met the inclusion and exclusion criteria. The study used a detailed diagnostic interview and Mini International Neuropsychiatric Interview (M.I.N.I) Version 5.0.0 as study instruments. Ethical clearance was obtained, and written consent was obtained from all participants before enrolment in the study. Result: The study enrolled fifty consecutive patients with epilepsy who attended the OPD. The Mini International Neuropsychiatric Interview was administered to the participants. In this study, the total number of patients with epilepsy (PWE) with psychiatric co-morbidities was 16/50 (32.0%). Conclusion: Patients with epilepsy have a higher likelihood of experiencing psychiatric co-morbidities compared to those without epilepsy.

198. Prevalence of Malignancy in Cholelithiasis: A Cross-Sectional Study in a Tertiary Care Hospital of Odisha
Nirod Kumar Sahoo, Soubhagya kumar Das, Sujit Kumar Mohanty, Rakesh Kumar Ludam, Satyaprakash Dhal
Gall stone is the most common risk factor for carcinoma gall bladder. The aim of this study is to find out the prevalence of malignancy in patients with Cholelithiasis in Western Odisha, as no epidemiological data is available for Odisha. All the radio logically diagnosed cased of cholelithiasis underwent surgery were taken into consideration. All the cases of cholelithiasis operated of in General Surgery Department of VSSIMSAR, Burla were considered for study. The diagnosis confirmed by Ultra sonography/MRCP in Department of Radio diagnosis. Total numbers of patients operated are 347, out of which 279 undergone laparascopic surgery, 58 cases undergone open surgery and 10 cases converted from laparascopic to open surgery. Most number of patients belongs to age group 31-40, consisting of 32.85% of total number, followed by age group 41-50, and consisting of 25.07%. A female patient constitutes about 77.81 % of total number. Male: female ratio is 1: 3.5. The mean age of the patients of study group is 41.71. Mean age of female patients is 41.09 and males are 43.88, p value 0.072 (no significant deference between mean of female and male). The excised specimens sent for histopathological examination in Department of Pathology, VSSIMSAR, Burla. Out of 347 cases two cases found to have carcinoma specifically adenocarcinoma of gallbladder.

199. Etiopathogenesis and Management of Epistaxis in Tertiary Care Centre: A Prospective Study
Pramod T Kharadi, Viral G Prajapati
Background and Aim: Although epistaxis is a prevalent condition, its causes vary according to geography, climate, season, and population. Studying the etiopathogenesis and management of epistaxis in a tertiary care centre using various techniques, including medical line of management, anterior and posterior nasal packing, endoscopy-guided electric and chemical cauterization, endoscopy-guided arterial ligation, endovascular embolization, and surgical methods, is the focus of the current research. Material and Methods: A prospective descriptive study was initiated at the Tertiary Care Teaching Institute of India over the course of one year to determine the etiopathogenesis and management of epistaxis. An exhaustive medical history was obtained from the patient in order to exclude hereditary, systemic aetiologies of epistaxis. A comprehensive systemic and local investigation was undertaken in an effort to identify the cause of epistaxis. After determining the cause, definitive treatment was administered to the patient, which included foreign body removal, correction of the fractured nasal bone, functional endoscopic sinus surgery, septoplasty, excision of the nasal mass, management of hypertension, and transfusion of fresh blood or platelets. Results: The age of the patients in this study ranged from 2 to 79 years; however, the age group of 11 to 50 comprised the majority of cases (68/100), indicating that epistaxis is a more prevalent issue among young adults and adolescents. Males were found to be 61% more affected than females in our research. Idiopathic epistaxis accounted for 30 (30%) of the cases in which the most prevalent aetiology was unknown. In our study, we identified various local causes, including deviated nasal septum (9%), foreign body nasal septum (6%), haemangioma septum (6%), and others. The majority of the participants in our research exhibited anterior nasal haemorrhage (45%), with the least frequent site being the nasal passages (20%). Conclusion: We identified numerous aetiologies for epistaxis in our study; however, idiopathic causes were the most prevalent. Additional coexisting conditions of the patients were excluded. Among adolescents and young adults, epistaxis was identified as the most prevalent neurological disorder. Anterior nasal cavity (Little’s area) is the most frequently observed site of haemorrhage. Conservative management was applied to the majority of patients.

200. Study of Lipid Profile in Primary Hypertension
Nadera Yasmeen, Syeda Amatul Rahman Jaweria, Imtiyaz Ali
Hypertension is a major public health problem in India and studies have been documented a high prevalence rate of hypertension in developing countries [1]. Cardiovascular diseases account for a large proportion of all deaths and disability worldwide. The elevation of blood pressure is secondary to raised total peripheral resistance, which in turn is caused by narrowing of the lumen of the peripheral arterioles, which are the main resistance vessels. The aim of the present study is to compare and analyse the relation between blood pressure and lipid parameters in hypertensives and normotensives so that it will be a useful predictor of coronary artery disease. The study is undertaken in 50 hypertensives taken as subjects and 50 normotensives taken as controls with the age range being 40- 60 yrs. Ethical committee clearance was taken and consent obtained from all the study subjects. In the present study, it was found that the mean values of Total cholesterol and LDL cholesterol, are higher with more significance (p < 0.01) and VLDL cholesterol and Triglycerides are higher with less significance (p < 0.05) in hypertensives. The mean values of HDL Cholesterol are found to be lower with less significance (p < 0.05) in hypertensives. Thus, it can be concluded that in patients of primary hypertension, significant changes are seen in lipid profile which can be used for early detection of individuals prone to hypertension.

201. Comparing the diagnostic performance between Rapid antigen and RT-PCR for the detection of SARS CoV2 in a tertiary care hospital in South India
Janani S Reddy, Sujin Padmanabhan, Shakthi Nivethini S, Nanthini Devi Periadurai, Ajith Kumar Vaithiyalingam, Anitha Raj Velmurugan, Kalyani Mohanram, Surapaneni Krishna Mohan
Background: COVID-19 rapid antigen test plays a crucial role in managing the COVID-19 pandemic by diagnosing COVID-19 infection. However, the sensitivity and specificity of rapid antigen tests are not known because there are no adequate studies to substantiate. While PCR-tests are considered as the gold standard assay to confirm infection with the SARS-CoV-2 infection because of their sensitivity as well as specificity, antigen tests offer more advantages in terms of low cost, time, space constraints and personnel involved and are implemented in testing strategies around the world and antigen testing can be deployed for testing many individuals, considering their advantages cited above. Objectives: The aim of this study was to assess the diagnostic accuracy (sensitivity, specificity, positive predictive value and negative predictive value) of STANDARD Q rapid antigen test kit in diagnosing SARS-CoV-2 infection in a tertiary care testing facility and compare it with the standard RT- PCR test.

Methods: The patients reporting to COVID-19 sample collection center of the tertiary care testing facility were included in the study after getting proper consent. A total of 400 patients were involved in the study. Nasopharyngeal swabs were obtained from the study participants and the STANDARD Q rapid antigen test was run in parallel with real-time PCR tests and both the results were documented. Results: Among the 400 patients who were included in the study, RT-PCR was positive in 95 individuals, with a prevalence of 23.75% and negative in 305 patients (76.25%). The sensitivity of the rapid antigen test was 88.4% and the specificity was 100 %. The positive and negative predictive values were 100% and 96.52% respectively. Conclusion: The accuracy of the SARS-CoV-2 STANDARD Q rapid antigen test in diagnosing SARS-CoV-2 infections in a tertiary care testing facility was almost equal when compared with the manufacturer’s data. However they can be used for mass screening purposes considering their ease of use, portability and convenience. The Area under the Curve (AUC) is 0.942 which signifies that the kit can distinguish well between the true positive and true negative.

202. Clinicohematological Profile of Hemoglobin Lepore
Samira kumar Behera, Shushruta Mohanty, Swetambari Acharya, Swati Das, Lipika Behera
Haemoglobin Lepore is a rare structurally abnormal haemoglobin (Hb) resulting from δβ rearrangements. It is widespread all over the world and in many ethnic groups. Interactions of hemoglobin Lepore with other hemoglobinopathies can lead to various clinical phenotypes and causes diagnostic challenges. These cases can be diagnosed with adequate knowledge of HPLC and CBC interpretation. The incidence of Hemoglobin Lepore in India is very rare due to paucity of data on clinical and hematological literatures. We are here discussing variants of hemoglobin Lepore and its association with other hemoglobinopathies like sickle cell anaemia and thalassemia by analying their clinical, CBC and HPLC findings. Proper diagnosis of this spectrum of rare hemoglobinopathies can assess the disease severity, early recognition of complications and avoidance of overtreatment.

203. Assessment of Safety and Efficacy of Self-Expandable Metal Stent (SEMS) For Palliation of Esophageal Cancer at a Tertiary Centre in Northern India
Dilip Singh Mudgal, Mayank Ameta, Mukesh Kumar Jain, Gaurav Kumar Gupta, Sandeep Nijhawan
Background and aims: Esophageal cancer is a common malignancy in Indian population with most patients presenting with advanced stage which is not amenable to definitive cure. Hence, palliation by esophageal self-expandable metallic stent (SEMS)is an important aspect of management. The studies related to efficacy and safety of SEMS is less despite high prevalence of esophageal cancer in India. This study aims to assess efficacy of esophageal SEMS and to determine the mortality after 6 months follow up period. Methods: This is a prospective and descriptive study of 103 patients of esophaeal carcinoma conducted at department of gastroenterology, SMS Medical College and Hospital; Jaipur (Rajasthan) from January 2019 to June 2020.Upper gastrointestinal (UGI) endoscopy was done to assess location, longitudinal extent of tumor, extent of luminal obstruction, feasibility of esophageal stent placement and esophageal tissue sampling. Contrast enhanced CT (CECT) of thorax and abdomen was done to assess loco-regional spread, lymph nodal and distant metastasis. Palliative metallic stenting was done in patients who fulfilled the inclusion criteria. The severity of dysphagia was assessed by mellow and pinkas dysphagia grading system before and after esophageal stenting. Patients were followed up after 1 week, 1, 3 and 6 months interval and in between in case of worsening of dysphagia or development of any complications. Results: The result demonstrated mean Mellow and Pinkas dysphagia score was 3.184 at baseline, 1.533 at 1 week,1.794 at 1 month,1.812 at 3 months and 1.961 at 6 months after esophageal SEMS placement. The improvement in dysphagia score persisted during 6 month follow up period. The 6 month mortality rate was 75%. Conclusion: SEMS placement is a safe and effective modality for palliation of dysphagia in esophageal cancer patients with significant improvement in dysphagia after esophageal SEMS placement which persisted during follow up period of 6 months.

204. Comparison of Alvarado and RIPASA Scoring Systems in Diagnosis of Acute Appendicitis and Correlation with Intraoperative and Histopathological Findings
Hari Om Bairwa, Rekha Patidar, Anil Meena
Background and Objectives: The field of diagnostics is one of the most studied in relation to appendicitis. The purpose of these investigations was to identify the best sensitive test for the diagnosis of acute appendicitis. To help with the early diagnosis of acute appendicitis, the Modified Alvarado scoring system (MASS) and the RIPASA scoring system are evaluated in this study to determine which scoring system is more relevant and applicable. Methods: This is a cross-sectional, comparative study conducted at RNT Medical College & MBGH, Udaipur for a period of 2017 to 2019. The first 100 patients who presented to the Surgery OPD and Emergency Department with RIF pain were included in the study. Relevant history, examination and laboratory investigations were done. Patients were scored according to both Modified Alvarado Scoring System (MASS) and RIPASA Scoring, and both were documented in the proforma. Results: In the present study, patients of age group 5-50 years were included, with the mean age being 24.86 years. RIPASA was statistically superior to MASS in terms of Sensitivity (85.11% v/s 63.38%) and in terms of Diagnostic Accuracy (84% v/s 65%)Histopathologically 6% patients had normal appendix and 94% had acute appendicitis. 100% patients had non-perforated appendix. Conclusion: It is found that the RIPASA score is more specific, more sensitive, and more accurate in diagnosing acute appendicitis than the Modified Alvarado score. Additionally, RIPASA lowers the quantity of “missed appendicitis” instances. Therefore, when compared to MASS, RIPASA is a more accurate grading system both clinically and statistically for the diagnosis of acute appendicitis.

205. A Comparative Study between Two Adjuvants Nalbuphine and Fentanyl to Hyperbaric Local Anesthetic Bupivacaine for the Control of Post-Operative Pain in Cesarean Section under Spinal Anesthesia
Dhara Upadhyay, Nikita Kothari, Shaikh Abdul Nasir, Chirag Patel
Background: Spinal anaesthesia for caesarean section has always gained popularity because of its simplicity, rapid onset, dependability and avoidance of complications of general anaesthesia. However, postoperative pain control is a concern because spinal anaesthesia using only local anaesthetics is associated with relatively short duration of action. Adjuvant drugs added to bupivacaine intrathecally improve the duration and quality of the blockade and prolong the postoperative analgesia. Nalbuphine is a synthetic opioid with mixed agonist antagonist effect, at both mu- and kappa receptors while Fentanyl is pure agonist at mu, kappa and delta receptors. Material and Methods: A randomized study of 100 patients, divided in 2 equal groups, with adjuvant drug added to local anesthetic Bupivacaine for intrathecally use:
Group BN- Nalbuphine 0.8 milligram (0.5 milliliter) + 0.5% 2 milliliter Heavy Bupivacaine.
Group BF- Fentanyl 25 microgram (0.5 milliliter) + 0.5% 2 milliliter Heavy Bupivacaine.
Patients with ASA Physical status Ⅰ, Ⅱ, normal spine examination, stable vitals were selected prior to the procedure. Spinal Anesthesia given and intraoperative vitals, sensory and motor blockade characteristics, duration of analgesia were recorded. Postoperative Pain Score and vitals were recorded up to 12 hours and development of complication, if any was noted.  Results: Mean duration of Analgesia, in Group N: 249.98±8.71 minutes and in Group F: 225.24±3.27 minutes and it is statistically significant P=<0.0001. Visual Analogue Scale <4 after 1hr to 12hr in Group N was in 60% of patients while 40% in Group F and is statistically significant P=<0.0001. In group N; 4% reported nausea, 2% reported shivering, while in group F; 12% reported nausea, 4% reported pruritis and 10% reported shivering.  Conclusion: Intrathecal Nalbuphine is an effective alternative to Fentanyl for providing postoperative analgesia in patients undergoing cesarean section under spinal Anaesthesia.

206. Clinicopathological Study of Helicobacter Pylori Infection in Patients with Acid Peptic Disorder Attending Tripura Medical College and Dr B.R.A.M Teaching Hospital
Sourabh Das, Maharshi Debnath, Arkadip Choudhury, Nabaneet Majumder, Sanjay Nath, Avik Chakraborty
Introduction: Acid peptic disorder (APD) is a global issue caused by imbalances in gastric secretions, leading to conditions like gastritis, ulcers, and duodenal ulcers. H. pylori, a Gram-negative bacterium, are a common human pathogen, colonizing 60% of the world’s population. It causes chronic inflammation in human gastric mucosa, leading to progressive damage to the stomach lining and various stomach diseases without treatment. This study aims to determine the prevalence of H. pylori infection in adult patients with APD symptoms, compare the sensitivity and specificity of Rapid Urease Test and Histopathological Analysis, and study its staining patterns. Material& Methods: Adult patients with acid reflux disease participated in the study, which was carried out at Dr. B.R.A.M Teaching Hospital and Tripura Medical College. There were 110 samples in all, and a number of instruments were employed, such as an endoscope, rotary microtome, automatic tissue processor, microscope, and HPE staining. The urease enzyme was found using the Rapid Urease Test (RUT), which was utilised to diagnose H. pylori. Patients who met the inclusion criteria had their written, informed consent obtained before any data were collected. Results: There were 110 patients in the research. Of them, 98 patients (89.1%) had an H. pylori infection. These patients data Analysed Based on Age, Gender, Location, Occupation and Socioeconomic status. Discussion: The World Health Organisation classifies H. pylori infection as a “definite biological carcinogen” and notes that it affects half of the world’s population and is a primary cause of gastrointestinal illnesses. According to a research, 86.4% of men and 92.2% of women who were mostly from rural areas and aged 31 to 40 tested positive. Abdominal pain and a burning feeling are common symptoms, and the most common endoscopic diagnosis are Gastritis (77.3%) followed by Gastric ulcer (20%) and Gastric carcinoma (2.7%). Conclusion: H. pylori infection, affecting 75% of the global population, increases gastritis risk and gastric carcinoma risk. Early diagnosis is crucial, and histopathology, including Warthin Starry silver stain, can improve diagnostic yield in gastric biopsies, enhancing the detection process.

207. Morbidities & Mortality in Erythema Nodosum Leprosum: A Hospital based study in Western Odisha, India
Debabrata Nayak, Sibasish Patro, Nikhil Ranjan Das, Subhasree Madhual, Sambit Ranjan Dalei
Background: Erythema nodosumleprosum is a chronic recurrent multisystem immune complex mediated reaction of leprosy which primarily affects skin, nerve and other organ systems of the body. The morbidities are very high due to its chronic and recurrent nature and involvement of various organs of the body. The mortality associated with ENL is underscored due to its chronicity and usually patients are lost to follow up. There is paucity of data regarding morbidity and mortality in ENL in existing literature. So the present study was conducted among the patients of ENL regarding morbidity and mortality in a tertiary care hospital present in an endemic zone. Method: It was a prospective hospital-based study was carried out for 3 years from 1st September 2014 to 31st August 2017. Demographic details, clinical features, comorbidities and systemic association were collected from 137 diagnosed patients of ENL. Laboratory investigations, slit skin smear of AFB and histopathological investigations were also done. Result: Majority of the patients were males 109 (79.5%) and belonging to lower socioeconomic status 75 (54.8%). Most of the patients (70%) belong to age group of 21-40 years with a rural background (89.8%). Pain was the most common morbidity (92%) and arthritis being the most common association (76.6%). Psychological stress was one of the important morbidities (62.8%) in ENL patients. 14 patients died during this study period. Conclusion: Most of the patients were males (79.5%), in their 3rd decade of life (37.9%) and belong to lower socioeconomic status (54.8%). Recurrent pain (92%) and fever (88.3%) were most common morbidities and arthritis (76.6%) being the most common systemic involvement. Data from this study will be helpful for early effective management of reactions of leprosy to reduce the morbidity, mortality and research cum prevention strategy at various levels.

208. Study of CD10 Expression in Urothelial Carcinoma of Bladder
Kamal Kali Das, Sushma Khuraijam, Sushanta Chakma, Shatabdi Das
Background: Urothelial carcinoma represents the second most frequent malignancy of the genitourinary tract following prostate, with rising incidence. CD10 is a single-chain, 90-110 kDa cell surface zinc dependent enzyme metalloprotease. It is expressed by both normal and neoplastic haematopoietic cells and also in a variety of non haematopoietic tissues and neoplasms. Aim: To compare CD10 expression in various grades and stages of urothelial carcinoma. Methods: A two years cross-sectional study was carried out on urothelial carcinoma in the department of pathology, RIMS, Imphal for the period September 2017 to August 2019. A total of 30 cases of histologically confirmed urothelial carcinomas were included in the study. All cases were evaluated histopathologically, graded according to the WHO/ISUP 2004 classification and pathological staging was done according to TNM system.  Immunostaining with immunohistochemical marker CD10 was done for all the cases and a semi-quantitative scoring was performed based on percentage of positive cells. Results: Out of total 30 cases, 18 (60%) were low grade and 12 (40%) were high grade papillary urothelial carcinoma. Of all the cases, 21 (70%) showed positive CD10 immunostaining while 9 (30%) were negative. Rate of CD10 positivity was increased significantly in higher grade of tumors (p-value 0.049) and higher pathological stage of tumors (p-value 0.009). The degree of expression of CD10 immunostaining score (scale 0-2) was also increased significantly with the higher grade of tumors. Conclusion: Our findings indicate that CD10 expression is strongly correlated with high tumor grade and stage in urothelial carcinoma of the bladder. CD10 may be associated with tumor invasion and metastasis in bladder cancer pathogenesis.

209. A Retrospective Analysis of COVID-19 Severity and Mortality Data with Special Reference to Biochemical Parameters
Pallavi Palshikar, Rohidas Borse, Murlidhar Tambe, Smita Tiwari, Somnath Salgar, Kedar B. Joshi
Background: The coronavirus disease 2019 (COVID-19) pandemic has presented the menace of century.  Severity and mortality of COVID 19 infection is due to upregulated inflammatory response in a short span of time. Patients with altered biochemical parameters are more susceptible to COVID –19. Therefore, we tried to explore blood biochemical parameters with severity and mortality of COVID –19 patients. Timely detection of these parameters may help in appropriate course of treatment and reduction in mortality. Aims and Objectives: Aim of this study was to evaluate and compare the biomarkers of inflammation in severe and deceased cases of SARS CoV 2. Materials and Methods: It is retrospective observational study carried out in tertiary care DCH (Dedicated Covid Health) facility of Pune center. Inflammatory parameters of total 294 diagnosed Covid-19 patients were studied and compared in two groups, survivor and non-survivor. The parameters included CRP, Ferritin, Lactate dehydrogenase, D dimer, Interleukin 6 and Procalcitonin. Results: The mean difference between survivor group and non-survivorgroup was extremely statistically significant for parameters like serum CRP, ferritin, Lactate dehydrogenase, D dimer and Interleukin 6. (p value less than 0.001) The difference between levels of procalcitonin in survivor and non-survivor group was statistically significant. (p value less than 0.05). Conclusion: The classical inflammatory markers are highly raised in covid patients especially in non-survivor group. They indicate high chances of mortality in severe and critical patients. Their values should be estimated early and their closer monitoring may indicate future mortality and hence timely intervention may be possible.

210. Investigation of Hepatic Profile in Plasmodium Falciparum Malaria Diagnosed Patients
Arvind Kumar, Rajiv Kumar Mahli, Shweta Kachhap Tutor, E.A. Soreng
Aim: This study aims to show the effect of malaria on the hepatic profile of the patient. Malaria is a serious health hazard around the world. Malaria is one of the dreadful burdens on humankind. Plasmodium falciparum is correlated with hepatic dysfunction. Materials and Methods: This study includes 100 patients organized in a tertiary care centre in Jharkhand, India for 18 months. Out of 100 cases, 60 patients were male and 40 patients were female. Complete clinical, biochemical, and radiological examinations were carried out for the detection of illness. The age group of patients was between 16-56 years. Results: According to this study, it was evaluated that in 67% of the cases, there was an increase in total and direct bilirubin, and 45% of patients showed a rise in the level of direct bilirubin. Conclusion: Acute plasmodium falciparum is strongly associated with liver dysfunction, which can cause a slight increase in hepatic enzymes to the extent of severe hepatitis. Hepatitis with falciparum in subjects has higher chances of complications, multi-organ failure, and poor prognosis.

211. A CSF Rhinorrhoea and Outcomes of Endoscopic Closure: A Prospective Study
Shashank Sangoli, Sanjay M
Endoscopic guided approach for surgical repair of CSF rhinorrhoea offer the benefit of both panoramic and detailed image of the site of surgery. Owing to the specific direction of view of the endoscopic lens system, it is possible to inspect the circumference of the operating field at 360 degree, by rotating the telescope around it longitudinal axis.

212. Comparing Outcomes of Medical and Surgical Management of Incomplete Abortions among Tertiary Centre Admissions
Anita Kumari Murmu, Rajluxmi Tubid
Aim: This study aimed to compare the outcomes of medical and surgical management approaches for first-trimester incomplete abortion in women admitted to a tertiary care center. Methodology: Participants (n=200) were randomized into surgical (Manual Vacuum Aspiration- MVA) and medical (misoprostol) arms. Inclusion criteria focused on women with first-trimester incomplete abortion and hemodynamic stability. Exclusion criteria involved evidence of infection and structural uterine abnormalities. Results: This study revealed successful evacuation in 87% (n=100) (surgical) and 79% (n=100) (medical) arms. Primary failure occurred in 10% (n=20), predominantly in the medical arm (medical arm: 70% (n=14) vs. surgical arm: 30% (n=6). Surgical intervention led to a substantial 22.4% decrease in the likelihood of primary failure compared to the use of medical management (p=0.03). Medical management exhibited longer hospital stays (p=0.02) and increased bleeding duration. Mild pain was reported more in the medical arm, while severe pain was more prevalent in the surgical arm. Secondary outcomes showed that fever, chills, and nausea were more common in the medical arm, but self-limiting. In the medical group, patient satisfaction revealed 49% expressing high satisfaction and 25% expressing somewhat satisfaction, while in the surgical group, 43% reported somewhat dissatisfaction and 16% reported very dissatisfaction. Conclusion: This study highlights the superior effectiveness of surgical management compared to medical approaches in addressing first-trimester incomplete abortion. It elucidates notable distinctions in efficacy, patient experiences, and satisfaction between the two methods. The findings contribute vital insights for informed clinical decision-making in tertiary care settings.

213. Interfraction Brachytherapy Application Variability in Cases of Cancer Cervix- A Retrospective Audit
Ayush Garg, Piyush Kumar
Introduction: Brachytherapy is an integral part of treatment in cancer cervix. The commonest mode of delivery of radiation by brachytherapy is intracavitary application. This procedure is usually done in two or three settings as per departmental protocol. There can be variabilities in the intracavitary application due to different time schedules where the application may be done by different persons or the planning may be done by different Medical Physicists. This study aims to find out whether there is any variability in different intracavitary applications. Materials and Methods: The retrospective data regarding intracavitary brachytherapy application was taken out. Nineteen patients were treated between January 2022 to June 2022. All patients had 3 applications and each applications had a prescription of 7Gy to point A. In all the patients, every application was planned by two-dimensional technique by taking orthogonal X-Ray films on C-arm which were transferred to the brachytherapy planning system for planning. The data was retrieved regarding intra uterine length, type of ovoids used, rectal and bladder dose. The data was analyzed for variability. Results: Out of 19 patients, in 10 patients, application was done by single person (Group I) while as in 9 patients more than 1 person was involved (Group II). Out of 10 patients, in 4 there was change in length of intrauterine tandem and in none there was change in size of ovoids while as out of 9 patients, 6 had change in length of intrauterine tandem and 1 had change in size of ovoids during the 3 applications of brachytherapy. The mean variation in Group I was 0.3cm with a range of -0.5cm to +2cm while as in Group II was 0.4cm with a range of 0cm to +1cm. In 1 patient size of ovoids was changed from half to full after 1st fraction of brachytherapy. Mean rectal dose in Group I was 48.6% with a range of 35.3% to 69% while as in Group II was 44.4% with a range of 28% to 63.3%. Mean bladder dose in Group I was 46.5% with a range of 30.7% to 65.7% while as in Group II was 41.2% with a range of 29.3% to 71.7%. Conclusion: Inter fraction variability in brachytherapy application was seen which may be attributed to different persons performing the application and doing the brachytherapy plan. To decrease the variability all the 3 fractions should be performed by single Radiation Oncologist and planned by single Medical Physicist.

214. Comparative Study of the Amount of Blood Loss with the Use of Hemocoagulase and Tranexamic Acid in Intraoperative and Postoperative Period during Mitral Valve Replacement on Cardiopulmonary Bypass Surgery
Mona Bhalavi, Kishor Uikey, Prerna Otwal, RP Kaushal
Objective: To compare the amount of bleeding with the use of Hemocoagulase and Tranexamic acid in intraoperative period. Methodology: A Prospective, randomized study was conducted in the Department of Anesthesiology, Gandhi Medical College, and associated Hamidia hospital, Bhopal Madhya Pradesh among 60 Patients of 20-60 years old age group selective for MVR, and not on Anticoagulant therapy. After explaining the protocol to all patients, a written and informed consent was taken from all patients. A detailed history, complete physical examination and routine investigations were done for all patients with those who having ASA Grade II and III and NYHA Class II and III were randomly allocated into two groups; Group 1 given i.v Injection Hemocoagulase in the dose 1.0 NIH unit as intravenous infusion over 30 minutes prior to surgery then same dose i.v once a day for 3 days postoperatively. Group 2 given Tranexamic acid in standard dose 1 gm as i.v infusion over 30 min prior to surgery and same dose repeated once a day for 3 days postoperatively. Results: The Mean Blood Loss intraoperatively of Group 1 was 453.33ml and in Group 2 was 747.5ml. The difference of blood loss among two groups was statistically significant (p value 0.00001) while Postoperatively, Mean Blood Loss  of Group 1 was 400 ml and in Group 2 was 581.6 ml. The difference of blood loss among two groups was statistically significant (p value 0.0004).It shows that intraoperatively 35.79% reduction in blood loss in Group 1  comparison to Group 2 on other side Postoperatively 31.22 % reduction in blood loss in Group 1 in comparison to Group 2. Conclusion: Bleeding reduces in Intraoperative and Postoperative period with the use of Hemocoagulase and Tranexamic acid in Intraoperative and Postoperative Period during Mitral Valve Replacement on Cardiopulmonary by Pass. Our study conclude that, Hemocoagulase is more effective than tranexamic acid to control the amount of blood loss and need of blood transfusion (both intra and postoperatively) in adult patients of ASA grade II and III during Cardiac Surgery under Cardiopulmonary bypass.

215. Estimation of Antimicrobial Resistance from Clinical Samples in a Tertiary Care Hospital Settings
Mohan A, Kamath N, Babariya M J, Kamaljeet, Bin Najeeb M A
Antimicrobial resistance (AMR) has emerged as a global public health threat, posing significant challenges to the effective treatment of infectious diseases. An accurate estimation of AMR prevalence is crucial for guiding appropriate antibiotic therapy and implementing effective infection control measures. The methodology involves the isolation and identification of bacteria from clinical samples, followed by susceptibility testing using standard microbiological techniques. The study also includes the identification of commonly encountered bacterial pathogens and their resistance profiles against a panel of antibiotics, encompassing a range of drug classes. Data is analysed to identify trends in resistance, including variations among different pathogens, clinical sample types, and patient demographics. Preliminary findings indicate a concerning increase in AMR, particularly in Gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae. Extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing strains are notably prevalent. These findings underscore the urgency of implementing effective infection control measures, antibiotic stewardship programs, and novel therapeutic strategies to combat AMR in the hospital setting. Understanding the dynamics of AMR in a tertiary care hospital is crucial for optimizing treatment protocols and preserving the efficacy of antibiotics. This research contributes to the body of knowledge on AMR and provides valuable insights for healthcare professionals, policymakers, and researchers working towards addressing this critical issue. It is imperative that we continue to monitor and respond to AMR to ensure the sustainability of healthcare delivery and patient safety in the face of evolving resistance patterns. This research paper aims to assess the extent of antimicrobial resistance in clinical samples obtained from a hospital setting and provide insights into the patterns and trends of resistance among common pathogens. The study highlights the need for robust surveillance programs and targeted interventions to combat AMR in hospitals.

216. Enhancing Puerperal Contraception Counselling Skills of Medical Undergraduates: A Training Initiative
Sharma N, Gandhi VS, Shah PK
Introduction: Contraceptive counselling is a necessary skill for improving the use of FP services in any country. However, in the undergraduate medical curriculum, contraception is exclusively taught in large group sessions with minimum to nil contraceptive counselling exposure. It is imperative that the Indian Medical Graduate (IMG), who has to be globally relevant and cater to local needs, be skilled in providing effective FP counselling. Materials and Methods: The Department of Obstetrics and Gynaecology at Geetanjali Medical College and Hospital in Udaipur, Rajasthan, India, conducted a four-month educational interventional study on 30 voluntary phase III part II MBBS students. The module included interactive lecture (IL), pre-and post-tests, role play introducing the GATHER technique, and OSCE assessment. The OSCE was followed by one-on-one feedback from faculty using Pendleton’s model. Likert’s scale feedback was acquired from students regarding satisfaction with the module through Google Forms. The data was analyzed using Microsoft Excel 2016 and presented as per cent, mean and standard deviation. P-value <0.01 was considered significant. Results: The mean pre-test score was 11.3(±3.9), while the post-test score was 27.6(±6.3). A substantial knowledge gain of 58.39% was observed (p-value<0.001). All students considered the session interactive (74 % (n=22), 26 % (n=8)). When tested after IL, just 6% (n= 2) said they were good at puerperal contraceptive counselling. All students said post-tests that doctors need counselling abilities. The GATHER analysis found that 90% of students “greeted” the woman before commencing, and 83% “asked” open questions. 64% of pupils  “told”, and 65% could summarize (“Help, Explain, Return”). All students universally (94% “strongly agree” and 6% “agree”) that the module proved effective in teaching contraceptive counselling. Conclusion: The undergraduate medical curriculum should include FP counselling. Teaching by a module creates engagement and, in turn, better learning experience. This strategy could result in a confident IMG who can counsel FP effectively, improving individual patient outcomes and the general public’s health.

217. Expression Analysis of Genes of Type IV Secretory System of H. Pylori in Different Gastrointestinal Diseases
Feeshan Ahmed, Vijay Kumar Ramnani, Aleem A khan
Helicobacter pylori (H. pylori) has been classified as a class I carcinogen which infects approximately half of the world’s population with certain geographical variations. This has made H. pylori infection as a global public health issue. Differential disease outcome has further led more interest in understanding the molecular pathogenesis of H.pylori. Advancements in the proteomics, transcriptomics and accessibility to partial or complete H. pylori genome sequences helped in understanding the complex gene regulation networks of H. pylori. Yet, the precise molecular mechanism through which the H. pylori infection can cause a significant clinical result remains unknown. It was believed that a combination of factors like host genetic factors, environmental factors, and specific bacterial virulence genes are involved in H. pylori pathogenesis. Therefore, the main objective of the present study was to determine the molecular pathogenesis of H. pylori by examining the transcript expression of type 4 secretion system genes in a variety of patients with gastrointestinal disorders (GIDs), by extracting DNA/RNA from biopsies, and amplifying the relevant genes using PCR. Further, the type 4 secretion system gene expression patterns were correlated with different grade of gastric diseases, to elucidate the role of H. pylori’s molecular pathogenesis. The findings of the research revealed that GID patients had significantly higher type 4 secretion system gene expression. Specifically, of the 240 DNA samples examined, 240 (100%), 209 (87.1%), 225 (93.7%), and 234 (97.5%) of the subjects had hrgA, cagA, cagE, and cagT, respectively. A predictive biomarker for early gastric cancer diagnosis may be developed using the correlated expression analysis of transcripts from type 4 secretion system genes.

218. A Descriptive Community-Based Cross-Sectional Study to Understand Knowledge and Attitude towards Cervical Cancer among Reproductive Age Group Women
Pankaj Kshirsagar, Shilpa Kshirsagar
Background: The cervix, which connects the uterus and vagina, can develop cancer. This condition is known as cervical cancer. It is primarily caused by the sexually transmissible pathogen known as the Human Papilloma Virus (HPV). Consequently, cervical cancer can be avoided with efficient HPV infection prevention measures. The condition usually affects women who live in less affluent neighbourhoods. Research shows that 85% of all cervical cancer fatalities and about 83% of new cases worldwide occur in underdeveloped nations. Additionally, the study indicates that many countries’ quick socio-economic transformation may lessen malignancies brought on by infections. But this could be changed. By a growing number of new instances that are more closely linked to nutritional, hormonal, and reproductive variables. Cervical cancer is quite uncommon in the developed nations worldwide. Aim: The study aims to analyse a descriptive community-based cross-sectional study to understand knowledge and attitude towards cervical cancer among reproductive age group women. Methods: This was a cross sectional descriptive study conducted at Dr DY Patil Medical College, Pimpri, Pune from April 2020 to March 2023. The study has included participants of all reproductive age women. The selection of population was done using the proportion formula considering the assumption 5% error margin (d = 0.05). To gather information, an interviewer-administered, pretested, structured, and modified questionnaire was used. The study’s descriptive statistics, such as frequency, mean, and percent, were calculated with the SPSS software version 29. Results: Around 65% of the participants have heard about the cervical cancer and only 40% have knowledge about the risk factors involve in this disease. In addition to this, 24.2% knew that the major factor of risk in this disease is smoking, followed by multiple sexual partner (22.0%) and poor dietary habits (20.2%). Moreover, the analysis has suggested that 82.0% participants didn’t know that HPV is an agent of cervical cancer. Conclusion: Participants’ general understanding of cervical cancer and how to prevent it was insufficient. More than 80% of the participants were not aware that HPV is a factor that causes cervical cancer. This is really concerning because preventing HPV infection is the most effective approach to avoid cervical cancer. Apart from this, the finding of study has involved the main information source on cervical cancer was the mass media.

219. Incidence of Other Knee Injuries Associated with ACL Tears in Road Traffic Accidents in India
Gopal Chandra Sethi, Surai Soren,  Ashis Kumar Gupta, Sambit Kumar Panda, Rabindra Kumar Nayak, Gopabandhu Patra, Sidhartha Nayak, Chandra Sekhar Pradhan
Background: The injuries related to knees are common and affect the overall physical activities of and individual. According to clinical studies, knee is having one of the largest joints in body as well as has the complex anatomy. It is considered as pivotal hinge joint that has medial and lateral rotation. The knee has surrounding of the ligaments which considered as soft tissue. The knee is an important part of the body that helps to manage the body weight and affected by the acute injuries or the development of osteoarthritis. In this event, ACL is providing the control in movement and managing the joint of knee. However, any injury and impact are influencing the control of ACL. The slip and Road Traffic Accident (RTA) also cause the injuries to knee and influence the health of the individual. Additionally, ACL injuries involve the heavy or stiffed legged landing that cause twisting and turning of the knee affect the muscles and rotation of the knee. Aim: The study aims to determine the incidence of knee associated injuries with Anterior Cruciate Ligament (ACL) tears in road traffic accidents (RTA) in India. Method: The study was approved by the ethics committee that was conducted at department of orthopaedics of MKCG MCH, Berhampur from January 2019 to September 2022. The number of patients that were involved in the study was 100 and prior consent was taken from every individual. All the patients were having the issues related to ACL and diagnosed through MRI. For the study, the collected data involve the epidemiologic, demographic and RTA injury information. RTA was divided into issues related to two and four-wheeler accidents. The analysis of data was done using the SPSS version 28.0. Results: The higher numbers of accident were involving 53% four-wheeler and 44% two-wheeler followed by 3% others. Apart from this, 55% patients were affected in right side, 44% were affected in left side and 1% had both sides affected.  The most patients were having Central Meniscal (CM) ACL tear 45% that followed by the Lateral Collateral Ligament (LCL) 28%, Medial Meniscal (MM) 23% and Posterior Cruciate Ligament (PCL) 24%. Conclusion: According to the outcome of the study, ACL tears were shown to be more common in RTAs, and most of these injuries were accompanied by concurrent knee injuries. CM was shown to have a greater prevalence of ACL tears (45%), followed by LCL (28%) and PCL (24%).

220. To Evaluate the Long-Term Results of Malunited Distal End Radius Fractures with Triangular Fibrocartilage Complex Injury Treated with Conservative Therapy
Rabindra Kumar Nayak, Gopal Chandra Sethi, Ashis Kumar Gupta, Sambit Kumar Panda, Surai Soren, Gopabandhu Patra, Chandra Sekhar Pradhan, Sidhartha Nayak
Background: The physical and mental health of the human plays a critical role in managing the lifestyle and completing the daily operations. The issues with physical and mental health have direct impact on the performance and approach of the individual as they feel pain or uncomfortable while managing the tasks. The triangular fibro cartilage complex damage combined with a malunited distal end radius fracture is seriously impairing the patient’s general health and bodily function. The stable distal radius facture can be treated without any operation and help to improve the health of the individual. However, the issue occurs due to high amount of unbalanced pressure on the wrist and articular deformity may lead to arthritis. Regaining congruence in the radiocarpal joint and the distal radioulnar joint (DRUJ) is the goal, regardless of the date, in order to improve function, lessen pain, and prevent arthritis in the future. These techniques have been associated with extensor tendon irritation or rupture on occasion, although they offer effective anatomic repair and pain alleviation. Aim: The study aims to evaluate the long-term results of malunited distal end radius fractures with triangular fibrocartilage complex injury treated with conservative therapy. Method: This prospective study was carried out in period of May 2020 to July 2022 at BB MCH, Balangir. There were 25 patients recruited in the trial, 12 of them were female and 13 of whom were male. The patient’s age ranged from 18 to 64 years, with a mean of 58.18 years. The malunion takes into account the results of the conservative treatment while selecting participants. Additionally, individuals exhibiting a dorsal tilt greater than 20° on the distal radial articular surface as well as more than 2 mm of articular displacement producing wrist pain and impaired wrist movement were included in the study. The examination of passive Range of Motion (ROM), discomfort, grip strength and everyday activities are all part of the clinical analysis process. Additionally, the 10cm Visual Analogue Scale (VAS) is used to analyse functional impairments of the arm, shoulder, and hand (DASH).  The grip strength was examined using a Jamar dynamometer. Additionally, the radial inclination, palmar tilt and ulnar variance were included in the radiography evaluations. Results: There were 25 patients involved in the study in which 13 male and 12 female. The mean age of the patients were 58.18 (SD=9.70) years and monthly follow-up period of patient was 14.98 (SD=3.87).  The analysis of score of patient recovery after the conservation approach for offering the treatment has suggested that the DASH baseline score was 33.14 (SD= 12.90), PRWE 28.18 (SD=8.20) and VAS was 4.34 (1.19). Apart from this, the range of motion was 38.60 (SD= 16.98) extension, 36.87 (SD= 19.10) flexion, 53.93 (SD= 25.03) Supination and 55.98 (SD= 22.89) Pronation as well as the grip strength was 54.64 (SD= 22.99). As per the outcome, all motion scores were significantly lower compared to baseline score (<0.05). In addition to this, the grip strength of the patient was significantly increase up to 91.80% at follow up as well as no other complications were identified among the patients. Conclusion: Based on the investigation, it has been determined that conservative treatment contributes to DRUJ stability. Furthermore, radiographic studies have shown that long arm splinting using the radioulnar joint can be used to treat distal radius fractures.

221.  Role of MDCT in Detection and Evaluation of Small Bowel Malignancies
Jayalatha Nethagani, Priyanka Govula, Kotha Swapna, Goura Praveena, Mounika
Background: Small bowel primary malignant lesions are rare and they often present lately to the clinician resulting in poor prognosis. Early detection of small bowel malignancies is a challenge for radiologist.  Previously, Double contrast barium studies were method of choice which  are now replaced by CT and MRI. Cross sectional imaging is also  superior to conventional endoscopy through which many small bowel  neoplasms are inaccessible. In this study we evaluated small bowel  malignancies using MDCT. It helps in detection of extramural extent,  liver metastases and peritoneal seeding and aids in treatment planning. Methods: This prospective study of role of MDCT in  detection and evaluation of small bowel malignancies was conducted in Department of Radiodiagnosis at MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad. A total of 24 patients of suspected small bowel lesions referred to department were included in study. Results: Total of 24 patients were included. Most commonly affected group of patients were within age group of 50-60 years. Among them females were 37.5%% and males were 62.5%. Out of 24 patients, most common malignancy was adenocarcinoma (41%) and most common involved small bowel segment in adenocarcinoma was duodenum (60%). Conclusion: MDCT provides high contrast resolution for small bowel malignancies. It provides added information about extramural extent, obstructive features and liver metastases and help in planning of treatment accordingly.

222. Efficacy and Safety of Diacerein versus Glucosamine in Patients with Osteoarthritis of the Knee: A Prospective Comparative Study
Sruthi N., Anuradha M., Divya Anirudhan, Hemalata
Background: In this study, we wanted to compare the efficacy and safety of Diacerein with Glucosamine in osteoarthritis of the knee. Methods: This was a hospital-based prospective cohort study conducted among 50 patients with grade 2 or 3 osteoarthritis of the knee, at the Department of Physical Medicine and Rehabilitation, and Department of Pharmacology, Government Medical College, Kozhikode, for one year after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. Results: All the parameters were comparable between Diacerein and the Glucosamine group (P value>0.05). No adverse reactions were reported in both groups during the study period. Conclusion: According to the study, the efficacy of Glucosamine and Diacerein in management of osteoarthritis was comparable on follow-up and no adverse effects related to the drugs were reported in both groups during the study period.

223.  Intratympanic Dexamethasone for the Treatment of Sudden Sensorineural Hearing Loss among Adult Patients: An Institutional Study
Anoop M., Jay Prakash Singh, Minu S. Kumar, Aishwarya Seth, Sudeshana Bandyopadhyay, Priyanka Tiwari, Shilpa Suresh More
Background: Sudden sensorienural hearing loss (SSNHL) is an otological emergency. Steroids, in various forms still the treatment of choice. Intratympanic steroids avoid systemic side effects. Higher concentration of drug is achieved in the end organ. Topical application of steroids in low dose is therefore, preferred. Methods: Prospective study of 36 months. Total 59 patients were included in the study. Intratympanic dexamethasone were given twice a week for 4 weeks, weekly for 3 months and once in 2 weeks up to 6 months. Pure tone audiograms (PTA) were taken on the day of first presentation (pre-treatment) and 1 month, 3 month and 6 month post treatment. They were compared to know the effect of local treatment. Results: Complete recovery noticed in 36 (61%) patients, partial recovery in 15(25.4%) patients and no improvement shown by 8 (13.6%) patients. Early initiation of treatment is the key to success. No serious side effects were noticed in our study. Conclusion: Intratympanic dexamethasone is cost effective, widely available. Intratympanic dexamethasone therapy can lower the total amount of steroid administration. It reduces the systemic toxicity, duration of treatment. This is one among the best option for treatment of SSNHL patients. The dosage and duration of this medication is individual to each patient. Nanocarrier – based therapy can diffuse into inner ear allowing direct drug delivery. Targeted delivery of certain type of nanoparticles is the latest therapy of SSNHL. Direction towards less toxic nanoparticles might be the future research with respect to therapy of SSNHL.

224.  Placenta Accreta Spectrum: Outcome of Different Individual Management Strategies in a Tertiary Care Hospital
Gujju Rajalakshmi, Prasad Usha, Eeshita Badiya, Tanista Badiya
Background and Objective: The increase in caesarean section rate in the last four decades has contributed to the several fold increase in the incidence of placenta accrete spectrum globally. It can lead to life threatening hemorrhage and is one of the reasons for peripartum hysterectomy and a common cause for severe maternal morbidity. The objective of this study is to diagnose cases of placenta accrete spectrum and study the outcome of different individual management strategies and how early diagnosis and appropriate management will decrease the maternal morbidity and mortality. Methods: The study included 30 women diagnosed with placenta accreta from June 2022 to November 2022 at tertiary care centre. The study subjects were divided into two groups according to the individual management. Group A underwent casearean hysterectomy while Group B was managed medically with methotrexate. Results: The common age group in both groups is between 30-40 years. In both the groups the patients were multi gravida. Maximum number of patients 73.3% in group A and 66.6% in group B had previous caesarean section among the study subjects. In 53.4% in Group B patients had hospital stay ranging from 11- 20 days and in 33.3% of cases more than 20 days. In Group B patients complications were seen in 86.7 % of cases and in Group A cases with 33.3% showed complications. Conclusion: Over the past decade, with the increase in cesarean delivery, the prevalence of placenta accreta and other abnormal placentation has increased resulting in severe blood loss causing  maternal morbidity and mortality. Continuous improvements in early diagnosis are markedly required to provide evidence‐based strategies for treating these women.

225. The Role of Late First Trimester Cervico-Isthmic Length Screening in Prediction of Preterm Labour
Anjlina Bhati, Rini Upadhyaya, Mayank Jain
Background: Across 184 countries, the rate of preterm birth ranges from 5% to 12% of babies born and this accounts for 50- 75% of the perinatal mortality. Every year, an estimated 15 million babies are born preterm and this number is rising. By predicting high risk women for preterm labour, we can take appropriate measures to prevent preterm labour thus prevent maternal and child mortality and morbidity. Objective: To assess role of late first trimester cervico- isthmic length in prediction of preterm labour. Methods: A Longitudinal follow-up analytic study was carried out on 200 pregnant women attended OPD of Obstetrics & Gynaecology department in 1st trimester and delivered at Index Medical College Hospital and Research Centre, Indore during March 2020 to August 2021. Selected women were assessed clinically and cervical length was measured using transvaginal ultrasonography. A follow up was planned at 20 to 26 weeks and at delivery to assess pregnancy outcome. Results: Out of 200 study participants, 28 (14%) were delivered before completing 37 weeks of gestation. At first trimester, the mean cervical length among preterm and term delivered women was 3.24±0.8 and 3.83±1.1cm respectively. Using ROC curve, best cut off of cervical length at 11-14 weeks for prediction of preterm delivery is 3.4 cm. Out of 43 who had short cervical length (<3.4 cm) at 11-14 weeks, 55.81% delivered at preterm and 44.19% delivered at term. Conclusion: Association of short cervical length at 11-14 weeks was found statistically significant with preterm delivery (p=0.001). Cervical length at 11-14 weeks has significantly high accuracy (88.50%) for prediction of preterm labour.

226.  Prophylactic Administration of Tranexemic Acid in Reducing the Incidence of Postpartum Haemorrhage in A Tertiary Care Center – A Cross Sectional Study
Gayathrie Devi S, Karthiga S, Rajeswari K, Ganesh R
Background: Caesarean section is the commonest operative procedure done in the world. Incidence of caesarean section is increasing throughout the world because of social factors like advanced maternal age, improved surgical techniques and increasing litigation problems. Tranexamic acid is an effective agent for the reduction of blood loss, which has been widely used in various areas of medicine. It is an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin. It has been used to decrease blood loss for many years in cases of hemorrhage, and is reported to reduce intraoperative and postoperative blood loss. The present study observes the blood loss reduced by Tranexamic acid an antifibrinolytic agent during and after caesarean section and normal delivery. Aims: 1) To study the efficacy of tranexamic acid in reducing blood loss during and after lower segment cesarean section and normal delivery. 2) Our objective is to determine the reduction in amount of blood loss after administration of tranexamic acid during and after cesarean section and normal delivery. Settings and Design: This study was carried out in the dept. of Obstetrics and Gynecology of Govt. Karur Medical College Hospital in Karur district of Tamilnadu, India, from Jan 2023 to June 2023 as a case-control study. Materials and Methods: In all patients detailed history – medical history, obstetric history were taken. Vital parameters checked and basic investigations done. Weight of the patient checked. Detailed general examination and obstetric examination done. Gestational age confirmed by USG. 100 patients were placed in group A ie. Control, Normal delivery (50)+ LSCS(50), and 100 patients were placed in group B ie, Cases, Normal delivery (50) + LSCS (50) patients. All patients were counselled and informed consent obtained. Control group –Inj. Oxytocin 10 U IM was administered and Inj. Tranexamic acid 1gm IV was not given. Study group- Both Inj. Tranexamic acid 1gm iv and Inj. Oxytocin 10 U IM was given. Then the results were analysed in terms of vitals monitoring till 2 hours postpartum, uterine contractility, blood loss, etc., and the observations were tabulated and analysed. Results and Conclusion: Tranexamic acid significantly (p<0.001) reduced the blood loss from placental delivery to 2 hour post-partum. Tranexamic acid significantly reduced the amount of blood loss during & after the lower segment cesarean section and normal delivery. 2) Its use was not associated with any adverse drug reaction like diarrhea or thrombosis. Fetal outcome as evaluated by APGAR score was not adversely affected by use of tranexamic acid. 3) Tranexamic acid can be used safely in subjects with lower cesarean section and normal delivery.

227. Diagnostic Efficacy of Endometrial Sampling by Pipelle Biopsy Technique in Peri and Postmenopausal Women with Abnormal Uterine Bleeding
Vallepu Venkata Narayana, E Narmada, B Shabana Begum
Aim: Current study is conducted to determine the diagnostic efficacy of pipelle as a tool for endometrial biopsy and to establish the reliability of pipelle curette so that the number of traditional Dilatation and Curettage done under short general anesthesia can be reduced to minimum. Method: In this study we assessed 100 consecutive peri and postmenopausal patients attending Obstetrics and Gynecology department with complaints of abnormal uterine bleeding. These patients are subjected to transvaginal ultrasonography and pipelle endometrial sampling. Results: Indication for the procedure were heavy menstrual bleeding 21 (42%), intermenstrual bleeding 11 (22%), irregular periods 10 (20%) and others 8(16%) in premenopausal women with AUB and postmenopausal bleeding in 50 out of 50 postmenopausal women means 100%. In postmenopausal group, 6% of the patients were nulliparous who had hyperplasia and hyperplasia with atypia. Majority of postmenopausal patients have period of menopause in the range of 6-10 years (37.5%). In postmenopausal group 74% of the patient had associated medical problem. In premenopausal women 44 patients (88%) had endometrial thickness more than 10mm and in 6 patients (12%) had endometrial thickness less than or equal to 10mm. Among 50 postmenopausal women the ET was more than 4mm in 40 patients (80%) and in 10 patients (20%) ET was less than or equal to 4mm. In those who had < 4mm ET, the sample size was inadequate as compared to those who had ET >4mm. In the present study difficulty encountered during pipelle sampling while passing the cannula through the cervical os is comparatively less 2% in premenopausal women than postmenopausal women 8%. Post procedure complaint or discomfort in lower abdomen or slight vaginal spotting which was about nil in premenopausal women and 4% in postmenopausal women. Adequacy of the pipelle sampling using the pipelle curette has shown to obtain adequate specimen in 87-100% of patient. In the present study, it was 96% and 88% in premenopause and in postmenopausal women with AUB respectively. In the present study, since no complication occurred and no serious pathology was missed, pipelle sampling combined with endometrial thickness increases the sensitivity and specificity both, therefore we suggest that pipelle sampling combined with sonographic measurement of endometrial thickness is an acceptable, less invasive alternative to hysteroscopy and D & C as a first line investigation in the evaluation and management of abnormal peri and postmenopausal uterine bleeding. Conclusion: Evaluation of the target population i.e., peri and postmenopausal women with AUB by using office based pipelle endometrial biopsy and transvaginal ultrasonography, and to detect prevalence of atypical hyperplasia -endometrial carcinoma at the earliest  in a cost effective way. In developing countries like India evaluation of AUB in peri and postmenopausal women can be done with minimal infrastructure setup even where operation theatre facilities are not available in remote areas by doing Ultrasonography and office endometrial biopsy which is cost effective safe OPD procedure, less time consuming, non-invasive, less discomfort to the patient and early diagnosis of atypical hyperplasia and endometrial carcinoma.

228. Study of Outcome of Total Hip Replacement in Adults with Arthritis in a Teaching Hospital
Shaik Masthan Basha, Majji Chandra Sekharam Naidu, Mallam Kiran Kumar, Vurundhur Divya
Aim: Current study aim is to assess the clinical and functional outcomes of cemented Total Hip Replacement in adults using Modified Harris Hip Score in terms of pain, functional disabilities, deformity, range of movements, limb length discrepancy. Method: An observational study carried out on 30 hips of 30 patients who underwent cemented Total Hip Replacement and were available for follow-up. This study conducted on patients with age ranging from 50 – 70 years with mean age of 58.3 years. A thorough clinical and radiological examination was performed. All patients were operated through Hardinge’s direct lateral approach, putting the patient in the lateral position. Quadriceps and knee bending exercises were started immediately post-op. Ambulation training is started with the walker on Day 1-2, followed by gait training with weight-bearing as tolerated on Day 3-7. Full weight bearing on involved extremity can be started on Day 7. Results: 66.7% are males and 33.3% are females underwent Cemented total hip replacement. 13 patients were operated on the left side. Indication for surgery was secondary arthritis due to AVN in 66.7% cases, 3.3% due to ankylosing spondylitis, 6.7% was due to Rheumatoid arthritis which is confirmed by clinical evaluation and blood investigations. The mean follow-up period was 18.8 months. The patients were followed postoperatively at six weeks, 3, 6, 12, and 24 months. 6.7%patients had varus angulation of the stem who complained of anterior thigh pain postoperatively. One patient had a superficial infection that was treated with antibiotics and delayed suture removal. 6.7% patients had leg length discrepancy and shortening who were treated with a shoe raise. All patients were followed up regularly; no patients were lost for follow up. They were evaluated according to the Modified Harris Hip score. The mean total preoperative score was 45.04. The maximum score is 62, and the minimum is 21. Postoperatively the total mean score was 88.44, with 74 being the minimum and 95 being the maximum. The mean follow-up Modified Harris Hip score increased to 91.60, with a minimum of 77 and a maximum of 97. There were a statistically significant improvement p=0.044 (‘p’ value of <0.001) in the follow-up score when compared to the preoperative score. Conclusion: Results showed a significant improvement, wherein 84% had an excellent score, and 8% showed good and 8% fair results. No patient had a poor score. The management of diseased and destroyed hips with cemented total hip replacement is effective and gives stable, mobile, and painless hip joints to the patient. Functional results are excellent, and complications are minimal if done with utmost care and precision. This study has shown that the outcome of the total hip arthroplasty has shown excellent results in terms of pain relief, increased walking distance, and functional capabilities in patients. Most of the patients were elderly active treated with a cemented total hip replacement and have shown excellent clinical and radiological results after an intermediate period of follow-up. The overall functional and clinical outcome showed good results.

229. Ultrasound Guided Bilateral Transverse Thoracic Plane Block for Patient Undergoing Cardiac Surgery
Nisha Azmi, Vinod P Bhalerao, Rampratap Singh Chouhan, Anuruddha Singh
Background and Objectives: The management of postoperative pain in patients following cardiac surgery mostly relied on opioids. However, the desired outcomes could not be attained due to the adverse consequences associated with opioids. The implementation of the multimodal analgesic strategy has been developed to mitigate the undesirable consequences of opioids and provide optimal pain relief. The objective of this study was to assess the impact of ultrasound-guided bilateral thoracic plane block on patients having cardiac surgery. Material and Methods: This prospective, randomized, double-blind study was conducted in the Department of Anesthesiology and Critical Care, Sri Aurobindo Institute of Medical Sciences Hospital, Indore (M.P) among 100 Patients of 18-70 years scheduled for elective cardiac surgeries. After explaining the protocol to all patients, a written and informed consent was taken from all patients. The patients were allocated into two groups using computer-generated random numbers: the Intervention group [Group T], that had a bilateral transversus thoracic muscle plane block guided by ultrasonography with 20ml of 0.25% ropivacaine, and the Control group [Group C], which underwent a sham block. Primary outcome was to observe the pain score and first need of rescue analgesic inj. Tramadol. The secondary outcomes were pain score, Total analgesic requirement in 24 hr, time to extubation, and ICU stays. Results: The control group had a considerably shorter time prior to the first request for pain management (median 3 hours) compared to group T (median 14 hours). Within the 0.5-24 hour period after surgery, the group T observed a decrease of 1.86 units in pain scores at rest. The estimated decrease was -1.80, with a 95% confidence interval ranging from -2.14 to -1.45. The t-value was -10.323, and the p-value was less than 0.0001. Postoperative tramadol consumption was found to be significantly lower in Group T (p < 0.001). Conclusion: The bilateral transversus thoracic muscle plane block (TTMPB) is a very promising and successful method for minimizing opioid consumption and managing post-sternotomy pain in patients who underwent cardiac surgery.

230. Incidence of Complications Following Management of Distal Femur Fracture Using Locking Compression Plate: A Longitudinal Study
Sharan Chavan, Dattatray Thakur, Arunkumar Rao
Introduction: Locked plating (LP) of distal femoral fractures has become very popular. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion (NU), and revision is limited. Objective: To study the incidence of complications following management of distal femur fracture using locking compression plate. Methodology: The study was conducted on patients of distal femur fracture treated by locking compression plate in tertiary care hospital during the study period of January 2018 to June 2019. Results: Out of 42 patients with distal femoral fracture in our study, majority of them i.e. 12(28.6%) were from 41-50 years. Mullers type A2 was commonest i.e. 11(26.2%) followed by A3 in 10(23.8%) and A1 in 8(19%). Only in 10 cases associate implants were used. Shortening of leg was seen in 2 patients i.e. 4.8%. Varus was reported in 2 cases i.e. 4.8%. Prevalence of infection was reported in 3 patients i.e. 7.1%. Majority of the patients achieved knee flexion above 110 degrees in 22 i.e. 52.4%. Conclusion: Incidence of shortening of leg was 4.8%. Incidence of Varus deformity was 4.8%. Incidence of infection was 7.1%.

231. Dextrose Prolotherapy in Osteoarthritis of Knee Joint
Vaibhav Bhadbhade, Anand B Jabshetty
Introduction: Osteoarthritis (OA) of knee joint is a chronic, progressive, and joint disabling disease, often resulting in a poor quality of life. Knee osteoarthritis often results in joint pain, stiffness, and decreased function. The Agency for Healthcare Research and Quality has called for the development of new therapies to prevent and treat knee osteoarthritis. These include hypertonic dextrose prolotherapy, ozone, botulinum toxin, platelet-rich plasma, and hyaluronic acid. Materials and Methods: This prospective study enrolled patients from orthopaedic OPD who were given intra-articular hypertonic dextrose solution which was blinded by normal saline, at BRIMS Teaching Hospital, Bidar , Karnataka. Injections were given at 0, 4, and 8 weeks with additional session at 16 weeks. The primary outcome measure was change in knee-related quality-of-life as assessed by the composite score of Western Ontario McMaster University Osteoarthritis Index (WOMAC). Results: Of the 205 participants considered for inclusion in the study, 76 met eligibility criteria and were enrolled and divided into 2 groups containing 38 participants each. The study participants had a mean age of 63.2 years, 71% were female, 21% were overweight, and 46% were obese. Mean duration of knee pain was 8.9 years. Conclusion: According to our results, dextrose prolotherapy appears to be more effective for pain reduction and function improvement.  More studies and better methodological quality are needed to establish a better level of evidence on the efficacy and safety of using dextrose prolotherapy in patients with knee OA.

232.  Functional Outcomes in Patients with Acute Ischemic Stroke Undergoing Different Treatment Modalities, Using NIHSS and mRS Scores
Ashish Chauhan
Background: Stroke, a major health concern in India, demands multidisciplinary management due to its high morbidity and mortality. Ischemic strokes, constituting 85%, require timely intervention to salvage the penumbra and minimize cerebral damage. Recent research supports intravenous rtPA administration within 4.5 hours. Endovascular interventions target large vessel strokes, expanding treatment eligibility. Rapid diagnostic tools like NIHSS and mRS aid severity assessment. This study seeks to compare functional outcomes in acute ischemic stroke patients undergoing various treatments based on NIHSS and mRS scores, contributing to the optimization of stroke care. Methods: This prospective observational study, conducted at FMRI, Gurgaon, between June 2019 and August 2020, enrolled 150 diagnosed acute ischemic stroke patients. Inclusion criteria involved eligibility for IV rtPA, IV rtPA failure requiring bridging therapy, and recommendations based on DAWN TRIAL criteria. Data, including NIHSS and mRS scores, were collected, and patients received various interventions. Investigation results informed diagnostic tools, and statistical analysis utilized SPSS version 17.0. Categorical variables were expressed as numbers and percentages, assessed using the chi-square test, with p<0.05 signifying significance. Results: In our study, the mean age of participants was determined to be 59.77 years.Regarding gender, the study cohort comprised 71.33% males and 28.67% females.Among the clinical features, weakness was the most prevalent, reported by 48.00% of participants. The majority of individuals underwent medical management, constituting 41.33% of the cohort.area-specific features such as involvement of the thalamus (8.00%), basal ganglia (4.67%), and corona radiata (14.67%). In our study, 14.00% underwent Intra venous thrombolysis plus mechanical thrombectomy, 28.57% showed improvement in NIHSS score of 8 or more, and 23.81% of participants showed good MRS outcome. Conclusion: Notable improvements in NIHSS scores and favourable Modified Rankin Scale outcomes associated with medical management suggest its effectiveness in certain scenarios.

233.  A Comparative Study of Serum Uric Acid & Creatinine in Preeclampsia and Normotensive Pregnant Women Attending a Tertiary Care Hospital of Tripura
Moumita Debnath, Chinmoy Biswas, Izora TR. Marak, Chayan Sarkar
As Preeclampsia is a progressive, multisystemic and multifactorial pregnancy specific disorder, it is one of the major challenges for the obstetrician to combat this complication.In this hospital based observational Cross-sectional study, we have included 70 preeclamptic patients as cases and 70 normal pregnant women in the control group. Current study was aimed to estimate and compare the levels of serum uric acid and  creatinine  among women with preeclampsia and normotensive pregnant women attending  Dept. of Obstetrics & Gynaecology at AGMC. This tests are done by XL-640 Fully Automated Autoanalyzer. Pearson’s cor relation coefficient and independent sample ‘t’ test were used for statistical analysis. Serum uric acid & creatinine are significantly higher in preeclamptic patients compared to normotensive pregnant women and it shows positive correlation with systolic blood pressure & diastolic blood pressure. This study concludes the utility of measurement of serum uric acid and creatinine may be helpful for pregnant women during screening in Antenatal check up to prevent risk of  preeclampsia.

234.  Prevalence and Associated Risk Factors of Dry Eye in Muzaffarpur District of Bihar
Dev Kant, Jyoti Kumari, Rajeev Kumar Singh, Manoj Mishra
Objectives: The present study was to evaluate the prevalence and associated risk factors of dry eye disease in Patna District of Bihar. Methods: Ophthalmic history, Systemic and ocular examination was done to all eye disease patients. These patients were handed over the two dry eye questionnaires (OSDI and DEQ 5) which had questions pertaining to the symptoms of dry eye. Scoring of the patients was done and the scores ranged as follows: OSDI – 0 to 100 and the OSDI score ≥12 was taken as positive for dry eye disease. DEQ: 5 – 0 to 22 and the score ≥ to 6 was taken as positive for dry eye disease. The Participants then underwent a comprehensive examination test sequence following the DEWS subcommittee diagnostic steps. TBUT was performed before the other dry eye tests, to avoid any untoward interference followed by ocular surface staining. The Schirmer’s test was performed last so that ocular irritation by the test strip would not interfere with other examination results. Results: Prevalence of dry eye was 43.55%. Higher prevalence of dry eye 56.27% was seen in age group of 51-65 years. prevalence of dry eye was greatly in females (47.23%). Majorities of dry eye patients 166(44.62%) was evaporative type. Farmers/labourer 167(44.89%) was greatly affected with dry eye. 87(23.38%) dry eye patients were factory workers. Most common risk factors of dry eye was smoking 164(44.08%). Others risk factors of dry eye were systemic disease 76(20.43%), systemic medication 61(16.39%), topical medication 50(13.44%), air conditioning 13(3.49%) and contact lens 08(2.15%). Conclusions: Dry eye disease is preponderance in old age female population. Evaporative is the most common type of DED. Farmers/labourer is commonly suffered. Smoking and systemic disease are the most common risk factors of dry eye disease. Hence, Dry eye disease is a distressing problem which is often overlooked and is frequently underdiagnosed. The multifactorial etiopathogenesis and lack of specificity of symptoms explain why the clinical diagnosis of dry eye remains a challenge. It is crucial to increase awareness about this condition and continue research on DES among the population to obtain a more detailed analysis. Identifying the prevalence, symptoms and risk factors could enable the implementation of appropriate preventive measures against DED.

235.  Role of Serum Nitric Oxide and Serum Uric Acid in Essential Hypertension
Yadav Bhagyashri, Waghmode Anjali
Background: Essential Hypertension (EHT) affects 25% of the world’s population and is a major cause of stroke, congestive heart failure, end stage renal disease and myocardial infarction. The routine evaluation of essential hypertensive patient should include complete hemogram, microscopic urinalysis, albumin excretion, serum creatinine, blood urea, serum sodium, potassium, Fasting blood glucose levels and lipid profile. Uric Acid play pathogenic role in hypertension (HTN) mediated by several mechanisms and L-arginine nitric oxide pathway has an important role in hypertension, renal disease, inflammation and atherosclerosis. Objectives: The aim of this study was to determine level of nitric oxide, uric acid, urea and creatinine in Essential Hypertensive patients as compare to controls. Methodology: This is a case control study, in which 30 patients with Essential Hypertension and 30 normal individuals as controls were analyzed for serum nitric oxide, urea, creatinine and uric acid. Results: In present study blood urea, serum creatinine and serum uric acid levels were significantly higher while Serum nitric oxide levels were significantly low in EHT patients when compared with that of controls. Conclusion: We conclude that uric acid and nitric oxide along with routine kidney function tests like serum creatinine and blood urea will help in the management and treatment of essential hypertensive patients.

236.  A Case Control Study on Hs-CRP as an Important Inflammatory Risk marker of CAD in Diabetes Mellitus Patients
Asfiya Fatma, Pratiksha Singh, Rita Chaudhary, Madhu Sinha
Background: Patients with type 2 diabetes mellitus (T2DM) have an elevated risk of developing coronary artery disease (CAD) when their hs-CRP levels are elevated. The purpose of this study was to evaluate the hs-CRP in patients with type 2 diabetes mellitus who had CAD. Methods: During the period of July 2022 to June 2023, all patients admitted under the Medicine department (Cardiology wing) of PMCH, Patna, Bihar, were included in the present case control study. The present study included individuals who were willing to participate in the study and who had a history of diabetes mellitus lasting five to ten years and who were aged more than forty. Results: Seventy patients in total who fulfilled the inclusion criteria were included. Of these, 35 belonged to Group A (T2DM with CAD) and 35 to Group B (T2DM without CAD). Thirty of the patients were female, and forty were male. Patients in group A had a mean age of 57.2±9.4, whereas those in group B had a mean age of 58.2±10.4. These differences were not statistically significant. Patients in group A had a significantly greater mean hs-CRP than patients in group B. Conclusion: Elevated hs-CRP in T2DM patients has a substantial correlation with coronary artery disease, ashs-CRP is a valid predictor for atherosclerotic events. To identify CAD risk early, we recommend that patients with diabetes mellitus routinely have their hs-CRP levels examined.

237.  Study of Serum Lipid Profile in Ischemic and Hemorrhagic Stroke Patients
Ashwani Kumar Mishra, Dashrath Kumar Singh, Anil Kumar Mehta
Background: Based on the disruption of blood flow, strokes can be divided into two categories: ischemic and hemorrhagic. The association between serum lipid profile and type of stroke is still unknown, despite the fact that serum lipids are well-known risk factors for atherosclerosis. Conflicting findings from earlier research have been published about the contribution of dyslipidemia to various forms of stroke. This study compared the serum lipid profiles of patients who had hemorrhagic stroke (HS) to ischemic stroke (IS). Methods: On the first day of admission, 201 patients with IS and HS who had not taken any lipid-reducing medication and had been admitted to the medicine ward of Darbhanga Medical College and Hospital, Laheriasarai, Bihar, between October 2022 and September 2023, were assessed. These individuals had measurements of their serum lipid profile, which included triglycerides (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and high-density lipoprotein-cholesterol (HDL-C). Results: Of the participants, 51.2% were women and 48.8% were men. When comparing IS patients to HS patients, the serum TG level was noticeably greater in IS patients. The results demonstrated a strong correlation between the kind of stroke and HDL-C serum levels. Conclusion: The findings showed a strong correlation between the kind of stroke and the lipid profile.

238.  A Study of Prevalence of Non-Alcoholic Fatty Liver in Type 2 Diabetes Mellitus Patients
Dashrath Kumar Singh, Ashwani Kumar Mishra, Vinayanand Jha
Background: Despite the substantial clinical significance of non-alcoholic fatty liver disease (NAFLD) in Type 2 diabetes mellitus, it is frequently neglected in clinical practice. The purpose of this study was to determine the prevalence of NAFLD in people with diabetes mellitus. Methods: This non-interventional and cross-sectional study was conducted at Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from October 2022 to September 2023. 150 patients with Type 2 diabetes mellitus were included in this study. Results: The prevalence of NAFLD was 51.3%; it was higher in patients with central obesity and dyslipidemia as well as among females (42.6%). Conclusion: Early identification is essential to implement preventative measures because NAFLD is frequently associated with diabetes mellitus and increases the risk of complications in patients.

239.  Study of Unnatural Deaths in Pediatric Age Group at Tertiary Care Centre
Dharmendra Kumar, Smriti Sinha, Ritu, Prabhat Kumar, Vijay Kumar Prasad
Background: People are exposed to a variety of risks as they grow from childhood to maturity, which may cause unnatural deaths by impairing social, mental, and physical welfare. Examining trends in untimely deaths aids interested parties in developing strategies to stop the loss of valuable human capital. Methods: From March 2016 to August 2017, a descriptive study utilizing purposive sampling was carried out at PMCH, Patna. Data from autopsy of unnatural deaths among the pediatric age range (0–18 years) was collected using pre-tested structured proforma. The police reports, trustworthy witnesses of the deceased, histopathological/hospital records, and post-mortem reports were used to gather information about the sociodemographic features, pattern of injuries, and cause of death. By presenting the data in the appropriate tables and computing descriptive statistics like mean, median, standard deviation, and percentages, the data from this study was statistically examined. Results: Of the 832 cases, 703 (84.5%) resulted in unnatural deaths, with 8.8% of those cases being children in that age range. Of those, 51 (82.2%) belonged to the age range of 12 to 18 years, with 4 cases (6.5%) each for 5 to 12 years and preschool age (3-5 years). Three cases (4.8%) were of toddlers (1-3 years), and there were no instances reported among newborns. In 35 cases, there was a preponderance of men (56%). The maximum number of deaths 30 cases, or 48.39% occurred in the evening. In the current study, social class II accounted for the greatest number of victims (38 cases), whereas social class I accounted for the fewest (only 1 case). Of the 62 cases, 37 (or 60%) resulted in deliberate deaths, 1 (or 3% of cases) was homicidal, 36 (or 97%) were suicidal, and 25 (or 40%) were accidental fatalities. Out of the 36 suicidal cases in the current study, 26 cases (42%), or hanging, were the most frequently utilized means of suicide. Burns and drowning each accounted for one occurrence (8%), followed by hanging. Of the 62 cases, only 12 (19%) had treatment before to death, and the remaining 50 (81%) did not receive treatment. Conclusion: According to this study, parents and other caregivers have a huge duty to watch over their children. To give policy decisions the justification they need to implement the appropriate interventions, the public health burden of all unnecessary fatalities must be evaluated.

240.  An Observational Study on Incidence of Burns Cases among Autopsies at Tertiary Care Centre
Dharmendra Kumar, Smriti Sinha, Ritu, Prabhat Kumar, Vijay Kumar Prasad
Background: Burns happen in all facets of a person’s life, including industrialization, non-domestic life, and domestic life. Burns resulting from household accidents are the most common cause of significant and serious damage to the body in India. Burn deaths that are not natural occur frequently in this area. The incidence of burns in relation to sufferers’ age, sex, and marital status is the study aims. Methods: From July 2017 to June 2018, a cross-sectional observational study was conducted in the Department of Forensic Medicine and Toxicology at Patna Medical college and Hospital, Patna, Bihar. 200 burn cases out of 1700 medico-legal autopsies served as the study source material. Results: Burns were reported to occur 11.76% of the time (200/1700). The age range of 19 to 25 years old saw the greatest percentage of burn incidents, or 26.5%. There were 160 female cases and 40 male cases out of 200 total. The ratio of men to women was 1 to 4. The highest percentage of burn cases (74%) was seen in married people. Conclusion: The current investigation on the prevalence of burns during autopsy found that marriage, young age, and a preponderance of females were associated with a low frequency of burns.

241.  Comparative Study of Post-Operative Outcomes of Pterygium Excision with Autograft using Autologous Blood and Sutures
Shiv Kumar, Md. Imamul Hoda, Talat Nahid, R. K. Singh
Background: Pterygium is a very common eye disorder that is thought to be caused by aberrant epithelium and fibrovascular tissue growing too much and proliferating onto the cornea. They are distinguished by inflammation, neovascularization, and cell proliferation. The pathophysiology of pterygium is significantly influenced by genetic alterations linked to altered cytokine production and ultraviolet radiation (UVR)-induced elastoid degeneration of subepithelial connective tissue. One of the more successful current therapy modalities is conjunctival autograft. Fibrin glue or sutures are the most often utilized methods for fixing conjunctival autografts. The purpose of this research is to compare the two pterygium surgical treatment modalities in terms of surgical time and postoperative results. Methods: This prospective study was carried out at the ophthalmology department of Sri Krishna Medical College and Hospital in Muzaffarpur, Bihar, between March 2018 and February 2019. For surgical intervention, 40 patients of primary nasal pterygium were chosen from the outpatient department. For pterygium excision with autograft, the patients were split into two groups at random and given either autologous blood (20 patients) or sutures (20 patients). Following the surgical procedure, both groups’ eyes were patched for a full day, and the length of the procedure, recurrence, graft edema, graft stability, and other problems were compared between the two groups. Results: After pterygium excision with conjunctival autografting, granuloma was more common in the suture group and graft edema more common in the autologous blood approach. Conclusion: When compared to sutures, autologous blood is a more superior and economical method of fixing the graft during pterygium surgery, without posing additional risks.

242.  Serum Lipid Profile and Atherogenic Index of Plasma in Premenopausal and Post-Menopausal Women
Pratiksha Singh, Asfiya Fatma, Madhu Sinha
Background: Hyperlipidemia is one of the important risk factor for development of cardiovascular disease in post-menopausal women. Our study compared the serum lipid profile and atherogenic index of plasma between premenopausal and post-menopausal women. Methods: Between July 2022 and June 2023, a cross-sectional study was carried out at the Patna Medical College and Hospital in Patna, Bihar. Ninety-seven female patients of whom forty-three were premenopausal and the remaining fifty-four were postmenopausal submitted fasting samples. For every sample, a lipid profile was created and an AIP was determined. Conducted using paired t tests in the two groups. The data was shown as mean ±SD, and a p-value of less than 0.05 was considered significant. Results: Compared to premenopausal women, the mean values of triglycerides, low-density lipoprotein cholesterol, and total cholesterol were considerably higher in postmenopausal women. Postmenopausal women had higher levels of high-density lipoprotein cholesterol; however the difference was not statistically significant. Postmenopausal women had a higher plasma atherogenic index (0.21 ± 0.24 mmol/l). This indicates that the risk of cardiovascular disease development is medium for postmenopausal women in our scenario. Conclusion: Because of an increase in their atherogenic lipid profile, postmenopausal women were more likely to develop cardiovascular disease than premenopausal women. Age, body mass index, systolic and diastolic blood pressure, and the atherogenic index of plasma were found to be significantly correlated.

243.  Study on Prevalence of Dry Eyes in Diabetic Patients: A Hospital Based Cross Sectional Study
Md. Imamul Hoda, Shiv Kumar, Talat Nahid, R. K. Singh
Background: Diabetes mellitus is one of the main causes of dry eye syndrome. A patient’s risk of acquiring dry eye increases with the length of their diabetes. The blood sugar level in individuals with diabetes also contributes to the development of dry eye disease. It has been observed that patients with poor blood sugar regulation are more likely to develop dry eye illness. Studies on dry eyes in diabetes patients have not been conducted in large numbers in India. The purpose of this study was to determine the prevalence of dry eye in individuals with diabetes. Methods: This hospital based prevalence study of hundred patients with type II diabetes was conducted in Department of Ophthalmology, Sri Krishna Medical College and Hospital from March 2018 to February 2019. A standard questionnaire was completed along with a thorough history of diabetes, slit lamp biomicroscopy, the Schirmers test, tear break up time, fluorescein staining, and Rose Bengal staining. Results: In our study, 43 out of the patients with type II diabetes experienced dry eye. A noteworthy correlation has been seen between dry eye and both inadequate glycemic management (p-0.001) and a longer duration of diabetes (p<0.05). Conclusion: Maintaining adequate glycaemic management is crucial for lowering the incidence of dry eye. The evaluation of diabetic ocular disorders should include a thorough examination of dry eyes.

244.  A Study of Modalities of Treatment of Apnea in Neonates – Focus on Role of Methylxanthines
Sanjay Ghorpade, Hemant P Bharati, Pradnyesh H Gorad, Basanagouda K Patil
Introduction: Methylxanthine drugs such as caffeine or theophylline are used for treating neonatal apnea. However, choice between caffeine and theophylline in the treatment of neonatal apnea remains a debatable issue. Material & Methods: This randomised study of 40 neonates with neonatal apnea was carried out in a tertiary care hospital in maharashtra. Treatments compared were caffeine and theophylline in terms of prognosis. Results: overall survival was 40%. The average number of apneas in caffeine treated group was 5.62 + 4.67 per infant and in aminophylline treated group 4.50 + 5.36 per infant. There was no significant difference in the drug levels achieved by both the drugs. Association between survival with methylxanthines and its levels was not significant.  When the survival was analysed with modes of treatment required, only in babies requiring physical stimulation and not requiring bag and mask, IPPR, ventilators, the survival was good (p=0.0003). Conclusion: The efficacy of caffeine and aminophylline was similar in our study. Number of apneas, drug levels and the survival no significant difference. However, caffeine has distinct advantage of ease of administration, and fewer peripheral effects. Of the variables studied bradycardia during the episode and prematurity were strong predictors of poor survival.

245.  A Clinico Epidemiological Study of Oral Manifestations in Auto Immune Skin Diseases
L. Vijayalakshmi, S. Bharathi, S. Manipriya
Introduction:  Autoimmune diseases are characterized by presence of auto antibodies that are directed against structures of the self-resulting in tissue damage and degeneration. Auto immune disorder often involves oral mucosa. Oral involvement is the first and most important or often it may be the only sign of such disease process. Oral mucosal lesions are erythema, erosions, ulcers rarely vesicle which are clinically similar and often non-specific. Timely recognition and therapy of oral lesion is critical as it may prevent skin involvement in pemphigus vulgaris. Based on this our aim is to study the epidemiological aspects like incidence, age and gender distribution of oral manifestations in auto immune skin diseases also to study the various oral manifestations, duration and distribution in auto immune skin diseases. Methodology:  This is a cross-sectional hospital-based study conducted from June 2018 to May 2019 at the outpatient Department of Dermatology, Coimbatore Medical College. 100 patients with oral involvement who were confirmed autoimmune skin disorders based on inclusion and exclusion criteria were enrolled in this study. Diagnostic procedures such as histopathological and immunofluroscence method was performed in all patients. Tzanck smear, ANA and ANA profile was carried out in selected patients. The results of the study were analysed. Results: Our study included 100 patients which included 76 female and 24 males. Among the 100 patients, Pemphigus and its variants 46 patients, pemphigoid and its variants 18 patients, Lupus erythematosus 28 patients, systemic sclerosis 7 patients and sjogren’s syndrome 1 patient. All five-disease group showed female predominance with 76 females and 24 males. The mean duration between the onset of oral lesion and skin lesion was 2-5 months. Erosion was the most common morphology. Buccal mucosa (27%) was the most common site in pemphigus whereas in pemphigoid, palate (39%) was the most common site. Erosion (74%) was the common morphology located on palate (44%) in LE patients. Microstomia (70-%) was common in SSc and sjogren’s syndrome patient had dry mouth. Conclusion: Oral mucosal lesions are often associated with pemphigus. They may occur before the cutaneous lesions by months. The significance of early diagnosis may help in early intervention and to reduce morbidity and mortality state.

246.  Analytical Cross-Sectional Study of Thyroid Function Test among Psoriasis Cases and Comparative Group
Chirag Chadha, Vikrant Jadhav, Anil Gugle, Paresh Agiwal
Background: Psoriasis is a chronically relapsing autoimmune skin disorder. It is characterised by complex alterations in epidermal growth and differentiation. Thyroid hormone plays a major role in the regulation of cell growth and differentiation. Triiodothyronine (T3) and thyroxine (T4) hormones have hyper-proliferative effect on epidermis of skin. Evidences regarding thyroid abnormalities in psoriasis are limited by less number of studies and in-conclusive outcome. Objective: To detect thyroid hormone abnormality in cases of psoriasis disease. Methods: One hundred cases of psoriasis were evaluated clinically and confirmed by histopathology. Thyroid stimulating hormone (TSH), T3 and T4 hormones were measured among cases and controls. Results: Eight percent cases of psoriasis had thyroid abnormalities as compared to four percent in control group. We did not find any significant association of thyroid disorder in cases of psoriasis as compared to control group (z value=1.191, p-value= 0.234, p-value <0.05). There was a positive trend of low TSH levels in cases of psoriasis, but it was not statistically significant (p-value=0.07).There was no statistically significant difference between levels of T3 and T4 hormone in cases and controls. Conclusion: Our study suggests that there was no statistically significant association between thyroid disorder and psoriasis disease. We did find a positive trend of low TSH levels in psoriasis disease, but not statistically significant.

247.  Analysis of Scrotal Swellings in a Tertiary Care Hospital
Mundhe Sonaji Ashruba, Siddharth Manohar Sarnaik, Sunita B Patil, Ranjeetsinha Kakasaheb Jadhav, R V Apparao, Sadanand Joshi
Introduction: The conditions of acute scrotum can occur due to a wide variety of causes. Testicular torsion, epididymo-orchitis & Fournier’s gangrene deserves special attention because of their prevalence and severity. Objectives of the study were to study the diagnostic and therapeutic modalities adopted in the management of scrotal swellings in our hospital and their outcome; and to study the relationship of certain scrotal swelling with male infertility. Materials and Methods: This cross-sectional study was done on a total of 110 patients with cystic swellings from the testes & its coverings, epididymis, spermatic cord & from scrotal skin. Results: 7.3% observed to have Infertility in the present study. About 22.7% had Epididymo orchitis, 21.8% had hydrocele, 20.9% had varicocele, 10% had Epididymitis, 7.3% had Epididymal cyst, 5.5% had Orchitis, 4.5% had Hematocele, 2.7% had Torsion testis, 1.8% had Spermatocele, 1.8% had Carcinoma testis, 0.9% had Pyocele. 41.8% had undergone conservative treatment and 58.2% had underwent surgical treatment. In the present study, 7 patients out of 23 had infertility and 1 patient out of 25 with Epididymo orchitis had infertility. All the carcinoma testis, Hematocele, Hydrocele, Pyocele, Spermatocele, Torsion of testis, Varicocele and 37.5% of Epididymal cyst, 4% of epididymo orchitis underwent surgical treatment. Epididymitis, Orchitis have underwent conservative treatment. Conclusion: The younger age group and manual labourers are more prone to scrotal swellings. There is a resurgence of thorough clinical examination to establish a diagnosis in patients with scrotal swelling. Majority have right sided swelling. Majority of the swelling are due to Epididymo orchitis, hydrocele and varicocele. About 7% have infertility and majority are due to varicocele. Most of the study subjects present with scrotal swelling needing surgical modality treatment.

248.  Description and Outcomes of Patients with Eclampsia and Severe Pre-Eclampsia in a Tertiary Care Hospital: A Retrospective Study
Prachi C Thool, Pravin Karwade, Sandhya Pajai, Chetan Vijay Janbade, Anand Bhide
Background: Eclampsia and severe pre-eclampsia are critical hypertensive disorders during pregnancy, posing significant risks to both maternal and fetal health. This retrospective study aims to comprehensively analyze the clinical characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a tertiary care hospital in Nagpur, Maharashtra, over duration of one year. Materials and Methods: The study population consisted of 250 pregnant women diagnosed with either eclampsia or severe pre-eclampsia. Detailed medical records, including demographic information, obstetric history, and clinical parameters, were meticulously reviewed. The management protocols, including antihypertensive medications, seizure prophylaxis, and delivery methods, were also scrutinized. Statistical analysis involved both descriptive and inferential methods to derive meaningful insights. Results: The demographic analysis revealed the diverse socio-economic background of the study population. The incidence of eclampsia and severe pre-eclampsia was stratified based on age, parity, and gestational age. Noteworthy parameters such as blood pressure levels, proteinuria, and laboratory findings were recorded with arbitrary values for comprehensive evaluation. The obstetric outcomes, including mode of delivery, neonatal outcomes, and maternal complications, were systematically documented. Statistical measures such as mean, standard deviation, and p-values were utilized to derive significant associations and trends. Conclusion: The retrospective study provided a comprehensive understanding of the clinical spectrum and outcomes associated with eclampsia and severe pre-eclampsia in a tertiary care hospital in Nagpur, Maharashtra. The findings underscored the importance of early detection, timely intervention, and close monitoring in managing these hypertensive disorders during pregnancy. The study contributes valuable insights into the risk factors, prognostic indicators, and treatment modalities, aiding in the refinement of existing clinical protocols. Further prospective studies are warranted to validate and extend these findings, promoting evidence-based practices in maternal-fetal medicine.

249.  Effects of Long Working Hours on the Cognitive Functions of Interns
Shah Jiya, Gavit Swati, Paul Justin
Objective: The study helped to assess the correlation between the cognitive functions of interns after long working hours and lack of sleep. It also assessed the effect of excess daytime sleepiness on cognitive functions. Methodology: A cross-sectional study of 50 interns, aged 23-25 years was taken. They were given 2 questionnaires: firstly, the Chalder Fatigue Scale, a self-reported scale of fatigue severity over 3 months, and Epworth Sleepiness Score which is a self-reported scale of daytime sleepiness. Afterwards, 4 tests were given to assess the cognitive functions. 1. Reaction Time Test 2. Stroop Test 3. Trail Making Test 4. Rey Auditory Verbal Test. Results: The correlation between excessive daytime sleepiness and cognitive function, as by the Epworth Sleepiness Scale (ESS), was positive but statistically insignificant. The Stroop Test also showed an insignificant p-value, suggesting sleep deprivation may not significantly impact cognitive performance. However, sleep-deprived individuals had significantly higher reaction times during the incongruent trial, suggesting a decline in cognitive function related to selective attention and executive functions. Trail Making Test (TMT) A and B showed decreased results post-night shift, but the p-values were insignificant. Rey Auditory Verbal Test yielded significant results emphasizing the potential impact of sleep deprivation on cognitive function among medical interns. Conclusion: Our findings highlight the potential impact of sleep deprivation on cognitive function among medical interns. Although the correlations were not statistically significant in some cases, sleep deprivation still showed trends toward decreased cognitive performance.

250.  A Prospective Comparative Study about the Efficacy of Sub Tenons versus Peribulbar Local Anesthesia in Small Incision Cataract Surgery
Smitha M, Devika K, A. M Raja
Aim:  The study aimed to compare the efficacy and safety of sub-tenon block to peribulbar block concerning analgesia, akinesia, and complications in small-incision cataract surgery (SICS). Methods: A comparative prospective study was conducted at Government hospital Palakkad. Sixty patients who reported to the ophthalmology OPD for small-incision cataract surgery (SICS) under local anaesthesia were included in the study. The participants were divided into two groups of 30. The pain was evaluated at the time of administration of the block and during the surgery. Lid & globe akinesia was noted in both the groups and any complications associated with the block such as chemosis or subconjunctival haemorrhage were also noted. Results: Sub-Tenon`s anaesthesia was relatively less painful at administration, providing good analgesia. Despite incomplete akinesia, complications were minimal, indicating that it did not significantly impact the surgical process. it needed significantly lesser volume of anaesthetic agent, good comfort to surgeon and had only minor complications in the form of subconjunctival haemorrhage, chemosis. Conclusion: Sub-tenon block was found to be an effective and safer technique of ocular anaesthesia for SICS, making it a potential alternative to the conventional peribulbar block. Despite the reduced akinesia compared to peribulbar block, sub-tenon block demonstrated fewer complications and increased patient comfort.

251. Role of TIRADS in Detecting Malignacy in a Thyroid Nodule
Shadik Basha Shaik, P. Venkareddy, K. Bhargavi, Arumulla Mithilesh
Background: The main concern for the evaluation of thyroid nodules is the possibility of malignancy. The incidence of thyroid cancer is low. There are wide variations in the reported proportions. The terminology of TIRADS was first used by Horvath to improve patient management and cost-effectiveness by avoiding unnecessary FNA Biopsies in patients with thyroid nodules. Aim: The aim of the study is to evaluate the reliability of TIRADS in determining the malignancy in the thyroid nodule so that the invasive cytology and surgery can be avoided in low risk group. Methodology: This was a Prospective observational study, done in 77 with nodular thyroid enlargement and underwent thyroidectomy the Department of General surgery, Tertiary Care Centre, for a period of 2 years. Results: Thyroid nodules were common in 31-50 years age group. In the study females were 87% and males were 13%. On TIRADS score no cases were in TR1, 42% of cases were TR2, 21% cases were TR3, 15% of cases were TR4 and 22% of cases fall in TR5 categories. FNAC showed benign lesions in 68% nodules, 2% cases were FLUS, 6% were of suspicious of follicular neoplasm, 9% cases were suspicious for malignancy and 15% cases showed malignant features on cytology. Histopathological examination of thyroidectomy specimen showed nodular goitre in 57% of cases, hashimotos thyroiditis in 12% cases, papillary carcinoma in 23% cases, follicular adenoma in 5% of cases, follicular carcinoma was seen in 3% of cases. Among the 32 cases in TR2 FNAC and histopathology was proved to be benign in all the 100% cases. 16 cases were in TR3 among them FNAC and histopathology showed benign etiology in 15 and malignant features in 1 case subsequently. In 12 cases with TR4 5 were benign, 2 were malignant and 5 showed follicular lesions on FNAC, and on histopathology 9 turned out to be benign lesions and 3 were of malignancy. Among the 17 cases in TR5 16 were malignant and 1 was benign on FNAC and histopathology. Conclusion: The PPV for malignancy was high for TIRADS category 5 and 4 nodules. Overall agreement between observers for assigning TIRADS category was substantial. Thus, TIRADS is a simple and practical method of assessing thyroid nodules and can be used in practice.

252. Review of Obstetrical Emergencies at Tertiary Care
Nisha Toshniwal, Munjal Pandya, Dipenti Mehta, Dhrumi Prajapati, Nikunj Patel, Keyur Patel
Introduction: A serious and frequently dangerous situation that arises suddenly and unexpectedly and necessitates immediate action to save lives is referred to as an emergency. The leading cause of maternal mortality worldwide are obstetric emergencies, especially in developing nation where a lake of antenatal care, poor transportation infrastructure ,low literacy rates and inadequate staff and equipment all contribute to problem. Aims and Objective: To review of obstetrical emergencies, its cause, management and outcome at tertiary care hospital. Material and Methodology: A prospective observational study conducted in our hospital on the patients with obstetric emergency at labour ward of LG hospital during November 2022 to November 2023. Results: In our study majority of the patients (42%) were in the 25 to 29 year old age range. Only 7.1% were over the age of 35, while 31.4% were under 24.The majority of patients who needed emergency obstetric care were lower gravida women. Emergency caesarean section accounted for 48.6% of deliveries.77.1 % outcome were uneventful. 5.7% of patient developed sepsis, 11.4% has significant anaemia. 6.3% of all maternal deaths were from 6 causes; PPH, sepsis, difficult labour, pulmonary oedema, and abruption with IUD. Conclusion: Obstetric emergencies are a significant cause of morbidity and mortality among pregnant women and their newborns. The management of these emergencies requires timely and appropriate intervention to improve maternal and fetal outcomes.

253. An Observational Study of Cutaneous Manifestations Associated with Diabetes Mellitus
Priyanka Sondarva, Amit Vaghela
Background and Aim: The pathophysiology of diabetes mellitus and its effects on the human body have been well analysed over the years. Nevertheless, the skin, which is the biggest organ in the body, has been given minimal attention. The purpose of this study was to determine the various skin symptoms observed in diabetic patients. Material and Methods: A cohort of 180 diabetes patients with cutaneous symptoms, who visited the skin outpatient department (OPD) at a prestigious teaching hospital in India over a period of 1 year, were chosen by a random selection process. A comprehensive evaluation was conducted, which included a thorough analysis of the patient’s medical history, a detailed physical examination, and an assessment of the involvement of the skin and mucous membranes. The diagnosis of Diabetes Mellitus was established through the assessment of urine sugar and blood sugar levels. The diagnosis of diabetes mellitus was made according to the criteria established by the national diabetic data group. Urine and blood sugar levels were assessed in all instances. Results: A total of 53 individuals fell into the age category of 40 years, accounting for 28% of the sample. Among the 180 instances, 61.1% were male patients and 38.8% were female patients. A total of 68 cases were diagnosed with various fungal diseases, including Tinea corporis, Tinea cruris, Tinea Versicolor, Candidal inteetrigo, Candidial vulvovaginitis, Candidal balanoposthitis, and oral candidiasis. These cases accounted for 37.7% of the total. Within this investigation, there were 22 instances of bacterial infections. Observations revealed symptoms such as excessive urination (polyurea), increased appetite (polyphagia), excessive thirst (polydipsia), weight loss, widespread itching (generalised pruritus), painful sensation, and itching in the genital area. Conclusion: Diabetes mellitus is a prevalent medical condition that affects various medical specialties due to its wide range of clinical symptoms. Even the skin is not exempt, with around one third of patients with diabetes predicted to experience cutaneous alterations.

254. Role of Diffusion Weighted Imaging and 1h MR Spectroscopy in Prognostication of Breast Cancer
Shweta Kothari, Rahul Singla
Background: This study evaluated the diagnostic and prognostic roles of magnetic resonance spectroscopy (MR Spectroscopy) and diffusion-weighted imaging (DWI) in breast cancer. Methods: Quantitative DWI and MR Spectroscopy were employed for lesion characterization. ADC values were calculated, and MR Spectroscopy assessed choline concentrations. Kinetic curve analysis and cross-tabulation with histopathological diagnosis were performed for validation. Statistical analysis included Cohen’s Kappa and ROC curve analysis. Results: A cohort of 77 women with 88 breast lesions underwent MR Spectroscopy and DWI, comprising 65 malignant and 23 benign cases. The mean age for malignancy was 48.1 years and for benign lesions was 36.2 years. The study included 77 women with 88 breast lesions, encompassing invasive ductal carcinoma, inflammatory intra-ductal carcinoma, and benign lesions such as fibroadenoma and idiopathic granulomatous mastitis. The study found a significant difference in mean ADC values between malignant (0.9526 x 10^-3 mm²/s) and benign (1.48 x 10^-3 mm²/s) breast lesions. The ADC cut-off of 1.1 x 10^-3 mm²/s demonstrated 92.3% sensitivity and 73.9% specificity. No significant associations were observed between ADC values and ER/HER2 statuses, but a significant association was found with positive PR expression (p=0.04). MR Spectroscopy showed a mean total choline concentration of 0.186 ppm for malignancy and 0.104 ppm for benignity. Conclusion: Quantitative DWI and MR Spectroscopy offer valuable insights into breast lesion characterization, with ADC values and choline concentrations serving as key discriminators between malignant and benign lesions. The study emphasizes the potential clinical utility of these imaging techniques for accurate diagnosis and prognostication in breast cancer.

255. A Study on Role of Magnetic Resonance Imaging in Determining the Etiology of Vertebral Collapse
Rahul Singla, Shweta Kothari
Background: Osteoporotic vertebral fractures, one of the common causes of vertebral collapse, are a global health concern, particularly affecting the elderly population. Objective: This study explores the utility of Magnetic Resonance Imaging (MRI) in diagnosing and categorizing vertebral collapse etiologies. Demographic parameters, MRI features, and statistical analysis were considered. Methods: Involving 52 patients, primarily male, MRI was employed for vertebral collapse diagnosis. Osteoporotic fractures dominated (44%) in the 41-60 age group. Statistical analysis determined the specificity, sensitivity, and accuracy of significant MRI features for malignancy, osteoporosis, and infection. Results: Osteoporotic fractures prevailed, with specific MRI features showing significance. Malignant fractures exhibited distinctive characteristics, as did infective fractures. Some features demonstrated 100% specificity. Statistical significance was attained for all MRI features. Conclusion: MRI emerges as a crucial tool for differentiating vertebral collapse etiologies. Osteoporotic fractures predominate, and specific MRI features contribute to precise categorization. Despite limitations, MRI proves reliable for early diagnosis and tailored management, playing a definitive role in determining vertebral collapse aetiology.

256. Comparative Study of Serum Calcium Levels in Pre-Menopausal and Post-Menopausal Women of Marathwada Region
Parveen Shabir Kavathekar, Ravindra Mahadev Survase
Background: In post-menopausal women, estrogen deficiency and age-related factors reduce calcium levels, which lead to osteoporosis and the non-fusion of bony fractures. Method: Out of 550 women, who participated in present study, 235 were pre-menopausal and 315 were post-menopausal. 3-5 ml of venous blood was collected from the median-cubital vein. Serum calcium was measured by OCPC (Ortho-Cresolphthalein-Complexone) method. Results: The mean value of pre-menopausal serum calcium was 8.7 (± 3.2) mg/dl and 7.5 (±1.4) mg/dl in post-menopausal women; the Unpaired t test was 2.4 and p<0.002 (the p value was highly significant). Conclusion: It is concluded that serum calcium levels are significantly lower in post-menopausal women; hence, they must be treated with calcium supplements to maintain their normal calcium levels and prevent osteoporosis.

257. Study of IgE levels As Biomarker in Bronchial Asthma Patients in Madhya Pradesh
Ashok Sudam Bansode, Balaji .G. Tuppekar
Background: Bronchial asthma is increasing day by day due to urbanization, air pollution, and the toxicity of tobacco. Serum IgE levels are also associated with the degree of air flow obstruction. Hence, IgE levels are directly proportional to airflow obstruction. Methods: 80 (eighty) bronchial asthma patients aged between 20 to 55 years were studied. The hematological examinations were ESR, CBC, AEC, sputum for AFB, gram stains, chest x-ray, and ECG. Estimation of IgE was done by using Quantia IgE, which is a turbid metric immunoassay for human use, and spirometry was used in every patient and compared with levels of IgE in different age groups and both sexes. Results: Clinical manifestations were: 34 (42.5%) dyspnea, 20 (32.5%) coughs, 20 (25%) wheezing, 14 (17.5%) had (100–200) IgE, 16 (20%) had (201–300) IgE, 20 (25%) had (301–400) IgE, and 30 (37.5%) had (400–500) IgE. As per the FEV1 parameters, 15 patients were mild, 16 were moderate, and 49 were severe. Distribution of IgE (IU/m) as per age: 21–30 years old were 21 with 363 mean IgE/IU/ml. 31–40 were 17 with 384 mean IgE, 41–50 years were 23 with 368.2 mean IgE, and 51–55 years were 19 with 389.8 mean IgE. Conclusion: The study of IgE levels and spirometry is an ideal technique to rule out the severity of bronchial asthma and can be treated efficiently to avoid morbidity and mortality in bronchial asthma patients.

258. Study of C – reactive protein in Respiration Tract Infections in Madhya Pradesh Population
Balaji G. Tuppekar, Ashok Sudam Bansode
Background: Substantially raised CRP values are usually found in pneumonia, and raised CRP values may be found in uncomplicated viral respiratory infections. Hence, a range of CRP values can be expected when the infection is uncomplicated. Method: Out of 250 patients, 160 had pneumonia, and 90 had COPD with acute exacerbations. Serum CRP levels and other biomarkers of infections and crest x-rays were studied. Results: Mean CRP in pneumonia patients was 74.86 (± 10.2) and in COPD 15.80 (± 8.6), and the t test was 48.6 and p< 0.001. 103 (± 96.6%) had a CRP value of 50, 35 (21.8%) had pneumonia, and 3 (3.3%) COPD patients had 50-100 CRP value. In pneumonia patients, 16 (± 10) had a 100-150 CRP value, and 2 (± 1.25%) had 201-250, 2 (1.25%) had 251-500, and 2 (1.25%) had 551-600 CRP value. Conclusion: C-reactive protein values are higher in pneumonia patients as compared to COPD patients. These variations can be diagnostic values for clinicians to treat different respiratory tract infections.

259. Study of Anatomical Variations of Circle of Willis – A Magnetic Resonance Study in North Karnataka Population – Retrospective Study
Shashank Sangoli, Md Munnawar S Hussain
Background: Anatomical variations of branches of the circle of Willis are often studied by MRI. These normal anatomical variations have great importance in distinguishing occluded or embolised arteries. Method: 40 (Forty) healthy volunteers aged between 25 to 55 years were studied. The technique used was three-dimensional times of flight magnetic resonance angiography (3D-ToF-MRA), and only the arteries forming the circle of Willis were studied. For the purpose of identification, COW is divided into anterior and posterior configurations. Result: The variations of COW were 7 (38.9%) had ant cerebral artery hypoplasia, 4 (22.2%) had post cerebral artery hypoplasia, and 5 (27.7%) had analogous origin, and 2 (11%) had hypoplasia of the post communicating artery. Conclusion: It is concluded that these anatomical variations with hypoplasa anomalous origin and attenuation of arteries must be known to neurologists, neurosurgeons, and radiologists for proper diagnosis of patients suffering from neurological diseases.

260. Study of Ultra-Sonographic Diagnosis of Appendicitis in Andhra Pradesh Population
Kiran Kumar Neelapu, V N Vamsi Krishna Setty
Background: The appendix is the most constricted part of the GIT and is a lymphatic organ. It is more likely to be inflamed and infected. Method: 300 patients with acute appendicitis (AA) of different age groups were studied using the USG machine. 5-12 MHz linear transducer was used. Longitudinal and transverse images of the right lower quadrant were obtained. Compression sonography was performed with documentation of the appearance of the appendix, including the tip. USG findings were retrospectively graded using five-point scales. Grades I and II were classified as negative, and grades 3–5 to 5 was as positive sonographic diagnoses. Surgical and pathological findings were compared. Results: In 11–20 years, the highest 5th grade was 43 and the least 5th grade was 16 in > 50 years of age. USG findings: 197 positive, 103 negative, and surgical; 88 negative and 212 positive; 152 (50.6%) AA proved histopathologically; 198 (66%) were true positive; 77 (25.6%) were true negative; 20 (6.6%) were false positive; and 2 (0.6%) were false negative in USG studies. Conclusion: The ultrasonographic study is a first-line imaging modality. The sensitiveness of USG has a limited range but is preferable in children and young patients. The USG technique is easily affordable for lower-middle-class patients.

261. Cervical Lymphadenopathy: A Clinicopathological Study
Girraj Singh, Amit Joon, Ritika Kansal
Background: Aim of the study was to evaluate the commonest presentations of underlying pathology of the head and neck region in patients presenting with cervical lymphadenopathy. Methods: The present study is a prospective study conducted in G S medical college and hospital, pilkhuwa. Our study included 100 patients with cervical lymphadenopathy are more than 02 years of age, from August 2022 to July 2023 were included. Results: Tuberculosis was found to be the most common cause of cervical Lymphadenopathy in 50% cases followed by reactive lymphadenitis in 34% cases, chronic nonspecific lymphadenitis in 7% cases and metastatic lymphadenopathy in 6% cases. Other causes were unknown primary in 2% cases and non-Hodgkin’s lymphoma in 1% cases. Sensitivity and specificity of FNAC was 85% and 100% respectively. Conclusions: Tuberculosis, reactive lymphadenitis and malignancy are the most important cause of cervical Lymphadenopathy. They present in different age groups with different clinical feature. Fine Needle Aspiration Cytology (FNAC) is extremely sensitive and highly specific investigation for early diagnosis.

262.   Beyond the Vapor: Exploring Hemodynamic Parameters and Recovery Characteristics in Valvular Cardiac Surgery with Sevoflurane and Isoflurane
Deepak Kumar Meena, Pradeep Charan, Asha Sharma, Mahesh Somani
Background: For patients with valvular heart disorders, valve cardiac surgery is a vital intervention that requires careful evaluation of anesthetic drugs to maximize perioperative results. This study investigates how hemodynamic parameters and recovery characteristics following valvular heart surgery are affected by sevoflurane and isoflurane. Methods: Seventy participants were randomly assigned to receive either isoflurane (Group B) or sevoflurane (Group A) in a hospital-based, randomized, comparative trial. Assessments were made of hemodynamic parameters such as cardiac output, pulmonary vascular resistance, and systemic vascular resistance. Sevoflurane or isoflurane anesthesia regimes were customized to meet the needs of each individual patient. Comprehensive research was done on recovery features such time to extubation, emergence from anesthesia, and postoperative problems. The two groups’ findings were compared using statistical techniques. Results: Comparable hemodynamic stability was observed between the isoflurane and sevoflurane groups, which is an important factor in valvular heart surgery. There were no discernible variations in diastolic blood pressure (D.B.P.) at different intervals, suggesting that both medications could offer comparable intraoperative hemodynamic stability. Furthermore, similar values were seen in the trend of stroke volume variation (SVV), which confirms the hemodynamic neutrality of the drugs during surgery. Conclusions: The present study provides significant insights into the administration of sevoflurane and isoflurane during valvular heart surgery. Similar hemodynamic stability was shown by both drugs, highlighting the significance of customizing anesthetic regimes to meet the demands of each patient. The thorough investigation of recovery traits improves perioperative care tactics even more. These results will help anesthesiologists make wise judgments that will eventually benefit patients having valvular heart surgery.

263. Association of Serum Electrolytes, Serum 25-Hydroxycholecalciferol and Serum Thyroid Stimulating Hormone (TSH) in Irritable Bowel Syndrome (IBS)
Nisha Jha, Rekha Kumari, Neha Bharti, Rajeev Kumar, Praveen Kumar, Kumar Pranay
Introduction: Irritable bowel syndrome (IBS) is one of the most prevalent, that affects up to 1 in 5 people over their lifetime. The Rome III committee defines IBS as a chronic functional disorder characterized by recurrent abdominal pain or discomfort associated with disordered defecation. Approximately 15 to 25% of the world population suffers from irritable bowel syndrome (IBS). Aim: To associate serum electrolytes, serum 25-hydroxy cholecalciferol and Thyroid Stimulating Hormones (TSH) in Irritable Bowel Syndrome (IBS). Objectives: To measure the serum electrolyte levels in patients with IBS and to compare the same with the serum electrolyte levels of normal healthy adults. Materials and Methods: A cross sectional study was conducted on 120 individuals 30-60 years age group, divided into 2 groups of 60 IBS cases and 60 apparently healthy control. Under aseptic precautions, 4 ml venous Blood was withdrawn from study participants, who visited to the department of general medicine and gastroenterology with symptoms of IBS on OPD basis and confirmed diagnosis of Irritable Bowel Syndrome (IBS) based on Rome’s criteria of IBS for cases and 60 samples collected from apparently healthy controls. S. potassium was estimated by fully automated analyser on DxC 700 AU. Serum TSH and serum 25-hydroxy cholecalciferol were estimated on abott architect i2000 SR that works on the principle of CMIA. Statistical analysis: All data was evaluated in the form of Mean ±SD and comparison was done based on pearson correlation coefficient. Then p value was calculated p<0.0001 was considered significant. Results: Serum chloride was considered to have significant p value when compared among cases and control.  Serum TSH, serum sodium, serum potassium and serum 25-hydroxycholecalciferol gave non-significant results in cases of IBS when compared with controls. Discussion: IBS lacks acceptable bio-markers, and its diagnosis largely depends on the exclusion of underlying organic disease. Hence the diagnosis and management of this disorder can be challenging. maintaining normal serum electrolyte balance is essential for the efficient functioning of living cells. A follow up study would best suggest the efficient role of Vitamin D in IBS. Conclusion: The present study also tried to provide an insight into the possible changes that can be incorporated in the diet or serum electrolyte supplementation in IBS cases. Since the results were non-specific and statistically nonsignificant, further clinical studies are recommended with larger sample sizes for correlation of dyselectrolytemia.

264. Splanchnic Block for Back Pain- A Unique Case
Prakash R Deshmukh, Helee Khetan, Manjiri Ranade, Kailash Kothari
The thoracic splanchnic nerves suppl